京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20230号 / 医博第4189号 / 新制||医||1019(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 野田 亮, 教授 武田 俊一, 教授 杉田 昌彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Pancreatic cancer is one of the most lethal cancers and despite all research efforts the last 50 years, there are still no effective therapy for this terrible disease. Until quite recently most research in the field of pancreatic duct adenocarcinoma (PDAC) was focused on the tumor cells and mechanisms essential for their proliferation and survival. However, the tumor does not only consist of tumor cells, rather a combination of tumor cells and numerous stroma cell types, i.e. the tumor microenvironment. The tumor cells have developed the ability to activate the surrounding cells to produce factors important for the progression of the tumor. Cancer associated fibroblasts (CAFs) are the major stroma component and as much as 70% of the total PDAC tumor mass consists of these cells. In this thesis I have investigated the mechanisms involved in the cross-talk between tumor cells and CAFs and distinguished the local and systemic effects of this communication. Tumor derived IL-1α was identified as an important factor creating the inflammatory profile seen in CAFs. In PDAC patients, IL-1α was detected in 90% of the tumors and high expression was associated with poor clinical outcome. Moreover, the PDAC tumors had elevated expression levels of many inflammatory factors that were induced in CAFs by the tumor derived IL-1α in vitro. Consequently, this high expression of inflammatory factors in CAFs will attract immune cells including tumor associated macrophages (TAMs), dendritic cells (DCs), and CD8+ T cells. This indicates an immune suppressive role of CAFs, protecting the tumor cells by acting as decoy targets for immune cells homing into the tumor. The inflammatory factors produced in the PDAC microenvironment did not only affect the infiltrating immune cells, but had also systemic effects that included decreased levels of blood DCs in PDAC patients. Furthermore, these myeloid and plasmacytoid DCs were partly activated and had a semi mature phenotype and impaired immunostimulatory function. Low levels of blood DCs were direct associated with poor patient prognosis and the same was seen for low expression of ICOSL by the DCs. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor  promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. The findings presented in this thesis indicate an essential role for the cross-talk between tumor cells and stroma in the production of tumor promoting factors. Treatment of PDAC patients with drugs that target the IL-1α signaling pathway could prevent the communication between these cells, thus reduce the amount of inflammatory factors both locally and systemically. Altogether, our findings support the idea that neutralization of the IL-1α signaling molecule could be a promising therapy for pancreatic cancer. / Mindre än 5% av patienterna som drabbas av cancer i bukspottkörteln förväntas överleva i mer än fem år. De typiska symtomen kommer sent och sjukdomen framskrider snabbt. Några av de riskfaktorer som identifierats är tobaksrökning, fetma och typ 2 diabetes. Forskningen har hittills siktat in sig på tumörcellerna och de mekanismer de använder för att överleva och föröka sig. Men en tumör innehåller också normala kroppsceller och vid bukspottkörtelcancer kan så mycket som 70 procent bestå av i sig ofarliga bindvävsceller. Miljön i tumören skapas av samspelet mellan dessa celltyper. De cancerceller som är bäst på att utnyttja omgivningen för sin tillväxt fortlever och för sina egenskaper vidare. En sådan egenskap är att kunna manipulera bindvävsceller till att producera signalsubstanser och tillväxtfaktorer som gynnar tumören. Mekanismerna bakom denna kommunikation har studerats och ett viktigt fynd var att tumörcellerna producerar signalämnet interleukin 1-alpha (IL-1a). Detta protein upptäcktes i 90 procent av de undersökta tumörerna, och var kopplat till dålig prognos hos patienterna. Signalen via IL-1a sätter igång tillverkningen av substanser som behövs för nybildning och tillväxt av blodkärl, i sin tur en förutsättning för att tumören ska leva vidare och växa. Proteinet stimulerar också celldelning i tumören, bidrar till att lura kroppens immunförsvar och underlättar spridning av dottertumörer till andra delar av kroppen. När vi slår ut signaleringen kan tumörcellerna inte längre påverka bindvävscellerna lika effektivt, och således minskar förekomsten av flera faktorer som gynnar tumörtillväxten. IL-1a kan därför vara en lovande kandidat att utforska vidare för framtida som ett läkemedel mot bukspottkörtelcancer.

