La Pioglitazone appartient à la famille des thiazolidinédiones et le Fénofibrate à la famille des fibrates. Ces molécules sont, respectivement, des agonistes synthétiques du récepteur activable par les proliférateurs de peroxysomes γ (PPARγ) et PPARα, membres de la famille des récepteurs nucléaires aux hormones. Le traitement de cellules cancéreuses humaines par ces molécules limite la croissance et peut induire leur apoptose. Cependant, l’impact de ces traitements sur les cellules cancéreuses est en partie dû à une action indépendante de l’activation du récepteur et met en cause la génération d'un stress oxydant. Au cours de ces travaux, un analogue de la Pioglitazone, la ΔPioglitazone, qui ne permet pas l’activation de PPARγ, a été synthétisé. Les effets de ces molécules ont été testés sur deux lignées cellulaires établies à partir de cancer colique, HT29 et HCT116. Ces traitements limitent la croissance des cellules cancéreuses sans induire de processus apoptotique. La production d’espèces réactives est responsable d’une diminution du contenu en glutathion intracellulaire. Le stress oxydant généré suite au traitement par la Pioglitazone et la ΔPioglitazone induit l’activation de la voie de signalisation antioxydante Nrf2/Keap1 et l’expression de ses gènes-cibles HO-1 et NQO1. En revanche, bien qu’il induise la production d’un stress oxydant, le Fénofibrate n’entraîne aucune activation de cette voie. De plus, ces trois composés sont responsables d’une modification du métabolisme cellulaire en faveur de la glycolyse. Parallèlement, l’impact de dérivés 4-thiazolidinones, analogues des thiazolidinédione, synthétisés au laboratoire, a été testé. L’effet de ces molécules a été évalué sur la survie cellulaire et le statut redox des cellules HT29. Plusieurs composés présentent une activité antiproliférative et sont capables de générer un stress oxydant sans activer la voie Nrf2/Keap1 / Peroxisome Proliferator-activated Receptors (PPAR) are members of the nuclear receptor family. Pioglitazone and Fenofibrate belong respectively to the thiazolidinedione and fibrate family. Pioglitazone is an agonist of PPARγ isotype whereas Fenofibrate is an agonist of PPARα isotype. Cancer cell exposure to each ligand inhibits cell growth and triggers apoptosis cell death. However, the effects of respective PPAR ligand on cell survival were found to be independent of receptor activation and were associated to redox changes within the cells. In order to discriminate PPAR independent from PPAR dependent activation, an analogue of Pioglitazone, Δ-Pioglitazone was synthesized. The molecule binds to PPARγ without activating it. Two cancer cell lines established from human colon adenocarcinoma, HT29 and HCT116 were tested. Cell exposure to each molecule inhibited cell growth but cells did not undergo apoptosis cell death. Cell treatment induced the production of reactive species and the decrease of intracellular glutathione content. Pioglitazone or [delta]-Pioglitazone-mediated oxidative stress triggered the activation of the Nrf2/Keap1 pathway as assessed by the increases of Nrf2 target genes expression such as HO-1 and NQO1. In contrast, Fenofibrate treatment increased reactive species production but did no activate this pathway. Moreover, cell exposure to Pioglitazone, Δ-Pioglitazone or Fenofibrate modulated cell metabolism, notably by enhancing glycolysis. In parallel, impact of 4-thiazolidinone derivatives synthesized in the laboratory was tested. These molecules are analogues of thiazolidinedione. Effect of 4-thiazolidinone treatments was assessed to cell growth arrest and redox changes within the HT29 cells. Several molecules have anti-proliferative effect and are able to generate oxidative stress without Nrf2/Keap1 pathway activation

We have studied aspirin as a potential chemopreventive for colorectal cancer, completing Phase I studies on aspirin pharmacology and potential biomarker assays (prostaglandins, PGE2 and PGF(2α) and cyclooxygenase modulation) in normal human subjects. These studies have determined the optimal dose of aspirin for future Phase IIa and IIb chemopreventive trials in high-risk cohorts of patients for colon cancer. Aspirin's effects on rectal prostaglandins are prolonged, detectable even after aspirin and its metabolite are removed from the plasma. Aspirin-mediated inhibition of prostaglandin production in the human rectal epithelium may be related to direct suppression of cyclooxygenase transcription and not to enzyme inactivation by acetylation. A systematic method to monitor adherence (self- report, telephone contact, pill count, and microelectronic monitoring) has been established for future trials. Strategies to improve recruitment of high-risk cohorts have been developed. Phase IIa non-randomized studies with aspirin at 81 mg in high-risk cohorts (resected Duke's A colon cancer, Duke's C colon cancer treated with adjuvant therapy and disease-free at 5 years, history of colon adenomas > 1 cm, two or more first-degree relatives with colon cancer, and familial adenomatous polyposis and hereditary non-polyposis colorectal cancer syndromes) are currently being conducted for surrogate end- point biomarker (prostaglandins, cyclooxygenase, cellular mucins, and proliferation) modulation.

