Submitted by Hiolanda Rêgo (hiolandarego@gmail.com) on 2017-02-22T14:27:22Z No. of bitstreams: 1 Tese_ICS_Joyce Moura Oliveira.pdf: 8050921 bytes, checksum: bf7fdf7ed918ea4d6412bc2167f0ab1d (MD5) / Made available in DSpace on 2017-02-22T14:27:22Z (GMT). No. of bitstreams: 1 Tese_ICS_Joyce Moura Oliveira.pdf: 8050921 bytes, checksum: bf7fdf7ed918ea4d6412bc2167f0ab1d (MD5) / CAPES /INCT – DT / A hanseníase é uma doença negligenciada que permanece como um importante problema de saúde pública, mantendo índices de detecção acima do preconizado pela OMS para o controle da doença. Com o objetivo de entender melhor os mecanismos moleculares de patogênese e contribuir para o controle futuro da doença, este estudo buscou avaliar o papel de genes do locus do MHC de classe III: TNFA, LTA e BAT1 e nos genes de IL10 e FLI1 na hanseníase em uma população da Bahia. Foi utilizado o modelo caso-controle com casuística de 362 pacientes com hanseníase e 368 indivíduos controles sem a doença. Nessa amostra, foram genotipados nove marcadores genéticos (SNPs) e avaliada a expressão gênica das principais citocinas, TNF-α e IL-10. Mecanismos de regulação epigenética do gene de FLI1 na hanseníase per se foram avaliados pelo padrão de metilação do gene em células de pacientes, cultivadas sem estímulo e estimuladas com antígeno sonicado de M. leprae em diferentes tempos. Não foram encontradas associações significantes entre a doença e os polimorfismos do MHC de classe III avaliados em TNFA, LTA e BAT1, e o mesmo ocorreu com os marcadores avaliados no gene de IL10 (p>0,05). A expressão do gene de TNFA ex vivo foi significativamente maior em pacientes quando comparados a controles sem a doença (p=0,002). Na análise deste gene considerando o SNP rs1800629 (-308 A/G), um marcador previamente associado à hanseníase em diferentes populações, observamos que indivíduos homozigotos para o alelo G expressam mais o gene do que indivíduos carreadores do alelo A (GA+AA) (p=0,002). Estes resultados reforçam que, mesmo não diretamente associado a hanseníase nesta população, este marcador pode ter um papel indireto na regulação da produção de TNF-α na infecção pelo M. leprae. A expressão do gene de IL10 ex vivo foi maior em indivíduos com o fenótipo de reação hansênica tipo I (Reação reversa – RR), do que pacientes sem manifestações agudas da doença e significante em relação a controles (p=0,01). Análise do marcador no gene de FLI1 (rs7930515 G\C) revelou um maior risco para o desenvolvimento de reações hansênicas entre carreadores do alelo C (OR=1,53; 1.09 - 2.15 p=0,001) em comparação com alelo G. Nas análises subsequentes observamos que essa associação ocorre na presença de reação do tipo II (ENH) com risco de 1,89 vezes maior para o seu desenvolvimento entre carreadores do alelo C (OR=1,89; IC: 1.25-2.85; p=0,001) e associação negativa para a reação do tipo I (P>0,05). O polimorfismo avaliado no gene de FLI1, que impacta no caminho de cura de lesões na Leishmaniose em humanos, aparece reforçado como potencial marcador de doença na hanseníase e para o desenvolvimento de reação hansênica do tipo II. Sendo a hanseníase uma doença complexa este resultado pode contribuir para um melhor entendimento sobre a patogênese, e inspirar a investigação de novas vias importantes no processo de dano tecidual observado nessa doença.

