abstract: Patients with malignant brain tumors have a median survival of approximately 15 months following diagnosis, regardless of currently available treatments which include surgery followed by radiation and chemotherapy. Improvement in the survival of brain cancer patients requires the design of new therapeutic modalities that take advantage of common phenotypes. One such phenotype is the metabolic dysregulation that is a hallmark of cancer cells. It has therefore been postulated that one approach to treating brain tumors may be by metabolic alteration such as that which occurs through the use of the ketogenic diet (KD). The KD is high-fat, low-carbohydrate diet that induces ketosis and has been utilized for the non-pharmacologic treatment of refractory epilepsy. It has been shown that this metabolic therapy enhances survival and potentiates standard therapy in mouse models of malignant gliomas, yet the anti-tumor mechanisms are not fully understood. The current study reports that KetoCal® (KC; 4:1 fat:protein/carbohydrates), fed ad libitum, alters hypoxia, angiogenic, and inflammatory pathways in a mouse model of glioma. Tumors from animals maintained on KC showed reduced expression of the hypoxia marker carbonic anhydrase 9 (CA IX), a reduction in hypoxia inducible factor 1-alpha (HIF-1α) and decreased activation of nuclear factor kappa B (NF-κB). Animals maintained on KC also showed a reduction in expression of vascular endothelial growth factor receptor 2 (VEGFR2) and decreased microvasculature in their tumors. Further, peritumoral edema was significantly reduced in animals fed the KC and protein analysis showed significantly altered expression of the tight junction protein zona occludens-1 (ZO-1) and the water channeling protein aquaporin-4 (AQP4), both of which have been implicated in malignant processes in glioma, including the formation of peritumoral edema in patients. Taken together the data suggests that KC alters multiple processes involved in malignant progression of gliomas. A greater understanding of the effects of the ketogenic diet as an adjuvant therapy will allow for a more rational approach to its clinical use. / Dissertation/Thesis / Masters Thesis Biology 2014

Glioblastoma multiforme (GBM) é o mais comum e mais maligno tumor cerebral. O péssimo prognóstico é parcialmente devido à baixa biodisponibilidade dos quimioterápicos no tecido tumoral, recorrência originada por células precursoras resistentes ao tratamento e um sistema imune comprometido. De fato, linfócitos regulatórios modulam o sistema imune para uma resposta pró-tumoral, tornando ainda mais difícil o tratamento. Nesse contexto, nanocápsulas lipídicas (LNCs) têm sido amplamente estudadas a fim de aumentar especificidade dos fármacos ao tecido tumoral. Metotrexato (MTX) e trans-resveratrol (RSV) possuem ação antitumoral já descrita, mas necessitam doses relativamente altas para ação anti-glioblastoma in vivo. O MTX também possui ação imunossupressora através do aumento de adenosina no meio extracelular. A Adenosina, por sua vez, pode modular tanto células efetoras quanto células regulatórias no microambiente tumoral. Dessa forma, a hipótese apresentada nessa tese é que o RSV e o MTX possam ser mais eficazes quando carreados por nanocápsulas em modelos de GBM. Além disso, buscamos avaliar se o MTX poderia interferir com enzimas do sistema purinérgico. Por fim, pesquisamos como a adenosina poderia modular linfócitos B e T através das enzimas CD39 e ecto-5’-NT/CD73. O RSV em nanocápsulas e o MTX em nanocápsulas (RSV-LNCs e MTX-LNCs) aumentaram a atividade anti-tumoral em relação aos compostos em solução, induzindo parada no ciclo celular e apoptose em células de GBM. O MTX diminuiu a expressão da proteína antiapoptótica BCL-2 e aumentou a caspase-3 ativa, levando as células de GBM à apoptose. Além disso, o MTX aumentou a expressão da enzima ecto-5’-NT/CD73 tanto em células de