O carcinoma mucoepidermóide (CME) é o tumor mais comum entre as neoplasias malignas de glândula salivar. Recentemente, uma rara população de células com características de multipotência, autorrenovação e potencial tumorigênico, denominadas como células tronco tumorais (CTT), foi descrita no CME. As CTT são resistentes as terapias atuais, e têm sido consideradas responsáveis pela recorrência e metástase, levando a um pior prognóstico para o paciente. A descoberta de que as CTT do CME superexpressam componentes da via de sinalização mTOR, levantou a hipótese que os pacientes poderiam ser beneficiados com o uso inibidores de mTOR como terapia para eliminação das CTT. O objetivo desse estudo foi avaliar o potencial uso de inibidores de mTOR como terapia para o CME com foco em CTT, assim como, investigar o funcionamento da via de sinalização mTOR e os efeitos moleculares do tratamento com inibidores dessa via nas CTT do CME. Foi realizada imuno-histoquímica para p-mTOR e p-S6K-1 em casos de pacientes diagnosticados com CME, os resultados foram correlacionados com os dados clínicos dos pacientes e também foi realizada dupla marcação por imunofluorescência para ALDH/p-mTOR. Estudos in vitro foram realizados em 3 linhagens de CME (UM-HMC-1, -3A, -3B) e com inibidores da via de sinalização mTOR. Após exposição aos inibidores, realizou-se ensaios de western blot (proteínas da via mTOR e BMI-1), citometria de fluxo para ALDH/CD44; salisfera; e apoptose, esse último comparando com quimioterápicos utilizados atualmente. Adicionalmente, foi utilizado o silenciamento genético de mTOR para confirmar os resultados obtidos com inibidores químicos. Por fim, foram realizados ensaios in vivo com as células silenciadas e com o inibidor de mTOR tensirolimo. Os resultados evidenciaram que a via de sinalização mTOR está ativa no CME, é correlacionada com pior prognóstico clínico e está superexpressa nas CTT. O tratamento com inibidores da via mTOR levaram a diminuição da fração de CTT, devido a perda de autorrenovação e apoptose das CTT. A apoptose, junto a diminuição de p-AKT revelada por western blot, sugeriram que esteja ocorrendo inibição de mTORC2 nas CTT, um importante componente na eficácia do tratamento com inibição de mTOR no câncer. Além disso, também houve redução de vasos sanguíneos, nichos das CTT, e diminuição do crescimento tumoral com uso de inibidores ou silenciando mTOR in vivo. Coletivamente, os resultados mostraram que a inibição de mTOR foi capaz de agir nas CTT por mecanismos diretos (indução de apoptose e diminuição da autorrenovação) e indiretamente através da redução de angiogênese, sugerindo que o uso de inibidores de mTOR no tratamento do CME é uma estratégia molecular eficiente para a redução de CTT, e uma potencial terapia adjuvante. / Mucoepidermoid carcinoma (MEC) is the most common tumor among malignant salivary gland neoplasms. Recently, a rare population of multipotent, self-renewing, and tumorigenic cells, termed cancer stem cells (CSC), was described in MEC. CSC are resistant to current therapies, and have been considered responsible for recurrence and metastasis, leading to worse patient prognosis. The discovery that CSC from MEC overexpressed the mTOR signaling pathway raised the hypothesis that use of mTOR inhibitors as therapy for CSC elimination could benefit patients. The objective of this study was to evaluate the potential use of mTOR inhibitors as a therapy for MEC targeting CTT, as well to investigate the functioning of mTOR signaling pathway and the molecular effects of treatment with mTOR inhibitors in MEC CSC. Immunohistochemistry was performed for p-mTOR and p-S6K-1 in paraffin samples from patients diagnosed with MEC and results were correlated with clinical data, in addition, co-immunoflorescence was performed for ALDH/p-mTOR. In vitro studies were performed with 3 MEC cell lines (UM-HMC-1, -3A, -3B) and with inhibitors of the mTOR signaling pathway. After exposure to inhibitors the following assays were performed: western blot (mTOR signaling pathway proteins and BMI-1), flow cytometry for ALDH/CD44, salispheres, and apoptosis, the latter comparing with currently chemotherapeutic agents used as treatment for cancer patients. In addition, mTOR genetically silent was used to confirm results with chemical inhibitors. Finally, in vivo assays were performed with knockdown cells and with mTOR inhibitor temsirolimus treatment. Results showed that mTOR signaling pathway is active in MEC, it is correlated with worse clinical prognosis and it is overexpressed in CSC. Treatment with inhibitors of mTOR signaling pathway led to a decrease in CSC fraction, caused by loss of self-renewal and apoptosis. Apoptosis, together with the decrease in p-AKT revealed by western blot, suggest that inhibition of mTORC2, an important compound in the efficacy of mTOR inhibition for cancer treatment, is occurring. In addition, there was reduction of blood vessels, CSC niches, and decreased tumor growth using mTOR inhibitors or silencing mTOR. Collectively, results showed that inhibition of mTOR was able to act in CSC by direct mechanisms (induction of apoptosis, decreased self-renewal) and indirectly through reduction of angiogenesis, suggesting that the use of mTOR inhibitors in treatment of MEC is an efficient molecular strategy to reduce fraction of CSC, and a potential therapy.

