<p dir="ltr">Lymphoma is a prevalent malignancy in dogs. Diffuse large B-cell Lymphoma (DLBCL) is the common subtype that represents about 50% of the clinically seen lymphoma cases. DLBCL diagnosis relies on cytological examination of a fine needle aspirate and histological evaluation by immunohistochemistry (IHC) in most common practices. This workflow is sufficient to confirm the diagnosis; however, it may be challenging to differentiate reactive and neoplastic forms in some controversial cases. In such cases, PCR-based clonality assays and flow cytometry (FC) can help with more conclusive diagnoses. So, finding more biomarkers that can detect and track DLBCL early and over time is a must for a final diagnosis and helps us learn more about how DLBCL starts at the molecular level. MicroRNAs (miRNAs), the small non-coding RNAs, regulate gene expression by binding to the 3'-untranslated region of protein-coding RNAs, leading to either RNA degradation or translational repression. They can switch on and off genes to regulate physiological and pathological processes. MicroRNA stability features and tissue availability make them promising biomarkers for identifying and sub-classifying patients and sequentially evaluating the disease status or the response toward a specific medicine. This dissertation investigates the small RNA sequence analysis, the differentially expressed miRNAs between healthy and DLBCL-affected lymph nodes, and the miRNA profile in DLBCL cases with different outcomes.</p>

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Les lymphomes diffus à grandes cellules B (DLBCL) sont la forme de lymphomes non–Hodgkiniens agressifs la plus fréquente chez l’adulte, et sont très hétérogènes à la fois sur le plan biologique et clinique. Bien que plus de la moitié des patients peuvent être guéris avec le traitement standard R-CHOP (combinant la polychimiothérapie CHOP aux anti-CD20 comme le rituximab) 30 à 40 % des patients échappent ou sont réfractaires au traitement, déterminant des morbidités et mortalités importantes liées au nombre limité d’alternatives thérapeutiques. L’objectif des travaux de cette thèse était centré sur les mécanismes de résistance thérapeutique dans ces lymphomes, et plus particulièrement les résistances au rituximab. Dans une première partie de la thèse, nous avons étudié le rôle de facteurs endogènes neuropeptidiques, les neurotrophines (NTs), et l’implication de leur signalisation dans la survie des cellules tumorales et leur sensibilité à l’apoptose induite par le rituximab. Nous avons montré dans un premier temps que les cellules B tumorales des patients présentaient des taux parfois élevés de neurotrophines (NGF, BDNF) et de leurs récepteurs de haute (Trk) et de basse affinité p75NTR. Puis les résultats obtenus in vitro sur des lignées cellulaires humaines de DLBCL et in vivo (xénogreffes tumorales) ont mis en évidence l’existence d’un axe de survie BDNF/TrkB/p75NTR pouvant interférer avec l’efficacité de l’immunothérapie. Cet axe contribue à la survie des cellules tumorales et pourrait aussi participer à la résistance thérapeutique aux anti-CD20 en modulant l’expression du CD20 à la surface des exosomes. En effet ces microvésicules, sécrétées en grande quantité par les cellules B tumorales, expriment le CD20 à leur surface et seraient à ce titre impliquées dans l’échappement thérapeutique en réalisant des « récepteurs –leurres » vis-à-vis des anticorps thérapeutiques. Dans une 2e partie de cette thèse, nous avons évalué dans les DLBCL