Head and neck squamous cell carcinomas are still challenging despite progress in the oncological treatment. Study of the molecular biology allows to deeply characterize tumor properties and to predict the prognosis for affected patients. Nowadays there are many drugs clinically tested in the group of targeted therapy medicine Experimental work comprised both in vitro and in situ assays, being performed thanks to the collaboration between a number of departments of the 1st Faculty of Medicine of the Charles University in Prague, Academy of Sciences of the Czech Republic, Institute of Hematology and Blood Transfusion and Faculty of Veterinary Medicine of the Ludwig-Maxmillian University Munich. Galectin-1 is important inductor of the myofibroblasts/cancer associated fibroblasts. These fibroblasts are regarded as negative prognostic markers thanks to their capability of invasive cancer cells induction. On the other hand, Galectin-9 is not present in the carcinoma and in the case of dysplasia, its expression indicate aberrant features together with aberrant expression of keratin 14 and 19. Except from galectins using as prognostic markers, we focused on the galectins as a therapeutics instruments as well. Presented work with mutant variants of galectin-2 proved their effect on both pharmacodynamics and...

Les tumeurs sont constituées de deux groupes cellulaires :les cellules tumorales et les cellules dites « hôtes ». Au sein de ce dernier groupe, on retrouve les cellules endothéliales, les cellules inflammatoires mais également les fibroblastes associés au cancer (FAC). De plus en plus de données dans la littérature suggèrent l’importance des FAC dans l’invasion tumorale et le développement métastatique. De nombreuses études immunohistochimiques ont démontré le rôle pronostique des FAC dans différents cancers. Les traitements néoadjuvants modifient l’environnement tumoral mais l’impact de ces traitements sur les FAC est assez méconnu.Notre travail porte, tout d’abord, sur une revue de littérature à propos de l’impact pronostique négatif des FAC dans différents cancers. Ensuite, nous avons étudié le ratio des FAC SMA+/surface épithéliale tumorale dans une cohorte de patients ayant été opérés d’un adénocarcinome rectal ayant bénéficié ou pas d’une thérapie néoadjuvante. La comparaison du ratio entre les groupes traités et non traités a montré un ratio plus élevé chez les patients ayant bénéficié d’une thérapie néoadjuvante. Par ailleurs, les tumeurs présentant un ratio élevé présentent également un indice de prolifération faible suggérant que la thérapie néoadjuvante modifie l’environnement tumoral par une majoration des FAC aux dépens des cellules tumorales et par l’acquisition d’un phénotype quiescent des cellules tumorales. Finalement, chez les patients traités par une thérapie néoadjuvante, un ratio supérieur à un est associé à une survie sans récidive mauvaise.Nous nous sommes ensuite intéressés à la protéine FHL2 qui est exprimée par les FAC mais également par les cellules tumorales. L’étude de l’expression immunohistochimique de la protéine FHL2 sur un tissue microarray de cancers coliques a démontré que celle-ci est exprimée fréquemment dans les FAC de cancers coliques alors que l’expression dans les cellules tumorales est plus variable. Nous avons démontré que les tumeurs coliques exprimant fortement FHL2 sont associées à un plus mauvais pronostic (survie et survie sans récidive). Ce résultat est probablement lié à l’implication de cette protéine dans la transition épithélio-mésenchymateuse.Finalement, nous avons étudié la possibilité d’une interaction entre FHL2 et ADAM-17. Nous avons démontré que cette interaction est plus fréquente dans le cancer colique comparé au tissu colique normal. Ce dernier résultat ouvre la voie vers un partenaire potentiel de FHL2 qui pourrait notamment interférer avec la voie de signalisation de l’EGF. / Tumours are composed of two cellular groups: the tumoural cells and the host cells. In this latter, we find endothelial cells, inflammatory cells but also the cancer-associated fibroblasts (CAFs). More and more litterature data suggest a key role of CAFs in the tumoural invasion and in the metastatic development. Several immunohistochemical studies have highlighted the prognostic role of CAFs in different cancers. Neoadjuvant treatments modulate the tumoural environment but the impact of such treatment on the CAFs is relatively unknown.In the first part of this thesis we revise the current knowledge on the adverse prognostic impact of CAFs in different cancers. We studied by immunohistochemistry the ratio CAFs SMA+/tumoural epithelial area within a patient cohort operated for rectal adenocarcinoma receiving or not a neoadjuvant treatment. The comparison of the ratio between the treated group and the non-treated group showed that this ratio is higher in patients treated with neoadjuvant therapy. Moreover, rectal cancer with a high ratio displayed a lower proliferation rate suggesting that the neoadjuvant treatment modifies the tumoural environment by an increase of CAFs and by acquisition of a quiescent phenotype of the tumoural cells. In the group of patients treated with neoadjuvant treatment, a ratio >1 was associated with an