PURPOSE: HCC is a complicated disease with high mortality rates and limited treatment options. No universal clinical or molecular classification established to inform better treatment options. There has been very limited success in determining a molecular profile that represent valid drivers in HCC patients and thus no targeted agents have obtained marketing approval. However, emerging data suggest the FGF19-pathway as a HCC driver and a potential therapeutic target. This research study aims to investigate whether the HCC prognostic risk factor, serum AFP, is predictive of FGF19 protein expression as assessed by immunohistochemistry in advanced HCC patients. METHODS: A cross-sectional analysis was performed from baseline data collected in a Phase 1 study conducted at various centers across the US, EU, and Asia. Only advanced HCC patients with adequate liver function were eligible for enrollment. Demographic data, detailed history of HCC, and any prior treatments or surgeries were recorded. Baseline laboratory values and prognostic factors including performance status (ECOG), lab values (i.e. bilirubin, albumin), and the number, size and biomarker status of the tumor(s) were collected. Differences between groups were assessed by t test, or Chi-square test, as appropriate. Multivariate logistic stepwise regression analyses were performed including all parameters with highly significant correlations in the multivariate analysis. RESULTS: Only AFP, metastatic disease, and prior surgery met the criteria to be incorporated into the final model. Results indicated that high AFP had a statistically significant (p-value = .01) positive association (Wald chi-square statistic = 6.601) with positive FGF19 IHC status. The odds ratio for being FGF19 IHC+ was 12.216 among the high AFP subjects as compared to low AFP subjects, and also statistically significant but had a very wide 95% confidence interval (1.811, 82.79). CONCLUSIONS: The results indicated that HCC patients with high serum AFP levels have a twelve fold higher chance of having a positive FGF19 IHC status than those with low AFP levels. Further studies are warranted in order to replicate the data in a larger sample size to understand future clinical implications once treatment options become available for FGF19 IHC positive patients.

Indiana University-Purdue University Indianapolis (IUPUI) / Many signaling pathways which are classically understood for their roles in early development are also known to be involved in tissue maintenance and adult energy homeostasis. Furthermore, dysfunction of these signaling pathways results in human diseases such as cancer. An in depth understanding of how developmentally important signaling pathways function in the adult will provide mechanistic insights into disease and potential new therapeutic targets. Here in Chapter 1, the Wnt, fibroblast growth factor (FGF), and Hedgehog (Hh) signaling pathways are discussed and examples of their relevance in development, adult homeostasis, and disease are provided. Wnt signaling provides an example of this concept as it has well described roles during both development and adult metabolism. Work included in Chapter 2, investigates the regulation of adult energy homeostasis by a member of the endocrine FGF family, FGF19. The three endocrine FGFs, FGF19 (FGF15 in mice), FGF21, and FGF23 have well described roles in the regulation of metabolic processes in adults. While FGF23 is primarily involved in the regulation of phosphate and vitamin D homeostasis, FGF19 and FGF21 have shown similar pharmacological effects on whole body metabolism. Here, the importance of adaptive thermogenesis for the pharmacological action of FGF19 is explored. Using UCP1KO animals we show that whole-body thermogenesis is dispensable for body weight loss following FGF19 treatment. Finally, the potential involvement of Hh signaling in mediating the hyperphagia driven obesity observed in certain ciliopathies is explored in Chapter 3. Emerging evidence suggests cilia play an important role in the regulation of feeding behavior. In mammals, the hedgehog pathway is dependent on the primary cilium as an organizing center and defects in hedgehog signaling share some clinical symptoms of ciliopathies. Here, we characterized the expression of core pathway components in the adult hypothalamus. We show that neurons within specific nuclei important for regulation of feeding behavior express Hh ligand and members of its signaling pathway. We also demonstrate that the Hh pathway is transcriptionally upregulated in response to an overnight fast. This work provides an important foundation for understanding the functional role of Hh signaling in regulation of energy homeostasis. In its entirety, this work highlights the emerging clinical relevance of developmentally critical pathways in diseases associated with dysfunction of adult tissue homeostasis, such as obesity.

