The research performed in this thesis aims to improve our understanding about one of the most malignant tumors of the human brain – glioma. From the early stages of my career I was confronted with the cruel reality of losing patients due to this devastating disease. The studies performed over the last four years involve extensive data analysis in different clinical and laboratory settings. The direct application of different analysis methods and tools in order to investigate the glioma infiltration delineation has potentially lead to direct applications of our results in the clinical setting. The overall approach of the study is based on three primary outcome measures, i.e., neuronal, electrophysiological and genetic/molecular features for distinguishing infiltrated and non-infiltrated zones within specifically peritumoral tissue (PT) and, more extensively, across the radiologically-defined boundaries of healthy, peritumoral and tumoral tissues. As such, we propose for the first time an objective demarcation and characterization of the PT and we detail how the genetic and epigenetic alterations within the tumoral and peritumoral area are linked with macroscopic functional MRI results. We also describe scale-free features (power law exponent) as well as distinct spectral features and reactivity to external stimulus in the tumoral and adjacent tissue of patients and provide novel insights in terms of glioma’s electrophysiology. The insights gained from these empirical studies further improve our understanding about the pathophysiology of this disease at micro- and macroscopic scales allowing us to envisage novel management methods for patients affected by glioma.

Insulin like Growth Factor Binding Proteins (IGFBPs) 1 to 6 have important physiological functions of regulating half life and bioavailability of Insulin like Growth Factors (IGFs). Consequently, these have been known to play important roles in embryonic development, postnatal growth and disease conditions like cancer. However, the physiological roles of IGFBPs are diverse and not restricted only to the IGF regulation. These molecules are found to be tumor suppressors or promoters depending on the physiological contexts. IGFBP-2 has been established as a tumor promoter and found to be unregulated in several cancers including breast, ovarian, prostate cancer and glioblastoma (GBM). Various in vitro and in vivo studies have convincingly demonstrated the role of IGFBP-2 in inducing tumor cell proliferation, migration, invasion and chemoresistance. Increased plasma and tissue levels of IGFBP-2 have been associated with poor clinical outcome with respect to patients’ response to the therapy, relapse and overall survival. Various studies so far have demonstrated the role of IGFBP-2 in promoting glioma cell proliferation, migration, invasion, chemoresistance and determining stamens of GICs (Glioma Initiating Cells). However, the exact mechanisms underlying these functions remain unknown. Apart from being a diagnostic and prognostic indicator, IGFBP-2 has also been proposed as a therapeutic target. Therefore it is essential to understand mechanistic insights into pro-tumorigenic functions of IGFBP-2. Apart from the conventional function of regulating IGFs, IGFBP-2 has been shown to have several IGF independent functions. In a previous study, we reported IGFBP-2 as an upstream regulator of β-catenin signaling pathway in breast cancer. Interestingly, this study linked the association of higher expression of IGFBP-2 and β-catenin with the lymph node metastasis status of breast cancer. β-catenin signaling has been considered as one of the most important pro-tumorigenic pathways in several cancers including glioblastoma. Considering the importance of IGFBP-2 and β-catenin signaling pathways in glioblastoma, it becomes important to evaluate regulation of β-catenin activity by IGFBP-2 in glioma and address its clinical relevance. With this aim, the objectives of this study are,  To study mechanism of IGFBP-2 mediated regulation of β-catenin signaling in glioma cells and prognostic significance of IGFBP-2 and β-catenin expression in GBM tissues.  Isolation of human single chain variable fragment (scFv) against IGFBP-2 and its characterization as an inhibitor for IGFBP-2 pro-tumorigenic functions. Towards this, we established stable IGFBP-2 knockdown U251 cell line and IGFBP-2 over expressing LN229 and U87 cell lines. IGFBP-2 modulation in these glioma cell lines did not alter the rate of proliferation but there was a significant effect on cellular migration and invasion. In case of U251 cell line, there was a significant decrease in the intracellular levels of β-catenin while in IGFBP-2 over expressing cell lines there was a marked increase in intracellular β-catenin suggesting that IGFBP-2 is involved in the regulation of β-catenin in these cells. It was observed that this regulation of β-catenin was not because of its transcriptional regulation or regulation of canonical Wnt ligands Wnt1, Wnt2 and Wnt3a. To further delineate the pathway and