le rôle potentiel de nouvelles cibles émergentes en oncologie, les prohibitines (PHBs) et le facteur d’initiation de la traduction eIF4A. Pour cela, nous avons utilisé un ligand de ces acteurs cellulaires de la famille des flavaglines, le FL3. Nous avons montré que le FL3 présente un effet apoptotique très important in vitro sur les lignées cellulaires de DLBCL et in vivo sur les tumeurs induites chez la souris. Nos travaux ont permis d’en préciser les mécanismes moléculaires, mettant en évidence le rôle des PHBs en lien notamment avec l’activation d’Erk1/2, et la formation et l’activité du complexe eIF4F dans la survie des cellules de DLBCL. Les données préliminaires obtenues à partir des biopsies de patients montrent, de plus, que la forte expression de PHB1 pourrait avoir une valeur pronostique dans ces lymphomes. L’ensemble de nos travaux ont permis de mettre en évidence de nouvelles voies de survie et d’échappement thérapeutique dans les DLBCL, qui pourraient permettre d’identifier aussi de nouveaux marqueurs biologiques à valeur diagnostique et/ou pronostique pour le choix de thérapies ciblées. / Diffuse large B cell Lymphomas (DLBCL) are the most aggressive and heterogeneous biological and clinical form of non-Hodgkin lymphomas in adults. Although more than 50% of patients can be cured with standard therapy R-CHOP (combining the CHOP chemotherapy to the anti-CD20 as rituximab) 30 to 40% of patients exhibit primary refractory disease or relapse after initial response to therapy, determining morbidities and significant mortality related to the limited number of treatment options. The aim of this thesis was focussed on therapeutic resistances of these lymphomas, notably those of rituximab. In the first part of this thesis, we have evaluated the role of endogenous factor signaling, the neurotrophins (NTs), in DLBCL cell survival and sensitivity to the cytotoxicity of rituximab. We showed first that a high expression of neurotrophines (NGF, BDNF) and their high (Trk) and low (p75NTR) affinity receptors was often found in tumor B cells of DLBCL patients. Results obtained in vitro, on human cell lines of DLBCL, but also in vivo (xenografts) showed evidence of a survival BDNF/TrkB/p75NTR axis that can interfere with the efficacy of immunotherapy. This axis promotes survival of tumor cells and may also participate in rituximab resistance in regulating CD20 expression at the surface of exosomes. Indeed, these microvesicles, secreted in large amounts by the tumoral B cells, express the CD20 and would be involved in the therapeutic escape acting as decoy receptors upon rituximab exposure. In the second part of the thesis, we evaluated in DLBCL the potential role of new oncogenic targets, PHBs proteins and the initiation factor of translation eIF4A. To this end, we used one of their ligands, a synthetic flavagline named FL3. We showed that FL3 determines a strong apoptosis in vitro on DLBCL cell lines and in vivo on tumors induced in mice (xenografts). Our works have clarified the molecular mechanisms, demonstrating involvement of PHBs, in correlation with ERK1/2 activation, and eIF4F complex formation and activity. Preliminary data obtained in patient biopsies showed a high expression of PHB1 in tumor B cells that may be decisive for cell survival and patient outcome lymphomas.Overall, present results show evidence of new survival and rituximab escape mechanisms in DLBCL, that should allow to identify new diagnostic and prognostic biomarkers for alternative therapeutic options.

A 28-year-old female patient with active and difficult-to-treat systemic lupus erythematosus (SLE) was diagnosed with liver-dominant diffused large B-cell lymphoma. Repeated response 18F-FDG-PET studies showed persistently high, and, despite intensified immunochemotherapy, further increasing metabolic activity of one of the hepatic lymphoma residuals, whereas all other initial lymphoma manifestations had achieved complete metabolic remission. As biopsy of the 18F-FDG-PET-positive liver residual turned out to be inconclusive, complete resection was performed. Subsequent histopathological examination, however, revealed only necrotic tissue. Thus, no further lymphoma treatment was scheduled. The patient undergoes regular surveillance and is disease-free 13 months after resection. Similarly, treatment of SLE is no longer required due to lack of activity already after the first two cycles of lymphoma treatment. The case shows how closely SLE and diffused large B-cell lymphoma can be connected and stresses the importance of interdisciplinary treatment approaches. In the future, artificial intelligence may help to further classify 18F-FDG-PET-positive lymphoma residuals. This could lead to an increase of the positive predictive value of interim- and end-of-treatment 18F-FDG-PET. The patient’s point of view enables another instructive perspective on the course of treatment, which often remains hidden to treating physicians due to lack of time in clinical routine.

Lymphomas are malignant tumours arising from cells in the lymphatic system. They are classified as B-cell lymphomas, T-cell lymphomas and Hodgkin lymphoma (HL). Of the B-cell lymphomas, one of the most common is diffuse large B-cell lymphoma (DLBCL). Many patients with lymphomas can be successfully treated however patients who relapse or are refractory have a poor prognosis, warranting further investigations to identify potential targets and develop novel drugs. Picropodophyllin (PPP), a potent and selective inhibitor of IGF-1R, inhibits malignant cell growth with low or no toxicity on normal cells in preclinical models. In paper I, we investigated the potential benefits of using PPP against DLBCL and found that the anti-tumor effects of PPP might possibly be explained by IGF-1R-unrelated mechanism(s). However, the inhibitory effects of PPP on lymphoma cells together with its low toxicity in vivo makes it a promising drug candidate for treatment. Melflufen, a derivative of melphalan, is currently being evaluated in a clinical phase I/II trial in relapsed or refractory multiple myeloma. In paper II, we confirmed previous reports of superior potency of melflufen over melphalan. Being active in cell lines and primary cultures of lymphoma cells as well as in a xenograft model in mice, melflufen considered being a candidate for further evaluation in treatment. bAP-15, a novel inhibitor of proteasome activity, inhibits ubiquitin specific peptidase 14 (USP14) and ubiquitin carboxyl-terminal hydrolase L5 (UCHL5). In paper III, we investigated the activity of b-AP15 in DLBCL and HL cell lines and compared the results to standard drugs used in treatment. Results showed inhibition of the proteasome and growth inhibition/cytotoxicity with IC50-values in the micromolar range. Treatment failure and lack of clinical benefit of proteasome inhibitors like bortezomib in DLBCL patients inspired us investigating for possible new targets, with major focus on proteasome inhibitors in DLBCL. In paper IV, we suggested that UCHL5 and/or USP14, as new targets for proteasome inhibitors in DLBCL, be further evaluated. The findings in this thesis suggest that PPP, Melflufen and b-AP15 are potential candidates for clinical drug development and UCHL5 and/or USP14 are new potential targets for proteasome inhibitors in DLBCL.

Le principal cancer hématologique est le lymphome B non-hodgkinien (LNH) dont la forme la plus courante est le lymphome B diffus à grande cellule (DLBCL). La présence d'un infiltrat lymphocytaire T dans le micro-environnement d'un LNH-B nodal a été clairement associée à un bon pronostic vital des patients. Le LNH-B peut se développer dans divers tissus dont certains organes immunologiquement privilégiés, comme les yeux et le cerveau, où les réponses immunitaires sont inhibées ou retardées. Mon projet de thèse a consisté à étudier les interactions tumeur-micro-environnement immunitaire dans des sites de privilège immunitaire. Nous avons comparé les infiltrats immunitaires de lymphomes B murins à grandes cellules intra-splénique, intra-cérébral et intra-oculaire par cytométrie en flux. Les lymphocytes T (LT), majoritairement CD4+, infiltrent les lymphomes B quelles que soient leurs localisations. Les Th17, une sous-population lymphocytaire CD4+ produisant de l'IL-17, sont présents dans les 3 sites tumoraux et nous avons démontré leur rôle anti-tumoral dans le lymphome intra-oculaire. Cependant, nous avons mis en évidence l'impact suppresseur des Treg sur les LT effecteurs dans les organes immunologiquement privilégiés uniquement, par stimulation ex vivo des LT et déplétion in vivo des Treg. Lorsque cette inhibition est levée, la progression tumorale est ralentie et d'autres sous-populations T CD4+ sont favorisées en fonction de la localisation de la tumeur : les Th2 dans l'œil et les Th17 dans le cerveau. L'ensemble de ces données montre l'importance des LT effecteurs dans le contrôle du développement du lymphome B à grandes cellules y compris dans les sites immunologiquement privilégiés. Une piste importante à explorer serait de stimuler les LT effecteurs en tenant compte de la localisation pour améliorer le traitement des DLBCL.