The main health interventions for health promotion and disease prevention that should be performed in women in the Peruvian health system are described. A review of normative technical documents and the recommendations of the main organizations for worldwide prevention was carried out. The prevention activities included physical activity, healthy eating, tobacco counseling, immunizations; In addition, the main screening for women, such as depression, violence, cardiovascular risk, cervical cytology, mammography, colon cancer, are detailed; and within the spectrum of quaternary prevention, interventions that have not shown evidence of benefit to women are detailed. The health interventions that are offered from the Peruvian health system for women, being merely focused on reproductive aspects, lose the conception of integrality that should prevail for the maintenance of health. In that sense, it is proposed to develop strategies that not only have evidence, but also know how to respond to the needs of women in the Peruvian context. / Revisión por pares

Genetisch bedingte Veränderungen im Wnt-Signalweg sind in der Tumorigenese des Darms von zentraler Bedeutung. Mutationen des Wnt-Effektormoleküls β-Catenin in den adulten Stammzellen des Darmepithels führen zu unkontrollierter Proliferation und Expansion der Darmstammzellen und initiieren die Tumorentstehung. Auch in fortgeschrittenen Darmtumoren unterstützt die Wnt-Signalgebung maßgeblich das Tumorwachstum und den Erhalt von Tumorstammzellen. Nach erfolgreicher chemotherapeutischer Behandlung treten oftmals Tumorrezidive auf, für deren Entstehung therapieresistente Tumorstammzellen verantwortlich gemacht werden. Trotz intensiver Forschung fehlen in der Darmkrebstherapie nach wie vor Behandlungsansätze zur gezielten Therapie der Tumorstammzellen. Ziel dieser Dissertation ist es, unser Verständnis der molekularen Regulationsmechanismen in Kolonkarzinomen zu erweitern und die Entwicklung rationaler Behandlungsstrategien zu fördern. Ich konnte die Histonmethyltransferase Mll1 als entscheidenden Faktor in der epigenetischen Regulation humaner und muriner Darmkrebsstammzellen und -tumore identifizieren. Humane Kolonkarzinome weisen eine erhöhte Mll1-Expression auf, die mit dem Level an nukleärem β-Catenin korreliert. Im adulten Darmepithel ist Mll1 insbesondere in den Lgr5+ Stammzellen exprimiert und maßgeblich an der Wnt/β-Catenin-induzierten Stammzellexpansion sowie der Tumorentstehung beteiligt. Der konditionelle Verlust von Mll1 im murinen Darmkrebsmodell verhindert die β-Catenin-induzierte Tumorigenese. Mll1 unterstützt die Selbsterneuerungsfähigkeit und Proliferation der Tumorstammzellen, indem es die Expression von essentiellen Stammzellgenen wie dem Wnt-abhängigen Stammzellmarker Lgr5 aufrechterhält. Eine Inhibition der Mll1-Funktion in der Darmkrebstherapie kann eine gezielte Eliminierung der Tumorstammzellen ermöglichen, wodurch das fortschreitende Tumorwachstum unterbunden und die Bildung von Rezidiven verhindert werden kann. / Genetic mutations inducing aberrant activity of Wnt signalling are causative for intestinal tumorigenesis. Mutations of the Wnt effector molecule β-catenin in adult stem cells of the intestinal epithelium drive uncontrolled proliferation, expand the stem cell pool and initiate tumor formation. In advanced tumors, aberrant Wnt signalling promotes tumor growth and maintains cancer stem cells. The cancer stem cells are highly resistant to conventional chemotherapy and frequently initiate tumor relapse after completion of treatment. Despite extensive research, we are still lacking efficient therapies for colon cancer that specifically eliminate the cancer stem cells. This dissertation aims to expand our knowledge on molecular gene regulatory mechanisms in colon cancer cells to promote the identification and future development of rational therapies for colon cancer patients. I identified the histone methyltransferase Mll1 as an epigenetic regulator in human and mouse intestinal cancer stem cells and tumors. Human colon carcinomas with nuclear β-catenin exhibit high levels of Mll1. In the adult intestinal epithelium of mice, Mll1 is highly expressed in the Lgr5+ stem cells and is a prerequisite for the oncogenic Wnt/β-catenin-mediated stem cell expansion and tumorigenesis. Conditional knockout of Mll1 in an intestinal mouse tumor model prevents the β-catenin-driven intestinal tumorigenesis. Knockdown of Mll1 impairs the self-renewal and proliferation of colon cancer sphere cultures and halts tumor growth in xenografts. Mechanistically, Mll1 sustains the expression of intestinal stem cell genes including the Wnt/β-catenin target gene Lgr5 by antagonizing gene silencing through polycomb repressive complex 2-mediated H3K27 tri-methylation. Interfering with Mll1 function can efficiently eliminate colon cancer stem cells, and has potential as a rational therapy for colon cancer.

