Head and neck cancer is the sixth leading type of cancer with 90 percent of head and neck cancer arising from squamous cell lining on the epithelium of the oral and nasal cavity, pharynx, and salivary gland. Even with tremendous achievements on chemotherapeutic drugs and therapies, the long-term prognosis of patients with advanced head and neck squamous cell carcinoma (HNSCC) has shown little improvement over the last three decades. Cisplatin is one of widely used chemotherapeutic drugs for multiple cancers, including head and neck cancer, but the prolonged use of this drug is limited by its toxicity and by the development of resistance. To overcome these major roadblocks to improved prognosis requires mechanism-based therapeutic strategies to maximize the antitumor effect of drugs while limiting their toxicities. Cisplatin exerts anticancer effects via multiple mechanisms, yet its most prominent mode of action involves the generation of DNA lesions followed by the activation of the DNA damage response and the induction of BCL-2 family-dependent mitochondrial apoptosis. DNA damage activates a tumor suppressor p53 to induce apoptosis. One of its functions is to induce the expression of several pro-apoptotic proteins such as Noxa, which binds to an anti-apoptotic BCL-2 family protein, MCL-1 (myeloid leukemia cell-1) to inactivate its pro-survival function and induce apoptosis. We examined Noxa expression and apoptosis induced by cisplatin in p53-wild-type HN30 and HN31, p53-truncated and inactive HN4 and HN12, and p53-deleted HN22 and HN8 HNSCC cell lines. We found that Noxa was induced in HN30 and HN31 cells and down-regulation of Noxa by shRNA (short-hairpin RNA) decreased apoptosis, indicating Noxa contribution to cisplatin-induced apoptosis. Interestingly, cisplatin treatment induced Noxa and apoptosis even in p53-deleted HN22 and HN8 cells, suggesting the existence of the p53-independent pathways for the induction of Noxa. Based on these observations, we hypothesized that modulation of Noxa/MCL-1 axis could mimic cisplatin-induced cell death. We found that Noxa overexpression induced cell death in all cell lines tested regardless of p53 status. This finding could be applicable as a potential therapeutic strategy to treat head and neck cancer.

A cisplatina ainda é um dos agentes quimioterápicos mais efetivos. No entanto, em elevadas doses pode ocorrer hepatotoxicidade. Alguns antioxidantes têm sido mostrado amenizar a hepatotoxicidade induzida pela cisplatina mas o mecanismo molecular envolvido não está bem esclarecido.No presente estudo nós investigamos moleculares subjacente ao efeito protetor da dimetiltiuouréia (DMTU), um conhecido eqüestrador de radical hidroxil, contra a lesão oxidativamitocondrial hepática induzida pela cisplatina em ratos. Ratos Wistar machos adultos ( 200 a 220g) foram divididos entre 4 grupos de 8 animais cada. O grupo controle foi tratado apenas com uma injeção intraperitoneal (i.p.) de solução salina (1 ml/ 100g de peso). Ao grupo DMTU foi administrado apenas DMTU (500 mg/kg de peso, i.p., seguido de 125 mg/kg, i.p., duas vezes ao dia até o sacrifício). Ao grupo cisplatina foi administrado uma injeção única de cisplatina (10 mg/kg de peso, i.p.). Ao grupo DMTU + cisplatina foi administrado DMTU (500mg/kg de peso, i.p.), pouco antes da injeção da cisplatina (10 mg/kg de peso, i.p.), seguido por injeções de DMTU (125 mg/kg de peso, i.p.) duas vezes ao dia até o sacrifício ( 72 horas após o tratamento). A hepatotoxicidade foi evidenciada no grupo cisplatina pelo aumento dos níveis séricos de alanina (ALT) e aspartato (AST)aminotransferases. O mecanismo de hepatotoxicidade induzido pela cisplatina mostrou-se envolvido na rigidez de membrana; na redução da razão glutationa reduzida em relação a glutationa oxidada (GSH/GSSG); na redução dos níveis de ATP, GSH e NADPH; na lipoperoxidação; na lesão oxidativa da cardiolipina e de proteínas com grupos fidrílicos. Mais ainda, a morte celular por apoptose foi também demonstrada e os achados fortemente sugerem a participação do xi mecanismo sinalizador mitocondrial neste processo; o DMTU não apresentou nenhum efeito direto sobre a mitocôndria e inibiu substancialmente a lesão mitocondrial induzida pela cisplatina, prevenindo a hepatotoxicidade. Todos os seguintes efeitos induzidos pela cisplatina foram previnidos pelo DMTU: (a) elevação dos níveis séricos de AST e ALT; (b) redução dos níveis de ATP hepático;(c)peroxidação lipídica;(d)oxidação da cardiolipina; (e)oxidação de proteínas sulfidrílicas; (f) rigidez da membrana mitocondrial; (g) oxidação de GSH; (h)oxidação de NADPH e (i) morte celular por apoptose. Os resultados mostraram o papel principal da mitocôndria e dos radicais hidroxilas na proteção do fígado