Orientador: Ramon Kaneno / Banca: Elaine Guadelupe Rodrigues / Banca: Daniela B. Kaneno / Resumo: O interferon alfa (IFN-α), um IFN do tipo I, se apresenta como uma citocina com grande potencial terapêutico, pois atua no combate direto às células tumorais, além de agir sobre a maturação de células dendríticas (DCs), que são células apresentadoras de antígenos profissionais e peças chave na elaboração da uma resposta antitumoral. Entretanto, a administração sistêmica de citocinas pode produzir toxicidade importante nos pacientes, de modo que a indução de sua produção in situ poderia representar uma forma de imunomodulação mais adequada. Assim, o objetivo deste estudo é verificar a ação de vetores lentivirais carregando o gene do IFN-α para transdução de células tumorais, permitindo assim a produção localizada de IFN-α, a fim de explorar, in vitro, seu potencial lítico e imunomodulatório sobre DCs. Vetores lentivirais carregando o gene do IFN-α humano (Lego-IFN) ou GFP (Lego-GFP) foram utilizados para a transdução in vitro de células de câncer colorretal. A transdução foi feita com diferentes multiplicidades de infecção (MOIs - 0.3, 1.0, 2.0, 4.0) para avaliarmos o efeito dose-dependente, seguido de co-cultura com DCs derivadas de monócitos de doadores saudáveis (DC-0.3, DC-1.0, DC-2.0, DC-4.0). Após 48h de co-cultura, as DCs foram avaliadas fenotípica e funcionalmente, através da análise dos marcadores de membrana por citometria de fluxo, capacidade de aloestimulação e de indução de linfócitos T citotóxicos (CTLs). Nós observamos que a transdução com Lego-GFP, mas não com Lego-IFN, aumentou a imunogenicidade das células tumorais, com aumento de expressão de CD54 e HLA-DR. A co-cultura de DCs com células tumorais transduzidas com Lego-IFN aumentou discretamente seu perfil de ativação, mas não seu potencial aloestimulatório in vitro. Observamos que linfócitos cultivados com DC-2.0 produziram níveis mais altos de IFN-γ, sugerindo a indução de um perfil Th1, enquanto que... / Abstract: Interferon alpha (IFN-α) is a type I IFN with great therapeutic potential, since it is able to directly fight tumor cells and enhance the maturation of dendritic cells (DCs), the main antigen-presenting cells, required for an effective antitumor response. However, the systemic administration of cytokines can induce severe collateral effects. Therefore, the induction of cytokine secretion in situ should represent a more adequate approach for cytokine-based immunotherapy. Thus, the goal of this study was to induce IFN-α secretion by colon cancer cells by transduction with a lentivirus vector carrying the human IFN-α gene, followed by analysis of its immunomodulatory potential over DCs. Transduction was made with different multiplicities of infection (MOIs - 0.3, 1.0, 2.0 and 4.0) to evaluate the dose-dependent effects. Such cells were co-cultured with monocyte-derived DCs from healthy donors (DC-0.3, DC-1.0, DC-2.0 and DC-4.0). Forty-eight hours later, DCs were evaluated for their phenotype (surface activation/maturation markers) by flow cytometry, their ability to induce allogeneic response in a mixed leukocyte reaction (MLR) and effectiveness to induce cytotoxic T cells. We observed that transduction with Lego-GFP, but not Lego-IFN, increased tumor cells' immunogenicity with up-regulation of the markers CD54 and HLA-DR. Co-culture of Lego-IFN-transduced tumor cells with DCs slightly enhanced their activation phenotype but not their potential to stimulate T cell proliferation in vitro. Furthermore, we observed that lymphocytes cultured with DC-2.0 produced higher levels of IFN-γ, suggesting an induction of Th1 profile on T cells, while DC-GFP induced more IL-10 and IL-4. Additionally, DC-4.0 was more efficient in generating cytotoxic T lymphocytes (CTLs) that the control DC, however DC-GFP induced even more CD8+T cell proliferation. The enhancement of tumor cell immunogenicity and the superior induction of CLTs ... / Mestre

