E-&ndashcadherin (CDH1) is a cell adhesion molecule that coordinates key morphogenetic processes regulating cell growth, cell proliferation and apoptosis. Loss of CDH1 is a trademark of the cellular event epithelial to mesenchymal transition (EMT), which increases the metastatic potential of malignant cells. PTEN is a tumor suppressor gene commonly mutated in many human cancers, including endometrial cancer. In the mouse uterus, ablation of Pten induces epithelial hyperplasia, leading to endometrial carcinomas. However, loss of Pten alone does not affect longevity until around 5 months. Similarly, conditional ablation of Cdh1 alone does not predispose mice to cancer. We characterized the impact of dual Cdh1 and Pten ablation using Pgr-Cre (Cdh1d/d Ptend/d) in the mouse uterus. We observed that Cdh1d/d Ptend/d mice died at postnatal day 15-&ndash19 with massive blood loss from their reproductive tract (abnormal metrorrhagia) with prevalent vascularization in both the endometrium and myometrium. Their uteri were abnormally structured with curly horns, disorganized epithelial structure, and increased cell proliferation. Co-&ndashimmunostaining of KRT8 and ACTA2 showed invasion of epithelial cells into the myometrium. Further, the uteri of Cdh1d/d Ptend/d mice had prevalent vascularization in both the endometrium and myometrium. We also observed reduced expression of estrogen and progesterone receptors, loss of cell adherens and tight junction molecules (CTNNB1 and claudin), as well as activation of AKT in the uteri of Cdh1d/d Ptend/d mice. However, complex hyperplasia was not found in the uteri of Cdh1d/d Ptend/d. Collectively, these findings suggest that ablation of Pten with Cdh1 in the uterus accelerates cellular invasiveness and angiogenesis, and causes early death. Thus, this model does not allow sufficient time for the emergence of advanced, clinically over aggressive endometrial tumorigenesis and metastasis. Additionally, we looked at a new Cre system to ablate Pten and Cdh1 only in the epithelial cells of the uterus. Sprr2f, an estrogen dependent gene that is found highly expressed in the uterus, helps with structure and barrier function of epithelial cells. Prg-Cre turns on at postnatal day 3-5 before development of the uterus; whereas, Sprr2f-Cre is active around 3 weeks which is after uterine development. We have driven the ablation of Cdh1d/d Ptend/d using the Sprr2f-Cre. The Sprr2f-Cre Cdh1d/d Ptend/d mice successfully lived to 2 months. The Sprr2f-Cre Ptend/d mice displayed hyperplastic epithelial cells, most prominently in the glandular like structures of the uterus. Lack of cellular structure was observed in the Sprr2f-Cre Cdh1d/d Ptend/d mice. We also developed a model of orthotopic tumor transplantation to study further tumor development including cell invasion, dissemination and metastasis. The uteri of control, Cdhd/d, Ptend/d and Cdhd/d Ptend/d mice were collected and dissected to approximately ~1 mm in diameter. Then, the tissue fragments were orthotopically implanted into the uterine wall (endometrium) of wild-type syngeneic host mice. We have observed successful implantation and sustainability of the tissue through this technique. The tissue viability was successfully verified by implanting donor uterine pieces under the kidney capsule of recipient wild type mice. This study has shown that the ablation of Cdh1 and Pten in the mouse uterus initiates a more aggressive form of type I endometrial carcinoma when using Pgr-Cre as well as Sprr2f-Cre. However, neither conditional ablation approaches allowed us to fully observe the progression of the carcinoma to a metastatic disease. Our intrauterine endometrial/myometrial implantation technique proved to be an incomplete method to further study the metastatic potential of the PgrCre/+ Cdh1f/f Ptenf/f mice.