adverse impact on recurrence free survival.Secondly, we studied Four-and-a-half LIM Domain protein 2 (FHL2) which is a protein expressed by CAFs but also by the tumoural cells. Immunohistochemical study of FHL2 expression on a colon cancer tissue microarray demonstrated that FHL2 is frequently expressed in colon cancer CAFs while its expression is variable in the tumoural cells. We demonstrated that high FHL2 expression in colon cancer is related to poor prognosis (overall survival and metastasis free survival). Aggressive behaviour in such tumours might be related to the implication of FHL2 in epithelial-to-mesenchymal transition.Finally, we studied a possible interaction between FHL2 and ADAM-17. We demonstrated that this interaction is more frequent in colon cancer compared to normal colonic tissue, suggesting a role for it in colon cancer development. This interaction possibly interferes with the EGF pathway / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

Les fibroblastes associés au cancer (CAF) jouent un rôle central dans un processus complexe d'interaction entre les tumeurs et le stroma et favorisent la croissance tumorale. Des preuves émergentes suggèrent que ces fibroblastes sont impliqués dans l'altération de la réponse immune anti-tumorale. Cependant, les mécanismes immuno-modulateurs sous-jacents dépendants de ces fibroblastes ne sont encore que très partiellement définis. Au cours de ma thèse, j’ai mis en évidence que les fibroblastes associés au mélanome diminuent la susceptibilité des cellules tumorales de mélanome à la lyse induite par les cellules Natural killer (NK) par un mécanisme dépendant de la sécrétion de métalloprotéinases matricielles (MMPs) actives. Cette sécrétion de MMPs réduit l'expression de deux ligands du récepteur activateur NKG2D, MICA/B, à la surface des cellules tumorales et diminue par conséquent l'activité cytotoxique des cellules NK dépendante de NKG2D contre les cellules tumorales de mélanome. D’autre part, grâce à une approche génomique globale, mon travail a montré que l’hypoxie au sein du stroma tumoral pourrait augmenter les capacités immuno-modulatrices des CAFs en modifiant l’expression d’un ensemble de gènes qui codent pour des protéines immunosuppressives. L’ensemble de ces résultats démontrent donc que les CAFs sont des déterminants essentiels modifiant la susceptibilité des cellules tumorales aux cellules tueuses mais qu’il existerait également un dialogue entre le microenvironnement hypoxique et les CAFs leur permettant d’augmenter leur potentiel immunosuppresseur. / Cancer-associated fibroblasts (CAF) play a central role in a complex process of interaction between tumors and stroma and promote tumor growth. Emerging evidence suggest that these fibroblasts are involved in the alteration of the anti-tumor immune response. However, the underlying immunomodulatory mechanisms dependent on these fibroblasts are still only partially defined. During my thesis, I demonstrated that melanoma-associated fibroblasts decrease the susceptibility of melanoma tumor cells to Natural killer (NK) cell lysis through a mechanism dependent on the secretion of active matrix metalloproteinases (MMPs). This secretion of MMPs reduces the expression of the two NKG2D ligands, MICA/B at the surface of the tumor cells and consequently decreases the NKG2D-dependent cytotoxic activity of NK cells against melanoma tumor cells. On the other hand, using a global genomic approach, my results suggested that hypoxia within the tumor stroma could increase the immunomodulatory capacities of CAFs by modifying the expression of a set of genes that encode for immunosuppressive proteins. Together, our results show that CAFs are essential determinants modifying the susceptibility of tumor cells to killer cells but that there is also a crosstalk between the hypoxic microenvironment and the CAFs allowing them to increase their immunosuppressive potential.

Head and neck squamous cell carcinomas are still challenging despite progress in the oncological treatment. Study of the molecular biology allows to deeply characterize tumor properties and to predict the prognosis for affected patients. Nowadays there are many drugs clinically tested in the group of targeted therapy medicine Experimental work comprised both in vitro and in situ assays, being performed thanks to the collaboration between a number of departments of the 1st Faculty of Medicine of the Charles University in Prague, Academy of Sciences of the Czech Republic, Institute of Hematology and Blood Transfusion and Faculty of Veterinary Medicine of the Ludwig-Maxmillian University Munich. Galectin-1 is important inductor of the myofibroblasts/cancer associated fibroblasts. These fibroblasts are regarded as negative prognostic markers thanks to their capability of invasive cancer cells induction. On the other hand, Galectin-9 is not present in the carcinoma and in the case of dysplasia, its expression indicate aberrant features together with aberrant expression of keratin 14 and 19. Except from galectins using as prognostic markers, we focused on the galectins as a therapeutics instruments as well. Presented work with mutant variants of galectin-2 proved their effect on both pharmacodynamics and...

