Drosophila lethal giant larvae (lgl) encodes a conserved tumor suppressor with established roles in cell polarity, asymmetric division, and proliferation control. Lgl's human orthologs, HUGL1 and HUGL2, are altered in human cancers, however, its mechanistic role as a tumor suppressor remains poorly understood. Based on a previously established connection between Lgl and Fragile X protein (FMRP), a miRNA-associated translational regulator, we hypothesized that Lgl may exert its role as a tumor suppressor by interacting with the miRNA pathway. Consistent with this model, we found that lgl is a dominant modifier of Argonaute1 overexpression in the eye neuroepithelium. Using microarray profiling we identified a core set of ten miRNAs that are altered throughout tumorigenesis in Drosophila lgl mutants. Among these are several miRNAs previously linked to human cancers including miR-9a, which we found to be downregulated in lgl neuroepithelial tissues. To determine whether miR-9a can act as an effector of Lgl in vivo, we overexpressed it in the context of lgl knock-down by RNAi and found it able to reduce the overgrowth phenotype caused by Lgl loss in epithelia. Furthermore, cross-comparisons between miRNA and mRNA profiling in lgl mutant tissues and human breast cancer cells identified thrombospondin (tsp) as a common factor altered in both fly and human breast cancer tumorigenesis models. Our work provides the first evidence of a functional connection between Lgl and the miRNA pathway, demonstrates that miR-9a mediates Lgl's role in restricting epithelial proliferation, and provides novel insights into pathways controlled by Lgl during tumor progression.

OBJETIVOS: Analisar a expressão de EGFR, proteínas da via de sinalização ou relacionadas aos seus efeitos em carcinoma hepatocelular (CHC) primários, metastáticos e em tecido hepático não tumoral em autópsias. Correlacionar os achados a dados clínico-patológicos e marcadores de classes moleculares. Avaliar a heterogeneidade de expressão em CHC metastáticos e fatores de disseminação extra-hepática. MÉTODOS: Oitenta autópsias de pacientes com CHC ao exame foram incluídas em estudo retrospectivo transversal. Foram analisados sexo, idade, raça, etilismo, infecção por vírus da hepatite B (VHB) e C (VHC), infecção pelo HIV, tratamento prévio, causas básica e imediata de óbito, peso do fígado, cirrose, número e tamanho dos nódulos, padrão macroscópico, grau histológico, variantes histológicas, padrão arquitetural, invasão de grandes veias e metástases extra-hepáticas. Imuno-histoquímica foi realizada em micromatrizes teciduais para pesquisa de EGFR, pEGFR(Tyr 1173), HER2, ERK1/2, MAPKAPK-2, pMAPK, Ag Ki67, caspase 3, citoqueratina 19 (CK19), mTOR, ciclina D1, Met, vimentina, p53 e beta-catenina. A expressão de EGFR foi avaliada em intensidade (0-3+) e distribuição (0-100%) em um sistema de escores de 0 a 300. Hiperexpressão foi definida para escores >= 200. Amostras de fígado normal foram incluídas como controles. Amostras de CHC primário foram pareadas às suas metástases e consideradas concordantes quando na mesma categoria de expressão. No tecido não tumoral foram semi-quantificadas a reação ductular expressando CK19 e a densidade da população de células estromais perissinusoidais pela vimentina. Estatística foi realizada através dos testes do qui-quadrado ou exato de Fisher ao nível de significância de 0,05. Para as correlações de escores e variáveis categóricas foi utilizado o coeficiente de Spearman. RESULTADOS: Foram incluídos 62 casos do sexo masculino e 18 do sexo feminino (58,1 ± 10,9 anos). Infecção pelo VHC foi a principal causa em 49% (39/80), seguida por etilismo em 30% (24/80) e infecção por VHB em 19% (15/80). Cirrose foi identificada em 90% (72/80) dos casos. Os tumores mostraram-se avançados em 95% (76/80). Invasão de grandes veias foi detectada em 19% (15/80) e metástases extra-hepáticas em 38% (30/80). MAPKAPK2, pEGFR (Tyr1173) e HER2 tiveram expressão fraca ou ausente. A expressão de EGFR foi mais frequente no fígado não neoplásico (26/26) (P < 0,05) - e nos controles normais (8/8) do que nas amostras tumorais primárias (60/75) e nas metástases (12/17). Nenhuma amostra dos controles apresentou hiperexpressão de EGFR, a qual foi mais frequente na cirrose (65% - 17/26) do que nos tumores avançados (36% - 26/72) (P < 0,05). EGFR hiperexpresso foi mais frequente nos tumores de grau 1/2 (P < 0,01) e nos casos com menos de quatro