Submitted by Biblioteca do Instituto Biomédico BIB (uffbib@gmail.com) on 2017-06-05T19:10:20Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Nataly Melo.pdf: 1795665 bytes, checksum: d444f8f78deb979ec897ad76fde8f8cd (MD5) / Made available in DSpace on 2017-06-05T19:10:20Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Nataly Melo.pdf: 1795665 bytes, checksum: d444f8f78deb979ec897ad76fde8f8cd (MD5) / Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro. / Uma série de genes vem sendo estudados por terem sua expressão aberrante em tumores de endométrio. Dentre eles, a osteopontina (OPN) e a p53, os quais são expressos de forma aberrante no carcinoma de endométrio (CE). Tem sido demonstrado que a expressão da OPN é capaz de regular a expressão de p53 e vice-versa. No entanto, ainda não há dados sobre as isoformas destes produtos gênicos e suas possíveis relações no CE. Este trabalho teve por objetivo avaliar o perfil de expressão e o potencial papel fisiopatológico das isoformas da OPN e da p53 em distintas linhagens celulares de endométrio. A expressão destes alvos foi avaliada por PCR em tempo real, imunoblot e imunofluorescência. Observamos que a OPNa é a isoforma predominante dentre as três isoformas, tanto em linhagens tumorais quanto não tumorais de endométrio. No entanto, apenas a isoforma OPNc apresenta expressão diferencial entre linhagens tumorais e uma não tumoral. De forma similar, todas as isoformas de p53 também são expressas nestas linhagens investigadas, sendo a p53 completa a isoforma predominante em linhagens tumorais e a Δ40p53 a segunda mais expressa, em especial em linhagens representativas de tumores do Tipo I. A variante Δ40p53 apresenta expressão predominante em linhagens celulares não tumorais de endométrio. Em conjunto, estes dados evidenciam correlação entre a expressão predominante da isoforma OPNa e a variante completa da p53, com padrões específicos de expressão da OPNc e da Δ40p53, de acordo as linhagens analisadas. Estes achados abrem perspectivas da potencial aplicação de isoformas variantes da OPN e de p53 enquanto biomarcadores no diagnóstico diferencial e também para avaliação prognóstica em tumores de endométrio. / Several genes have been studied by being overexpressed in endometrial tumors. Among them, osteopontin (OPN) and p53, which are overexpressed in endometrial carcinoma (EC). It has been demonstrated that the expression of OPN can regulate the expression of p53 and vice-versa. However, data is lacking regarding these gene products and their putative associations in EC. This work aims to evaluate the expression profile and the potential physiopathological roles of OPN and p53 isoforms in distinct endometrial cell lines.The expression of these gene targets has been evaluated here by real time PCR, immunoblot and immunofluorescense. We observed that OPNa is the predominant isoform among those three tested, both in tumor and non-tumoral cell lines. However, only OPNc isoform is differentially expressed between tumor and non-tumoral cell lines. Similarly, all p53 isoforms are expressed in these tested cell lines, being the full lenght p53 the predominant isoform in tumor cell lines, while Δ40p53 is the second variant in expression levels, especially in cell lines that are representative of Type I tumors. The Δ40p53 variant has predominat expression in non-tumoral cell lines. As a whole, these data evidence correlation between the predominant expression of OPNa and the full lenght p53 variant, with specific expression patterns observed for OPNc and Δ40p53, according to analyzed cell lines. These data open perspectives of the potential use of OPN and p53 isoform variants as biomarkers for differential diagnosis and prognostic evaluation in endometrial tumors.