Orientador: Maria Aparecida Marchesan Rodrigues / Coorientador: Luís Fernando Barbisan / Banca: Carla Adriene da Silva Franchi / Banca: Fernando Silva Ramalho / Banca: Juliana Elaine Perobelli / Banca: Luis Antonio Justilin Junior / Resumo: Investigamos as repercussões do padrão alimentar ocidental, rico em gordura, (óleo de milho) (20%) e pobre em micronutrientes [ácido fólico (1 mg/g), colina (0,12%) e fibra (2%)], ocorrido durante a gestação, lactação e puberdade na susceptibilidade ao desenvolvimento de câncer do cólon induzido pela 1,2-dimetilhidrazina (DMH) no rato. Avaliamos se a reintrodução da dieta Ocidental durante a vida adulta em animais previamente expostos à dieta Ocidental durante a vida intrauterina, lactação e puberdade, pode modificar a susceptibilidade à oncogênese do cólon pela DMH. Ratas fêmeas SD prenhes receberam dieta semi-purificada controle (AIN-93) ou do tipo Ocidental (WD - Western Style Diet) a partir do dia gestacional 12 (DG 12). Após o desmame (dia 21), a prole de machos permaneceu com o mesmo tipo de dieta de suas mães até o dia pós-natal 50 (DPN 50). Nesse momento, receberam quatro injeções subcutâneas de DMH (40mg/kg) e foram divididos nos seguintes grupos/dietas: Grupo I (AIN-93/DMH/AIN-93) recebeu dieta controle durante todo o experimento (DG 12- DPN 370), o Grupo II (AIN-93/DMH/Ocidental) recebeu dieta Ocidental somente na vida adulta, a partir do DPN 260, Grupo III (Ocidental/DMH/AIN-93) recebeu dieta Ocidental desde a vida intrauterina até o início da puberdade (DG 12 - DPN 50), e o Grupo IV (Ocidental/DMH/Ocidental) recebeu dieta Ocidental desde a vida intrauterina até o início da puberdade (DG 12 - DPN 50), e foi reintroduzido à dieta Ocidental na vida adulta (DPN 260). Todos os animais foram eutanasiados ao final da 50ª semana de experimento (DPN 370). O cólon foi removido e submetido à análise estereoscópica e histológica para determinar o número, distribuição e multiplicidade dos focos de criptas aberrantes (FCAs). As características das lesões neoplásicas e os níveis séricos de insulina e leptina foram analisados à necropsia. A exposição à dieta Ocidental durante a gestação,... / Abstract: We examined the effects of a Western Style Diet (WD), high in fat (corn oil) (20%) and low in micronutrients [i.e.; folic acid (1 mg/g), choline (0.12%) and fiber (2%)] during pregnancy, lactation and in prepubertal stage to examine the susceptibility to colon carcinogenesis induced by dimethylhydrazine (DMH) in male Sprague-Dawley (SD) rats as later adults. We also evaluated whether WD reintroduction during adulthood can modify susceptibility to colon carcinogenesis. Pregnant SD rats received one of two diets AIN-93G or WD at gestational day 12 (GD 12). F1 male pups were weaned (21d) and fed the same AIN- 93G or WD diets from their dams until postnatal day 50 (PND 50). At this point, they were given four subcutaneous injections of carcinogen DMH (40 mg/body weight) and were shared the following diets/group: group I (AIN-93/DMH/AIN-93) a lifetime control diet-fed group (GD 12 until postnatal day - PND 370), group II (AIN-93/DMH/WD) received WD only in adulthood (at PND 260), group III (WD/DMH/AIN-93) received WD during pregnancy from dams until prepubertal stage (GD 12 - PND 50) and group IV (WD/DMH/WD), received WD since pregnancy from dams (GD 12) until prepubertal stage (PND 50) and was reintroduced to WD during adulthood (PND 260). All groups were euthanized at the end of 50th week (PND 370). The colon was removed and the aberrant crypt foci (ACF) were stereoscopically and histologically scored for number, distribution and multiplicity. Neoplastic lesions and serum insulin and leptin concentrations were analysed at necropsy. ACF multiplicity and dysplastic lesions were significantly higher in the group fed WD during pregnancy until prepubertal stage (group III) than control group (group I). In the group III, the number of adenocarcinomas were higher than control (group I). In the group fed WD only in adulthood (group II), ACF multiplicity was significantly higher than in the control (group I). The group ... / Doutor