nódulos hepáticos (P = 0,014). A expressão de EGFR correlacionou-se à expressão de caspase 3 (P < 0,01). A expressão das quinases ERK1 e ERK2 foi correlacionada à proliferação celular pelo Ag Ki67 (P < 0,01), porém não ao escore de expressão de EGFR. CK19, p53 e beta-catenina nuclear foram correlacionaram-se às lesões de maior grau e a maiores taxas de proliferação celular (P<0,01). Met, EGFR e caspase 3 foram correlacionados a lesões mais diferenciadas. Vimentina teve forte correlação com CK19 (P < 0,01). A concordância de expressão entre tumores hepáticos e respectivas metástases variou de 50 a 85%. Para o EGFR foi de 61%. A expressão endotelial 2-3+ de pMAPK foi mais frequente nas metástases (P = 0,09). A disseminação extra-hepática foi mais frequente nos casos com baixa densidade de células perissinusoidais positivas para vimentina (P = 0,054) e nos casos sem reação ductular no tecido não neoplásico (P = 0,095). CONCLUSÕES: O EGFR tem papel relevante nas etapas iniciais e intermediárias do CHC, sendo sua expressão reduzida nas formas avançadas. Diferentes classes de CHC podem estar associadas a ativação da via do EGFR. A presente análise imuno-histoquímica ampla parece validar pelo menos dois grupos de CHC que nesta série de autópsias parecem ter sido separados pelo grau histológico. Confirma-se a hiperexpressão das quinases como evento importante na progressão tumoral, porém não necessariamente associada à hiperexpressão de EGFR. A heterogeneidade de expressão entre o CHC primário e suas metástases variou de 15 a 45% / OBJECTIVES: To analyze the expression of EGFR and proteins related to its signaling pathway or to its effects in hepatocellular carcinoma (HCC), metastases and surrounding liver tissue in a series of autopsies. To correlate expression patterns to clinicopathological data and other markers of molecular classification. To assess the heterogeneity of expression in metastatic HCC and factors related to extrahepatic spread. METHODS: Eighty autopsies of patients with HCC were included in a cross-sectional retrospective study. We analyzed gender, age, race, alcohol intake, infection with hepatitis B (HBV) and C virus (HCV), HIV infection, prior treatment, basic and immediate causes of death, the weight of the liver, cirrhosis, number and size of nodules, gross pattern, histological grade, histological variants, architectural pattern, invasion of large veins and extrahepatic metastases. Immunohistochemistry was performed on tissue microarrays to survey EGFR, pEGFR(Tyr 1173), HER2, ERK1/2, MAPKAPK-2, pMAPK, Ag Ki67, caspase 3, cytokeratin 19 (CK19), mTOR, cyclin D1, Met, vimentin, p53 and beta-catenin. EGFR expression was evaluated in intensity (0-3+) and distribution of membrane staining (0-100%) in a 0 - 300 score. Overexpression was defined for scores >= 200. Normal liver samples were included as controls. Intra-hepatic HCC samples were matched to their respective metastases and expression was considered concordant when they were assigned to the same category. Ductular reaction expressing CK19 and the density of perisinusoidal vimentin positive stromal cells were semi-quantified in non-tumor tissue. Statistics was performed using the chi- square or Fisher exact test at a significance level of 0.05. For the correlations of scores and categorical data we used the Spearman coefficient. RESULTS: Sixty-two males and eighteen females were included (age 58.1 ± 10.9). HCV was the major cause in 49% (39/80), followed by alcoholism in 30% (24/80) and HBV infection in 19% (15/80). Cirrhosis was identified in 90% (72/80) and advanced tumors in 95% (76/80). Large vein invasion was detected in 19% (15/80) and extra-hepatic metastases in 38% (30/80). MAPKAPK2, pEGFR (Tyr1173) and HER2 expression were weak or absent. The EGFR expression was more frequent in non-tumoral liver (26/26) (P <.05) and in normal controls (8/8) than in primary HCC tumor samples (60/75) and in metastatic HCC (12/17). No samples taken from the controls showed overexpression of EGFR, which was more common in cirrhotic tissue (65% - 17/26) than in advanced tumors (36% - 26/72) (P <0.05). EGFR overexpression was more frequent in grade 1/2 tumors (P <0.01) and in cases with less than four hepatic nodules (P = 0.014). EGFR expression was correlated to the expression of caspase 3 (P <0.01). The expression of the kinases ERK1 and ERK2 was correlated to Ag Ki67 cell proliferation index (P <0.01), but not to the EGFR expression