glioma quanto em linfócitos T presentes no microambiente dos gliomas. Esse aumento da expressão foi acompanhado da diminuição em linfócitos T efetores e T regulatórios. Também, demonstramos que linfócitos B que possuem alta expressão da enzima CD39, tem capacidade supressiva sobre linfócitos efetores. Em conjunto, os resultados apresentados nessa Tese apresentaram possíveis novas alternativas de tratamento e contribuíram para melhor compreender esse maligno câncer cerebral. / Glioblastoma multiforme (GBM) is the most common and most malignant brain tumor. The awful prognosis is in part due to the low bioavailability of chemotherapy agents in the tumoral tissue, recurrence originated from treatment-resistant progenitor cells and an impaired immune system. Indeed, regulatory lymphocytes modulate the immune system toward a pro-tumoral response, turning the treatment even more difficult. In this sense, lipid-core nanocapsules (LNCs) have been widely studied to raise the drug specificity to the tumor. Methotrexate (MTX) and trans-resveratrol (RSV) have antitumoral activity, but need relatively high doses to the anti-glioblastoma outcome in vivo. MTX has immunosuppressive capability mediated by the increase of adenosine in the extracellular milieu. Adenosine in turn may modulate both effector and regulatory immune cells in the tumoral microenvironment. Thereby, the hypothesis presented is that RSV and MTX may have an antitumor improvement when loaded into LNCs in GBM models. Moreover, we sought to evaluate whether MTX could interfere with purinergic enzymes. Lastly, we evaluated how adenosine could modulate B- and T-lymphocytes through CD39 and ecto-5’NT enzymes. RSV- and MTX-loaded lipid-core nanocapsules (RSV-LNCs or MTX-LNCs) increased their antitumoral outcome in relation to the solution compounds, inducing both cell cycle arrest and apoptosis in GBM cells. MTX decreased the expression of the antiapoptotic protein BCL-2 and increased the active caspase-3, triggering glioblastoma cells to apoptosis. Furthermore, MTX increased the expression of ecto-5’-NT/CD73 in glioma cells and T lymphocytes of the glioma microenvironment. This up-regulation was followed by decreasing in T effector and T regulatory lymphocytes. Also, we further demonstrated that B lymphocytes with high expression of CD39 enzyme can suppress T efector lymphocytes. Also, we further demonstrated that B lymphocytes with high expression of CD39 enzyme can suppress T efector lymphocytes. Taken together, the results presented herein indicate newfound treatment approaches and new knowledge regarding to this deadliest brain tumor.

A linhagem de glioma de rato C6 tem sido amplamente utilizada para investigar vários aspectos da biologia celular. Esta linhagem apresenta variações morfológicas, bioquímicas e fisiológicas de acordo com o número de passagens em cultivo. Segundo a literatura, culturas de passagens recentes apresentam características similares a glioblastomas, enquanto que culturas de passagens tardias assemelham-se à astroglia madura. Devido a isso, muitos estudos têm utilizado a linhagem C6 como modelo celular de glioblastoma e de astrócitos para investigar parâmetros relacionados ao sistema glutamatérgico, como por exemplo, captação de glutamato. Entretanto, até o presente momento a caracterização e comparação desses parâmetros entre as culturas da linhagem C6 de passagens recentes e tardias ainda não foram avaliadas. O objetivo desta dissertação foi investigar e comparar alguns parâmetros do sistema glutamatérgico entre as culturas de C6 com passagens recentes e tardias. As passagens recentes apresentaram um conteúdo intracelular de [3H] derivado da captação de L-[3H]-Glu 55% maior quando comparadas às passagens tardias e ambas as culturas atingiram o platô a partir dos 120min de incubação. Além disso, ambas as culturas apresentaram, após incubação com glutamato, os mesmos níveis de incorporação