Orientador: Luís Fernando Barbisan / Banca: Luís Antônio Justulim Júnior / Banca: Carlos Eduardo Andrade Chagas / Resumo: Yacon (Smallanthus sonchifolius) é uma raiz originária da região dos Andes que tem se destacado pelos seus compostos bioativos principalmente frutanos como futooligossacarídeos e inulina. O presente projeto teve como objetivo determinar a atividade quimioprotetora da ingestão de Yacon sobre o desenvolvimento de lesões pré-neoplásicas (focos de criptas aberrantes-FCA) induzidas pela dimetilhidrazina (DMH) em ratos Wistar machos. Os animais foram divididos em seis grupos com 5 a 12 animais cada. Os animais dos Grupos 1 a 4 e Grupos 5 e 6 receberam respectivamente, quatro injeções subcutâneas de DMH (40 mg/Kg) e solução de EDTA (veículo da DMH) nas duas semanas iniciais do experimento respectivamente. Os animais receberam ração basal até a sexta semana do experimento e a partir desta os animais dos grupos 2, 3, 4, 5 receberam ração acrescida de extrato de Yacon a 0,5%, 1%, 1% e 1%, respectivamente. Os animais do grupo 4 receberam Lactobacilus casei (2,5 x 1010 de UFC por Kg de ração). O sacrifício ocorreu na vigésima semana de experimento para análise de focos de criptas aberrantes (FCA) e tumores. Nossos resultados mostraram uma redução no número, multiplicidade de FCA e no número de adenocarcinomas invasivos nos grupos tratados com 1% yacon (G3) e na combinação simbiótica (G4), (0,05 < p < 0, 001). A multiplicidade de tumores (invasivos e não invasivos) foi significativamente menor no grupo tratado com a combinação simbiótica (p < 0,02). Observou-se também uma redução significativa nas taxas de proliferação celular tanto em criptas colônicas como em tumores nos grupos tratados com 1% yacon (G3) e na combinação simbiótica (G4), p < 0.001. Os resultados sugerem que a ingestão de extrato de yacon exerce atividade quimiopreventiva contra carcinogênese de cólon / Abstract: Yacon (Smallanthus sonchifolius) is a tuberous root native to the Andean region of South America which contains high amounts of inulin-type fructans. The present study investigated the beneficial potential of yacon root intake on development of colon carcinogenesis induced by 1,2-dimethylhydrazine (DMH) in male Wistar rats. Six groups were studied: Groups 1-4 were given four s.c. injections of DMH (40 mg/kg b.w.) twice a week, during two weeks, whereas Groups 4 and 5 received similar injections of EDTA solution (DMH vehicle). After 6 weeks of DMH-initiation, groups were fed with basal diet (G1 and G6) or basal diet containing dried extract of yacon root at 0.5% (G2), 1.0% (G3 and G5) or a synbiotic formulation (G4) (1.0% yacon root plus Lactobacillus casei at 2.5 x 1010 CFU per g diet) for 13 weeks. At 20 week, all animals were killed and the colons were analyzed for development of aberrant crypt foci (ACF) and tumor. A significant reduction in number and multiplicity of ACF and in number of invasive adenocarcinomas was observed in the groups orally treated with 1.0% yacon root (G3) or their synbiotic formulation (G4) (0.05 < p < 0.001). Tumor multiplicity (noninvasive plus invasive) was significantly lower solely in group fed with symbiotic formulation (p < 0.02). Also, a reduction in cell proliferation indexes in colonic crypt and tumor were observed in groups orally treated with 1.0% yacon root (G3) or their synbiotic formulation (G4) (p < 0.001). The findings this study suggest that yacon root intake may have potential as chemopreventive agent against colon carcinogenesis / Mestre

Colon cancer is a leading cause of cancer related deaths worldwide. Lifestyle factors such as diet and exercise have been implicated as important agents in colon cancer development and progression. Epidemiological, in vivo and in vitro studies have found that n-3 polyunsaturated fatty acids (PUFAs) reduce colon carcinoma. The role of n-6 PUFAs remains a controversial topic, with studies indicating both promoting and preventing capabilities published. In order to better understand the effects of PUFAs on colon carcinoma, it is important to have an understanding of how they will be broken down in the body. During this study, in silico metabolism of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and arachidonic acid (AA) predicted the formation of hydroxy-, di-hydroxy- and epoxy-FAs. A gas