Fibroblast Growth Factor 19 (FGF19 chez l’humain ; FGF15 chez la souris) est un régulateur central du métabolisme hépatique. Cette molécule a un impact important au niveau de la différentiation neurologique et de l’oreille interne au stade foetal. À l’âge adulte, le patron d’expression est restreint au système gastro-intestinal. Contrairement aux autres membres de la superfamille des FGFs, FGF19/15 agit de manière endocrine car il n’est pas retenu par la matrice extracellulaire et peut rejoindre la circulation sanguine. L’expression de FGF19/15 est induite par les acides biliaires au niveau de l’intestin grêle, plus précisément l’iléon. Les acides biliaires lient le récepteur nucléaire Farnesoid-XReceptor (FXR) qui peut ensuite s’hétérodimériser avec Retinoid-X-Receptor (RXR) pour se lier au promoteur de FGF19/15, ce qui enclenche son expression. Une fois dans le sang, l’hormone rejoint le foie et son action est médiée par le complexe de récepteur Fibroblast Growth Factor Receptor 4 (FGFR4) et β-Klotho (BKL). Une fois les récepteurs activés, FGF19/15 module la glycémie en inhibant la néoglucogenèse hépatique et en activant la synthèse du glycogène, le flux protéique en activant eIF4B et la lipémie en inhibant les enzymes clefs de la lipogénèse. FGF19/15 joue aussi un rôle majeur au niveau du métabolisme biliaire. Ce dernier permet de réduire la production d’acide biliaire en inhibant la Cholesterol 7-α oxygenase (CYP7A1). Les travaux présentés dans ce mémoire portent dans un premier temps sur la caractérisation des conséquences amenées par l’infection sur l’axe endocrine FGF15/FGFR4. Un premier manuscrit traite de l’expression des différents gênes clefs du système et de leur perte lors d’une infection à Salmonella typhimurium, l’agent pathogène causant la fièvre typhoïde chez la souris, et des conséquences sur l’homéostasie biliaire. Il est possible de remarquer une perte de l’expression de FGF15 au niveau de l’intestin et de FGFR4 et β-Klotho au niveau du foie, en plus de plusieurs transporteurs responsables d’amener différents composants clefs de la bile à la vésicule biliaire ou à la circulation sanguine. Le deuxième volet du travail consistait à déterminer le mécanisme derrière la perte du complexe de récepteurs FGFR4/β-Klotho. Les résultats préliminaires démontrent que la perte de β-Klotho semble être médiée seulement par le processus inflammatoire normal et la perte de FGFR4 semble être Salmonella dépendante, par le biais de la voie c- Jun N-terminal kinases (JNK) et le facteur de transcription Hepatic Nuclear Factor 1 alpha (HNF1α)

<p>Proper development of the inner ear, including the cochlea, is necessary for normal hearing. Development of the inner ear requires many signaling molecules under both spatial and temporal control. These signaling molecules include the wingless-related integration site (Wnts) and the fibroblast growth factors (Fgfs) gene families. The embryonic chick inner ear was chosen as the model to study cochlear development due to its homology with the mammalian cochlea and the ease of access to the inner ear in ovo. Both the mammalian cochlea and the homologous chick basilar papilla contain two domains with their own type of hair cells and innervation. The neural side of the basilar papilla contains the tall hair cells innervated by the afferent axons which takes the noise signal to the brain. The abneural side of the basilar papilla contains the short hair cells innervated by the efferent axons which receive signals from the brain to turn down added gain.</p> <p>Previous research showed that virally induced cWnt9a overexpression within the basilar papilla generated a neural side phenotype across the basilar papilla (Munnamalai et al., 2017). These basilar papillas contained more tall hair cells and increased innervation at embryonic day 18 (E18) than their wild-type counterparts. Additionally, there were many differentially expressed genes found to be downstream of cWnt9a including cFgf3 and cFgf19. This project focused on determining the role of cFgf19 in inducing a neural side phenotype in the basilar papilla. First, in situ hybridization was used to determine the cFgf3 and cFgf19 mRNA transcript location with cWnt9a overexpression. Both Fgfs were found across the basilar papilla. Next, a possible cWnt9a receptor, cFzd4, which was upregulated with cWnt9a overexpression, was found in the neural side of the basilar papilla. cFgf19 was then overexpressed using one of two different vectors: RCAS(A)/EGFP-P2A-Fgf19 or RCAS(B)/Fgf19-P2A-EGFP in which the order of cFgf19 transcription was altered. RCAS(B)/Fgf19-P2A-EGFP was found to produce less GFP when transfected into DF-1 cells than RCAS(A)/EGFP-P2A-Fgf19. Additionally, RCAS(B)/Fgf19-P2A-EGFP transfected cells produced secreted fusion proteins of GFP and Fgf19, compared to RCAS(A)/EGFP-P2A-Fgf19 transfected cells which produced secreted individual proteins. The viruses were injected into the otocyst at E3 and the embryos harvested several days later including at E6, E10, and E14. Inner ears injected with either virus showed no changes in innervation, hair cells, proliferation, cartilage formation around the cochlear duct, cFgf3 expression, or phosphorylation of ERK. To determine understand where Fgf19 could be producing an effect, the location of a possible receptor, Fgfr4, was determined in wild-type embryos. At E6 and E8, cFgfr4 was found within the basilar papilla, but many more transcripts were found surrounding the cochlear duct. Overall, the role of Fgf19 in neural side fate of the basilar papilla was not determined. Possible reasons for the lack of phenotypic changes include nonfunctional Fgf19 being secreted which could not bind and induce downstream signaling, Fgf19 being responsible for an untested aspect of the cWnt9a overexpression model, or other misregulated genes would be needed for the phenotypic change to occur.</p>