de iodeto de propídeo. Este resultado indica que o menor nível intracelular de [3H] observado nas culturas de passagens tardias não se deve a uma alteração na permeabilidade ou integridade de membrana dessas células. Ambas as culturas expressam somente o transportador Na+ dependente de alta afinidade EAAC1 (carreador de aminoácido excitatórios 1), sendo que sua expressão total foi similar tanto nas culturas de passagens recentes quanto nas tardias. Para verificar se a captação de L-[3H]-Glu estava ocorrendo através de outro sistema de transporte, as culturas foram incubadas na presença ou ausência de PDC (L-trans-2,4--trans-Pyrrolidine-2,4-dicarboxylic acid ) ou TBOA (DL-threo-β-Benzyloxyaspartic acid). O tratamento com os inibidores reduziu de forma similar a captação de L-[3H]-Glu tanto nas culturas de passagens recentes quanto nas tardias, indicando que este aminoácido é captado principalmente através do transportador de alta afinidade EAAC1. Com relação à liberação de glutamato, observou-se que 50% da radioatividade incorporada na forma de L-[3H]-Glu foi liberada para o meio extracelular tanto nas passagens recentes quanto nas tardias após 2h de incubação. Este resultado pode estar relacionado com o estabelecimento do platô do conteúdo intracelular de [3H] observado após 120 min de captação de L-[3H]-Glu. Para investigar se a liberação de L-[3H]-Glu ocorreu via transporte reverso dos transportadores Na+ dependentes de alta afinidade, ambas as culturas foram incubadas na presença do inibidor não transportável TBOA. Não foi observada alteração no perfil de liberação de radioatividade intracelular nas culturas após incubação com TBOA. Para verificar se a metabolização do L-[3H]-Glu estaria relacionado com a diferença nos níveis intracelulares de [3H], ambas as culturas foram incubadas com o análogo não-metabolizável D-[3H]-Asp. Tanto as passagens recentes como as tardias apresentaram um aumento tempo-dependente do conteúdo de [3H] derivado da captação de D-[3H]-Asp, não atingindo o platô. Além disso, o bloqueio dos transportadores Na+ dependentes de alta afinidade por PDC ou TBOA reduziu a captação de D-[3H]-Asp em ambas as culturas, indicando que sua captação ocorreu principalmente através deste tipo de transporte. Além disso, diferentemente do observado com L-[3H]-Glu, apenas 10% do D-[3H]-Asp captado é liberado após 2h de incubação em ambas as culturas. Este resultado, juntamente com a não inibição por TBOA da liberação da radioatividade captada na forma de L-[3H]-Glu, indica que possivelmente o que está sendo liberado para o meio extracelular é um metabólito marcado com [3H] e não o próprio L-[3H]-Glu. Além disso, nas passagens tardias, o conteúdo de [3H] derivado da captação de D-[3H]-Asp foi menor quando comparado com as passagens recentes aos 60 e 120 min de incubação, sugerindo que as passagens recentes possuem intrinsecamente uma maior capacidade de transporte tanto de L-[3H]-Glu quanto de D-[3H]-Asp quando comparadas às passagens tardias. Os resultados dessa dissertação demonstram que as passagens recentes e tardias da linhagem de glioma C6 diferem na sua capacidade de acumular o [3H] derivado da captação de L-[3H]-Glu. A maior capacidade das passagens recentes da linhagem C6 em acumular a radioatividade não está relacionada a uma maior expressão dos transportadores de glutamato e nem a uma reduzida liberação de L-[3H]-Glu para o meio extracelular. Como conclusão, os resultados obtidos nesta dissertação indicam que o número de passagens deve ser considerado em futuros estudos que pretendam avaliar parâmetros relacionados ao sistema glutamatérgico utilizando a linhagem C6 como modelo celular. / Rat C6 lineage has been widely used to investigate several aspects of cell biology. This lineage presents morphological, biochemical and physiological variations according to number of passages in culture. Early passage cells exhibit characteristics similar to