understand the mechanism behind regulation of β-catenin, upstream regulators of β-catenin were analyzed. GSK3β is an important negative regulator of β-catenin which primes it for ubiquitination and proteasomal degradation. Phosphorylation of GSK3β at Ser9 position renders this enzyme inactive. In our study, it was observed that there was a significant downregulation of p-GSK3β in U251 cells with IGFBP-2 knockdown and upregulation in IGFBP-2 over expressing cell lines. Overexpression of IGFBP-2 in LN229 and U87 cell lines resulted in considerable decrease in the GSK3β mediated phosphorylation of β-catenin. This study unequivocally established that regulation of β-catenin by IGFBP-2 is via inactivation of GSK3β. Furthermore, regulation of GSK3β was found to be due to action of FAK following binding of IGFBP-2 to integrins. The expression pattern of IGFBP-2 and β-catenin protein in the tumor tissues of 112 GBM patients was studied and its correlation with patient survival was analysed. In this analysis it was observed that co-expression of IGFBP-2 and β-catenin is a strong predictor of patient prognosis. These results further implied the importance of understanding IGFBP-2 and β-catenin association in GBM pathology. One of the interesting observations in our study is that, not only full length IGFBP-2 protein but also C-terminal domain of IGFBP-2 was sufficient to regulate β-catenin and other IGFBP-2 mediated functions. This strongly asserts the importance of C-terminal region of IGFBP-2 as a tumor promoter. Towards an attempt to develop an inhibitor for IGFBP-2 actions, we screened a human single chain variable fragment (scFv) library using phage display technique. From this screening, one scFv (B7J) was identified which was a binder of full length IGFBP-2 as well as C-terminal domain of IGFBP-2. This scFv showed inhibition of IGFBP-2-cell surface interaction and also efficiently inhibited IGFBP-2-induced signaling pathways like ERK, FAK and GSK3β/β-catenin. B7J treatment also neutralized regulation of IGFBP-2 transcriptional targets like MMP2 and CD24. Gelatin zymography indicated the ability of B7J to decrease matrix metalloprotease activity in the conditioned medium of glioma cells. These effects ultimately reflected on the IGFBP-2-induced cellular migratory and invasive behaviour which was largely abrogated by B7J scFv treatment. Considering the therapeutic importance of scFvs because of their small size, better tumor penetration and tumor retention capacity than full length antibody molecules, such kind of strategy could be of great importance in the management of GBM. Altogether, this study provides a mechanistic insight of IGFBP-2 mediated actions involving integrin/FAK/GSK3β/β-catenin pathways and the possible role of this crosstalk in the aggressiveness of glioblastoma. This study also provides a proof of principle that an inhibitor like anti IGFBP-2 scFv could be of importance for controlling invasive glioblastoma.

Glioma, the tumor of glial cells, is one of the common types of primary central nervous system (CNS) neoplasms. Astrocytoma is the most common of all gliomas and originates from astrocytic glial cells. Astrocytoma tumors belong to two main categories: benign tumors, comprising of grade I Pilocytic astrocytoma and malignant tumors which diffusely infiltrate throughout the brain parenchyma. Diffusely infiltrating astrocytomas are graded into diffuse astrocytoma (DA; grade II), anaplastic astrocytoma (AA; grade III) and glioblastoma (GBM; grade IV) in the order of increasing malignancy. Patients with grade II astrocytoma have a median survival time of 6 to 8 years after surgical intervention. While the more aggressive grade III (AA) and grade IV (GBM) are together called malignant astrocytomas, the treatment protocols and length of survival are distinctly different between these grades. The median survival time for grade III patients is 2 to 3 years whereas patients with grade IV have a median survival of 12-15 months. GBMs have been further divided into primary GBM and secondary GBM on the basis of clinical and histopathological criteria. Primary GBM presents in an acute de novo manner with no evidence of an antecedent lower grade tumor and it accounts for >90% of all GBMs. In contrast, secondary GBM results from the progressive malignant transformation of a grade II or grade III astrocytoma. The current WHO grading system of astrocytomas is based on the histopathological characteristics of the underlying tumor tissue. Diagnoses by pathologists are dependent on specific histologic features: increased mitosis, nuclear atypia, microvascular proliferation and/or necrosis, which associate with biologically aggressive behaviour (WHO 2007). Though grading based on histology is largely reproducible and well accepted, subjectivity involved and substantial disagreement between pathologists has remained a major concern. Because of inherent sampling problems (mainly due to tumor location in the brain) and inadequate sample size available for histological evaluation, there exists a very