chromatography-mass spectrometry method was developed and validated for the detection of these PUFAs and their cytochrome P450 (CYP) metabolites. A human liver microsomal system for the in vitro metabolism of EPA, DHA and AA was optimised in terms of microsomal and PUFA concentration. The system resulted in the metabolism of the positive control, lauric acid, to 12-hydroxy-lauric acid but was unable to metabolise the PUFAs of interest. EPA, DHA and AA reduced cell viability in the colon carcinoma cell lines SW480 and SW620 in the micromolar concentration range (25 – 200 μM). The CYP epoxidation metabolite of EPA, 17, 18-epoxyeicosatetraenoic acid (17, 18-EpETE) resulted in a significant reduction in SW480 cell viability relative to the parent compound at lower concentrations (25 and 50 μM). Annexin V apoptosis analysis revealed that EPA and 17, 18- EpETE did not result in apoptosis in SW480 cells at a concentration of 25 μM and over an incubation period of 24 hours. A significant reduction in reactive oxygen species production was seen in SW480 cells after incubation with 25 μM 17, 18-EpETE for 24 hours. EPA and 17, 18-EpETE were implicated in the reduction of colon cancer metastasis since they were able to reduce SW480 migration and anchorage independent cell growth. These results indicate that the dietary intake of EPA, DHA and AA may be beneficial to one’s health due to the negative effects that these PUFAs had on colon carcinoma. Future studies are needed to confirm these benefits and compare the effects of the PUFAs to their CYP-metabolites.

Colonic epithelial glycoproteins were histochemically studied in rats during the induction of colorectal cancer with 1,2,-dimethylhydrazine-diHCl (DMH). 310 male Wistar rats were separated into 3 groups: 10 control rats were sacrificed without treatment, 150 rats were given weekly subcutaneous injections of the carcinogen and 150 rats were given sham Injections on the same schedule. Groups of rats (10 control and 10 treated) were sacrificed at various time intervals in an effort to obtain a large number of pre-neoplastic rat colons to be used to determine whether histochemical changes could be detected prior to morphologic change. Three histochemically distinct regions in the Wistar rat distal colon have been described using recently developed techniques. Two major histochemical changes have been shown to occur prior to malignancy. Change 'A' represented a decrease or loss of sulphate from the glycoproteins; this was the earliest and predominant change and has been shown to occur prior to any identifiable morphologic change. Change 'B' represented a decrease or loss of sulphate occurring in the same cells as a decrease or loss of side chain 0-acetylation of sialic acid residues; this change occured later and to a lesser extent than change 'A'. The data suggests that histochemical change may be a premalignant marker, however, further investigations are necessary to firmly establish this conclusion. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Ample studies have shown that perturbation of metabolic phenotype is correlated with gene mutation and pathogenesis of colorectal cancer (CRC) and rheumatoid arthritis (RA). Mass spectrometry (MS)-based metabolomics as a powerful and stable approach is widely applied to bridge the gap from genotype/metabolites to phenotype. In CRC suffers, KRAS mutation accounts for 35%-45%. In previous study, SLC25A22 that encodes the mitochondrial glutamate transporter was found to be overexpressed in CRC tumor and thus to be essential for the proliferation of CRC cells harboring KRAS mutations. However, the role of SLC25A22 on metabolic regulation in KRAS-mutant CRC cells has not been comprehensively characterized. We performed non-targeted metabolomics, targeted metabolomics and isotope kinetic analysis of KRAS-mutant DLD1 cells with or without SLC25A22 knockdown using ultra-high performance liquid chromatography (UHPLC) coupled to Orbitrap MS and tandem MS (MS/MS). In global metabolomics analysis, 35 differentially regulated metabolites were identified, which were primarily involved in