Les siRNA se sont des agents actifs et spécifiques couramment utilisés en thérapie génique. L’intérêt d’utiliser des nanoparticules en tant que vecteurs des siRNA est leur capacité à protéger ces derniers de la dégradation par les nucléases et également de leur permettre d’être délivrés au niveau de leur cible thérapeutique. Afin d’appuyer cette théorie, ce travail s’est concentré sur un modèle cellulaire de sarcome d’Ewing, dans le but de mettre au point un nouveau système galénique pour le transport de siRNA formé des nanoparticules bifonctionnelles de diamants fluorescentes recouvertes par des polymères cationiques. Ces nano-vecteurs sont capables d’induire efficacement l’inhibition de l’expression de l’oncogène EWS-Fli1 dans les cellules en culture s’ils transportent des siRNA dirigés contre ce gène. Par ailleurs, les nanodiamants, grâce à leurs propriétés de fluorescence stable et intense, ont constitué des outils de détection permettant de suivre leurs voies de pénétration, leur biodistribution cellulaire, ainsi que la cinétique de libération des siRNA dans le cytoplasme. Enfin, un modèle de nanodiamants fonctionnalisés par le polyéthylenimine a été choisi pour la poursuite des travaux biologiques en raison de son efficacité de vectorisation. / SiRNA are powerful and commonly used agent for the specific inhibition of gene expression. They need to be vectorized by nanoparticles to facilitate cell penetration and their protection from degradation in biological media. At first, cationic nanodiamonds coated with cationic polymers were developed and were able to adsorb siRNA on their surface. Using antisense siRNA against the oncogene EWS-Fli1, nanodiamonds allowed to efficiently induce the inhibition of expression of the oncogene EWS-FLI1 in cultured Ewing sarcoma cells. As a second goal of this study, the fluorescence of red color center created in the nanodiamonds was used to follow their pathways, their cellular biodistribution and the kinetics of release of siRNA into the cytoplasm. In conclusion, nanodiamonds functionalized by polyethylenimine showed a better transfection efficiency and were chosen for further biological studies.

Submitted by Hiolanda Rêgo (hiolandarego@gmail.com) on 2017-03-06T13:14:08Z No. of bitstreams: 1 Tese_Med_ Lucas Frederico de Almeida.pdf: 7866748 bytes, checksum: c6c7f11d9447181d9a6b3340df160336 (MD5) / Approved for entry into archive by Delba Rosa (delba@ufba.br) on 2017-03-23T12:36:46Z (GMT) No. of bitstreams: 1 Tese_Med_ Lucas Frederico de Almeida.pdf: 7866748 bytes, checksum: c6c7f11d9447181d9a6b3340df160336 (MD5) / Made available in DSpace on 2017-03-23T12:36:46Z (GMT). No. of bitstreams: 1 Tese_Med_ Lucas Frederico de Almeida.pdf: 7866748 bytes, checksum: c6c7f11d9447181d9a6b3340df160336 (MD5) / NIH;FAPESB / Estudos prévios têm demonstrado um papel para os genes de cura de lesão na resolução das lesões cutâneas causadas por espécies de Leishmania em camundongos e humanos, incluindo o gene FLI1 (Friend leukemia vírus integration 1). O alto grau de metilação de ilhas CpG na região promotora do gene FLI1 é conhecido por tornar o gene transcricionalmente inativo. Redução da expressão de FLI1 resulta na regulação positiva dos genes COL1A1 (collagen type I alpha 1) e COL1A2 (collagen type I alpha 2), e, inversamente, na regulação negativa do gene MMP1 (matrix metallopeptidase 1). Ambos, colágeno do tipo 1 e metaloproteinase de matriz 1, desempenham um importante papel nas condições fisiológicas normais e patológicas de muitas doenças, e estão envolvidos no reparo de lesões. Adicionalmente, em estudo prévio, foi mostrada uma associação entre leishmaniose e um polimorfismo regulatório no gene IL6 (interleukin 6), e dados na literatura sugerem uma interação funcional entre IL6 e FLI1. Para entender melhor o papel desta via na leishmaniose, nós avaliamos o polimorfismo dos genes COL1A1, COL1A2 e MMP1 e sua possível associação com a leishmaniose tegumentar americana na população de Corte de Pedra, Bahia, assim como também avaliamos a expressão gênica de COL1A1, COL1A2, MMP1, FLI1, e o grau de metilação em ilhas CpG da região promotora deste último gene em biópsias de pele e em culturas de macrófagos infectados por Leishmania braziliensis. No estudo de associação genética, FBAT (Family-based association tests) mostrou uma forte associação entre os marcadores COL1A1_rs1061237 (P = 0,002) e COL1A1_rs2586488 (P = 0,027) e o fenótipo leishmaniose cutânea. O estudo com biópsias de pele revelou que a porcentagem de DNA metilado na região promotora de FLI1 foi mais baixa (P = 0,001) em biópsias de lesão de leishmaniose cutânea comparadas com biópsias de pele normal. A expressão gênica de FLI1 e de COL1A1 não diferiu entre as biópsias de lesão e as biópsias de pele normal, enquanto