glioblastomas, whereas later passage cells resemble mature astroglia. Thus, many studies have been using C6 lineage as astroglial and glioma model to investigate several parameters related to glutamatergic system, such as glutamate uptake. However, the characterization and comparison of these parameters between C6 cultures at early and late passages have not been evaluated. Therefore, the aim of this study was to investigate and compare some glutamatergic system parameters between early and late passage C6 cells in cultures. Early passages have an L-[3H]-Glu-derived intracellular content of [3H] 55% higher when compared to later passages and both cultures reached plateau at 120 min. In addition, after incubation with glutamate, both cultures showed the same levels of propidium iodide incorporation. This result indicates that lower levels of intracellular [3H] in later passages are not due to an alteration of cellular membrane permeability. Both cultures expressed only the higher affinity Na+ dependent transporter EAAC1, and its total expression was similar in early and later passage cultures. To verify if L-[3H]-Glu uptake occurred through another kind of glutamate transport system, the cultures were incubated in the presence or absence of PDC or TBOA. Treatment with this inhibitors reduced the L-[3H]-Glu uptake in both cultures at same levels, indicating that glutamate is taken up mainly by the higher affinity transporter system. Regarding the release of glutamate, it was observed that 50% of the radioactivity incorporated as L-[3H]-Glu was released to extracellular medium in both early and late passages after 2 h of incubation. This result could be related to the establishment of the plateau observed after 120 min for intracellular content of [3H] derived from L-[3H]-Glu uptake. To investigate if the release of L-[3H]-Glu occurred trough reverse transport, both cultures were incubated in the presence of non-transportable inhibitor TBOA. There was no alteration of intracellular radioactivity release in cultures after incubation with TBOA. In order to verify if the metabolism of L-[3H]-Glu could be related to the differences in intracellular levels of [3H], both cultures were incubated with the non-metabolizable analogue D-[3H]-Asp. Early and late passage C6 cells showed a time-dependent increase in intracellular content of [3H] derived from D-[3H]-Asp uptake, without reaching the plateau. Moreover, blockade of Na+ dependent transporters of high affinity by PDC or TBOA reduced D-[3H]-Asp uptake in both cultures, indicating that uptake occurred mainly through EAAC1. Moreover, differently from L-[3H]-Glu, only 10% of D-[3H]-Asp captured is released after 2 h of incubation in both cultures. This result, taken together with the fact that TBOA did not inhibit the release of radioactivity captured as L-[3H]-Glu, indicates that a [3H]-metabolite is being released to extracellular medium and not L-[3H]-Glu itself. Moreover, in later passages, D-[3H]-Asp-derived intracellular content of [3H] was lower when compared to early passages at 60 and 120 min of incubation, suggesting that early passage C6 cells intrinsically have a greater capacity to transport both L-[3H]-Glu and D-[3H]-Asp when compared to later passages. This study demonstrates that early and late passage C6 cells differ in their ability to accumulate L-[3H]-Glu-derived intracellular content of [3H]. From 60 min of incubation, early passages have an intracellular content of [3H] derived from L-[3H]-Glu uptake 55% higher in relation to later passages. This increased capacity is not related to a higher expression of glutamate transporters nether nor by reduced release of L-[3H]-Glu to extracellular medium. In conclusion, our results indicate that the number of passages should be considered in future studies that intent to evaluate parameters relating to glutamatergic system using Rat C6 lineage as cell model.