saudável contra a lesão hepática induzida pela cisplatina, delineando um número de etapas que podem ser consideradas no desenvolvimento de futuros agentes citoprotetores / Cisplatin is still one of the most effective chemotherapeutic agents. However, at higher doses hepatotoxicity may occur. Some antioxidants have been shown to ameliorate cisplatin-induced hepatotoxicity but the involved molecular mechanism has not been clarified. In the present study we investigated the molecular mechanism underlying the protective effect of dimethylthiourea (DMTU), a known hydroxyl radical scavenger, against liver mitochondrial oxidative damage induced by cisplatin in rats.Adult male Wistar rats (200 to 220g) were divided into 4 groups of 8 animals each. The control group was treated only with an intraperitoneal (i.p.) injection of saline solution (1ml/100g body weight). The DMTU group was given only DMTU (500 mg/kg body weight, i.p, followed by 125 mg/Kg, i.p., twice a day until sacrifice). The cisplatin group was given a single injection of cisplatin (10 mg/kg body weight, i.p.). The DMTU+cisplatin group was given DMTU (500 mg/kg body weight, i.p.), just before the cisplatin injection (10 mg/kg body weight, i.p.), followed by injections of DMTU (125 mg/kg body weight, i.p.) twice a day until sacrifice (72 hours after the treatment). epatotoxicity was evidenced in the cisplatin group by the increased serum levels of alanine (ALT) and aspartate (AST) aminotransferases. The mechanism of cisplatininduced hepatotoxicity was found to involve membrane rigidification; decreased GSH/GSSG ratio, ATP, GSH and NADPH levels; lipid peroxidation; oxidative damage of cardiolipin and protein sulfhydryl groups. Moreover, cell death by apoptosis was also demonstrated and the findings strongly suggest the participation of the mitochondrial signaling pathway in this process; DMTU did not present any direct effect on mitochondria and substantially inhibited cisplatin-induced mitochondrial injury, therefore preventing the hepatotoxicity. All the following cisplatin-induced xiv effects were prevented by DMTU: (a) elevation of AST and ALT serum levels; (b) decreased hepatic ATP levels; (c) lipid peroxidation; (d)cardiolipin oxidation; (e) sulfhydryl protein oxidation; (f) mitochondrial membrane rigidification; (g) GSH oxidation; (h) NADPH oxidation and (h) apoptotic cell death. Results show the central role of mitochondria and hydroxyl radicals in the protection of healthy liver against cisplatin-induced injury, highlighting a number of steps that might be considered in the development of novel cytoprotective agents.

Dicer é um membro da família RNase III que controla a maturação de microRNA. A up-regulação de Dicer está associada a características agressivas e proliferação do melanoma. Nosso objetivo foi avaliar a expressão de Dicer em amostras de pacientes com melanoma nos diferentes estadios e em linhagens celulares de melanoma correlacionando a expressão de Dicer com progressão tumoral e resistência à apoptose. Comparamos Dicer no tecido de pacientes diagnosticados com melanoma em diferentes estadios, os resultados sugerem que o aumento da expressão de Dicer está associado à progressão do melanoma. Avaliamos nas linhagens knockdown para dicer1 a proliferação, capacidade clonogênica e sobrevida global. A linhagem celular SK-MEL-5 DICER KD foi mais suscetível à apoptose após o tratamento com cisplatina. Essa sensibilidade pode ser pela regulação dos receptores de morte, FAS e TNFR1, que estão envolvidos na indução de apoptose. Concluímos que o aumento na expressão de Dicer está relacionado com a progressão do Melanoma e com a resistência ao tratamento com cisplatina. / Dicer is a member of the RNase III family that controls the maturation of microRNA. Up-regulation of Dicer is is only associated with melanoma. The aim of this study was to evaluate the expression of Dicer in samples of patients diagnosed with melanoma at different stages of the disease and in melanoma cell lines correlating the expression of Dicer with tumor progression and resistance to apoptosis. We compared Dicer protein in the tissue of patients diagnosed with melanoma at different stages. We observed that the increased dicer expression is associated with melanoma progression. Cell proliferation, clonogenic capacity and overall survival were evaluated in the knockdown cell lines for dicer1. The SK-MEL-5 DICER KD cell line was more susceptible to apoptosis after treatment with cisplatin. The regulation of FAS and TNFR1 death receptors expressed by knockdown cell line were important in the induction of apoptosis. We conclude that the increase in Dicer expression is related to the progression of Melanoma and resistance to treatment with cisplatin.