a expressão de COL1A2 foi menor (P = 0,033) e a expressão de MMP1 foi maior (P = 0,0002) nas biópsias de lesão de leishmaniose cutânea. Por fim, a análise da expressão gênica em macrófagos infectados mostrou que a expressão de FLI1 induzida pela infecção por Leishmania braziliensis teve um pico com 24 horas de infecção (P < 0,0001), e foi maior (P = 0,005) e teve um pico mais tardio (48 horas) na presença de IL-6. A expressão de genes de colágeno do tipo 1, COL1A1 e COL1A2, foi baixa em macrófagos infectados, e não foi detectável em macrófagos tratados com IL-6. A expressão de MMP1 foi fortemente induzida (P = 0,007) após infecção de macrófagos, mas não foi facilmente detectável em macrófagos tratados com IL-6 até 72 horas de infecção, quando o efeito da IL-6 na expressão de FLI1 diminuiu. MMP1 quebra o colágeno do tipo 1 intersticial, que é essencial para a migração de queratinócitos e o processo de re-epitelização. Porém, em lesões ativas de leishmaniose cutânea, baixos níveis de colágeno do tipo 1 junto com a exagerada expressão de MMP1 indica que o MMP1 está contribuindo para o dano tecidual em vez de levar ao reparo. Similarmente, foi observado que níveis exagerados de MMP1 contribuem para a destruição do tecido e progressão para a doença na tuberculose, levando outros autores a destacar o MMP1 como potencial alvo terapêutico. Nossos dados sugerem que a modulação desta via pode também ser relevante no tratamento da leishmaniose cutânea.

Scleroderma (SSc) is an autoimmune disease characterized by dysfunctional immunity, vasculopathy, and fibrosis of the skin and internal organs. There is a poor prognosis for SSc patients and effective therapeutics have not yet been developed. Many mouse models have been developed, but most fail to recapitulate all of the symptoms seen in SSc patients. In this study we characterize a Fli1flox/flox mouse with CAG Cre under the beta-actin promoter. Based on what has been previously described in mice with deletion of Fli1 in specific cell types, we predicted that global postnatal deletion of Fli1 will result in systemic fibrosis, vasculopathy, and inflammation in these mice. The penetrance of a phenotype was highly variable; however, mice that developed a phenotype displayed disorganized vascular networks, fibrosis and proinflammatory cytokines and chemokines in the skin and lungs after 4 and 8 weeks of Fli1 deficiency. Increased macrophage and dendritic cell populations were observed in the lungs after 8 weeks. Fli1flox/flox CAG Cre mice exhibited hair loss after 5 months of Fli1 deletion. Since our experiments focus mainly on the lungs and skin, more experiments are required to characterize these mice to determine if they can be used as a novel animal model of SSc.

Le sarcome d’Ewing est une tumeur pédiatrique de l’os très agressive, généralement causée par une translocation chromosomique aboutissant à la protéine de fusion EWSR1-FLI1 qui dérégule l’expression d’un grand nombre de gènes participant à l’oncogenèse du sarcome d’Ewing. Au laboratoire, nous avons pu mettre en évidence une hétérogénéité intra-tumorale de l’expression d’EWSR1-FLI1 aboutissant à un nouveau modèle de la biologie du sarcome d’Ewing basé sur la coexistence de cellules EWSR1-FLI1high, participant à la prolifération de la tumeur primaire, et de cellules EWSR1-FLI1low, capables de dissémination métastatique. Au cours de ma thèse, je me suis intéressée en particulier aux mécanismes moléculaires sous-jacents aux capacités migratoires et invasives des cellules EWSR1-FLI1low. Nous avons ainsi pu mettre en évidence une diminution des jonctions serrées intercellulaires associée à une augmentation des interactions cellule-matrice chez les cellules EWSR1 FLI1low. Nous avons ensuite révélé le rôle clé des MMP dans l’invasion du sarcome d’Ewing, plus spécifiquement de la MMP2 et de la MT1-MMP qui sont toutes deux réprimées par EWSR1-FLI1 et sont apparues nécessaires à l’invasion des cellules EWSR1-FLI1low. L’un des défis majeurs actuels est de parvenir à visualiser cette sous-population très minoritaire et à suivre la plasticité de l’expression d’EWSR1-FLI1. Pour cela, l’identification de marqueurs des cellules EWSR1-FLI1low est cruciale. Ceci est également important pour déterminer si les chimiothérapies actuelles, qui ciblent plutôt les cellules prolifératives, n’entraînent pas une augmentation de la proportion de ces cellules au sein de la tumeur primaire. Enfin, nos essais infructueux d’utilisation de l’embryon de poulet comme nouveau modèle de la métastase du sarcome d’Ewing in vivo ont souligné la fragilité globale et les limitations de ce type de modèle, indiquant plutôt la nécessité d’améliorer les modèles murins existants. La mise au point de modèles in vivo apparaît en effet primordiale pour mieux