alanine, aspartate and glutamate metabolism, urea cycle and polyamine metabolism. Then targeted metabolomics analysis on intracellular metabolites, including tricarboxylic acid (TCA) cycle intermediates, amino acids and polyamines, was established by using LC-MS/MS coupled with an Amide BEH column. Targeted metabolomics analysis revealed that most TCA cycle intermediates, aspartate (Asp)-derived asparagine, alanine and ornithine (Orn)-derived polyamines were strongly down-regulated in SLC25A22 knockdown cells. Moreover, the targeted kinetic isotope analysis using [U-13C5]-glutamine as isotope tracer showed that most of the 13C-labeled TCA cycle intermediates were down-regulated in SLC25A22-silencing cells. Orn-derived polyamines were significantly decreased in SLC25A22 knockdown cells and culture medium. Meanwhile, accumulation of Asp in knockdown of GOT1 cells indicated that oxaloacetate (OAA) was majorly converted from Asp through GOT1. Exogenous addition of polyamines could significantly promote cell proliferation in DLD1 cells, highlighting their potential role as oncogenic metabolites that function downstream of SLC25A22-mediated glutamine metabolism. SLC25A22 acts as an essential metabolic regulator during CRC progression as promotes the synthesis of TCA cycle intermediates, Asp-derived amino acids and polyamines in KRAS-mutant CRC cells. Moreover, OAA and polyamine could promote KRAS-mutant CRC cell growth and survival. Rheumatoid arthritis (RA) is a chronic, inflammatory and symmetric autoimmune disease and a major cause of disability. However, there is insufficient pathological evidence in term of metabolic signatures of rheumatoid arthritis, especially the metabolic perturbation associated with gut microbiota (GM). Based on consistent criteria without special diet and therapeutic intervention to GM, we enrolled 50 RA patients and 50 healthy controls. On basis of the platform of UHPLC-MS and GC-MS, were performed for the non-targeted metabolomics to investigate alterations of endogenous metabolites in response to RA inflammation and interaction with GM. 32 and 34 significantly changed metabolites were identified in urine and serum of patients with RA, respectively. The altered metabolites were identified by HMDB, METLIN database or authentic standards, and mostly metabolites were attributed into tryptophan and phenylalanine metabolism, valine, leucine and isoleucine biosynthesis, aminoacyl-tRNA biosynthesis and citrate cycle. To obtain alterations of more components in tryptophan and phenylalanine metabolism, we developed and validated a targeted metabolomics method of 19 metabolites by using LC-QqQ MS. Combining the results of targeted metabolomics with global metabolomics, significantly up-regulated kynurenine (KYN), anthranilic acid (AA) and 5-hydroxylindoleacetic acid (HIAA) simultaneously in urine and serum was found to implicate the activation of tryptophan metabolism under the condition of RA, which acted pro-inflammatory roles in inflammation and was closely correlated with GM. IDO/TDO functioned as a pro-inflammation mediator was overexpressed in RA patients. Urinary kynurenic acid and serum serotonin that have impacts on anti-inflammation in immune system were down-regulated in RA patients. The levels of phenylacetic acid and phenyllactic acid serving as a pro-inflammatory and an anti-inflammatory agent, respectively, increased in serum of patients with RA. Moreover, certain essential amino acids (EAAs), and mostly conditional EAAs were decreased in RA patients, which have been reported to inhibit cell proliferation of immune cells. In particular, deficiency of branched chain amino acids (BCAAs, valine and isoleucine) was observed in serum of patients with RA, which may lead to muscle loss and cartilage damage. The specificity of all altered metabolites resulted from RA was considerably contributed through the GM-derived metabolites. The findings revealed that GM-modulated RA inflammation was mainly resulted from tryptophan and phenylalanine metabolism, and amino acid biosynthesis, which may provide more information for better understanding the RA mechanism.