Os gliomas malignos, tumores que normalmente originam-se de células da linhagem astrocítica, são os mais comuns e devastadores tumores primários do sistema nervoso central. O Glioblastoma multiforme (GBM) é a classe mais freqüente e uma das formas mais agressivas de câncer. Como conseqüência, a sobrevivência após o diagnóstico é geralmente de menos de um ano. Desta maneira, novas estratégias terapêuticas se fazem necessárias. Durante as últimas décadas, estudos sobre compostos naturais têm tido sucesso no que diz respeito à pesquisa de agentes anti-câncer, sendo que os alcalóides aporfinóides representam uma categoria com grande potencial. Assim, o objetivo deste estudo foi avaliar o efeito da boldina, um alcalóide aporfinóide do Peumus boldus, em linhagens de glioma, e investigar os possíveis mecanismos de ação envolvidos com este efeito. A boldina foi capaz de diminuir o percentual de células das linhagens U138-MG, U87-MG e C6. Neste estudo, observamos células necróticas após tratamento na linhagem C6. O mesmo efeito não foi observado para baixas concentrações do tratamento nas linhagens U138-MG e U87-MG. A exposição à boldina por 24 h não causou ativação das caspases 3 e 9, executoras-chave da apoptose, ou clivagem do substrato PARP. De acordo com a análise do ciclo celular, boldina induziu parada na fase G2/M. O índice mitótico também demonstrou redução no número de mitoses. O tratamento com boldina não causou dano no DNA das células U138-MG e não afetou células normais (fatias organotípicas de hipocampo de ratos) com a mesma extensão que afetou as células tumorais. De acordo com estes resultados, sugerimos que a boldina pode ser um novo composto para o desenvolvimento de estratégias anticâncer. / Malignant gliomas, tumors that usually arise from cells of astrocytic lineage, are the most common and devastating primary tumors of the central nervous system. Glioblastoma multiforme (GBM) is the most frequent class and one of the most aggressive forms of cancer. As a consequence, survival after diagnosis is normally just less than 1 year. In this manner, new therapeutic strategies are urgently needed. During the last decades, works on natural compounds have been particularly successful in the field of anticancer drug research, and the aporphines alkaloids represent an interesting, potencially useful category of this agents. Thus, the aim of this study was to evaluate the effect of boldine, an aporphine alkaloid of Peumus boldus, in glioma cell lines, and investigate the possible mechanisms involved in this effect. Boldine was capable to decrease the percentage of cells in U138-MG, U87-MG and C6 glioma lineages. In this study we observed necrotic cells in C6 lineage after treatment. The same effect was not seen in low concentrations of treatment in U138-MG and U87-MG lineages. The exposure to boldine for 24 h did not result in increase of the activation of caspase-3 and caspase-9, key executioners in apoptosis. No increase in cleavage of the downstream substrate PARP was observed. According to cell cycle analysis, boldine appeared to induce G2/M arrest in U138-MG cells. Mitotic index also showed a reduction in the percentage of cells in mitosis. The treatment with boldine did not caused DNA damage in U138-MG cells and did not affect normal cells (rat organotypic hippocampal slices) to the extent that it affects tumor cells. According to these results, we suggest that boldine could be a new compound to the development of anticancer therapies.

Os glioblastomas multiforme (GBM), são tumores cerebrais, que por sua malignidade, aliada ao seu rápido crescimento e frequente recorrência, exigem uma maior investigação da comunidade científica. Novas terapias devem afetar as células-tronco tumorais (CSC), as quais são responsáveis pela resistência e progressão tumoral. Neste trabalho fizemos o uso da Tricostatina A (TSA), um inibidor de histonas deacetilase, para se obter a modulação epigenética, e portanto, manipulação da expressão gênica, da linhagem celular U87-MG de GBM, utilizada aqui como um modelo para a pesquisa com CSC. Observamos a redução da proliferação e sobrevivência das tumoresferas de U87, as quais são formadas por CSC, seguida de alterações morfológicas nas células tratadas. A diferenciação das U87 foi confirmada pelo aumento dos níveis de marcadores neuronais e gliais, tais como NeuN e GFAP. Além disso, mostramos evidências de senescência celular após o tratamento com TSA. Nenhum efeito sobre a migração celular foi encontrado após a modulação epigenética. Portanto, os nossos resultados mostram a influência da TSA na diferenciação, proliferação e sobrevivência de CSC de glioma e também na indução da senescência celular, demonstrando o potencial da TSA na terapia dos tumores cerebrais. / Glioblastoma multiforme (GBM), because of its fast growth and recurrence, require further investigation by the scientific community in order to find promising new therapies for these tumors, specially affecting their Cancer stem cells (CSC), which drive many tumorigenic processes. In this work we have made use of the HDAC inhibitor Trichostatin A to achieve the epigenetic modulation of the U87-MG GBM cell line, as a model for CSC research. We have observed reduction of the U87 tumorspheres, which are enriched for CSC, proliferation and survival followed by morphological changes both in the treated tumorspheres and in single cells. Enhanced on the U87 differentiation was confirmed by increased levels of neuronal and glial markers such as NeuN and GFAP. Furthermore we showed evidences of cellular senescence after the TSA treatment. No effect on cell migration was found after TSA treatment. Therefore, these results demonstrate a plethora effects on differentiation, proliferation, survival of glioma cells and induction of cellular senescence by TSA, making TSA a promising agent for glioma therapy.