disséquer les mécanismes moléculaires de la métastase et permettre le test de drogues susceptibles d’inhiber ce processus. / Ewing sarcoma is a very aggressive pediatric bone tumor generally caused by a chromosomal translocation that leads to the expression of the EWSR1-FLI1 fusion protein. This protein deregulates the expression of a number of genes involved in Ewing sarcoma oncogenesis. In the laboratory, we discovered an intra-tumor heterogeneity of EWSR1-FLI1 expression which lead us to propose a new model for Ewing sarcoma biology based on the coexistence of EWSR1-FLI1high cells, responsible for primary tumor growth, and EWSR1-FLI1low cells, with metastatic dissemination capacities. During my phD, I was especially interested in the molecular mechanisms underlying the migration and invasion capacities of EWSR1-FLI1low cells. We showed a decreased expression of intercellular junctions proteins associated with an increased expression of cell-matrix interaction proteins in EWSR1-FLI1low cells. We then revealed the key role of MMPs in Ewing sarcoma invasion, in particular of MMP2 and MT1-MMP, which are both repressed by EWSR1-FLI1 and were found necessary for invasion of EWSR1-FLI1low cells. One of the current major challenges is to visualize this very small sub-population and to track the plasticity of expression of EWSR1-FLI1. To this end, the identification of markers of EWSR1-FLI1low cell is crucial. This is also important in order to determine if current chemotherapies that primarily target highly proliferative cells do not increase the proportion of these EWSR1-FLI1low cells. Finally, our unsuccessful attempts to use the chick embryo as a new in vivo model of Ewing sarcoma metastasis indicate the need to improve the existing murine models. Indeed, the development of in vivo models appears essential for the dissection of the molecular mechanisms of Ewing sarcoma metastasis and the test of drugs susceptible to inhibit this process.

No description available.

The EWSR1-FLI1 t(11;22)(q24;q12) translocation is the pathognomonic genomic alteration in 85% of the Ewing Family of Tumors (EWFT) a malignancy of the bone and the surrounding tissue, predominantly affecting children and adolescents. This translocation results in the formation of a chimeric oncoprotein which acts as an aberrant transcription factor that is currently not pharmaceutically druggable, driving the need for more effective targeted therapies. The EWSR1-FLI1 translocation induces a variety of changes including dysregulation of the epigenome and altered gene expression to drive tumorigenesis, and consequently contributes to the hypersensitivity of EWFT to several classes of chemotherapeutics. We sought to exploit these intrinsic sensitivities by employing a matched pair of cell lines derived from the same patient with Ewing sarcoma prior to and following chemotherapy, a panel of Ewing sarcoma cell lines, and several patient-derived xenografts (PDX) collected at the time of relapse or autopsy, which led us to the development of two novel combination targeted therapies for EWFT. In our matched pair of EWFT cell lines, we found sensitivity to the Poly(ADP-ribose Polymerase (PARP) inhibitor olaparib was diminished following chemotherapy, despite a predicted sensitivity. In addition, we discovered increased expression of the antiapoptotic protein BCL-2 in the chemotherapy-resistant cells, conferring apoptotic resistance to olaparib. We found that EWS-FLI1 increases BCL-2 expression; however, inhibition of BCL-2 alone is insufficient to sensitize EWFT cells to olaparib, revealing a dual necessity for BCL-2 and BCL-XL (BCL2L1) in EWFT survival. These data reveal BCL-2 and BCL-XL act together to drive olaparib mediated apoptotic resistance in Ewing sarcoma and identify a novel, rational combination therapy using olaparib and the BCL-2/BCL-XL inhibitor navitoclax. In addition, using high throughput drug screening we have identified a novel epigenetic susceptibility in EWFT to GSK-J4 (GlaxoSmithKline), an inhibitor of lysine 27 of histone 3 (H3K27) demethylases: ubiquitously transcribed tetratricopeptide repeat, X chromosome (UTX) and Jumonji D3 (JMJD3). Treatment with GSK-J4 leads to a decrease in H3K27 acetylation (H3K27ac) and ultimately, the silencing of EWS-FLI1 gene targets. We sought to sensitize GSK-J4-mediated inhibition of EWS-FLI1 targets by blocking RNA polymerase II activity using the Cyclin Dependent Kinase 7 (CDK7) inhibitor THZ1. By targeting CDK7-mediated transcription we were able to sensitize EWFTs to H3K27 demethylase inhibition. We therefore propose co-targeting of H3K27 demethylases and CDK7 acts as a surrogate EWS-FLI1 inhibitor. Given the difficulties targeting EWS-FLI1, these strategies may present viable clinical therapies.