Colon cancer is one of the most common cancers in both the United States (US) and throughout the world. Over the last 30 years, despite the development of multiple classes of effective anti-tumor agents, colon cancer has consistently remained the second leading cause of mortality amongst all cancers and is today responsible for over 50,000 deaths a year in the US alone. Among the greatest challenges to the successful treatment of colon cancer is its heterogeneity in terms of drug-sensitivity, whereby it is often difficult to identify which patients will benefit from a specific class of anti-tumor agents before treatment has begun. It is therefore imperative to identify predictive biomarkers that can be leveraged to distinguish which colon tumors are most likely to respond to individual anti-cancer drugs. This will help develop new therapeutic algorithms that can maximize patient survival by rapidly matching individual patients with the specific treatment combinations that are most likely to benefit them as well as sparing them the toxicities from drugs that would be ineffective. Previous studies have reported that human colon carcinomas lacking expression of the caudal-type homeobox 2 (CDX2) transcription factor can be leveraged as a predictor of benefit from adjuvant chemotherapy containing 5-fluorouracil (5-FU). Lack of CDX2 expression associates with microsatellite instability (MSI), as well as several histopathological and molecular features that associate with exceptionally poor prognosis such as poor differentiation, lympho-vascular invasion, and BRAF mutation. However, the molecular mechanisms linking lack of CDX2 expression with increased drug sensitivity are currently unknown. In the first section of this study, we conducted a high throughput screen (HTS) aimed at identifying clinically approved anti-tumor drugs that display selective activity against colon carcinomas lacking CDX2 expression (CDX2-negative). The results of our screening, which compared an isogenic pair of CDX2+/+ and CDX2-/- cell lines generated by genetic inactivation of CDX2 using CRISPR/Cas9 constructs, revealed that CDX2-negative colon cancer cells display increased sensitivity to anti-tumor drugs that are substrates of the ATP binding cassette sub-family B member 1 (ABCB1) transporter. ABCB1 is a drug-efflux protein known for its capacity to extrude multiple classes of anti-tumor agents from the cytoplasm, therefore contributing to drug-resistance in cancer cells. Importantly, analysis of CDX2 and ABCB1 expression in two independent gene-expression databases (NCBI-GEO: n=2115; TCGA: n=478) revealed that a lack of CDX2 expression is invariably associated with lack of ABCB1 expression in human primary colon carcinomas. Furthermore, our molecular studies revealed that forced expression of CDX2 in human CDX2-negative colon cancer cells was capable of inducing expression of ABCB1, while genetic inactivation of CDX2 in human CDX2-positive cancer cells using CRISPR/Cas9 constructs resulted in loss of ABCB1 expression, thus establishing CDX2 as a direct mechanistic regulator of ABCB1 expression. Amongst all of the anti-tumor drugs identified as being ABCB1 substrates with preferential activity against CDX2-negative colon cancer cells, we observed that paclitaxel was the FDA-approved drug with the greatest degree of selectivity with a 10-fold difference in IC50. When tested in vivo against a collection of human patient derived xenograft (PDX) lines representative of both CDX2-negative and CDX2-positive colon carcinomas, paclitaxel displayed selective activity against CDX2-negative models, often inducing volumetric regression of established lesions. Our study, therefore, identified paclitaxel as a clinically approved anti-tumor agent that should be investigated for use in the treatment of CDX2-negative colon carcinomas. In the second portion of our study, we sought to conduct a preliminary evaluation of the possibility of using immune checkpoint inhibitors (ICIs) for the treatment of CDX2-negative colon carcinomas. ICIs have been shown to display substantial anti-tumor activity against colon carcinomas with microsatellite instability (MSI) and against epithelial malignancies over-expressing the immune-suppressive molecule PD-L1/CD274. Because CDX2-negative tumors are enriched for MSI and high levels of PD-L1/CD274, they are predicted to include a subgroup that is responsive to ICIs. However, not all MSI tumors respond to ICIs and, contrary to the