Darmkrebszellen und T-Zellen regulieren ihren zentralen Kohlenstoffmetabolismus um ihren anabolen Bedarf zu erfüllen. Tumorzellen mit einer KRAS- oder BRAF-Mutation zeigen ein schnelles Wachstum, welches eine Umprogrammierung des Metabolismus vor aussetzt. Der mitochondriale T-Zellen-Aktivierungsinhibitor (TCAIM) ist bekannt dafür die mitochondriale Zellstruktur zu beeinflussen. Der Einfluss auf den Metabolismus nicht klar. In dieser Arbeit präsentiere ich erstmalig ein mathematische Model des zentralen Kohlen stoffmetabolismus in Darmkrebszellen und T-Zellen. Mithilfe dieses Modells analysiere ich, wie sich die Regulation in ähnlichen Zelllinien unterscheidet. In Bezug auf die Darm krebszellen vergleiche ich BRAF-(CaCO2-BRAFV600E), KRAS-(CaCO2-KRASG12V) mu tierte Zelllinien mit einer Basiszelllinie (CaCO2-control) und zeige, dass der Kohlenstoff metabolismus in BRAF-mutierten Zellen im Vergleich zu den beiden übrigen Zelllinien herabreguliert ist. Das Modell bestätigt außerdem, dass der Monocarboxylattransporter (MCT) in den Darmkrebszellen eine wichtige Rolle, insbesondere in den KRAS mu tierten Zellen, spielt. In T-Zellen zeigt der Vergleich von Wildtypzellen (CD8 T-Zellen) mit TCAIM homozygoten Zellen (TCAIM homozygote CD8 T-Zellen), dass der Kohlen stoffmetabolismus in zweiteren überwiegend herabreguliert und weniger aktiv ist. Diesen Effekt konnte ich durch die Analyse von RNASeq-Daten der jeweiligen Zelltypen bestä- tigen. Des Weiteren stelle ich fest, dass sich der Tricarbonsäurezyklus umkehrt, wenn durch die Glykolyse nicht ausreichend Laktat exportiert und die Biomasseproduktion unterstützt werden kann. Meine Arbeit stellt damit insgesamt einen neuartigen Ansatz zur Integration von Meta bolomik und RNAseq Daten dar, um die Regulation des zentralen Kohlenstoffmetabo lismus zu verstehen. / Colon cancer cells and T cells regulate central carbon metabolism to meet their anabolic needs. In KRAS and BRAF tumors, metabolic reprogramming is a premise to support rapid proliferation. In T cells, the mitochondrial T cell activation inhibitor (TCAIM) is known to affect mitochondrial morphology but its effect on cellular metabolism is not well understood. Via mathematical modelling, I investigate the differential regulation of closely related cell lines. I present the first mathematical model for colon cancer and T cell metabolism, unraveling differential regulation between related cell lines. The model shows that CaCO2-BRAFV600Ecells are mostly downregulated compared to CaCO2-KRASG12Vand CaCO2-control. Additionally, it demonstrates the critical role of monocarboxylate transporter (MCT), especially for CaCO2-KRASG12V. Concerning T cells, I compare wild-type T cells to homozygous TCAIM T cells. This unveils that TCAIM homozygous cells have a mostly downregulated TCA cycle, validated by RNASeq data, and are less metabolically active than wild-type T cells. Furthermore, if the glycolytic flux is not sufficient to support lactate export and biomass production, the model reveals that the TCA cycle is reversed as it requires less regulation. Taken together, this work presents a novel approach to integrate data referring to metabolic and genetic regulation of metabolism. On this basis, we can now better discriminate the metabolic capacity of CaCO2-control, CaCO2-BRAFV600E, CaCO2-KRASG12V, wildtype CD8 T cells, and homozygous TCAIM CD8 T cells.

No description available.

No description available.