Le sarcome de Ewing est la seconde tumeur pédiatrique de l’os la plus fréquente. Elle est caractérisée par une translocation chromosomique résultant à la fusion de EWSR1 avec un membre de la famille ETS. Chez 85% des patients, cette fusion conduit à l’expression de la protéine chimérique EWS-FLI1 qui est l’oncogène majeur de ce sarcome. Ce dernier agit principalement par son action transcriptionelle sur des cibles qui lui sont propres. Au niveau thérapeutique, le sarcome d’Ewing est traité par chimiothérapie, chirurgie locale et par radiothérapie. La survie à long terme des patients est de l’ordre de 70%, mais beaucoup plus basse pour les patients métastatiques et quasi nulle lors d’une récidive. Parmi maintes caractéristiques, certains cancers présentent une dérégulation énergétique. L’influence d’EWS-FLI1 sur cet aspect n’a fait l’objet d’aucune étude dans le contexte du sarcome d’Ewing. Nous avons donc étudié par profilage métabolomique des cellules de sarcome d’Ewing en présence ou en absence d’EWS-FLI1. En comparant ces deux conditions, des modulations du profil énergétique relatif au cycle de Krebs, des précurseurs de le glycosylation ainsi que des métabolites de la voie de la méthionine et du tryptophane ont été observés. En parallèle, grâce à un crible de banque de shRNAs réalisé dans des conditions expérimentales similaires à l’étude métabolomique (lignée d’Ewing avec ou sans EWS-FLI1), nous avons pu identifier des gènes présentant des caractéristiques « synthétique létales », c'est-à-dire tuant uniquement les cellules du sarcome d’Ewing en présence de son oncogène. / Ewing sarcoma, the second most commonly occurring pediatric bone tumor, is most often characterized by a chromosomal translocation between EWSR1 and FLI1. The gene fusion EWS-FLI1 accounts for 85% of all Ewing sarcoma and is considered the major oncogene and master regulator of Ewing sarcoma. EWS-FLI1 is a transcriptional modulator of targets, both directly and indirectly. Ewing sarcoma is aggressively treated with chemotherapy, localized surgery and radiation and has an overall survival of about 70%, however, survival for metastasis or relapsed cases remains low. One of the cancer hallmarks, metabolic deregulation, is most likely partly dependent on EWS-FLI1 in Ewing sarcoma cells. In order to get a better understanding of Ewing sarcoma biology and oncogenesis, it might be of high interest to investigate the influence of EWS-FLI1 in Ewing sarcoma cells. We therefore performed a global metabolic profiling of Ewing sarcoma cells with or without inhibition of EWS-FLI1. Several changes in the energy metabolism were observed throughout this study; the observed changes were consistent with an energy profile that moved from a cancer cell energy metabolism towards the energy metabolism of a more normal cell upon EWS-FLI1 inhibition, primarily based on the TCA cycle. Levels of TCA intermediates, glycosylation precursors, methionine pathway metabolites and amino acids, especially changes in the tryptophan metabolic pathway, were altered upon EWS-FLI1 inhibition. Parallel to this study, we performed a high-throughput synthetic lethality screen, in order to not only identify essential genes for cell survival and proliferation, but also to identify new synthetic lethal targets that could specifically target Ewing sarcoma cells carrying the EWS-FLI1 fusion gene.