score. CK19, p53 and nuclear beta- catenin were correlated to high grade lesions and to higher rates of cell proliferation (P <0.01). Met, EGFR and caspase 3 were correlated with more differentiated lesions. Vimentin was strongly correlated with CK19 (P <0.01). The concordance of expression between liver tumors and their metastases ranged from 50 to 85% (61% for EGFR). The 2-3+ expression of pMAPK in tumor endothelial cells was more common in metastases (P = 0.09). Extrahepatic dissemination was more frequent in cases with low density of vimentin positive perisinusoidal cells (P = 0.054) and in cases with no detectable ductular reaction in non-neoplastic tissue (P = 0.095). CONCLUSIONS: EGFR plays an important role in the early and intermediate stages of HCC progression, with lower expression in advanced tumors. Different classes of HCC may be associated with activation of EGFR. The present comprehensive immunohistochemical approach seems to validate at least two molecular classes of HCC, and histological grade seems to be able to discriminate these groups. We herein confirmed overexpression of kinases as a key event in tumor progression, but not necessarily associated with overexpression of EGFR. The heterogeneity of expression between primary HCC and its metastases ranged from 15 to 45%

OBJETIVOS: Analisar a expressão de EGFR, proteínas da via de sinalização ou relacionadas aos seus efeitos em carcinoma hepatocelular (CHC) primários, metastáticos e em tecido hepático não tumoral em autópsias. Correlacionar os achados a dados clínico-patológicos e marcadores de classes moleculares. Avaliar a heterogeneidade de expressão em CHC metastáticos e fatores de disseminação extra-hepática. MÉTODOS: Oitenta autópsias de pacientes com CHC ao exame foram incluídas em estudo retrospectivo transversal. Foram analisados sexo, idade, raça, etilismo, infecção por vírus da hepatite B (VHB) e C (VHC), infecção pelo HIV, tratamento prévio, causas básica e imediata de óbito, peso do fígado, cirrose, número e tamanho dos nódulos, padrão macroscópico, grau histológico, variantes histológicas, padrão arquitetural, invasão de grandes veias e metástases extra-hepáticas. Imuno-histoquímica foi realizada em micromatrizes teciduais para pesquisa de EGFR, pEGFR(Tyr 1173), HER2, ERK1/2, MAPKAPK-2, pMAPK, Ag Ki67, caspase 3, citoqueratina 19 (CK19), mTOR, ciclina D1, Met, vimentina, p53 e beta-catenina. A expressão de EGFR foi avaliada em intensidade (0-3+) e distribuição (0-100%) em um sistema de escores de 0 a 300. Hiperexpressão foi definida para escores >= 200. Amostras de fígado normal foram incluídas como controles. Amostras de CHC primário foram pareadas às suas metástases e consideradas concordantes quando na mesma categoria de expressão. No tecido não tumoral foram semi-quantificadas a reação ductular expressando CK19 e a densidade da população de células estromais perissinusoidais pela vimentina. Estatística foi realizada através dos testes do qui-quadrado ou exato de Fisher ao nível de significância de 0,05. Para as correlações de escores e variáveis categóricas foi utilizado o coeficiente de Spearman. RESULTADOS: Foram incluídos 62 casos do sexo masculino e 18 do sexo feminino (58,1 ± 10,9 anos). Infecção pelo VHC foi a principal causa em 49% (39/80), seguida por etilismo em 30% (24/80) e infecção por VHB em 19% (15/80). Cirrose foi identificada em 90% (72/80) dos casos. Os tumores mostraram-se avançados em 95% (76/80). Invasão de grandes veias foi detectada em 19% (15/80) e metástases extra-hepáticas em 38% (30/80). MAPKAPK2, pEGFR (Tyr1173) e HER2 tiveram expressão fraca ou ausente. A expressão de EGFR foi mais frequente no fígado não neoplásico (26/26) (P < 0,05) - e nos controles normais (8/8) do que nas amostras tumorais primárias (60/75) e nas metástases (12/17). Nenhuma amostra dos controles apresentou hiperexpressão de EGFR, a qual foi mais frequente na cirrose (65% - 17/26) do que nos tumores avançados (36% - 26/72) (P < 0,05). EGFR hiperexpresso foi mais frequente nos tumores de grau 1/2 (P < 0,01) e nos casos com menos de quatro nódulos hepáticos (P = 0,014). A expressão de EGFR correlacionou-se à expressão de caspase 3 (P < 0,01). A expressão das quinases ERK1 e ERK2 foi correlacionada à proliferação celular pelo Ag Ki67 (P < 0,01), porém não ao escore de expressão de EGFR. CK19, p53 e beta-catenina nuclear foram correlacionaram-se às lesões de maior grau e a maiores taxas de proliferação celular (P<0,01). Met, EGFR e caspase 3 foram correlacionados a lesões mais diferenciadas. Vimentina teve forte correlação com CK19 (P < 0,01). A concordância de expressão entre tumores hepáticos e respectivas metástases variou de 50 a 85%. Para o EGFR foi de 61%. A expressão endotelial 2-3+ de pMAPK foi mais frequente nas metástases (P = 0,09). A disseminação extra-hepática foi mais frequente nos casos com baixa densidade de células perissinusoidais positivas para vimentina (P = 0,054) e nos casos sem reação ductular no tecido não neoplásico (P = 0,095). CONCLUSÕES: O EGFR tem papel relevante nas etapas iniciais e intermediárias do CHC, sendo sua expressão reduzida nas formas avançadas. Diferentes classes de CHC podem estar associadas a ativação da via do EGFR. A presente análise imuno-histoquímica ampla parece validar pelo menos dois grupos de CHC que nesta série de autópsias parecem ter sido separados pelo grau histológico. Confirma-se a hiperexpressão das quinases como evento importante na progressão tumoral, porém não necessariamente associada à hiperexpressão de EGFR. A heterogeneidade de expressão entre o CHC primário e suas metástases variou de 15 a 45% / OBJECTIVES: To analyze the expression of EGFR and proteins related to its signaling pathway or to its effects in hepatocellular carcinoma (HCC), metastases and surrounding liver tissue in a series of autopsies. To correlate expression patterns to clinicopathological data and other markers of molecular classification. To assess the heterogeneity of expression in metastatic HCC and factors related to extrahepatic spread. METHODS: Eighty autopsies of patients with HCC were included in a cross-sectional retrospective study. We analyzed gender, age, race, alcohol intake, infection with hepatitis B (HBV) and C virus (HCV), HIV infection, prior treatment, basic and immediate causes of death, the weight of the liver, cirrhosis, number and size of nodules, gross pattern, histological grade, histological variants, architectural pattern, invasion of large veins and extrahepatic metastases. Immunohistochemistry was performed on tissue microarrays to survey EGFR, pEGFR(Tyr 1173), HER2, ERK1/2, MAPKAPK-2, pMAPK, Ag Ki67, caspase 3, cytokeratin 19 (CK19), mTOR, cyclin D1, Met, vimentin, p53 and beta-catenin. EGFR expression was evaluated in intensity (0-3+) and distribution of membrane staining (0-100%) in a 0 - 300 score. Overexpression was defined for scores >= 200. Normal liver samples were included as controls. Intra-hepatic HCC samples were matched to their respective metastases and expression was considered concordant when they were assigned to the same category. Ductular reaction expressing CK19 and the density of perisinusoidal vimentin positive stromal cells were semi-quantified in non-tumor tissue. Statistics was performed using the chi- square or Fisher exact test at a significance level of 0.05. For the correlations of scores and categorical data we used the Spearman coefficient. RESULTS: Sixty-two males and eighteen females were included (age 58.1 ± 10.9). HCV was the major cause in 49% (39/80), followed by alcoholism in 30% (24/80) and HBV infection in 19% (15/80). Cirrhosis was identified in 90% (72/80) and advanced tumors in 95% (76/80). Large vein invasion was detected in 19% (15/80) and extra-hepatic metastases in 38% (30/80). MAPKAPK2, pEGFR (Tyr1173) and HER2 expression were weak or absent. The EGFR expression was more frequent in non-tumoral liver (26/26) (P <.05) and in normal controls (8/8) than in primary HCC tumor samples (60/75) and in metastatic HCC (12/17). No samples taken from the controls showed overexpression of EGFR, which was more common in cirrhotic tissue (65% - 17/26) than in advanced tumors (36% - 26/72) (P <0.05). EGFR overexpression was more frequent in grade 1/2 tumors (P <0.01) and in cases with less than four hepatic nodules (P = 0.014). EGFR expression was correlated to the expression of caspase 3 (P <0.01). The expression of the kinases ERK1 and ERK2 was correlated to Ag Ki67 cell proliferation index (P <0.01), but not to the EGFR expression score. CK19, p53 and nuclear beta- catenin were correlated to high grade lesions and to higher rates of cell proliferation (P <0.01). Met, EGFR and caspase 3 were correlated with more differentiated lesions. Vimentin was strongly correlated with CK19 (P <0.01). The concordance of expression between liver tumors and their metastases ranged from 50 to 85% (61% for EGFR). The 2-3+ expression of pMAPK in tumor endothelial cells was more common in metastases (P = 0.09). Extrahepatic dissemination was more frequent in cases with low density of vimentin positive perisinusoidal cells (P = 0.054) and in cases with no detectable ductular reaction in non-neoplastic tissue (P = 0.095). CONCLUSIONS: EGFR plays an important role in the early and intermediate stages of HCC progression, with lower expression in advanced tumors. Different classes of HCC may be associated with activation of EGFR. The present comprehensive immunohistochemical approach seems to validate at least two molecular classes of HCC, and histological grade seems to be able to discriminate these groups. We herein confirmed overexpression of kinases as a key event in tumor progression, but not necessarily associated with overexpression of EGFR. The heterogeneity of expression between primary HCC and its metastases ranged from 15 to 45%

Receptor tyrosine kinases (RTK) are key regulators of growth, differentiation and survival of epithelial cells and play a significant role in the development and progression of cancers derived from these tissues. In malignant cells, these receptors and their downstream signalling pathways are often deregulated, leading to cell hyper-proliferation, enhanced cell survival and increased metastatic potential. Furthermore, endothelial expressed RTKs regulate tumor angiogenesis allowing for tumor growth and maintenance by promoting their vascularization. Epithelial malignancies such as squamous cell carcinomas (SCC), non-small cell lung (NSCLC) and malignant mesotheliomas have very limited treatment options when presenting as metastatic disease. RTKs, particularly the epidermal growth factor (EGFR) and the vascular endothelial growth factor (VEGFR) receptors, have been shown to play significant roles in the pathogenesis of these tumor types. Statins are potent inhibitors of HMG-CoA reductase, the rate limiting enzyme of the mevalonate pathway, that are widely used as hypercholesterolemia treatments. The mevalonate pathway produces a variety of end products that are critical for many different cellular pathways, thus, targeting this pathway can affect multiple signalling pathways. Our laboratory has previously shown that lovastatin can induce tumor specific apoptosis especially in SCC and that 23% of recurrent SCC patients treated with lovastatin as a single agent showed disease stabilization in our Phase I clinical trial. Subsequently, our lab was able to demonstrate that lovastatin in combination with gefitinib, a potent inhibitor of the EGFR showed co-operative cytotoxicity when combined (Chapter 2). Furthermore, the pro-apoptotic and cytotoxic effects of these agents were found to be synergistic and to be manifested in several types of tumor cell lines including SCC, NSCLC and glioblastoma. I was able to expand upon these important findings and demonstrated that lovastatin, through its ability to disrupt the actin cytoskeleton, inhibited EGFR dimerization and activation (Chapter 3). This novel mechanism targeting this receptor has clinical implications as lovastatin treatment combined with gefitinib showed co-operative inhibitory effects on EGFR activation and downstream signalling. The RTK family of proteins share similar features with respect to activation, internalization and downstream signalling effectors. I further demonstrated that lovastatin can inhibit the VEGFR-2 in endothelial cells and mesotheliomas, where VEGF and its receptor are co-expressed driving their proliferation, and induces synergistic cytotoxicity in mesothelioma cells in combination with VEGFR-2 tyrosine kinase inhibitors (Chapter 4). These findings suggest that statins may augment the effects of a variety of RTK inhibitors in a similar fashion representing a novel combinational therapeutic approach in a wide repertoire of human cancers. More importantly, based on this work, we initiated a Phase I/II study evaluating high dose rosuvastatin and the EGFR inhibitor tarceva in SCC and NSCLC patients at our institute. This clinical evaluation will provide invaluable data that will play a role in developing this novel therapeutic strategy. Together, the work embodied in this thesis provides a model for the regulation of EGFR/VEGFR-2 activation and signalling by targeting the rho family of proteins that demonstrates a novel mechanism that can be exploited to refine current therapeutic paradigms.