DNA sequence information is constantly threatened by damage. In the clinic, intentional DNA damage is often used to treat cancer. Cisplatin, a first-line chemotherapy used to treat millions of patients, functions specifically by generating physical links within DNA strands, blocking DNA replication, and killing dividing cells. To maintain genome integrity, organisms have evolved the capacity to repair, respond, or otherwise resist change to the DNA sequence through a network of genetically encoded DNA damage tolerance pathways. In chapter 1, I present advances in experimental design and current progress for a systems genetics approach, using Saccharomyces cerevisiae, to reveal relationships between cisplatin tolerance pathways. Additionally, recent efforts to sequence thousands of cancer genomes have revealed recurrent genetic changes that cause overexpression of specific cisplatin tolerance genes. In chapter 2, I present a submitted manuscript that models overexpression of an essential cisplatin tolerance gene. This study uses a systems genetics approach to reveal the genetic pathways that are essential for tolerating this perturbation, which ultimately led to mechanistic insights for this gene. Convenient genome engineering in Saccharomyces has made this organism an ideal model to develop systems genetics concepts and approaches. In chapter 3, I present a published manuscript that demonstrates a new approach to disrupting genes by making site-specific nonsense mutations. Importantly, this approach does not require cytotoxic double-strand DNA breaks and is applicable to many model organisms for disrupting almost any gene, which may advance systems genetics into new model organisms. Systems genetics provides a framework for determining how DNA damage tolerance pathways act together to maintain cellular fitness and genome integrity. Such insights may one day help clinicians predict which cancers will respond to treatment, potentially sparing patients from unnecessary chemotherapy.

Made available in DSpace on 2014-06-11T19:31:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-12Bitstream added on 2014-06-13T18:41:39Z : No. of bitstreams: 1 santos_gc_dr_arafcf.pdf: 2386901 bytes, checksum: b46aa55b36f051a8683831df1b69f150 (MD5) / Universidade Estadual Paulista (UNESP) / A neuropatia induzida por drogas quimioterápicas é uma complicação no tratamento do câncer e outras doenças por ser freqüentemente dolorosa e requerer a interrupção da terapia. O antitumoral cisplatina é comumente usado contra muitas formas de câncer há aproximadamente 40 anos. Entretanto, sua aplicação é associada a muitos efeitos tóxicos, como neurotoxicidade, nefrotoxicidade, perda da audição e vômitos. Estes efeitos adversos têm levado ao desenvolvimento de agentes específicos para amenizar a toxicidade do fármaco. Alguns estudos sugerem que a administração de antioxidantes é capaz de reduzir os danos e proteger os tecidos. Dessa forma, os carotenóides são mais uma opção a ser avaliada, pois são considerados eficazes agentes antioxidantes. O urucum é uma fonte natural de corantes vermelhos e além da bixina (fração lipossolúvel do extrato), estão presentes nas suas sementes, outros carotenóides, como a norbixina, o bcaroteno, a criptoxantina, a luteína e a zeaxantina. Neste estudo, foi avaliada a genotoxicidade e a antigenotoxicidade do urucum e da bixina sobre a toxicidade induzida pelo antitumoral cisplatina em culturas de células PC12. A citotoxicidade foi determinada pelo método do MTT, a frequência de danos cromossômicos pelo Teste do Micronúcleo e a extensão de danos primários ao DNA pelo Ensaio do Cometa. O urucum e a bixina foram avaliados preliminarmente quanto a sua genotoxicidade. O urucum nas concentrações 0,2, 0,5 e 1,0 mg/mL e a bixina nas concentrações 0,05, 0,08 e 0,10 mg/mL não foram citotóxicos e nem genotóxicos às células PC12. Assim, essas concentrações foram utilizadas nos experimentos para verificar a proteção do urucum e da bixina contra os danos induzidos pela cisplatina. Embora o efeito protetor do urucum e da bixina não tenha sido evidente nos resultados obtidos pelo Ensaio do Cometa, eles se mostraram... / The neuropathy induced by chemotherapeutic drugs is a complication in the treatment of cancer and other diseases, because it is often painful and requires discontinuation of the therapy. Cisplatin has been commonly used against many forms of cancer for approximately 