The dissertation is focused on the study of intercellular interactions in skin tumors. It is based on 5 original publications that cover several topics. We studied the origin of tumor-associated fibroblasts concerning the primary tumor population. We demonstrated using a mouse model that tumor-associated fibroblasts are produced from the host organism and thus did not arise from transformation directly from tumor cells. We also investigated the relationship between tumor-associated fibroblasts and keratinocytes. We have shown that tumor-associated melanoma fibroblasts affect keratinocytes which, under their influence, acquire the features typically observed in migrating cells and cells undergoing epithelial-mesenchymal transition. We studied the interactions between healthy fibroblasts and tumor cells. We have demonstrated that fibroblasts acquired from healthy skin from a patient suffering from melanoma are significantly different from control fibroblasts of healthy donors in the expression profile. Changes in distal fibroblasts support the view of melanoma as a systemic disease. We have further demonstrated that melanoma-associated fibroblasts do not carry a BRAF mutation, in contrast to BRAF positivity of melanoma cells. And therefore, they did not arise from the transition from melanoma. The...

Les cancers du sein ont la particularité de développer un microenvironnement tumoral important où les fibroblastes associés au cancer (CAF) jouent un rôle crucial dans la tumorigénèse via la sécrétion de différents facteurs de croissance, cytokines, protéases et composants de la matrice extracellulaire. Ces différents facteurs secrétés par les CAFs sont impliqués dans de nombreuses voies de signalisation suggérant que la reprogrammation des cellules cancéreuses par les CAFs peut affecter de nombreux gènes.Le séquençage des ARN messagers (RNAseq) de lignées cellulaires de cancer du sein cultivées en présence de milieux conditionnés de CAF, nous a permis d'identifier 372 gènes surexprimés in vitro par les facteurs sécrétés par les CAF et in vivo selon la teneur en cellules stromales des tumeurs mammaires. De façon inattendue, nous avons pu constater que les facteurs sécrétés par les CAF ainsi que le contenu en cellules stromales des tumeurs n'induisent pas de changements significatifs de méthylation de l'ADN mais activent de manière spécifique des gènes caractérisés par une signature méthylation. Différentes approches expérimentales, telles que l'inhibition de la méthylation de l'ADN, l'inhibition de l'expression de la protéine MBD2 (protéines de liaison à l'ADN méthylé) et des expériences d'immuno-précipitation de la chromatine (ChIP) ont permis de montrer l'implication de ces marques de méthylation et des protéines de liaison à l'ADN méthylé dans la réponse des cellules cancéreuses aux facteurs sécrétés par les CAFs. Ces résultats ont permis l'identification d'événements moléculaires impliqués dans la réponse des cellules tumorales aux signaux sécrétés par les cellules stromales dans les tumeurs mammaires mettant en lumière l'importance des marques épigénétiques dans la reprogrammation des cellules cancéreuses induites par les cellules stromales / Breast cancers develop in complex tissue environments where cancer associated fibroblasts (CAF) play a crucial role in tumorigenesis by secreting various growth factors, cytokines, proteases and extracellular matrix components. Soluble factors secreted by CAFs are involved in many pathways including inflammation, metabolism, proliferation, and epigenetic modulation suggesting that CAF-dependent reprograming of cancer cells affects a large set of genes. From RNAseq data obtained from breast cancer cell lines grown in presence of CAF-secreted factors, we identified 372 upregulated genes exhibiting an expression level positively correlated with the stromal content of breast cancer specimens. Furthermore, we observed that gene expression changes were not mediated through significant DNA methylation changes. Nevertheless CAF-secreted factors but also stromal content of the tumors remarkably activated specific genes characterized by a DNA methylation signature: hypermethylation at transcription start site (TSS) and shore regions. Experimental approaches (inhibition of DNA methylation, knockdown of MBD2, and ChIP assays) demonstrated the implication of DNA methylation and methyl DNA binding protein in the response of cancers cells to CAF-secreted factors. These data put in light the importance of epigenetics marks in the cancer cell reprogramming induced by stromal cell and indicate that the interpreters of the DNA methylation signal play a major role in the response of the cancer cells to the microenvironment