majority of MSI tumors, the subgroup of MSI tumors characterized by a CDX2-negative phenotype is often associated with poor prognosis. Because the clinical activity of ICIs is dependent upon expression of class-I HLA molecules by tumor cells, we decided to evaluate whether CDX2-negative tumors were associated with inactivating mutations in class-I HLA genes. Our attention focused on a highly conserved poly-cytosine repeat region in the coding sequence of HLA-A (c.621_627) and HLA-B (c.621_626) genes. Because this sequence fulfilled the molecular definition of microsatellite, we predicted it to be highly susceptible to frameshift mutations (insertions or deletions) in MSI colon tumors. Indeed, a search across three independent genetic databases (TCGA, COSMIC, EBI) confirmed that this highly conserved poly-cytosine repeat region was targeted by recurrent and deleterious mutations in at least one HLA-A or HLA-B allele of at least 13% (n=21/156) of human MSI colon tumors, as compared to 0.3% (n=2/770) of human colon tumors with a microsatellite stable (MSS) phenotype (p<0.0001). Among tumors assessable for CDX2 expression, this specific type of class-I HLA mutations was more frequent among CDX2-negative (12%; n=6/49) as compared to CDX2-positive (1.5%; n=5/340) colon tumors (p<0.001), but was similar within MSI CDX2-negative (21%; n=6/28) and MSI CDX2-positive (17%; n=5/30) subgroups. In summary, this work achieved two main results: 1) it identified paclitaxel, a clinically approved anti-tumor drug, as a new treatment option for patients with CDX2-negative colon cancers, which represents an extremely aggressive subgroup of colorectal malignancies; 2) it revealed that, in human MSI colon tumors, class-I HLA genes are prone to recurrent frameshift mutations in a genomic hotspot, mutations that are likely to associate with tumor resistance to ICIs and that they are therefore likely to represent a new class of actionable predictive biomarkers for both MSI and CDX2-negative colon carcinomas. These findings will help advance our understanding of colon cancer biology, and hopefully improve treatment algorithms for the clinical management of colon cancer patients.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Colorectal cancer (CRC), the third leading cause of cancer-related death in the U.S., could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment has been identified as one important barrier to colonoscopy, but little is known about embarrassment in this context. Further, there is no instrument available to measure this construct. Therefore, the purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. The study aims were to: 1) estimate reliability and validity of a new instrument, the Colonoscopy Embarrassment Scale (CES); 2) examine relationships among demographic/personal characteristics, health beliefs, and CES scores; 3) examine relationships among demographic/personal characteristics, physician recommendation, health beliefs, and colonoscopy compliance; and 4) evaluate participants’ perceptions of aspects of having a colonoscopy that are most embarrassing and their suggestions for reducing embarrassment. The Health Belief Model and Transtheoretical Model of Change provided theoretical support for this study. Participants were HMO members aged 50-65 years (n=234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. The response rate was 56%. Data were analyzed using independent samples t-tests, correlations, Chi Square, and regression. Results showed that the six-item CES had internal consistency (Cronbach’s alpha of .89) and construct validity. Lower income, higher BMI, lower CRC knowledge, higher barriers, and lower self-efficacy were related to higher CES scores (or more embarrassment). Higher CRC knowledge, lower barriers, higher self-efficacy, and a physician recommendation for the test were related to higher compliance with colonoscopy. Lower barriers, higher self-efficacy, and a physician recommendation were predictive of compliance with colonoscopy. In conclusion, embarrassment is a significant barrier to colonoscopy, yet there are steps that can be taken to reduce embarrassment such as increasing privacy and limiting bodily exposure. The CES is a tool that can be used to measure colonoscopy-related embarrassment and the results could be used in developing further interventions to reduce embarrassment, leading to increased colonoscopies and lower mortality.

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy