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Dans le traitement des cancers des voies aérodigestives supérieures (VADS), une approche biologique par des anti-EGFR (Epidermal Growth Factor Receptor) comme le cetuximab (Erbitux®) a récemment été proposée. Le cetuximab est un anticorps monoclonal chimérique qui se lie spécifiquement au domaine extracellulaire de l’EGFR, régulateur central de la prolifération et de la différenciation dans les cancers. Par cette liaison, le cetuximab entre en compétition avec les ligands du récepteur et empêche son activation, induit son internalisation et bloque la transduction du signal vers les voies de signalisation en aval. Même si cette approche thérapeutique est rationnelle puisque l’EGFR est surexprimé dans la plupart des cancers et notamment dans les cancers des VADS, certains types de cancers présentent une résistance à cet anticorps. Parmi les molécules qui ciblent EGFR il existe également des inhibiteurs de l’activité tyrosine kinase intracellulaire de l’EGFR comme le gefitinib (Iressa®), mais ce dernier n’est actuellement pas prescrit dans le traitement des cancers des VADS.Le but de notre travail a été d’étudier les mécanismes de résistance au cetuximab dans des lignées cellulaires de cancers des VADS puis de proposer des associations thérapeutiques pouvant pallier à cette résistance.Nous avons choisi deux lignées cellulaires de cancers des VADS, CAL33 et SQ20B en comparaison à la lignée épidermoïde A431 sur exprimant EGFR et sensible au cetuximab. Nous avons pu mettre en évidence que CAL33 et SQ20B étaient résistantes au cetuximab mais de manière surprenante sensibles au gefitinib. Nous avons montré que l’absence d’inhibition de phosphorylation d’AKT et qu’une altération de l’internalisation de l’EGFR par le cetuximab étaient responsables en partie de la résistance au cetuximab dans ces modèles cellulaires.Afin de pallier à cette résistance nous avons alors étudié les conséquences biologiques de l’association du cetuximab avec (i) des inhibiteurs de la voie PI3K/AKT par différentes approches et avec (ii) les radiations ionisantes. Dans un premier temps, nous avons étudié l’influence de l’inhibition de la voie AKT par un inhibiteur de PI3K ou un siRNA ciblant AKT. Nous avons démontré que l’inhibition de la phosphorylation d’AKT par l’inhibiteur LY294002 sensibilisait au cetuximab la lignée CAL33 porteuse d’une mutation activatrice du gène PIK3CA codant pour la sous-unité catalytique p110 de la protéine PI3K. Nous avons montré que la persistance de l’activation d’AKT dans la lignée CAL33 prévenait l’effet anti tumoral du cetuximab, tandis que la résistance au cetuximab dans la lignée SQ20B ne semblait pas dépendante de la voie AKT.Une association de traitement du cetuximab avec les radiations ionisantes est déjà proposée en clinique dans le traitement des cancers des VADS. Nous avons donc dans un second temps déterminé les effets de cette association de traitement dans les lignées SQ20B et CAL33 respectivement sauvage et mutée dans la voie de signalisation AKT et dans la lignée contrôle A431. Nous avons montré que l’association du cetuximab aux radiations ionisantes potentialisait l’effet du cetuximab sur l’inhibition de prolifération de la lignée A431 alors que nous n’avons observé aucune potentialisation de l’effet du cetuximab sur la prolifération dans les lignées résistantes CAL33 et SQ20B. Dans ce travail, nous montrons que la voie AKT apparaît donc comme un élément central dans la réponse au cetuximab dans la lignée CAL33 et que l’association du cetuximab avec un inhibiteur de la voie PI3K/AKT pourrait être une bonne option thérapeutique dans le traitement des cancers des VADS mutés pour PIK3CA. / In the treatment of HNSCC (Head and Neck Squamous Cell Carcinoma), a biological approach by anti-EGFR (Epidermal Growth Factor Receptor) such as cetuximab (Erbitux ®) has been recently proposed. Cetuximab is a chimeric monoclonal antibody that specifically binds the extracellular domain of EGFR, a central regulator of proliferation and differentiation in cancer. For this binding, cetuximab is in competition with EGFR ligands, prevents receptor activation, induces its internalization and blocks the transduction and the downstream signaling pathways. Although this therapeutic approach is rational because EGFR is overexpressed in most of cancers, some cancers are resistant to this antibody. Among the molecules that target EGFR, there are also inhibitors of intracellular tyrosine kinase activity of EGFR such as gefitinib (Iressa ®), but these molecules are not currently used for the treatment of HNSCC cancers. The aim of our study was to characterize resistance mechanisms to cetuximab in a panel of HNSCC cell lines and to propose the treatment combination able to overcome this resistance.We chose two cell lines of HNSCC, CAL33 and SQ20B in comparison with A431 cell line which over express EGFR and which is sensitive to cetuximab. We had shown that CAL33 and SQ20B were resistant to cetuximab but sensitive to gefitinib. This study showed that the absence of inhibition of phosphorylation of AKT by cetuximab and the alteration of the EGFR internalization were responsible in part of the cetuximab resistance in these cell models. Then we studied the biological effects of the combination of cetuximab with (i) inhibition of PI3K/AKT by different approaches and (ii) ionizing radiation.We initially studied the influence of inhibition of AKT pathway by a PI3K inhibitor or siRNA targeting Akt. We demonstrated that inhibition of AKT phosphorylation by LY294002 sensitized CAL33 to cetuximab. This cell line carries an activating mutation of the PIK3CA gene encoding the catalytic subunit p110 of PI3K protein. We have shown that persistent activation of AKT in line CAL33 warned antitumor effect of cetuximab, while resistance to cetuximab in line SQ20B did not seem dependent on the AKT pathway. A combination therapy of cetuximab with ionizing radiation is already proposed in the clinical treatment of these cancers. We therefore determined n the second step, the effects of this combination treatment in lines CAL33 and SQ20B respectively in the wild and mutant AKT signaling pathway and the control line A431. We have shown that the combination of cetuximab to ionizing radiation potentiated the effect of cetuximab on the inhibition of proliferation of line A431, whereas we observed no potentiation of the effect of cetuximab on the proliferation in the resistant lines CAL33 and SQ20B. In this work, we show that the AKT pathway is therefore a central element in the response to cetuximab in line CAL33 and the combination of cetuximab with an inhibitor of the PI3K/AKT pathway might be a good therapeutic option in the treatment of these cancers with a PIK3CA mutation.

In humans, von Willebrand factor (vWF) is a key component in hemostasis and acts as a 'cellular adhesive' by letting the circulating platelets bind to exposed subendothelium. It also acts as a carrier and stabilizer of factor VIII (FVIII). A dysfunction or reduction of vWF leads to von Willebrand disease (vWD), resulting in bleeding phenotype which affects 1% of the population. Currently there are a variety of animal models used for the study of vWF and vWD; however, they do not possess the advantages found in zebrafish. Therefore, we set out to establish zebrafish as a model for the investigation of vWF and vWD through the use of bioinformatics and various molecular techniques. Using bioinformatics we found that the vWF gene is located on chromosome 18, that the GPIb? protein sequence is conserved. Confirmation of vWF production was shown by means of immunostaining and by RT-PCR, in thrombocytes as well as in veins and arteries. Evidence of vWF involvement in hemostasis and thrombosis was shown using MO and VMO technology to produce a vWD like phenotype, resulting in an increase in TTO and TTA, as well as a reduction in FVIII when blood was tested using the kPTT assay, coinciding with a decrease in vWF. Stimate treatment provided opposite results of MO and VMO, showing a decrease in TTO and TTA. Investigation of the role of microparticles in hemostasis and their interaction with vWF resulted in a conclusion that the GPIb? receptor should exist on MPs and that it may interact not only with zebrafish vWF but also with human UL-vWF. Agglutination of MPs in the presence of UL-vWF but in the absence of ristocetin and plasma, treatment with ADAMTS-13 abolishing the interaction between MPs and UL-vWF provided evidence that vWF interacts with MPs probably with the GPIb?. We also found that TMPs agglutinate within the vessel wall in vivo when treated with Stimate. In conclusion, this research provided evidence for the presence of vWF in zebrafish and its conserved role in hemostasis. In addition to this we also showed that MPs also participation in hemostasis.

With its widespread use across the country and increasing evidence of its effectiveness, the wraparound process has been accepted widely as a feasible alternative to restrictive residential treatments for children with severe emotional and behavioral disorders. Yet wraparound has been implemented and conceptualized in such a variety of ways that many have begun to question whether it truly is a single definable approach. Recently, a conceptual model for wraparound was offered that included ten essential elements as the key ingredients for this approach. Subsequently, the Wraparound Fidelity Index (WFI) was designed to measure the degree to which an intervention adheres to these ten elements. The purpose of the current study was to use data collected via the WFI to provide the first empirical test of wraparound’s conceptual model. Programs providing wraparound to children with severe emotional and behavioral disorders and their families used the WFI to collect data from caregivers (n = 481), youths (n = 355; 11 to 19 years), and resource facilitators (n = 610). Confirmatory factor analysis (CFA) was used to test the fit of a series of structural models consistent with the proposed element model of wraparound. First, CFA models were examined separately for each of the elements. Second, CFA models that represent the full wraparound model were tested, separately for each of the three informants. And third, a multitrait-multimethod (MTMM) analysis was conducted using a final CFA model including all elements (traits) and the three informants (methods). Findings supported the majority of elements and WFI items when tested separately at the first step. However, at the second step, only the youth model provided adequate fit to the data. Significant modification was necessary to yield admissible solutions for the caregiver and resource facilitator models. Finally, an inadmissible solution resulted when the three informants and revised model were tested in step three. Implications of the findings for the wraparound process, the WFI, and future research are discussed.

This project has three parts. The first part is to use the efficient frontier and find the tangency portfolio to form our optimal portfolio. We built our portfolio using the Interactive Brokers software and rebalanced every week for 4 holding periods to see the relationship between our projected returns and actual market returns. In the second part we considered the Capital Asset Pricing Model (CAPM) and ran linear regressions on the stocks we chose in the first part of the project. This process is based on our idea of finding the systematic risk in each stock to improve our stock choosing ability. In the last part we introduce the concept of factor models and add more factors into our original CAPM model. Via a back-testing method, we test the reasonability of our factors and give advice to further improve our portfolio optimization project.

University of Macau / Institute of Chinese Medical Sciences

by Wai-kwan Fong. / Bibliography: leaves 37-39 / Thesis (M.Phil.) -- Chinese University of Hong Kong, 1983