40 years. However, its application is associated with many toxic effects such as neurotoxicity, nephrotoxicity, hearing loss and vomiting. These adverse effects have led to the development of specific agents to lessen the toxicity of the drug. Some studies have suggested that the administration of antioxidants is able to reduce the damage and protect the tissues. Thus, the carotenoids are one more option to be evaluated, because they are considered to be effective antioxidants. Annatto is a natural source of red dyes and pigments and in addition to bixin (liposoluble fraction of the extract), other carotenoids are present in its seeds, such as norbixin, B-carotene, cryptoxanthin, lutein and zeaxanthin. In the present study, the genotoxicity and antigenotoxicity of annatto and bixin on the cisplatin induced-toxicity in PC12 cell cultures was assessed. Cytotoxicity was determined by the MTT assay, chromosomal damage by the Micronucleus test and the extent of primary damage to the DNA by the Comet assay. Annatto and bixin were first assessed with respect to their genotoxicity. Annatto concentrations of 0.2, 0.5 and 1.0 mg/ml and bixin concentrations of 0.05, 0.08 and 0.10 mg/ml were neither cytotoxic nor genotoxic to the PC12 cells. Thus, these concentrations were used in experiments to verify the protective effect of annatto and bixin against damage induced by cisplatin. Although the protective effect of annatto and bixin was not evident in the results obtained by the Comet assay, effective inhibition of the chromosomal damage (Micronucleus test) induced by cisplatin was shown. Annatto and bixin protected... (Complete abstract click electronic access below)

Orientador: Carlos Roberto Daleck / Banca: Paulo Henrique Franceschini / Banca: Maria Denise Lopes / Resumo: A correta orientação do Médico Veterinário, aos proprietários de cães, usados com finalidades reprodutivas, submetidas à quimioterapia com cisplatina, é importante na medida que este agente citostático age nas células em constante divisão, podendo ser citotóxicos para as células germinativas testiculares. O objetivo desse trabalho foi avaliar a qualidade espermática através do espermograma de cães que receberam cisplatina em diferentes momentos de análise espermática. A dose utilizada foi de 70 mg/mø, em intervalos de 21 dias, totalizando 4 infusões. Os cães foram divididos em dois grupos de 4 animais cada, sendo que um dos grupos recebeu a quimioterapia e o protocolo de diurese para proteção renal, já o grupo controle não recebeu a cisplatina, estando sujeito apenas aos fatores ambientais. Os resultados obtidos demonstraram que a cisplatina influenciou na qualidade espermática de cães, pois elevou as patologias maiores e totais acima do aceitável para cães aptos a reprodução. Portanto, infere-se que este citostático possa acarretar alterações morfofuncionais nos túbulos seminíferos e conduto epididimário. / Abstract: The correct veterinary's orientation for male dogs' owners used for reproduction goals, undergone cisplatin administration, is important because of this cistostatic act in cell with frequently proliferation, and could to cause germ cell injury. The objections of this experiment was to analysis the sperm quality through dogs' spermogram that received cisplatin's infusions. The dose used was 70 mg/mø in 21 days periods, with 4 infusion in total. The dogs were divided in 2 groups with 4 animal each one. One of the groups received all the diuresys protocol (to protect the kidney) and the citostatic. And the other control group just didn't receive the cisplatin infusion to know the real action of cisplatin effects without environmental stresses. The results show that cisplatin influence at the sperm quality in the dogs, because it elevated the major and total defects above that would be acceptable for competent dog to reproduct. It could deduct that cisplatin cause phisiologic alteration in the testis and epididymis. / Mestre

O presente estudo teve como principal objetivo aprimorar os efeitos antitumorais de uma nova estratégia imunoterapêutica para controle de tumores induzidos pelo vírus do papiloma humano tipo 16 (HPV-16). Para tal finalidade foi utilizado um novo conceito de imunoterapia ativa, baseada em uma vacina de DNA recombinante, desenvolvida no Laboratório de Desenvolvimento de Vacinas da USP (pgDE7h) e diferentes abordagens experimentais delineadas com a finalidade de aumentar a eficácia terapêutica do tratamento. Desta forma, o presente trabalho focou no desenvolvimento de novos sistemas de entrega para a vacina de DNA empregando três nanocarregadores distintos, de natureza lipídica, proteica ou peptídica, e a avaliação da eficácia terapêutica desses frente a tumores pré-estabelecidos. O presente trabalho também avaliou a combinação da imunoterapia, baseada no vetor pgDE7h, com a quimioterapia, empregando o composto cisplatina, de forma a permitir o tratamento de tumores em estágios mais avançados de crescimento. Os resultados demonstram que a associação do plasmídeo vacinal com vesículas peptídicas mostrou-se capaz de ativar células dendríticas murinas in vitro e promover aumento na sobrevivência de animais frente ao modelo de tumores subcutâneos, sem induzir toxicidade. Quando combinada ao tratamento com cisplatina, a vacina, principalmente associada à eletroporação, demonstrou um efeito sinérgico, promovendo regressão total de tumores, aumento expressivo na ativação de linfócitos T CD8 E7-específicos, indução de resposta de memória efetora e memória residente e controle de populações imunossupressoras de forma sistêmica e no microambiente tumoral. Em resumo, a pesquisa ampliou os conhecimentos sobre a ação da imunoterapia ativa contra tumores induzidos por HPV e abriu perspectivas importantes para sua utilização em condições clínicas. / The present study aimed to improve the antitumor effects of a new immunotherapeutic strategy for the control of tumors induced by human papillomavirus type 16 (HPV-16). For this purpose, a new concept of active immunotherapy based on a recombinant DNA vaccine developed at the Laboratory of Vaccine Development at USP (pgDE7h) was used, and different experimental approaches were designed to increase the therapeutic efficacy of the treatment. Thus, the present work focused on the development of new delivery systems for the DNA vaccine using three distinct nanocarregadores, of a lipid, protein or peptidic nature, and the evaluation of the therapeutic efficacy of these in front of pre-established tumors. The present study also evaluated the combination of pgDE7h-based immunotherapy with chemotherapy using the cisplatin compound to allow the treatment of tumors in more advanced stages of growth. The results demonstrate that the association of the peptide-vesicle vaccine plasmid was shown to activate murine dendritic cells in vitro and promote increased survival of animals against the subcutaneous tumor model without inducing toxicity. When combined with cisplatin treatment, the vaccine, mainly associated with electroporation, demonstrated a synergistic effect, promoting total tumor regression, expressive increase in the activation of CD8 E7-specific T lymphocytes, induction of effector and resident memory response and control of immunosuppressive populations in a systemic way and in the tumor microenvironment. In summary, the research expanded knowledge about the action of active immunotherapy against HPV-induced tumors and opened important perspectives for its use under clinical conditions.

Lung cancer is the leading cause of cancer-related death and the second most diagnosed cancer in the United States. Unfortunately, many patients either do not have any common mutations for which there are already targetable agents, or they eventually become resistant to these compounds. As such, there is a high demand for new, effective methods of treating this disease as well as predicting patient prognosis and potential benefit from chemotherapy. In this work, numerous strategies for treating lung cancer are explored. The first method described here is through the use of a pan-early 2 factor (E2F) inhibitor, HLM006474, which is shown to synergize with paclitaxel in non-small cell lung cancer (NSCLC). Next, we explored the creation and utilization of an E2F signature that is prognostic and predictive of early-stage NSCLC patient benefit from adjuvant chemotherapy (ACT). The third project examined possible targets to enhance sensitivity to cisplatin in NSCLC lacking Kirsten rat sarcoma viral oncogene homolog (KRAS) and epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma receptor tyrosine kinase (ALK) fusions (triple-negative), for which cisplatin is one of the few treatment options. These studies led to the identification of a kinase that is overexpressed in NSCLC and whose knockdown sensitizes cells to platinum agents.

Malignant mesothelioma (MM) is an aggressive malignancy that originates from mesothelial cells and is highly resistant to conventional forms of anti-cancer therapy. Defects in apoptotic pathways are believed to play a major role in determining resistance to chemotherapy. The characterization of these pathways in mesothelioma is essential in order to develop more effective therapies. The inhibitor of apoptosis proteins (IAPs) are a family of proteins that regulate apoptosis and have been implicated in the resistance of malignant cells. There is evidence that upregulation of specific IAP molecules can influence tumour progression and response to chemotherapy. In this study we examined the apoptotic signalling in MM cells and the potential role of IAPs in both cell proliferation and chemosensitivity. We examined expression of six IAP genes or isoforms in both malignant and normal mesothelial cells. Results demonstrated that XIAP, IAP-1, IAP-2, survivin and Bruce were expressed in all four MM cell lines and four primary mesothelial cultures. There was no evidence for differential expression of these genes between MM and mesothelial cultures. Livin expression was detected in only one MM cell line. Various aspects of apoptotic signalling pathways in response to the chemotherapeutic drug cisplatin were also analysed including: a) the mitochondrial integrity, b) caspase activation, c) cell viability and d) phosphatidylserine translocation. In order to further characterize the role of IAPs, the transcriptional regulation of these genes in response to cisplatin was investigated using real-time RT-PCR. The results of these experiments indicated that there was no significant regulation of IAPs at the transcriptional level in the cells examined during cisplatin-induced apoptosis. Overall the data was consistent with cisplatin inducing apoptosis in MM cells via intrinsic signalling pathways in a dose dependent manner. Regulation of IAP expression was not seen at the RNA transcription level as has been described in other tumour types but may occur through protein posttranslational events. In order to further investigate IAP function we performed analyses of two IAPs which had previously been proposed as having a role in mesothelioma: XIAP and survivin. Protocols for RNAi knockdown at the protein expression level were established. Although the data indicated significant reduction in protein expression, the effects on cell survival after treatment with cisplatin were moderate. These studies were then extended to other molecules that are known to interact with and modulate the function of IAPs. We characterized the expression of the proteins: XAF1, HTRA2, ARTS in MM cells. RT-PCR data showed that HTRA2 and XAF1 genes were expressed in MM cell lines, however we did not see expression of ARTS. On the basis of recently published data we examined the XAF1 splice variants expressed in MM cell lines by sequence determination and PCR screening.

Doctor of Philosophy (PhD) / The H69CIS200 cisplatin-resistant and H69OX400 oxaliplatin-resistant cell lines developed as part of this study, are novel models of low-level platinum resistance. These resistant cell lines do not have common mechanisms of platinum resistance such as increased expression of glutathione or decreased platinum accumulation. Rather, these cell lines have alterations in their cell cycle allowing them to proliferate rapidly post drug treatment in a process known as ‘regrowth resistance’. This alteration in cell cycle control has come at the expense of DNA repair capacity. The resistant cell lines show a decrease in nucleotide excision repair and homologous recombination repair, the reverse of what is normally associated with platinum resistance. The alterations in these DNA repair pathways help signal the G1/S checkpoint to allow the cell cycle to progress despite the presence of DNA damage. The decrease in DNA repair capacity has also contributed to the development of chromosomal alterations in the resistant cell lines. Similarities in chromosomal change between the two platinum resistant cell lines have been attributed to inherent vulnerabilities in the parental H69 cells rather than part of the mechanism of resistance. The H69CIS200 and H69OX400 resistant cells are cross-resistant to both cisplatin and oxaliplatin. This demonstrates that oxaliplatin does not have increased activity in low-level cisplatin-resistant cancer. Oxaliplatin resistance also developed more rapidly than cisplatin resistance suggesting that oxaliplatin may be less effective than cisplatin in the treatment of SCLC. The resistant cell lines have also become hypersensitive to taxol but show no alterations in the expression, polymerisation or morphology of tubulin. Rather, the PI3K/Akt/mTOR pathway is involved in both platinum resistance and taxol sensitivity as both are reversed with rapamycin treatment. mTOR is also phosphorylated in the resistant cell lines indicating that platinum resistance is associated with an increase in activity of this pathway. The mechanism of regrowth resistance in the platinum-resistant H69CIS200 and H69OX400 cells is a combination of activation of PI3K/Akt/mTOR signalling and alterations in control of the G1/S cell cycle checkpoint. However, more work remains to determine which factors in these pathways are governing this novel mechanism of platinum resistance.