high possibility of error in grading. Recent studies have attempted to characterize the molecular basis for the histological and prognostic differences between grade III and grade IV astrocytoma. While reports have shown the grade specific profile of gene expression, there is no molecular signature that can accurately classify grade III and grade IV astrocytoma samples. In the current work, we have identified molecular signatures for the accurate classification of grade III and grade IV astrocytoma patients by using transcriptome and miRNome data. The receptor tyrosine kinase pathway is known to be overexpressed in 88% of glioblastoma patients. The expression and activation of the receptors is reported to be deregulated by events like amplification and activating mutations. The aberrant expression of RTKs could also be due to the deregulation of miRNAs, which, in the untransformed astrocytes regulate and fine-tune the levels of the RTKs. In the current study, we have identified that tumor suppressor miRNA miR-219-5p regulates RTK pathway by targeting EGFR and PDGFRα. Part I. Transcriptome approach: Identification of a 16-gene signature for classification of malignant astrocytomas In order to obtain a more robust molecular classifier to accurately classify grade III and grade IV astrocytoma samples, we used transcriptome data from microarray study previously performed in our laboratory. The differential regulation of 175 genes identified from microarray was validated in a cohort of grade III and grade IV patients by real-time qRT-PCR. In order to identify the classification signature that can classify grade III and grade IV astrocytoma samples, we used the expression data of 175 genes for performing Prediction Analysis of Microarrays (PAM) in the training set of grade III and grade IV astrocytoma samples. PAM analysis identified the most discriminatory 16-gene expression signature for the classification of grade III and grade IV astrocytoma. The Principal Component Analysis (PCA) of 16-genes astrocytoma patient samples revealed that the expression of 16-genes could classify grade III and grade IV astrocytoma samples into two separate clusters. In the training set, the 16-gene signature was able to classify grade III and grade IV patients with an accuracy rate of 87.9% as tested by additional analysis of Cross-Validated probability by PAM. The 16-gene signature obtained in the training set was validated in the test set with diagnostic accuracy of 89%. We further validated the 16-gene signature in three independent cohorts of patient samples from publicly available databases: GSE1993, GSE4422 and TCGA datasets and the classification signature got validated with accuracy rates of 88%, 92% and 99% respectively. To address the discordance in grading between 16-gene signature and histopathology, we looked at the clinical features (age and survival) and molecular markers (CDKN2A loss, EGFR amplification and p53 mutation) that differ substantially between grade III and grade IV in discordant grade III and grade IV samples. The grading done by 16-gene signature correlated with known clinical and molecular markers that distinguish grade III and grade IV proving the utility of the 16-gene signature in the molecular classification of grade III and grade IV. In order to identify the pathways that 16 genes of the classification signature could regulate, we performed protein-protein interaction network and subsequently pathway analysis. The pathways with highest significance were ECM (extracellular matrix) and focal adhesion pathways, which are known to be involved in the epithelial to mesenchymal transition (EMT), correlating well with the aggressive infiltration of grade IV tumors. In addition to accurately classifying the grade III and grade IV samples, the 16-gene signature also demonstrated that genes involved in epithelial-mesenchymal transition play key role in distinguishing grade III and grade IV astrocytoma samples. Part II. miRNome approach microRNAs (miRNAs) have emerged as one of the important regulators of the interaction network that controls various cellular processes. miRNAs are short non-coding RNAs (mature RNA being 21-22nt long) that regulate the target mRNA by binding mostly in the 3’ UTR bringing about either translational repression or degradation of the target. miRNAs are shown to play key roles in cell survival, proliferation, apoptosis, migration, invasion and various other characteristic features that get altered in human cancers. miRNAs are characterized to have oncogenic or tumor suppressor role and the aberrant expression of miRNAs is reported in multiple human cancer types. Part A. Genome-wide expression profiling identifies deregulated miRNAs in malignant astrocytoma With an aim to identify the role of miRNAs in the development of in malignant astrocytoma, we performed a large-scale, genome-wide microRNA (miRNA) (n=756) expression profiling of 26 grade IV astrocytoma, 13 grade III astrocytoma and 7 normal brain samples. Using Significance Analysis of Microarrays (SAM), we