Many signaling pathways which are classically understood for their roles in early development are also known to be involved in tissue maintenance and adult energy homeostasis. Furthermore, dysfunction of these signaling pathways results in human diseases such as cancer. An in depth understanding of how developmentally important signaling pathways function in the adult will provide mechanistic insights into disease and potential new therapeutic targets. Herein Chapter 1, the Wnt, fibroblast growth factor (FGF), and Hedgehog (Hh) signaling pathways are discussed and examples of their relevance in development, adult homeostasis, and disease are provided. Wnt signaling provides an example of this concept as it has well described roles during both development and adult metabolism.<div><br></div><div> Work included in Chapter 2, investigates the regulation of adult energy homeostasis by a member of the endocrine FGF family, FGF19. The three endocrine FGFs, FGF19 (FGF15 in mice), FGF21, and FGF23 have well described roles in the regulation of metabolic processes in adults. While FGF23 is primarily involved in the regulation of phosphate and vitamin D homeostasis,FGF19 and FGF21 have shown similar pharmacological effects on whole body metabolism. Here, the importance of adaptive thermogenesis for the pharmacological action of FGF19 is explored. UsingUCP1KO animals we show that whole-body thermogenesis is dispensable for body weight loss following FGF19 treatment.<br></div><div><br></div><div>Finally, the potential involvement of Hh signaling in mediating the hyperphagia driven obesity observed in certain ciliopathies is explored in Chapter 3. Emerging evidence suggests cilia play an important role in the regulation of feeding behavior. In mammals, the hedgehog pathway is dependent on the primary cilium as an organizing center and defects in hedgehog signaling share some clinical symptoms of ciliopathies. Here, we characterized the expression of core pathway components in the adult hypothalamus. We show that neurons within specific nuclei important for regulation of feeding behavior express Hh ligand and members of its signaling pathway. We also demonstrate that the Hh pathway is transcriptionally upregulated in response to an overnight fast. This work provides an important foundation for understanding the functional role of Hh signaling in regulation of energy homeostasis. In its entirety, this work highlights the emerging clinical relevance of developmentally critical pathways in diseases associated with dysfunction of adult tissue homeostasis, such as obesity.<br></div>

Primary sclerosing cholangitis (PSC) is a rare chronic liver disease characterized by inflammation and fibrosis of the biliary ducts, resulting in cholestasis and eventually liver failure. No effective treatment is currently available and most patients ultimately require liver transplantation in order to survive. The underlying mechanisms of the disease is poorly understood but a range of hypotheses exist, many of which recognize and grapple with PSC's close relationship with inflammatory bowel disease. Most agree genetics is involved, predisposing for an imbalance in 1) bile acid metabolism, 2) immune response and/or 3) gut microbiota. This literature study aims to describe and elucidate recent progress in the field of pharmacotherapy, as it relates to PSC and our current understanding of the disease. Covered in this study is a total of seven randomized, controlled trials, published between 2015-2022, and available through the medical database/search engine PubMed. Endpoints of particular note are ALP and ELF. ALP, or alkaline phosphatase, is an enzyme found in the liver. Rising levels of ALP in the blood stream is indicative of liver damage. ELF, or Enhanced Liver Fibrosis, is a blood test measuring markers of fibrosis, useful in assessing and staging fibrosis in chronic liver disease. Drugs included in this literature study are aldafermin, cilofexor, fenofibrate, norUrsodeoxicholic acid, obeticholic acid, simtuzumab and vancomycin. With the exception of aldafermin and simtuzumab, all showed promise as ALP reducing agents, in general lowering levels with 15-40 percent. In the case of fenofibrate, a reduction of 65 percent was observed. Of the drugs measured against ELF, only aldafermin produced a statistically significant reduction in fibrosis markers. At the time being it is not entirely clear what to make of the results, due to uncertainties surrounding ALP as a prognostic marker. To what extent ALP predicts transplantation free survival is still a matter of debate. Although considerable efforts have been made to further our understanding of PSC, much is yet to be solved. With regards to pharmacotherapy, the field is experiencing somewhat of a renaissance, showcased by the dozen on-going randomized, controlled trials on a plethora of potential PSC substances. Thus, the search for an effective therapy against PSC goes on.