Receptor tyrosine kinases (RTK) are key regulators of growth, differentiation and survival of epithelial cells and play a significant role in the development and progression of cancers derived from these tissues. In malignant cells, these receptors and their downstream signalling pathways are often deregulated, leading to cell hyper-proliferation, enhanced cell survival and increased metastatic potential. Furthermore, endothelial expressed RTKs regulate tumor angiogenesis allowing for tumor growth and maintenance by promoting their vascularization. Epithelial malignancies such as squamous cell carcinomas (SCC), non-small cell lung (NSCLC) and malignant mesotheliomas have very limited treatment options when presenting as metastatic disease. RTKs, particularly the epidermal growth factor (EGFR) and the vascular endothelial growth factor (VEGFR) receptors, have been shown to play significant roles in the pathogenesis of these tumor types. Statins are potent inhibitors of HMG-CoA reductase, the rate limiting enzyme of the mevalonate pathway, that are widely used as hypercholesterolemia treatments. The mevalonate pathway produces a variety of end products that are critical for many different cellular pathways, thus, targeting this pathway can affect multiple signalling pathways. Our laboratory has previously shown that lovastatin can induce tumor specific apoptosis especially in SCC and that 23% of recurrent SCC patients treated with lovastatin as a single agent showed disease stabilization in our Phase I clinical trial. Subsequently, our lab was able to demonstrate that lovastatin in combination with gefitinib, a potent inhibitor of the EGFR showed co-operative cytotoxicity when combined (Chapter 2). Furthermore, the pro-apoptotic and cytotoxic effects of these agents were found to be synergistic and to be manifested in several types of tumor cell lines including SCC, NSCLC and glioblastoma. I was able to expand upon these important findings and demonstrated that lovastatin, through its ability to disrupt the actin cytoskeleton, inhibited EGFR dimerization and activation (Chapter 3). This novel mechanism targeting this receptor has clinical implications as lovastatin treatment combined with gefitinib showed co-operative inhibitory effects on EGFR activation and downstream signalling. The RTK family of proteins share similar features with respect to activation, internalization and downstream signalling effectors. I further demonstrated that lovastatin can inhibit the VEGFR-2 in endothelial cells and mesotheliomas, where VEGF and its receptor are co-expressed driving their proliferation, and induces synergistic cytotoxicity in mesothelioma cells in combination with VEGFR-2 tyrosine kinase inhibitors (Chapter 4). These findings suggest that statins may augment the effects of a variety of RTK inhibitors in a similar fashion representing a novel combinational therapeutic approach in a wide repertoire of human cancers. More importantly, based on this work, we initiated a Phase I/II study evaluating high dose rosuvastatin and the EGFR inhibitor tarceva in SCC and NSCLC patients at our institute. This clinical evaluation will provide invaluable data that will play a role in developing this novel therapeutic strategy. Together, the work embodied in this thesis provides a model for the regulation of EGFR/VEGFR-2 activation and signalling by targeting the rho family of proteins that demonstrates a novel mechanism that can be exploited to refine current therapeutic paradigms.

Receptor tyrosine kinases (RTK) are key regulators of growth, differentiation and survival of epithelial cells and play a significant role in the development and progression of cancers derived from these tissues. In malignant cells, these receptors and their downstream signalling pathways are often deregulated, leading to cell hyper-proliferation, enhanced cell survival and increased metastatic potential. Furthermore, endothelial expressed RTKs regulate tumor angiogenesis allowing for tumor growth and maintenance by promoting their vascularization. Epithelial malignancies such as squamous cell carcinomas (SCC), non-small cell lung (NSCLC) and malignant mesotheliomas have very limited treatment options when presenting as metastatic disease. RTKs, particularly the epidermal growth factor (EGFR) and the vascular endothelial growth factor (VEGFR) receptors, have been shown to play significant roles in the pathogenesis of these tumor types. Statins are potent inhibitors of HMG-CoA reductase, the rate limiting enzyme of the mevalonate pathway, that are widely used as hypercholesterolemia treatments. The mevalonate pathway produces a variety of end products that are critical for many different cellular pathways, thus, targeting this pathway can affect multiple signalling pathways. Our laboratory has previously shown that lovastatin can induce tumor specific apoptosis especially in SCC and that 23% of recurrent SCC patients treated with lovastatin as a single agent showed disease stabilization in our Phase I clinical trial. Subsequently, our lab was able to demonstrate that lovastatin in combination with gefitinib, a potent inhibitor of the EGFR showed co-operative cytotoxicity when combined (Chapter 2). Furthermore, the pro-apoptotic and cytotoxic effects of these agents were found to be synergistic and to be manifested in several types of tumor cell lines including SCC, NSCLC and glioblastoma. I was able to expand upon these important findings and demonstrated that lovastatin, through its ability to disrupt the actin cytoskeleton, inhibited EGFR dimerization and activation (Chapter 3). This novel mechanism targeting this receptor has clinical implications as lovastatin treatment combined with gefitinib showed co-operative inhibitory effects on EGFR activation and downstream signalling. The RTK family of proteins share similar features with respect to activation, internalization and downstream signalling effectors. I further demonstrated that lovastatin can inhibit the VEGFR-2 in endothelial cells and mesotheliomas, where VEGF and its receptor are co-expressed driving their proliferation, and induces synergistic cytotoxicity in mesothelioma cells in combination with VEGFR-2 tyrosine kinase inhibitors (Chapter 4). These findings suggest that statins may augment the effects of a variety of RTK inhibitors in a similar fashion representing a novel combinational therapeutic approach in a wide repertoire of human cancers. More importantly, based on this work, we initiated a Phase I/II study evaluating high dose rosuvastatin and the EGFR inhibitor tarceva in SCC and NSCLC patients at our institute. This clinical evaluation will provide invaluable data that will play a role in developing this novel therapeutic strategy. Together, the work embodied in this thesis provides a model for the regulation of EGFR/VEGFR-2 activation and signalling by targeting the rho family of proteins that demonstrates a novel mechanism that can be exploited to refine current therapeutic paradigms.

Receptor tyrosine kinases (RTK) are key regulators of growth, differentiation and survival of epithelial cells and play a significant role in the development and progression of cancers derived from these tissues. In malignant cells, these receptors and their downstream signalling pathways are often deregulated, leading to cell hyper-proliferation, enhanced cell survival and increased metastatic potential. Furthermore, endothelial expressed RTKs regulate tumor angiogenesis allowing for tumor growth and maintenance by promoting their vascularization. Epithelial malignancies such as squamous cell carcinomas (SCC), non-small cell lung (NSCLC) and malignant mesotheliomas have very limited treatment options when presenting as metastatic disease. RTKs, particularly the epidermal growth factor (EGFR) and the vascular endothelial growth factor (VEGFR) receptors, have been shown to play significant roles in the pathogenesis of these tumor types. Statins are potent inhibitors of HMG-CoA reductase, the rate limiting enzyme of the mevalonate pathway, that are widely used as hypercholesterolemia treatments. The mevalonate pathway produces a variety of end products that are critical for many different cellular pathways, thus, targeting this pathway can affect multiple signalling pathways. Our laboratory has previously shown that lovastatin can induce tumor specific apoptosis especially in SCC and that 23% of recurrent SCC patients treated with lovastatin as a single agent showed disease stabilization in our Phase I clinical trial. Subsequently, our lab was able to demonstrate that lovastatin in combination with gefitinib, a potent inhibitor of the EGFR showed co-operative cytotoxicity when combined (Chapter 2). Furthermore, the pro-apoptotic and cytotoxic effects of these agents were found to be synergistic and to be manifested in several types of tumor cell lines including SCC, NSCLC and glioblastoma. I was able to expand upon these important findings and demonstrated that lovastatin, through its ability to disrupt the actin cytoskeleton, inhibited EGFR dimerization and activation (Chapter 3). This novel mechanism targeting this receptor has clinical implications as lovastatin treatment combined with gefitinib showed co-operative inhibitory effects on EGFR activation and downstream signalling. The RTK family of proteins share similar features with respect to activation, internalization and downstream signalling effectors. I further demonstrated that lovastatin can inhibit the VEGFR-2 in endothelial cells and mesotheliomas, where VEGF and its receptor are co-expressed driving their proliferation, and induces synergistic cytotoxicity in mesothelioma cells in combination with VEGFR-2 tyrosine kinase inhibitors (Chapter 4). These findings suggest that statins may augment the effects of a variety of RTK inhibitors in a similar fashion representing a novel combinational therapeutic approach in a wide repertoire of human cancers. More importantly, based on this work, we initiated a Phase I/II study evaluating high dose rosuvastatin and the EGFR inhibitor tarceva in SCC and NSCLC patients at our institute. This clinical evaluation will provide invaluable data that will play a role in developing this novel therapeutic strategy. Together, the work embodied in this thesis provides a model for the regulation of EGFR/VEGFR-2 activation and signalling by targeting the rho family of proteins that demonstrates a novel mechanism that can be exploited to refine current therapeutic paradigms.

Doctor Scientiae (Odontology) - DSc(Odont) / Investigations of pathoses of the oral cavity encompass a relatively wide spectrum of diseases, abnormalities, tumours and tumour-like conditions affecting and occurring in the dental hard tissues and supportive structures, the bony skeleton of the face and the soft tissues of the. mouth. It involves a study of the normal - oral biology - and the abnormal - oral pathology. Oral pathology is a relatively new specialized field of dental science and practice. In South Africa, prior to the nineteen-fifties, research in oral pathology was primarily directed towards dental disease. Two people - Julius Staz of the University of the Witwatersrand and Tony Ockerse of the University of Pretoria - were the doyens in this field and made major contributions to dental science. Staz reported on the status of dental caries and tumorous malformations of teeth and Ockerse on the prevalence and severity of fluorosis in South Africa. During the fifties a second generation of dental surgeons, who were interested in soft tissue, bone and tumour pathology, emerged. They ,were Bertie Cohen, George Baikie, Mervyn Shear and John Lemmer who, at that time, were all from the University of the Witwatersrand. Bertie Cohen later joined the Royal College of Surgeons of England. Mervyn Shear led the field with his research on cysts of the oral cavity. The practice of oral pathology, moulded on anatomical pathology, was established in the early sixties and Mervyn Shear and the author, from the University of Pretoria, became known as oral pathologists. Research at that early stage comprised clinical and histological observations of oral lesions, diseases, tumours and tumour-like conditions. Observation techniques became more sophisticated during the sixties and seventies with the advent of histochemistry and electronmicroscopy. The next major development which blossomed in the seventies and early eighties was the application of epidemiological methods in the study of disease. Epidemiological principles enabled the correct recording of profiles of oral pathoses in the community. Much was learnt about the prevalence and distribution of oral conditions. The application and use of experimental models, especially laboratory animals, became popular in the eighties. Amongst others, a germfree animal unit was established in the Faculty of Dentistry of the University of Stellenbosch enabling workers to study the microbiological aetiology of dental and oral disease. Morphological observations of tumours and mucosal lesions were further enhanced during this period with the development of immunocytochemistry Experimental cell studies by means of cell culture techniques, commenced late in the eighties and was established in the early nineties. These models fostered molecular biology techniques which have become useful tools for the investigation of the aetiology of disease at a cellular and molecular level. At present molecular techniques are also popular in other spheres of oral pathology such as microbiological, immunological and oncological research. The author's first contact with oral pathology as a subject, forming an important and interesting part of dentistry, was the prescribed textbook "Oral and Dental Diseases", 2nd ed., 1951., by HH Stone of the University of Liverpool in the United Kingdom. Subsequently an enduring interest in the subject and research was cultivated by three teachers and colleagues, Ivor Kramer, Robert Bradlow and Mervyn Shear. Ivor Kramer, Professor of Oral Pathology in the Eastman Dental Institute of the University of London was a superb postgraduate teacher of oral pathology, and revelled in research. The Dean of the Institute, Professor Sir Robert Bradlow was a clinician and splendid diagnostician. He correlated the clinical and histopathological features of oral diseases. These two teachers set the course in oral pathology for the author during his postgraduate studies. In the sixties, after a spell at the University of Pretoria, the author joined Professor Mervyn Shear at the University of Witwatersrand. It was here that the author could further his skills of presenting lectures and research papers in an orderely manner and strengthen his love of research. The research carried out by the author reflects to a large extent the development of research in oral pathology in South Africa since 1960.. It includes studies of diseases and lesions of the oral mucosa, the dental hard tissues, tumours of the oral cavity and jaws and forensic odonto-stomatology. To date 139 articles have been published and accepted in scientific journals of which I was the first or co-author. The research presented here, however, comprises only those studies related to pathoses of the oral mucosa as it occurs in South Africa. Fifty-four papers and two abstracts are submitted. The papers are grouped into two divisions which include studies on (I) normal human oral and ectocervical mucosa and (II), those related to pathoses of the oral mucosa. The latter is subdivided into sections on: the profile of lesions of the oral mucosa in the community; cytological, clinical and morphological features of lesions of the oral mucosa; and studies on the aetiology of lesions of the oral mucosa. Each division and section is preceded by a declaration as to the contribution of the author or co-authors and a précis of the aims, objects and research findings. In the introduction of the précis statements are made explaining the aims of the study. These statements are not referenced because they appear in the respective articles.