Up to 60% of patients with aggressive B-cell lymphoma who receive chimeric antigen receptor (CAR) T-cell therapy experience treatment failure and subsequently have a poor prognosis. Allogeneic hematopoietic stem cell transplantation (alloHSCT) remains a potentially curative approach for patients in this situation. Induction of a deep response prior to alloHSCT is crucial for long-term outcomes, but the optimal bridging strategy following relapse after CAR T-cell therapy has not yet been established. Polatuzumab vedotin, an antibody drug conjugate targeting CD79b, is a novel treatment option for use in combination with rituximab and bendamustine (Pola-BR) in relapsed or refractory disease. Patients: We report two heavily pretreated patients with primary refractory diffuse large Bcell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL) respectively who relapsed after therapy with CAR T-cells with both nodal and extranodal manifestations of the disease. After application of three courses of Pola-BR both patients achieved a complete metabolic remission. Both patients underwent alloHSCT from a human leukocyte antigen (HLA)-mismatched donor following conditioning with busulfan and fludarabine and are disease free 362 days and 195 days after alloHSCT respectively. We conclude that Pola-BR can be an effective bridging therapy before alloHSCT of patients relapsing after CAR T-cell therapy. Further studies will be necessary to define the depth and durability of remission of this salvage regimen before alloHSCT.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. It is a molecular and prognostic heterogeneous disease. Three main genetic subtypes are called germinal center-like DLBCL (GC-like DLBCL), non-germinal center-like DLBCL (nonGC-like DLBCL) and primary mediastinal B-cell lymphoma (PMBL). These subtypes can be reliably distinguished only with usage of gene expression profiling (GEP). The GEP method can be applied only when fresh frozen tissue is available. The method is technically difficult and expensive. Thus, it is not used routinely. Since the DLBCL subtypes differ in prognosis, it is extremely important to be able to distinguish them. The presented thesis is focused on distinguishing of PMBL diagnosis in the group of DLBCL. Easily stored formalin-fixed, paraffin-embedded tissue (FFPE) and gene expression analysis using real-time quantitative polymerase chain reaction (RTqPCR) are used. In the first step, PMBL and DLBCL cases were distinguished with an internationally accepted clinical-pathological method. The agreement between clinical-pathological diagnosis and GEP is only 76%. In the presented text a genetic algorithm for PMBL/DLBCL distinguishing is suggested. It uses three carefully chosen genes and their expression is measured with RTqPCR. Both, the...

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. It is a molecular and prognostic heterogeneous disease. Three main genetic subtypes are called germinal center-like DLBCL (GC-like DLBCL), non-germinal center-like DLBCL (nonGC-like DLBCL) and primary mediastinal B-cell lymphoma (PMBL). These subtypes can be reliably distinguished only with usage of gene expression profiling (GEP). The GEP method can be applied only when fresh frozen tissue is available. The method is technically difficult and expensive. Thus, it is not used routinely. Since the DLBCL subtypes differ in prognosis, it is extremely important to be able to distinguish them. The presented thesis is focused on distinguishing of PMBL diagnosis in the group of DLBCL. Easily stored formalin-fixed, paraffin-embedded tissue (FFPE) and gene expression analysis using real-time quantitative polymerase chain reaction (RTqPCR) are used. In the first step, PMBL and DLBCL cases were distinguished with an internationally accepted clinical-pathological method. The agreement between clinical-pathological diagnosis and GEP is only 76%. In the presented text a genetic algorithm for PMBL/DLBCL distinguishing is suggested. It uses three carefully chosen genes and their expression is measured with RTqPCR. Both, the...

High grade aggressive lymphomas have high mortality. By their nature, more than 40% of patients die from these diseases even with the improved treatment strategies currently available for oncology patients. The characteristic feature is that they are functionally heterogeneous and therefore have different biological and molecular signatures which make it difficult for all groups to respond to same line of treatment. Based on the above, I set out to look at the impact of viral and cellular gene products on these groups of diseases: In chapter 3 I developed monoclonal antibodies against HERV‐K10. I subsequently investigated their expressions in aggressive lymphomas including Diffuse Large B‐cell lymphoma, Hodgkin’s lymphoma and Primary CNS lymphomas. I showed HERV‐K10 is expressed in cell lines of aggressive lymphomas, but not in paraffin‐embedded tissues. In chapter 4 I showed that the expression of ATM using immune‐histochemistry techniques in aggressive lymphomas does offer a guide to prognosis and treatment. Nearly 30% of Diffuse Large B‐cell lymphomas express ATM, 55% of Hodgkin’s lymphomas and more than 80% of Primary CNS lymphomas. I also showed there is a correlation of ATM expression and EBV‐driven aggressive lymphomas and that this has a poor prognostic significance. Chapter 5 analysed the results obtained by generating, validating and evaluating data base of DLBCL and PCNSL from a retrospective cohort over a 17‐year period. The results confirmed that prognostic indicators including ATM, S1PR2, Autotaxin and EBV using immuno‐histochemistry techniques help with categorising aggressive lymphomas into different prognostic groups and does influence future management. In summary, my results showed there is a critical place for immuno‐histochemistry techniques in convincingly helping understand the expressions of viral and cellular gene products in aggressive lymphomas and in contributing positively to their management.