Introduction: Genetic rearrangements in Ewing sarcoma, prostate, and leukemia cells result in activation of oncogenic ETS transcription factor fusions. Mithramycin (MTM) has been identified as an inhibitor of EWS-FLI1 transcription factor, a gene fusion product responsible for oncogenesis in Ewing sarcoma. Despite preclinical success, a phase I/II clinical trial testing MTM therapy in refractory Ewing sarcoma was terminated. Liver and blood toxicities resulted in dose de-escalation and sub-therapeutic exposures. However, the promise of selectively targeting oncogenic ETS transcription factors like EWS-FLI1 prompted us to undertake the discovery of more selective, less toxic analogues of MTM. MTM is a potent inhibitor of ubiquitous SP1 transcription factor, likely inducing non-specific toxicity. In collaboration with two medicinal chemistry groups, two semi-synthetic efforts were implemented to develop novel analogues of MTM. The first effort utilized the biosynthetic product mithramycin SA (MTMSA) to modify C3-side chain. The second effort utilized an oxime linker directly formed on MTM’s C3-side chain (MTM-oxime; MTMox). Here I present the pharmacological assessment of over 75 novel MTM analogues towards selectively targeting oncogenic ETS transcription factors, like EWS-FLI1, over ubiquitous transcription factors, like SP1. Methods: Novel MTM analogues were evaluated for selective cytotoxicity against ETS fusion-dependent cell lines. Selectively cytotoxic analogues were evaluated for inhibitory effects on several gene promoters in TC-32 reporter cell lines, a Ewing sarcoma cell line dependent on EWS-FLI1, transfected with luciferase reporter vector. Cloned reporter vectors incorporated NR0B1 (EWS-FLI1 binding), β-actin (SP1 binding) and CMV (non-specific) gene promoters. Furthermore, gene (mRNA) and protein expression changes of EWS-FLI1 and SP1, as well as regulated target genes, namely NR0B1, VEGFA and BCL-2 were evaluated with MTM analogue treatments. The MTM analogues with most selective activity in vitro were administered to mice by intravenous bolus dose for pharmacokinetic analysis. The MTM analogues with highest systemic exposure from each semi-synthetic effort, namely MTMSA-Trp-A10 and MTMox-24, were further evaluated. Metabolic stabilities in whole blood, plasma, and tumor cell matrices, and across multiple species were compared with MTM. Moreover, intrinsic hepatic clearances were estimated using mouse liver microsomes. Tumor and liver distributions were estimated in tumor bearing mice. Additionally, the effect of organic anionic transporter polypeptides (OATP) on distribution of MTM was investigated. Maximum tolerated doses were evaluated for lead MTM analogues, having both selective activities in vitro and high systemic exposure, compared to MTM. Complete blood cell counts and plasma alanine aminotransferase activity were measured to evaluate dose-dependent blood and liver toxicities, respectively. ETS fusion-dependent and non-dependent cell lines were implanted subcutaneously into immunocompromised mice for efficacy studies. Average tumor volumes and survival were tracked for mice receiving treatment, compared to MTM and vehicle treatment. Results: Evaluation of MTM analogues from both semi-synthetic efforts revealed that conjugation of MTM C3-side chain with tryptophan (Trp) and/or phenylalanine (Phe) improved selective cytotoxicity against ETS fusion-dependent cell lines. This was highlighted by MTMSA-Trp-A2 (also refer to as MTMSA-Phe-Trp) and MTMSA-Trp-A10 (also refer to as MTMSA-Trp-Trp), with selective indices of 19.1 and 15.6, respectively, compared to MTM (1.5). Similarly, MTMox-23 (also refer to as MTMox-Phe-Trp) and MTMox-20 (also refer to as MTMox-Trp) had selectivity indices of 4.6 and 4.5, respectively. These selectively cytotoxic MTM analogues inhibited EWS-FLI1-mediated transcription 10-fold more effectively than both non-specific CMV-mediated and SP1-mediated (via β-actin promoter) transcription in TC-32 reporter cell lines. Moreover, gene (mRNA) and protein expression of EWS-FLI1 and regulated gene, NR0B1, were inhibited with MTM analogue treatment (GI50, 6-hour) in TC-32 cells. Similarly, SP1 and target genes, VEGFA and BCL-2, gene (mRNA) and protein expressions were also inhibited with MTM analogue treatment (GI50, 