L'extraction par CO2 supercritique démontre les avantages d'un procédé de chimie verte en comparant ce procédé à la méthode d'extraction par solvant organiques et en tenant compte du degré de toxicité et de pollution du solvant. L'extraction par solvants organiques met en évidence l'influence du solvant d'extraction alors que l'extraction par CO2-SC met en évidence l'influence de différents paramètres dont la pression, la température, le temps de contact entre la matrice végétale et le CO2-SC, le diamètre moyen des particules et l'ajout d'un co-solvant. L'analyse chromatographique a permis d'identifier et de quantifier les flavonolignanes (silychristine, silydianine, silybine, taxifoline) dans les extraits de graines obtenus par solvants organiques et par CO2-SC avec co-solvant. A 220 bar, les concentrations en silydianine (38,87 mg/g) et en silybine (45,91mg/g) sont les plus élevés et à 40°C les concentrations en silychristine (31,97mg/g), en silydianine (38,87 mg/g) et en silybine (45,91mg/g) sont les plus importantes. Les extraits huileux obtenus à 220 bar et à 40°C des graines de Silybum marianum sont riches en acides gras : acide linoléique (65,22%), acide oléique (27,01%), acide palmitique (12,12%). L'activité antioxydante a été évaluée par deux tests : test DPPH et test ABTS. Ces deux tests sont complémentaires et ont permis de conclure que l'extrait ayant un effet antioxydant le plus important est l'extrait obtenu par CO2-SC à 220 bar et à 40°C. L'activité biologique de cet extrait est mise en évidence par rapport à une lignée cellulaire cancéreuse du colon Caco-2. La silychristine, la silydianine et la silybine ainsi que l'extrait obtenu par CO2-SC avec co-solvant (éthanol) à 220 bar et à 40°C ont été testés vis à vis de cette lignée cancéreuse. Ces expérimentations in vitro reflètent une activité cytotoxique quantifiable et une mortalité cellulaire des Caco-2 des flavonolignanes allant jusqu'à 71% / The supercritical CO2 extraction demonstrates the benefits of green chemistry process comparing with the method of organic solvents extraction and depending to toxicity and pollution solvent degree. Organic solvents extraction shows the solvent extraction influence, so that the SC-CO2 extraction highlights different parameters including pressure, temperature, contact time between the plant matrix and CO2 SC, the average particle diameter and the addition of a cosolvent. Chromatographic analysis identified and quantified four flavonolignans (silychristin, silydianin, silybin, taxifolin) in seed extracts obtained by organic solvents and SC-CO2 with cosolvent. At 220 bar, silydianin (38.87 mg / g) and silybin (45.91 mg / g) have highest concentrations and at 40°C silychristin (31.97 mg / g), silydianin (38.87 mg / g) and silybin (45.91 mg / g) have the most important concentrations. The oily extracts obtained at 220 bar and 40°C of Silybum marianum seeds are rich in fatty acids: linoleic acid (65.22%), oleic acid (27.01%), palmitic acid (12.12%). The antioxidant activity measured by two tests: DPPH and ABTS test. These two tests are complementary and confirm that the extract with the higher antioxidant effect is the extract obtained by SC-CO2 at 220 bar and 40°C. The biological activity of this extract is demonstrated with respect to a colon cancer cell line Caco-2. Silychristin, silydianin and silybin and the extract obtained by CO2-SC with co-solvent (ethanol) at 220 bar and 40°C were tested with respect to this line cancer. These experiments in vitro cytotoxic activity reflect estimable and cell death of Caco-2 flavonolignans of up to 71%