O glioblastoma (GBM) é o tumor cerebral primário mais comum e o mais grave tumor de células da glia. O GBM é um tumor astrocítico de grau IV caracterizado pela proliferação descontrolada, infiltrado difuso, tendência à necrose, angiogênese, resistência a apoptose e grande heterogeneidade genética. Apesar da terapia abranger a remoção cirúrgica máxima, a radioterapia e a quimioterapia, o tumor torna-se resistente à drogas utilizadas no tratamento levando o paciente a recorrência e morte em menos de 15 meses após o diagnóstico. Uma alternativa para o tratamento do GBM é a imunoterapia, a qual é capaz de estimular o sistema imunológico do próprio paciente a gerar uma resposta específica e duradoura que pode proteger contra a recorrência da doença. Uma dessas alternativas envolve o uso de vacinas de DNA codificando antígenos tumorais e proteínas imunomoduladoras capazes de ativar eficientemente linfócitos B e T específicos aos antígenos presentes no tumor. Nesse contexto, o objetivo do presente trabalho foi construir vacinas de DNA utilizando-se os genes dos antígenos EGFRvIII, cERBB2, MAGE e GLEA de GBM e os genes das proteínas imunomoduladoras hsp65, hsp70, gp96 e gD e avaliar suas respectivas imunogenicidades. Os genes foram avaliados in silico, sintetizados in vitro e utilizados na construção das vacinas de DNA. Ferramentas de biologia molecular e o vetor pVAX foram utilizados para obtenção das vacinas. Elas foram caracterizadas por sequenciamento e western blot e utilizadas na imunização de camundongos C57BL/6. As imunizações foram realizadas com três doses em intervalos de 12 dias combinando um antígeno tumoral e uma proteína imunomoduladora na forma de vacina de DNA. A imunogenicidade foi avaliada 20 dias após a última dose. Os ensaios ex vivo foram realizados com o soro dos animais imunizados para dosagem de anticorpos específicos contra os antígenos tumorais e com as células do baço que foram re-estimuladas com as proteínas EGFRvIII, cERBB2, MAGE e GLEA para identificar a presença de células específicas aos antígenos tumorais. Como resultado, a vacina pVAXgDGLEA foi a única capaz de induzir anticorpos do subtipo IgG2a anti-GLEA. As vacinas pVAXgDGLEA, pVAXgDEGFRvIII e pVAXgDMAGE foram capazes de ativar células específicas aos antígenos que após o re-estímulo responderam rapidamente com produção de IFN-g e IL-10. A proteína imunomoduladora gD foi, portanto, capaz de ajudar na indução de um padrão de resposta Th1, específica aos antígenos de GBM, importante no combate ao tumor e a IL-10 pode favorecer e/ou balancear a resposta no cérebro que deve ser eficaz, mas não exacerbada. / Glioblastoma multiforme (GBM) is the most common form of primary brain cancer and the most severe tumour affecting glia cells. GBM is a grade IV astrocytoma known by uncontrolled proliferation, diffused infiltrate, necrosis tendency, angiogenesis, apoptosis resistance and a wide genetic heterogeneity. The standard of care consists of maximal surgical resection, followed by a combination of radiation and chemotherapy. Despite that, tumour becomes resistant to drugs used to treatment, and the patient experiences recurrence followed by death in less than 15 months after diagnosis. An alternative in GBM treatment could be immunotherapy which aims to stimulate patients immunological system in order to obtain a specific and long-term response that can protect against recurrence. One of these alternatives involves the use of DNA vaccines codifying tumoral antigens and immunomodulatory proteins that can effectively activate tumour antigen specific B and T lymphocytes. In this context, the objective of this work was the construction of DNA vaccines using GBM antigen genes (EGFRvIII, cERBB2, MAGE e GLEA) and immunomodulatory proteins (hsp65, hsp70, gp96 e gD), followed by their immunogenicity evaluation. Genes were evaluated in silico, synthesized in vitro and used in DNA vaccines construction. Molecular biology tools and the pVAX vector were used to obtain the vaccine. They were characterized by sequencing, western blot and were used in the immunization of C57BL/6 mice. Immunizations were performed in 3 doses of a DNA vaccine combining a tumoral antigen and an immunomodulatory protein at each 12 days. Immunogenicity was evaluated 20 days after the last dose. The ex vivo assays were