6-hour) in TC-32 cells. Conjugation of Trp and/or Phe to C3-side chain of MTM increased systemic exposure in vivo. Most impressively, the addition of two Trp residues, namely MTMSA-Trp-A10 and MTMox-24 (also refer to as MTMox-Trp-Trp), resulted in systemic exposure increases of 218- and 42-fold, respectively, after intravenous (IV) bolus dose. Metabolically, tryptophan/phenylalanine conjugated MTM analogues are liable to esterase activity on carboxy-methyl functional group. Very rapid de-methylation in biological matrix was observed with MTMox-24, compared to MTMSA-Trp-A10, suggesting a regiospecific effect. However, esterase activity was limited to rodent matrices and demethylation occurred at significantly diminished rates in non-human primate and human plasma. MTM analogues were not susceptible to p450-mediated metabolism, with negligible loss in mouse liver microsome assay compared to verapamil control. MTM (1mg/kg) and MTMox-24 (6mg/kg) were detected in subcutaneously implanted (flank) LL2 tumors and liver homogenates after IV bolus dose. Interestingly, MTMSA-Trp-A10 (2mg/kg) was not. Despite a 3-fold increase in systemic exposure with rifampin oral pretreatment, an OATP inhibitor, exposure of MTM was unaffected in Oatp knockout mouse model. Exposure of MTM in liver tissue was 8.4-fold higher compared to tumor tissue with low tissue clearance. This agrees with the lack of metabolism observed in liver microsomes and may provide a mechanism for clinically observed liver toxicity. MTMSATrp-A10 had a single maximum tolerated dose (MTD) of 0.75mg/kg, compared to 1mg/kg for MTM, administered by IV bolus. In contrast, MTM-oxime analogues (MTMox-20, -23, -24 and -25) had single maximum tolerated doses of 20 – 25mg/kg. These increased tolerances are the result of additive differences in whole blood stability, cytotoxicity and systemic exposure. At a dose of 0.75mg/kg, administered every 3 days, MTMSA-Trp-A10 did not result in an efficacious result in tumor xenograft studies. These studies remain under further investigation, but the result may indicate high plasma protein binding of MTMSA-Trp-A10 and lack of free fraction available within tumor. The most selective MTM-oxime analogue in vitro, MTMox-23, significantly inhibited TC-32 (EWS-FLI1+) tumor xenograft growth (p=0.0025, day 16, one-way ANOVA multiple comparisons test) compared to MTM (p=0.1174, day 16) and extending survival for 17 days out of 48 days on study (p=0.0003, Log Rank (Mantel-Cox) single comparison test) with treatment at MTD every 3 days, compared to vehicle. Additionally, the MTM-oxime analogue with highest systemic exposure, MTMox-24, also significantly inhibited TC-32 (EWS-FLI1+) tumor xenograft growth (p=0.0003, day 21, one-way ANOVA multiple comparisons test) compared to MTM (p=0.032, day 21) and extending survival for 12 days out of 37 days on study (p=0.0004, Log Rank (Mantel-Cox) single comparison test) with treatment, compared to vehicle. Conclusion: These studies in whole highlight the importance of exposure (pharmacokinetics; PK), toxicity and efficacy (pharmacodynamics; PD) relationships. The cytotoxicity and high systemic exposure of MTMSA-Trp-A10 directly contributes to its lower tolerated dose. However, despite a similar tolerated dose to MTM, systemic exposure remains 163-fold higher at the MTD. High systemic exposure may be attributed to high plasma protein binding, but also reduces the exposure of free MTMSA-Trp-A10 within the tumor tissue, which drives the efficacious response. In contrast, the less cytotoxic and rapidly de-methylated MTM-oxime analogues allow for 25-fold higher tolerances in mice. This unique metabolism and clearance may prevent exposures required to induced systemic blood and liver toxicities induced by MTM. Moreover, at these highly tolerated doses, the initial systemic exposure at MTD is highest among analogues tested, which resulted in an efficacious response with MTMox-23 and MTMox-24 treatment in tumor xenograft models. It remains to be determined if these PK/PD relationships can be reproduced in additional animal models, including human, without inducing toxicity. Nonetheless, these initial studies in mice demonstrate that a more selective, more tolerated analogue of MTM has potential for clinical success in treating ETS fusion-dependent tumors.