Dietary fiber (DF) consumption is related with several healthy benefits such as the decreasing risk of colon cancer development. The DF is not digested by the digestive enzymes and reach to colon where is fermented by the colonic microbiota. The fermentation process releases metabolites as short chain fatty acids (SCFA) such as butyrate, propionate and acetate. Besides the fermentation process, the DF can directly interact with intestinal epithelial cells inducing mechanism that can also be related with the associated DF consumption benefits. The lack of information regarding DF and colon cancer are due to the complexity of both the cancer and the DF structure. The papayas DF are derived from the fruit cell wall, and they are probably naturally modified during ripening through a massive polysaccharide hydrolysis, because papayas show a very fast pulp softening. Due to the lack of information about DF and their beneficial effects to human health as well as the possibility of the natural papaya ripening to modifying the DF presented in the fruit pulp, the present thesis had as the primary objectives: 1) to evaluate how the cell-wall degrading enzymes affect the fruit cell wall solubilization and molecular weight; 2) to investigate the direct effects of the papaya pectin derived from unripe to ripe papayas in cancer cell lines, in galectin-3 interaction and in HEK cells expressing pattern recognition receptors (PRR); 3) to evaluate the human colonic in vitro fermentation using DF from unripe and ripe papayas as substrates; 4) to conduct an in vivo experiment using rats with pre-neoplastic colon lesions while receiving a diet with DF from unripe and ripe papayas. The endopolygalacturonases were the main enzymes acting on the solubilizing papaya cell wall pectin affecting both the papaya firmness and pectin structure. Overall, the papayas DF showed a ripening dependent structureeffects. In the cancer cell lines experiments, the ripe papayas pectin showed a more pronounced effects in inducing cancer cell death, inhibiting cancer cells migration and aggregation, activating PRR as toll-like receptors and inhibiting the pro-metastatic protein galectin-3. The DF from papayas also showed different aspects in colonic in vitro fermentation regarding the DF utilization by the bacteria and the bacteria abundance profile. Lastly, the animals receiving the diet with the DF from ripe papayas had less aberrant crypt foci in colon than the animals that received the DF from unripe papayas or cellulose (AIN-93G DF). Therefore, the study of papaya DF was carried out both during papaya ripening and its biological effects in vitro and in vivo, generating unprecedented results relating the endogenous biochemical changes of the fruits during maturation with the possible beneficial effects of their ingestion for health human. / O consumo de fibras alimentares (FA) está relacionado com vários benefícios à saúde como a diminuição no risco do desenvolvimento de câncer de cólon. A FA não é digerida pelas enzimas digestivas do trato gastrointestinal sendo fermentada pela microbiota intestinal do cólon. Como subproduto do processo de fermentação há a liberação de ácidos graxos de cadeia curta (SCFA) - como o butirato, o propionato e o acetato. Além do processo de fermentação, a FA pode interagir diretamente com as células epiteliais do intestino, induzindo mecanismos que também podem estar relacionados com os benefícios associados ao consumo de FA. A falta de informação sobre a FA e o câncer de cólon é, em partes, devido à complexidade de ambos, tanto do câncer quanto da estrutura da FA. As FA do mamão papaia são derivadas da parede celular da fruta apresentando diferentes estruturas dependendo do ponto de amadurecimento do fruto. Esse fato ocorre, pois, durante o amadurecimento do mamão papaia, existe uma extensa hidrólise dos polissacarídeos presentes na parede celular, diminuindo rapidamente a firmeza da polpa do fruto. Devido à falta de informações sobre FA e seus efeitos benéficos à saúde humana que são dependentes da sua estrutura, bem como a possibilidade do amadurecimento do mamão papaia naturalmente modificar as FA presentes na polpa dos frutos, a presente tese teve como principais objetivos: 1) avaliar como as enzimas que degradam a parede celular do mamão papaia afetam a solubilização e o peso molecular da parede celular do fruto; 2) investigar os efeitos diretos da pectina derivada de mamões verdes e maduros em linhagens de células de câncer, na interação com a galectina-3, e em células do tipo HEK que expressam receptores de reconhecimento de padrões (RRP); 3) avaliar a fermentação colônica humana in vitro utilizando as FA de mamões verdes e maduros; 4) avaliar em ratos com lesões pré-neoplásicas no cólon o efeito do consumo de ração com ou sem FA de mamões papaias verdes e maduros. As endopoligalacturonases foram relacionadas como as principais enzimas que atuam solubilizando a pectina da parede celular do mamão, afetando tanto a firmeza da polpa do fruto quanto a solubilização da pectina durante o amadurecimento. De modo geral, as FA dos mamões exerceram um efeito estruturadependente de acordo com a maturação do fruto. Nos experimentos utilizando linhagens de células de câncer, a pectina do mamão papaia maduro apresentou efeitos mais pronunciados na indução da morte e na inibição da migração e da agregação das células, bem como ativando os RRP, como por exemplo, os receptores do tipo toll-like, além de inibir a proteína pró-metastática galectina-3. As FA dos mamões também apresentaram diferentes resultados na fermentação colônica in vitro quanto à utilização das FA pelas bactérias do intestino, e também no perfil de crescimento dessas bactérias. Por fim, os animais que receberam a dieta com as FA dos mamões maduros apresentaram menor incidência de focos de criptas aberrantes do que os animais que receberam as FA provenientes de mamões verdes ou de celulose (FA da ração AIN-93G). Portanto, o estudo das FA dos mamões foi efetuado tanto durante o amadurecimento dos mamões quanto dos seus efeitos biológicos in vitro e in vivo, tendo gerado resultados inéditos relacionando as alterações bioquímicas endógenas dos frutos durante o amadurecimento com os possíveis efeitos benéficos da sua ingestão para a saúde humana.

<p>Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.</p>