A hipótese das células-tronco tumorais vem ganhando destaque como um dos principais modelos para explicar a formação de neoplasias malignas. CD44, ALDH1 e p75NTR são alguns dos marcadores usados com êxito para separar a subpopulação de células-tronco tumorais, mas sua expressão imuno-histoquímica nunca foi estudada em lesões de lábio causadas pela radiação ultravioleta (UV). O objetivo deste estudo foi avaliar a expressão de CD44, ALDH1 e p75NTR em lábio normal (LN), queilite actínica (QA) e carcinoma epidermoide de lábio (CEL), além de estudar a expressão de p53 e correlacioná-la com a expressão dos marcadores de células-tronco tumorais. Para isso, foram selecionados blocos de material parafinado provenientes do serviço de patologia oral, resultando em 4 casos de LN, 43 casos de QA, subdivididos de acordo com o grau de displasia, e 20 casos de CEL. Os casos foram submetidos à reação imuno-histoquímica. Todos os casos foram positivos para CD44, com expressão membranosa e padrão de marcação praticamente invariável entre os grupos de QA e CEL (p=0,09). Os casos de LN foram negativos para o ALDH1; 51,1% e 55,5 % dos casos de QA e CEL, respectivamente, forma positivas para o ALDH1. A marcação era citoplasmática, geralmente em poucas células. Não houve diferença na expressão de ALDH1 entre os graus de displasia epitelial (p=0,37) e quando CEL era comparado à QA (p=0,9). Todos os casos de LN foram positivos para p75NTR; 95,3% e 80% dos casos de QA e CEL foram positivos para p75NTR. A expressão era membranosa/citoplasmática em LN e QA, em camada basal e parabasal, e citoplasmática em CEL, na região periféricas das ilhas. Houve diferença na expressão de p75NTR entre os grupos de displasia epitelial (p<0,001), mas não entre QA e CEL (p=0,4). Todos os casos de LN e QA foram positivos para p53; 80% dos casos de CEL foram positivos. A expressão foi nuclear apenas, mas não houve diferença na expressão de p53 entre os graus de displasia epitelial (p=0,33) e entre QA e CEL (0,24). Não houve correlação significativa entre CD44, ALDH1 e p75NTR, quando avaliados entre si, e não houve correlação entre p53 e os marcadores de células-tronco tumorais. Os marcadores de células-tronco tumorais estão presentes em lesões potencialmente malignas e malignas de lábio, porém suas expressões não variaram entre QA e CEL. A expressão de p75NTR variou entre os graus de displasia epitelial. / Cancer stem cell hypothesis is becoming one of the main models to explain the generation of malignant neoplasms. CD44, ALDH1 and p75NTR are some of the markers successfully used to sort the subpopulation of cancer stem cells. However, their immunohistochemical expression were not studied in lip lesions caused by ultraviolet radiation (UV) so far. The aim of this study was to evaluate CD44, ALDH1 and p75NTR expression in normal lip (NL), actinic cheilitis (AC) and lip squamous cell carcinoma (LSSC). We also evaluated p53 expression and its correlation with the expression of the stem cell markers. In order to do that, paraffin-embbeded cases were selected from the oral pathology service, giving a total of 4 cases of NL, 43 cases of AC and 20 cases of LSCC. Immunohistochemical staining was performed in all the sample. All cases were positive for CD44, showing a membranous staining and a pattern of expression almost invariable between the groups AC and LSSC (p=0,09). All cases of NL were negative for ALDH1; 51,1% of AC and 55,5% of LSCC were positive. It was observed cytoplasmic staining, usually in a few cells. The ALDH1 expression showed no difference between the grades of epithelial dysplasia (p=0,37) and between AC and LSCC (p=0,9). All cases of NL were positive for p75NTR; 95,3% of AC and 80% of LSCC were positive for p75NTR. We observed membranous/cytoplasmic staining in NL and AC in the basal and parabasal layer and cytoplasmic staining in LSCC in the peripheral layers of the tumor islands. P75NTR showed difference in the expression among the grades of epithelial dysplasia (p<0,001) but showed no difference between the groups AC and LSCC (p=0,4). All cases of NL and AC were positive for p53; 80% of LSCC were positive for p53. The protein showed nuclear expression with no difference among the grades of epithelial dysplasia (p=0,33) and between AC and LSCC (0,24). There was no significant correlation among CD44, ALDH1 and p75NTR was observed and no significant correlation between p53 expression and the stem cell markers. The stem cell markers are present in potentially malignant and malignant lesions of the lip, but their expression show no variation between AC and LSCC. The expression of p75NTR varied between the grades of epithelial dysplasia.

A hipótese das células-tronco tumorais vem ganhando destaque como um dos principais modelos para explicar a formação de neoplasias malignas. CD44, ALDH1 e p75NTR são alguns dos marcadores usados com êxito para separar a subpopulação de células-tronco tumorais, mas sua expressão imuno-histoquímica nunca foi estudada em lesões de lábio causadas pela radiação ultravioleta (UV). O objetivo deste estudo foi avaliar a expressão de CD44, ALDH1 e p75NTR em lábio normal (LN), queilite actínica (QA) e carcinoma epidermoide de lábio (CEL), além de estudar a expressão de p53 e correlacioná-la com a expressão dos marcadores de células-tronco tumorais. Para isso, foram selecionados blocos de material parafinado provenientes do serviço de patologia oral, resultando em 4 casos de LN, 43 casos de QA, subdivididos de acordo com o grau de displasia, e 20 casos de CEL. Os casos foram submetidos à reação imuno-histoquímica. Todos os casos foram positivos para CD44, com expressão membranosa e padrão de marcação praticamente invariável entre os grupos de QA e CEL (p=0,09). Os casos de LN foram negativos para o ALDH1; 51,1% e 55,5 % dos casos de QA e CEL, respectivamente, forma positivas para o ALDH1. A marcação era citoplasmática, geralmente em poucas células. Não houve diferença na expressão de ALDH1 entre os graus de displasia epitelial (p=0,37) e quando CEL era comparado à QA (p=0,9). Todos os casos de LN foram positivos para p75NTR; 95,3% e 80% dos casos de QA e CEL foram positivos para p75NTR. A expressão era membranosa/citoplasmática em LN e QA, em camada basal e parabasal, e citoplasmática em CEL, na região periféricas das ilhas. Houve diferença na expressão de p75NTR entre os grupos de displasia epitelial (p<0,001), mas não entre QA e CEL (p=0,4). Todos os casos de LN e QA foram positivos para p53; 80% dos casos de CEL foram positivos. A expressão foi nuclear apenas, mas não houve diferença na expressão de p53 entre os graus de displasia epitelial (p=0,33) e entre QA e CEL (0,24). Não houve correlação significativa entre CD44, ALDH1 e p75NTR, quando avaliados entre si, e não houve correlação entre p53 e os marcadores de células-tronco tumorais. Os marcadores de células-tronco tumorais estão presentes em lesões potencialmente malignas e malignas de lábio, porém suas expressões não variaram entre QA e CEL. A expressão de p75NTR variou entre os graus de displasia epitelial. / Cancer stem cell hypothesis is becoming one of the main models to explain the generation of malignant neoplasms. CD44, ALDH1 and p75NTR are some of the markers successfully used to sort the subpopulation of cancer stem cells. However, their immunohistochemical expression were not studied in lip lesions caused by ultraviolet radiation (UV) so far. The aim of this study was to evaluate CD44, ALDH1 and p75NTR expression in normal lip (NL), actinic cheilitis (AC) and lip squamous cell carcinoma (LSSC). We also evaluated p53 expression and its correlation with the expression of the stem cell markers. In order to do that, paraffin-embbeded cases were selected from the oral pathology service, giving a total of 4 cases of NL, 43 cases of AC and 20 cases of LSCC. Immunohistochemical staining was performed in all the sample. All cases were positive for CD44, showing a membranous staining and a pattern of expression almost invariable between the groups AC and LSSC (p=0,09). All cases of NL were negative for ALDH1; 51,1% of AC and 55,5% of LSCC were positive. It was observed cytoplasmic staining, usually in a few cells. The ALDH1 expression showed no difference between the grades of epithelial dysplasia (p=0,37) and between AC and LSCC (p=0,9). All cases of NL were positive for p75NTR; 95,3% of AC and 80% of LSCC were positive for p75NTR. We observed membranous/cytoplasmic staining in NL and AC in the basal and parabasal layer and cytoplasmic staining in LSCC in the peripheral layers of the tumor islands. P75NTR showed difference in the expression among the grades of epithelial dysplasia (p<0,001) but showed no difference between the groups AC and LSCC (p=0,4). All cases of NL and AC were positive for p53; 80% of LSCC were positive for p53. The protein showed nuclear expression with no difference among the grades of epithelial dysplasia (p=0,33) and between AC and LSCC (0,24). There was no significant correlation among CD44, ALDH1 and p75NTR was observed and no significant correlation between p53 expression and the stem cell markers. The stem cell markers are present in potentially malignant and malignant lesions of the lip, but their expression show no variation between AC and LSCC. The expression of p75NTR varied between the grades of epithelial dysplasia.

Abstract Cancer treatments have remarkably improved over the past years since targeted therapies and immunotherapy have been introduced to the field of oncology. The benefit of these new therapies is often limited, however, by de novo or acquired therapy resistances, which should be noticed when making clinical decisions. In this current work, we studied the prognostic and predictive values of several immunological markers in metastatic HER2-positive breast cancer treated with trastuzumab, because trastuzumab is still given to patients according to the HER2 status only, without certainty of tumor response. We also determined the role of HER2 and HER3 for cancer stem cells (CSC) in ALK translocated non-small cell lung cancer (NSCLC) cell lines since the CSCs are causing therapy resistance and cancer recurrence. The results demonstrated that a high number of cytotoxic T cells, together with a high number of M1-like macrophages in the center of the tumor (CT), are promising and independent prognostic factors in HER2-positive breast cancer. These markers together also can predict the progression of the disease and the length of trastuzumab discontinuation in tumor response. Expression of HER2 and HER3 increased the stem-like properties of ALK translocated NSCLC cells, which were decreased when the expressions were downregulated. HER2-HER3-dependent CSCs also mediated the ALK therapy resistance. In conclusion, this study suggests that patients with a favorable immunological tumor profile (high number of cytotoxic T cells and M1-like macrophages in the CT) could be treated in a less-intensive manner, that trastuzumab discontinuation could be feasible for these patients, and that targeting of HER2 and HER3 receptors can lead to more effective killing of cancer stem-like cells and should be further studied. / Tiivistelmä Syöpähoidot ovat kehittyneet huomattavasti, kun kohdennetut hoidot ja immunologiset hoidot ovat tulleet perinteisten hoitojen rinnalle. Usein näiden hoitojen hyötyä kuitenkin rajoittaa jo olemassa oleva lääkeresistenssi tai sen kehittyminen, mikä tulisi ottaa huomioon hoitoja suunniteltaessa. Tässä työssä tutkittiin immunologisia merkkiaineita, joilla voitaisiin ennustaa trastutsumabi-hoidon vastetta sekä potilaiden ennustetta levinneessä HER2-positiivisessa rintasyövässä. Tällä hetkellä trastutsumabi-hoitopäätös tehdään pelkän HER2-geenimonistuman mukaan ilman varmuutta siitä, hyötyykö potilas oikeasti hoidosta. Lisäksi tutkimme HER2- ja HER3-reseptorien merkitystä syövän kantasoluille ALK-translokoituneessa ei-pienisoluisessa keuhkosyövässä (NSCLC), sillä syövän kantasolut ovat yksi merkittävimmistä tekijöistä lääkeresistenssin kehittymisessä ja syövän uusiutumisessa. Työssä havaittiin, että kasvaimen keskellä oleva suuri määrä sytotoksisia T-soluja sekä M1-tyypin makrofageja on yhteydessä potilaiden parempaan ennusteeseen ja että kyseiset merkkiaineet ovat toisistaan riippumattomia. Merkkiaineet pystyivät ennustamaan myös taudin etenemistä sekä trastutsumabi-hoitokeskeytyksen pituutta. HER2- ja HER3-proteiinien tuotto lisäsi ALK-translokoituneiden NSCLC-solujen kantasolumaisia ominaisuuksia, jotka puolestaan vähenivät, kun proteiinien tuotto estettiin. Lisäksi HER2-HER3 -riippuvaiset syövän kantasolut säätelivät lääkeresistenssiä kyseisessä taudissa. Työn tulokset viittaavat siihen, että potilaita, joilla on suotuisa kasvaimen immunoprofiili (suuri määrä sytotoksisia T-soluja ja M1-tyypin makrofageja kasvaimen keskellä) pystyttäisiin hoitamaan keveimmillä hoidoilla ja HER2-hoitokeskeytys voisi olla mahdollinen näillä potilailla. Lisäksi työ korostaa HER2- ja HER3-reseptorien kohdentamista syövän kantasolumaisten solujen tehokkaamman tuhoamisen saavuttamiseksi. / Huomautus/Notice Painetussa virheelliset ISBN -tunnukset: ISBN (print) 978-952-42-2343-8 pitäisi olla 978-952-62-2343-8. ISBN (PDF) 978-952-42-2344-5 pitäisi olla 978-952-62-2344-5. Printed version has incorrect ISBNs: ISBN (print) 978-952-42-2343-8 it should be 978-952-62-2343-8. ISBN (PDF) 978-952-42-2344-5 it should be 978-952-62-2344-5.

DNA Methylierung ist ein zentraler epigenetischer Prozess, welcher entscheidend an der Organisation von Genregulation beteiligt ist. Dieser Vorgang ist wichtig für die Funktion sowohl von embryonalen als auch von Gewebs-Stammzellen. Krebszellen weisen häufig veränderte DNA Methylierungsmuster auf, was auf eine ähnlich wesentliche Rolle der DNA Methylierung in Krebsstammzellen (KSZ) hindeutet. Diese These wurde hier mit Hilfe eines Mausmodells mit verringerter Expression der DNA Methyltransferase Dnmt1 anhand verschiedener Leukämiemodelle untersucht. In einem bi-linearen B-lymphatischen/myeloischen Leukämiemodell konnte gezeigt werden, dass hypomethylierte leukämieinitiierende (Stamm-)zellen (LSZ) myeloische Krebszellen hervorbringen, allerdings nicht zur Bildung von B-lymphatischen Leukämiezellen befähigt sind. Darüber hinaus konnte in einem T-Zell-spezifischen Leukämiemodell gezeigt werden, dass reduzierte Dnmt1 Expression nicht mit der Bildung von T-Zelllymphomen vereinbar ist. Detaillierte Analysen eines myeloischen Leukämiemodells ergaben, dass hypomethylierte LSZs ein vermindertes Selbsterneuerungspotenzial aufweisen. Im Gegensatz zu den starken Funktionseinschränkungen hypomethylierter LSZs, hatten hypomethylierte Knochenmarks-Stromazellen keinen Effekt auf die Entwicklung von Leukämien. Außerdem führte die Behandlung leukämischer Zellen mit demethylierenden Agenzien zu einer teilweisen Aufhebung methylierungsvermittelter Genrepression. Die dadurch verstärkte Expression von Differenzierungsfaktoren verminderte das Leukämiewachstum, was einen möglichen Erklärungsansatz für das eingeschränkte Potenzial hypomethylierter Leukämien darstellt. Diese Ergebnisse demonstrieren eine zentrale Rolle der DNA Methylierung für die Selbsterneuerung und Linienwahl von LSZs, und erlauben somit neue Einblicke in die epigenetische Regulation von KSZs. Diese Erkenntnisse implizieren, dass KSZs möglicherweise ein geeignetes Ziel für epigenetische Therapieansätze darstellen. / DNA methylation is one of the major epigenetic processes which is crucially involved in orchestrating gene regulation primarily by repression of gene expression. DNA methylation plays an important role in controlling functional programs of embryonic and tissue stem cells. As altered DNA methylation patterns are a hallmark of cancer, we hypothesized that DNA methylation might be equally important for cell fate determinations of cancer stem/initiating cells (CSC). To test this, I analyzed a genetic knockdown mouse model of the main somatic DNA methyltransferase Dnmt1 in the context of three different leukemia models. In a bilinear B-lymphoid/myeloid leukemia model hypomethylated bi-potential leukemia stem/initiating cells (LSCs) were shown to be capable of forming a myeloid leukemia, whereas the generation of B-lymphoid blasts was almost entirely abrogated. Moreover, failure of hypomethylated cells to develop T-cell lymphomas in a Notch1-based leukemia model demonstrated their profound lack of T-lineage commitment capacities. Furthermore, detailed analyses of a myeloid leukemia model revealed a severely impaired self-renewal potential in LSCs with reduced Dnmt1 expression. However, contrasting the drastic cell-intrinsic impairments of LSC function by reduced DNA methylation, leukemia development was found to be unaffected by hypomethylated bone marrow stroma. Mechanistically, treatment of cell lines with a demethylating drug led to enhanced expression of differentiation factors due to loss of methylation mediated gene silencing. This was followed by inhibition of leukemia cell growth, thus providing a potential mechanism for impaired functions of hypomethylated leukemias. Collectively, this thesis revealed a critical role for DNA methylation levels in malignant self-renewal and lineage fate choices. These new insights into epigenetic regulation of CSCs suggest that epigenetic therapy displays a potential treatment concept specifically targeting CSCs.

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.

Le carcinome spinocellulaire (SCC) est le 2ème cancer de la peau le plus fréquent avec plus d’un million de nouveaux patients diagnostiqués dans le monde chaque année. On retrouve également des SCCs associés à un pronostic plus sombre au niveau de la tête, du cou, de la cavité orale et de l’œsophage. Des travaux récents ont démontré l’existence de cellules souches cancéreuses (CSCs) dans les SCCs cutanés mais les mécanismes moléculaires contrôlant leurs fonctions restent indéterminés. Dans une première étude, nous avons montré que Sox2, un facteur de transcription (TF) associé aux cellules souches, est détecté de manière hétérogène dans une grande majorité des papillomes et des SCCs chez la souris et chez l’humain. La délétion conditionnelle de Sox2 dans l’épiderme réduit drastiquement l’apparition de tumeurs démontrant le rôle clé de Sox2 dans l’initiation tumorale. En utilisant une souris génétiquement modifiée Sox2-GFP knock-in, nous avons démontré que les cellules tumorales Sox2+ sont enrichies en cellules propagatrices de tumeurs dont la proportion augmente au fur et à mesure des transplantations sériées. L’ablation des cellules Sox2+ dans les papillomes et les SCCs conduit à une importante régression des tumeurs, indiquant que ces cellules ont un rôle crucial dans le maintien des tumeurs. La délétion conditionnelle de Sox2 dans des papillomes et SCCs préexistants provoque également une régression majeure des tumeurs, soulignant le rôle essentiel de Sox2 dans la régulation des fonctions des cellules tumorales. Une analyse transcriptionnelle et des expériences d’immunoprécipitation de chromatine nous ont permis de mettre en évidence un réseau de gènes associés à des fonctions essentielles des cellules tumorales et régulés par Sox2 dans les tumeurs primaires in vivo. Dans une 2ème étude, nous avons montré que les SCCs issus de l’épiderme inter-folliculaire (IFE) présentent en général un caractère différencié alors que ceux issus du follicule pileux (HF) présentent fréquemment des caractéristiques de transition épithélio-mésenchymateuse (EMT). En réalisant une analyse transcriptionnelle et épigénétique, nous avons démontré que les différentes cellules à l’origine expriment un réseau de gènes spécifiques et présentent une accessibilité différentielle à des sites de liaison d’importants TFs associés soit à un phénotype épithélial soit à l’EMT. Ces résultats démontrent que l’état transcriptionnel et épigénétique de la cellule à l’origine amorce spécifiquement les tumeurs vers le processus d’EMT. L’ensemble de ces résultats souligne des mécanismes cruciaux à l’établissement de l’hétérogénéité tumorale et seront essentiels pour parvenir à des pronostics affinés et au développement de nouvelles thérapies ciblées dans le traitement du cancer. / Skin squamous cell carcinoma (SCC) is the second most frequent skin cancer with more than a million new patients affected every year throughout the world. It is also the predominant cancer of the head, neck, oral cavity and esophagus, associated with a poor prognosis. Recent studies have identified cancer stem cells (CSCs) in skin SCC but the molecular mechanisms controlling their functions remain unclear. In a first study, we show that Sox2, a transcription factor (TF) associated with stemness, is expressed in a heterogeneous manner in the vast majority of benign and malignant skin tumors in mouse and human. Sox2 conditional deletion in the epidermis impairs tumor development showing that Sox2 plays a crucial role in tumor initiation. Using a Sox2-GFP knock-in mouse model, we show that Sox2-expressing tumor cells are greatly enriched in tumor-propagating cells, which further increase upon serial transplantations. Lineage ablation of Sox2-expressing cells in primary benign and malignant SCCs leads to tumor regression, consistent with the critical role of Sox2-expressing cells in tumor maintenance. Conditional Sox2 deletion in pre-existing skin papilloma and SCC leads to tumor regression, supporting the essential role of Sox2 in regulating cancer cells functions. Using transcriptional profiling and chromatin immunoprecipitation, we uncovered a gene network controlling many cancer hallmarks regulated by Sox2 in primary tumour cells in vivo.In a second study, by targeting the same oncogenic mutations to distinct skin compartments, we show that interfollicular epidermis (IFE)-derived SCCs are generally well-differentiated, while hair follicle stem cells (HFSCs)-derived SCCs frequently exhibit features of epithelial-mesenchymal transition (EMT). Using transcriptional and epigenetic profiling, we show that IFE and HF tumor-initiating cells harbor distinct chromatin landscapes and gene regulatory networks associated with tumorigenesis and EMT. These different chromatin landscapes correlate with the differential accessibility of key epithelial and EMT TFs binding sites in the cancer cell of origin. These findings demonstrate that cell type-specific chromatin and transcriptional states differentially prime tumours towards EMT.Altogether, these results highlight crucial mechanisms for the establishment of tumor heterogeneity which will be relevant for better prognostic assessment and the development of novel targeted therapies for cancer treatment. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Abstract Ovarian cancer is the fifth leading cause of cancer-associated death in women in Finland. Although ovarian cancer is relatively common, the precise mechanism of its development is still unknown. Additionally, it appears that the modes of pathogenesis differ depending on histotype. Although the initial response to platinum-based chemotherapy is usually good, the majority of ovarian cancer patients relapse and develop platinum resistance. This is a major problem in the treatment of ovarian cancer. Reactive oxygen species (ROS) are metabolites of oxygen. They are continuously formed in normal cells as a by-product of aerobic respiration and they play an important role in normal cell functions. Oxidative stress occurs when ROS formation overrides the antioxidative defence system. Oxidative stress is associated with carcinogenesis. A small proportion of cancer cells are stem cells that survive initial chemotherapy. These cells are suspected of being associated with the development of platinum resistance. To evaluate the significance of oxidative stress in ovarian cancer we examined ROS-derived damage and antioxidant regulators in benign and borderline ovarian tumours and ovarian cancer samples by immunohistochemistry and analysis of serum samples. The existence of cancer stem cell markers was also assessed in ovarian cancer samples. The expression levels of various markers were compared with clinicopathological parameters. Our results confirm that oxidative stress (8-hydroxydeoxyguanosine) exists in benign tumours and antioxidant enzymes, such as peroxiredoxins and thioredoxin are widely expressed in benign and borderline tumours. Oxidative stress was associated with poor survival, higher stage and platinum resistance in ovarian cancer. Oxidative stress markers were more strongly expressed in certain histotypes of ovarian cancer, such as serous and endometrioid type. Cancer stem cell markers were found in ovarian cancer and they were associated with the development of platinum resistance. These observations are beneficial in understanding the pathobiology of ovarian cancer and help in the design of new treatment options. / Tiivistelmä Munasarjasyöpä on yksi merkittävistä syöpäkuolleisuuden aiheuttajista naisilla Suomessa. Se on kohtalaisen yleinen, mutta sen perimmäinen syntymismekanismi on vielä epäselvä. Lisäksi näyttää siltä, että eri histologioilla syntymekanismit poikkeavat toisistaan. Vaikka yleensä platinapohjaisella solunsalpaajahoidolla saadaan hyvä vaste, suurimmalla osalla hoidetuista potilaista tauti uusii ja kehittyy vastustuskyky platinapohjaisille solunsalpaajille. Tämä on suuri ongelma munasarjasyövän hoidossa. Vapaat radikaalit ovat hapen johdannaisia. Niitä muodostuu jatkuvasti soluissa soluhengityksen sivutuotteena, ja niillä on tärkeä merkitys normaaleissa solun toiminnoissa. Jos vapaiden radikaalien tuotanto ylittää antioksidatiivisen puolustusjärjestelmän, syntyy oksidatiivinen stressitilanne. Oksidatiivisen stressin on todettu olevan yhteydessä useiden syöpien syntymiseen. Osaa syövän soluista kutsutaan kantasoluiksi. Nämä solut voivat selvitä solunsalpaajahoidoista ja niiden epäillään olevan yhteydessä vastustuskyvyn kehittymisessä platinapohjaisia sytostaatteja kohtaan. Tutkimuksessamme arvioimme oksidatiivisen stressin merkitystä munasarjakasvaimissa. Tutkimme vapaiden radikaalien aiheuttamia vaurioita ja antioksidatiivisia säätelijöitä hyvänlaatuisissa, rajalaatuisissa sekä munasarjasyöpä kasvaimissa immunohistokemiallisesti ja seeruminäytteistä. Lisäksi selvitimme syövän kantasolumerkkiaineiden esiintymistä munasarjasyövässä. Tutkittujen merkkiaineiden pitoisuuksia verrattiin kliinisiin potilastietoihin. Tutkimustuloksemme mukaan oksidatiivista stressiä (8-hydroxydeoxyguanosine) esiintyi jo hyvänlaatuisissa kasvaimissa. Myös antioksidatiiviset entsyymit, kuten peroksiredoksiinit ja tioredoksiini, esiintyivät jo hyvänlaatuisissa ja rajalaatuisissa kasvaimissa. Oksidatiivinen stressi oli yhteydessä huonompaan tautiennusteeseen ja platinakohtaisen vastustuskyvyn kehittymiseen. Oksidatiivista stressiä oli enemmän seroosissa ja endometrioidissa munasarjasyöpätyypissä. Syövän kantasolumerkkiaineita esiintyi munasarjasyövässä, ja ne olivat yhteydessä huonontuneeseen hoitovasteeseen platinapohjaisille solunsalpaajille. Tulokset auttavat ymmärtämään munasarjasyövän syntymekanismeja ja suunnittelemaan uusia hoitovaihtoehtoja erityyppisissä munasarjasyövissä.

Les glioblastomes sont les tumeurs primitives cérébrales les plus fréquentes chez l’adulte et les plus agressives. L’objectif de cette thèse était de mieux comprendre l’hétérogénéité qui caractérise les glioblastomes et qui pourrait être en partie responsable de leur mauvais pronostic. Ainsi, nous avons mis en évidence une corrélation entre une localisation tumorale et un profil moléculaire particulier. De plus, l’utilisation de deux lignées cellulaires souches de glioblastomes établies au laboratoire, nous a permis de réaliser le criblage d’une banque chimique et de proposer la proscillaridine A, appartenant à la famille des glycosides cardiaques, comme un agent anti-tumoral potentiel. Par ailleurs, nous avons identifié une sialyltransférase, la ST8Sia III, comme responsable de la biosynthèse de l’antigène souche A2B5. La surexpression de la ST8Sia III par les cellules souches cancéreuses fait d’elle une possible cible thérapeutique. L’ensemble des travaux rapportés ici contribue à améliorer les connaissances sur la gliomagenèse, à proposer des cibles thérapeutiques potentielles et de nouvelles stratégies de traitement des glioblastomes. / Glioblastomas are the most frequent and aggressive primary brain tumors in adult. This thesis aimed to better understand the heterogeneity that characterizes glioblastomas and which could be partly responsible for their poor prognosis. We highlighted a relationship between tumor location and a specific molecular profile. Further, using two glioblastoma stem cell lines, we realized the screening of a chemical library and we proposed the proscillaridin A, a cardiac glycoside, as a new anti-tumoral molecule. Besides, we identified a sialyltransferase, ST8sia III, which produces A2B5 antigen. Overexpression recording in cancer stem cells, suggested that ST8Sia III could be considered as a potential therapeutic target. All this work contributes towards a better understanding of gliomagenesis and points out potential therapeutic targets. At last, we propose new therapeutic strategies in glioblastoma.

Le produit naturel salinomycine (SAL) est largement utilisé comme médicament anticoccidien et maintenant de plus en plus reconnu comme un agent destiné à réduire la proportion de population CD44⁺ / CD24⁻ cellules souches du cancer du sein. Ce facteur est important et intervient lors des rechutes des tumeurs du sein. Pour la première fois, nous avons décrit que l'action n’était pas ionophorique mais que le proton dit "éponge" de la salinomycine ciblait particulièrement la population des cellules souches du cancer. De plus, un analogue alcyne-amine synthétisé de la salinomycine a une action similaire à cette dernière sur la population CD44⁺ / CD24⁻ mais à une concentration inférieure : 30 nM pour 500 nM pour la salinomycine. En utilisant la méthode de clic-imagerie, nous avons observé le composé incolore dans les lysosomes et les auto-lysosomes. En augmentant le pH des vésicules acides, la salinomycine et ses analogues inhibent les activités des cathepsines B, L et D empêchant ainsi l'autophagie. Cette autophagie joue un rôle important dans la survie des cellules souches du cancer conduisant à une augmentation du facteur ROS et à une mort cellulaire par apoptose. Notre étude donne un aperçu du mécanisme par lequel la salinomycine élimine les cellules souches cancéreuses et propose des stratégies pour le traitement de cancers résistants. / A natural product Salinomycin (SAL) is widely used as an anticoccidial drug now being increasingly recognized as an agent for reducing the proportion of CD44⁺/CD24⁻ breast cancer stem cell which is perceived as important factor for breast tumor relapse. We first time report that not ionophoric action but the proton “sponge” of SAL is responsible for distinguishingly targeting cancer stem cell population. In addition, one SAL-analog alkyne-amine performed the similar action with SAL on CD44⁺/CD24⁻ population but at much lower concentration than SAL, at 30 nM compare to 500 nM of SAL. Using click-imaging method we visually observed the colorless compound saturated in lysosomes and autolysosomes. By raising pH of acidic vesicles, SAL and its analogs inhibit cathepsin B, L, D activity preventing the autophagy which plays an important role in cancer stem cell maintain and survival thus lead to cell death via increasing ROS and apoptosis. Our study provides the insight mechanism how SAL actually eradicates cancer stem cells and suggests sharpened strategies for treating resistant cancers.