performed with the serum of immunized animals for antibody evaluation and spleen cells were stimulated with EGFRvIII, cERBB2, MAGE e GLEA proteins to assess tumoral antigen specific cells. The pVAXgDGLEA vaccine was the only able to induce IgG2a subtype anti-GLEA antibodies. Vaccines pVAXgDGLEA, pVAXgDEGFRvIII e pVAXgDMAGE were able to activate antigen-specific cells that produced IFN-g e IL-10 quickly after reestimulation. The gD immunomodulatory protein was able to induce a Th1 immune response, specific to GBM antigens, which is important in tumor combat while IL-10 could favor and/or balance the response in brain, which should be effective but not exacerbated.

Philosophiae Doctor - PhD / Cancer is a group of diseases that arises from irreversible genomic and epigenomic alterations that result in unrestrained proliferation of abnormal cells. Detailed understanding of the molecular mechanisms underlying a cancer would aid the identification of most, if not all, genes responsible for its progression and the development of molecularly targeted chemotherapy. The challenge of recurrence after treatment shows that our understanding of cancer mechanisms is still poor. As a contribution to overcoming this challenge, we provide an integrative multi-omic analysis on glioblastoma multiforme (GBM) for which large data sets on di erent classes of genomic and epigenomic alterations have been made available in the Cancer Genome Atlas data portal. The rst part of this study involves protein network analysis for the elucidation of GBM tumourigenic molecular mechanisms, identification of driver genes, prioritization of genes in chromosomal regions with copy number alteration, and co-expression and transcriptional analysis. Functional modules were obtained by edge-betweenness clustering of a protein network constructed from genes with predicted functional impact mutations and differentially expressed genes. Pathway enrichment analysis was performed on each module to identify statistical overrepresentation of signaling pathways. Known and novel candidate cancer driver genes were identi ed in the modules, and functionally relevant genes in chromosomal regions altered by homologous deletion or high-level amplication were prioritized with the protein network. Co-expressed modules enriched in cancer biological processes and transcription factor targets were identified using network genes that demonstrated high expression variance. Our findings show that GBM's molecular mechanisms are much more complex than those reported in previous studies. We next identified differentially expressed miRNAs for which target genes associated with the protein network were also differentially expressed. MiRNAs and target genes were prioritized based on the number of targeted genes and targeting miRNAs, respectively. MiRNAs that correlated with time to progression were selected by an elastic net-penalized Cox regression model for survival analysis. These miRNA were combined into a signature that independently predicted adjuvant therapy-linked progression-free survival in GBM and its subtypes and overall survival in GBM. The results show that miRNAs play significant roles in GBM progression and patients' survival finally, a prognostic mRNA signature that independently predicted progression-free and overall survival was identified. Pathway enrichment analysis was carried on genes with high expression variance across a cohort to identify those in chemoradioresistance associated pathways. A support vector machine-based method was then used to identify a set of genes that discriminated between rapidly- and slowly-progressing GBM patients, with minimal 5 % cross-validation error rate. The prognostic value of the gene set was demonstrated by its ability to predict adjuvant therapy-linked progression-free and overall survival in GBM and its subtypes and was validated in an independent data set. We have identified a set of genes involved in tumourigenic mechanisms that could potentially be exploited as targets in drug development for the treatment of primary and recurrent GBM. Furthermore, given their demonstrated accuracy in this study, the identified miRNA and mRNA signatures have strong potential to be combined and developed into a robust clinical test for predicting prognosis and treatment response.