Indiana University-Purdue University Indianapolis (IUPUI) / Endometrial cancer is the most common gynecologic cancer in the United States, and patients with early-stage endometrioid adenocarcinoma have a favorable prognosis. Over the past decade, the gynecologic oncology community has debated whether potential harms of systematic lymph node dissection (LND) outweigh potential benefits for these patients. To minimize number of nodes removed, sentinel lymph node dissection (SLND) is under investigation as an alternative. However, ongoing uncertainty of LND/SLND best practices may result in variations in disease management and discrepant outcomes. Methods Three retrospective cohort studies examined LND/SLND use in patients with endometrioid adenocarcinoma. Two examined temporal and geographic variations, respectively, utilizing the Surveillance, Epidemiology, and End Results (SEER) 18 dataset for the years 2004 through 2015. The third used the SEER-Medicare dataset from 2003 through 2016 to quantify and compare the risk of developing 6-month post-surgical lymphedema, lymphocele, hemorrhage, ileus, infection, thrombosis, and all-cause death by number of lymph nodes removed (0, 1-4, 5-9, or 10+). Results Time trend analyses found LND increased from 2004 through 2008, followed by a significant decline through 2015. SLND was rare and did not increase significantly. Significant geographic variation existed for LND use but not SLND. Per 1,000 patients, analyses of 6-month post-surgical complications found 6.5 experienced lymphedema, 3.9 experienced lymphocele, 15.7 experienced hemorrhage, 28.7 experienced ileus, 37.1 experienced infection, 18.6 experienced thrombosis, and 19.8 died. Controlling for size of primary tumor, tumor grade, comorbidities, race/ethnicity, age at diagnosis, adjuvant chemotherapy, and radiotherapy, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) showed greater risk for ileus (HR: 1.53; 95% CI: 1.24-1.90), infection (HR: 1.52; 95% CI: 1.25-1.83), and thrombosis (HR: 1.41; 95% CI: 1.09-1.82) when comparing removal of 10+ nodes versus 0 nodes. Conclusion Overall, these studies found significant temporal and geographic variation in LND, as well as increasing risk of post-surgical complications associated with increasing numbers of lymph nodes removed. Should continued research into SLND find strong evidence that it effectively detects cancer spread, patients may benefit through decreased risk of post-surgical ileus, infection, and thrombosis.

Black women have higher incidence rates of aggressive subtypes of endometrial cancer and worse survival rates compared with white women. The overall incidence rate has been increasing in black women and, accounting for their higher prevalence of hysterectomy, may be higher than in white women. Exposures related to obesity and metabolic disorders, reproductive factors, and use of exogenous hormones have been associated with endometrial cancer risk in prior studies. However, because these studies have primarily included white women, little is known about these associations in black women. We therefore examined associations of endometrial cancer with previously identified risk factors in 47,555 participants in the Black Women’s Health Study, a prospective cohort of U.S. black women. Study 1 focused on anthropometric and metabolic factors. After adjustment for age at menarche, parity, menopausal status, smoking, and use of oral contraceptives, estrogen-only female menopausal hormones (FMH), and estrogen plus progestin FMH, self-reported body mass index (BMI), BMI at age 18, greater weight gain since age 18, and diagnosis of diabetes were positively associated with endometrial cancer risk. Self-reported diagnosis of hypercholesterolemia and hypertension were not independently associated. In study 2, we examined associations with reproductive factors. Endometrial cancer incidence was higher among women with early age at menarche, a history of infertility, a greater number of lifetime menstrual cycles, and diagnosis of polycystic ovary syndrome. Parity and early age at first birth were associated with lower risk, while a greater number of births and breastfeeding were not associated with risk. Positive associations with late age at menarche among premenopausal women and longer duration of breastfeeding among obese women require confirmation in other studies. In study 3, we examined the associations of endometrial cancer with exogenous hormone use. The inverse association with oral contraceptive use was primarily among women who used oral contraceptives for ≥5 years. Incidence was higher among current users of estrogen-only and estrogen plus progestin FMH, and ever users of progestin only FMH. Lower risk was observed among former users of estrogen plus progestin FMH. / 2019-04-30

No description available.

Le cancer de l’endomètre est le plus fréquent des cancers gynécologiques pelviens. L’envahissement ganglionnaire constitue l’un des principaux facteurs pronostiques mais le rôle des curages ganglionnaires reste débattu.Nous avons construit le score PREGE (Prédiction du Risque d’Envahissement Ganglionnaire dans le cancer de l’Endomètre), à partir d’une base de données de près de 20000 cancers de l’endomètre, après la sélection de caractéristiques individuelles (race et âge) et tumorales définitives, obtenues sur la pièce d’hystérectomie (type, grade et extension locale) significativement associées à l’existence de métastase ganglionnaire. Le score PREGE a été validé sur une base de données multicentrique française (AUC dans les populations de développement et de validation de 0,80 et 0,79 respectivement). Le score était correctement calibré.En utilisant les données préopératoires (IRM et biopsie d’endomètre), les capacités de discrimination du score PREGE étaient conservées. Différents seuils d’intérêt pour la décision clinique ont été définis. Avec un seuil de 100 points, la valeur prédictive négative était de 100%.Dans aucun quantile du score PREGE, la survie spécifique n’était supérieure chez les patientes ayant eu une lymphadénectomie. Toutefois, avec un seuil prédit d’envahissement ganglionnaire supérieur à 20%, nous avons mis en évidence un bénéfice de la lymphadénectomie emportant au moins 10 ganglions.L’utilisation du score PREGE pour la sélection des patientes atteintes d’un cancer de l’endomètre candidates à une lymphadénectomie pourrait permettre de réduire le recours à cette intervention morbide sans altérer la survie spécifique / Endometrial cancer is the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors. However, the therapeutic role of lymphadenectomy is still debated.We developed the score PREGE, able to predict lymph node metastasis based on pathological hysterectomy characteristics in endometrial cancer. Data from almost 20,000 patients who underwent hysterectomy and lymphadenectomy were analyzed and significant prognostic features were selected: final pathological characteristics (histologic type, grade and primary site tumoral extension) and patients’ characteristics (age and race). In a French multicentric cohort, the nomogram showed good discrimination (AUC=0.79 ) and was well calibrated.Lymph node metastasis prediction by the score using preoperative data was as accurate as that obtained using the final tumor characteristics. With a cut-off value of 100 points for the total score, the negative predictive value was 100%.Patients were clustered into quintiles according to their lymph node metastasis probability. The cancer related survival was compared based on whether patients underwent lymphadenectomy. In the five quintile groups, the specific survival rate was significantly higher in the patients who did not undergo lymphadenectomy. However, when lymph node letastatic probabilityexceeded 20%, specific survival was higher in patients in whom at least 10 lymph nodes were removed.PREGE score could be useful to select few patients who will really benefit from lymphadenectomy and avoid lymphadenectomy in most patients with endometrial cancer

Human telomerase is a ribonucleoprotein complex that adds hexameric TTAGGG repeats to the ends of chromosomes in order to prevent their shortening. Telomerase activity has been evaluated for its diagnostic and prognostic value in cancer since it is observed in most malignancies but not in most normal somatic tissues. In this study telomerase activity was examined in tumor specimens obtained from cervix, endometrium and their non-cancerous regions by an improved telomeric repeat amplification protocol (TRAP) &ndash / silver staining assay. Appearance of characteristic TRAP leader with 6 base pair increments indicate a positive result and was observed in all cancerous and some of the non-cancerous tissues. Telomerase activities of carcinoma tissues and normal counterparts were compared by densitometric analysis after PCR. Significantly higher telomerase activity was observed in cervical carcinoma samples compared to normal adjacent tissue. No significant difference was observed between endometrium carcinomas and normal endometrial tissue in terms of telomerase activity. High telomerase activity in normal endometrium restricts the use of assay for detection of carcinogenesis. However, in cervical tissues an accurate quantification of telomerase activity by TRAP &ndash / silver stain assay may be valuable as a confirmatory assay.

Aims: To describe use of post-operative radiation for endometrial cancer in Ontario. To identify system-related and patient-related factors affecting access to this treatment. Materials and Methods: We performed a retrospective population-based cohort study of patients with surgically resected endometrial cancer in the Canadian province of Ontario between 1992-2003. Patients with evidence of incurable cancer at diagnosis or previous cancer diagnosis were excluded. We used multiple logistic regression to assess patient and system factors affecting radiation use. We controlled for disease-related and treatment-related factors: histology, surgical staging, type of hysterectomy and peritoneal biopsy. We applied a mixed model to account for clustering of data by operating hospital. Results: 9,411 women comprised the study cohort. The median age was 63 years. 26.2% received adjuvant radiation. The proportion of patients receiving radiation varied between cancer centre catchment areas from 18.0% to 34.3% (median 26.3%). In multivariate analysis, older patients were more likely to receive radiation up to the age of 80 (p<.0001). Patients who lived further from regional cancer centres were less likely to receive radiation (p=.0210). Patients who had their surgery during longer prevailing wait times at regional cancer centres were less likely to receive radiation (p=.0441). There was a 2.7-fold variation in the odds of radiation use between cancer centre catchments (p<.0001). Management at a comprehensive gynecologic oncology centre was associated with use of radiation for patients who had surgical staging of lymph nodes. Year of diagnosis and neighborhood income quintile did not significantly affect the use of radiation. Conclusions: There is wide variation in use of radiation for endometrial cancer in Ontario. There is evidence that system factors unrelated to patient’s needs affect use of adjuvant radiation for endometrial cancer in Ontario. Age is a key patient-related factor affecting radiation use. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-07 22:02:37.308

The garlic extract ajoene is considered to have antimicrobial and antitumor effects against a variety of cell types, and it is suggested to have the potential to be used as an antifungal or antitumor drug clinically. The underlying mechanism of its inhibitory effects is still uncertain. In this project, the effects of ajoene on the growth of fungal and oomycete cells were studied on Candida albicans, Neurospora crassa and Achlya bisexualis. Endometrial cancer is the most common gynecologic cancer. A 3D spheroid model of endometrial cancer cells were for the first time used to investigate the antitumor effects of ajoene and selected antitumor agents. Ajoene was extracted from fresh garlic by chromatographic methods and the outcome of the extractions was verified with Mass spectrometry and NMR spectroscopy. Ajoene was then tested on the yeast form or germ tubes of C. albicans, and the cell division and germ tube formation was analyzed. N. crassa and A. bisexualis were treated with ajoene on plates or on glass slides to measure the hyphae radial extension or individual hyphal extension. 3D endometrial adenocarcinoma cell (Ishikawa) spheroids were treated with ajoene, paclitaxel, targeted drugs everolimus, sorafenib, gefitinib and canertinib alone or in combinations. The growth activity, metabolic activity, cell proliferation, apoptotic activity and the cytoskeletons were analyzed after the treatments. Cell division of C.albicans was inhibited by ajoene at 5µg/ml or higher concentrations. The length of C.albicans germ tubes was significantly shorter in ajoene treated groups than the untreated ones. Radial extension and individual hyphal extension of N. crassa and A. bisexualis were both inhibited by ajoene. Ajoene did not show any antitumor effects on the 3D cell model of Ishikawa cells. No synergistic effect was detected between ajoene and paclitaxel or ajoene and everolimus. The targeted drugs Canertinib and everolimus showed an inhibitory effect on growth activity of the spheroids, but no synergy with paclitaxel. In conclusion, ajoene was able to inhibit various forms of fungal and oomycete growth, but any antitumor activity of ajoene did not show on 3D culture of endometrial cancer cells.

Early diagnosis of endometrial cancer (EC) is uncertain and women undergo preventive hysterectomy in cases where a non-invasive treatment can be used instead. To contribute to solving this challenge we investigated if early changes in the nuclear 3D telomere architecture during carcinoma development can be detected prior to the first morphological evidence of precancerous lesions. We utilized Pten heterozygous mice that develop progressive carcinoma in the endometrial tissue similar to EC development in women. We used telomere fluorescence in situ hybridization (FISH), 3D molecular imaging and analysis techniques on interphase nuclei of endometrial glandular epithelial cells to identify alterations in the 3D-telomere profile. We found that telomere dysfunction in Pten heterozygous mice is present already in endometrial simple hyperplasia lesions prior to detectable loss of PTEN protein expression and that the 3D telomere architecture has a specific signature that indicates early telomere dysfunction predictive for endometrial malignant transformation.