Inflammation is a homeostatic response to tissue injury or infection, which is normally short- lived and quickly resolves to limit tissue damage. In contrast, chronic inflammation has been linked to a variety of human diseases, including cancers such as glioblastoma multiforme (GBM). GBMs are very aggressive tumors with very low patient survival rates, which have not improved in several decades. GBM tumors are characterized by necrosis and profound inflammation; with cytokines secreted by both GBM cells and the tumor microenvironment. The mechanisms by which chronic inflammation develops and persists in GBM regardless of multiple anti-inflammatory feedback loops remain elusive. This project identifies a molecular switch which promotes chronic inflammation in GBM, but not primary human astrocytes.

Glioblastoma is the most common primary brain tumor in adults, and it is associated with a dismal prognosis with a median survival of 15 months. Despite treatment with chemotherapy, radiation therapy and surgery, patients inevitably have disease recurrence. Bevacizumab is a monoclonal humanized antibody that inhibits vascular endothelial growth factor signaling, and it has been shown to be effective in recurrent glioblastoma with respect to prolonging progression-free survival (PFS). The use of bevacizumab and other anti-angiogenic agents in recurrent glioblastoma have created novel challenges in interpreting magnetic resonance imaging (MRI) of patients. Furthermore, since only some patients appear to have a durable benefit from bevacizumab, there is a need for imaging biomarkers that can reliably identify this subgroup of patients. Partly due to the challenges created by anti-angiogenic agents, the Response Assessment in Neuro-Oncology (RANO) was proposed to address some of the limitations with traditional response assessment criteria. In the first part of this project, we attempted to validate the RANO criteria by performing a comparative analysis of the RANO criteria vs. the Macdonald criteria using imaging from the phase II BRAIN trial. As we hypothesized, the RANO criteria yielded a significantly decreased PFS by identifying a subset of patients who had progression of nonenhancing tumor evident on T2-weighted imaging. Additionally, response and progression as defined by the RANO criteria correlated with subsequent overall survival (OS) in landmark analyses. While this supports the implementation of RANO criteria for response assessment in glioma clinical trials, future research will be necessary to further improve response assessment by incorporating advanced techniques such as volumetric anatomic assessment, perfusion-weighted MR (PWI-MR), diffusion-weighted MR (DWI-MR), MR spectroscopy (MRS) and positron emission tomography (PET). Advanced imaging techniques are becoming increasingly recognized for their ability to provide objective, non-invasive assessment of treatment response but also to serve as predictive and prognostic biomarkers allowing for stratification of patient subgroups with better treatment outcome. In the second part of the project, we attempted to perform volumetric analysis of tumor size based on conventional MRI, as well as a histogram analysis of apparent diffusion coefficients (ADC) derived from diffusion-weighted MRI, to evaluate imaging parameters as predictors for PFS and OS in a single institution database of recurrent glioblastoma patients initiated on bevacizumab. Volumetric percentage change and absolute early post-treatment volume (3-6 weeks after initiation) of enhancing tumor can stratify survival for patients with recurrent glioblastoma receiving bevacizumab therapy. ADC histogram analysis using a multi-component curve-fitting technique within both enhancing and nonenhancing components of tumor prior to the initiation of bevacizumab can also be used to stratify OS in recurrent glioblastoma patients. While prospective studies are necessary to validate findings, future studies will increasingly incorporate multiparametric approaches to elucidate biomarkers that combine the value of conventional MRI with advanced techniques such as DWI-MR, PWI-MR, MRS and PET to obtain better predictors for PFS and OS in recurrent glioblastoma.

No description available.