identified several differentially regulated miRNAs between control normal brain and malignant astrocytoma, grade III and grade IV astrocytoma, grade III astrocytoma and grade IV secondary GBM, progressive pathway and de novo pathway of GBM development and also between primary and secondary GBM. Importantly, we identified a most discriminatory 23-miRNA expression signature, by using PAM, which precisely distinguished grade III from grade IV astrocytoma samples with an accuracy of 90%. We re-evaluated the grading of discordant samples by histopathology and identified that one of the discordant grade III samples had areas of necrosis and it was reclassified as grade IV GBM. Similarly, out of two discordant grade IV samples, one sample had oligo component and it was reclassified as grade III mixed oligoastrocytoma. Thus, after the revised grading, the prediction accuracy increased from 90% to 95%. The differential expression pattern of nine miRNAs was further validated by real-time RT-PCR in an independent set of malignant astrocytomas (n=72) and normal samples (n=7). Inhibition of two glioblastoma-upregulatedmiRNAs (miR-21 and miR-23a) and exogenous overexpression of two glioblastoma-downregulatedmiRNAs (miR-218 and miR-219-5p) resulted in reduced soft agar colony formation but showed varying effects on cell proliferation and chemosensitivity. Thus, we have identified the grade specific expression of miRNAs in malignant astrocytoma and identified a miRNA expression signature to classify grade III astrocytoma from grade IV glioblastoma. In addition, we have demonstrated the functional relevance of miRNA modulation and thus showed the miRNA involvement and their importance in astrocytoma development. Part B. miR-219-5p inhibits the receptor tyrosine kinase pathway by targeting mitogenic receptor kinases in glioblastoma The receptor tyrosine kinase (RTK) pathway, being one of the important growth promoting pathways, is known to be deregulated in 88% of the patients with glioblastoma. In order to understand the role of miRNAs in regulating the RTK pathway, we undertook a screening procedure to identify the potential miRNAs that could target different members of the RTK pathway. From the screening study involving bioinformatical prediction of miRNAs and subsequent experimental validation by modulation of miRNA levels in glioma cell lines, we identified miR-219-5p as a candidate miRNA. The overexpression of miR-219-5p reduced the protein levels of both EGFR and PDGFRα. We confirmed the binding of miR-219-5p to the 3’ UTRs by using reporter plasmids. We also confirmed the specificity of miR-219-5p binding sites in the 3’ UTR of EGFR by site directed mutagenesis of binding sites which abrogated the miRNA-UTR interaction. The expression of miR-219-5p was significantly downregulated in grade III as well as in grade IV astrocytoma samples in the miRNA microarray experiment and we further validated the downregulation in an independent cohort of grade III and grade IV astrocytoma patients by real-time qRT-PCR. The ectopic overexpression of miR-219-5p in glioma cell lines inhibited cell proliferation, colony formation, anchorage independent growth and the migration of glioma cells. In addition, overexpression of miR-219-5p decreased MAPK and PI3K pathways, in concordance with its ability to target EGFR and PDGFRα. Additionally, for the further characterization of miR-219-5p – EGFR interaction and its effect on MAPK and PI3K pathways, we used U87 glioma cells that stably overexpress wild-type EGFR and constitutively active ΔEGFR (both lacking 3’-UTR and thus being insensitive to miR-219-5p overexpression) along with U87 parental cells. In these cell lines with the overexpression of EGFR lacking 3’-UTR, miR-219-5p was unable to inhibit - MAPK and PI3K pathways and also glioma cell migration suggesting that these effects were indeed because of its ability to target EGFR. Further, in the glioblastoma patient cohort (TCGA dataset), we found significant negative correlation between EGFR protein levels, both total EGFR and phospho EGFR and miR-219-5p levels in the glioblastoma tissue samples suggesting a role of miR-219-5p in increasing the protein levels of EGFR in glioblastoma. In summary, we have identified and characterized miR-219-5p as the RTK regulating tumor suppressor miRNA in glioblastoma.

Metalofármacos baseados em rutênio têm se mostrado promissores com relação à atividade anticancerígena frente a diversos tipos de tumores. Nosso grupo de pesquisa dedica-se ao estudo de compostos contendo o centro dimetálico de valência mista Ru2(II,III) coordenado a ligantes derivados de Faines (Fármacos anti-inflamatórios não esteroides), tendo demostrando o potencial desses complexos frente a glioma. O entendimento do modo de ação destes complexos requer o estudo de suas interações com biomoléculas presentes no meio biológico. Neste cenário, o presente trabalho teve por objetivo investigar a interação de três complexos de dirutênio-Faines, ou RuFaines, [Ru2(ibp)4Cl], [Ru2(ceto)4Cl] e [Ru2(npx)4(H2O)2]PF6 (ibp = ibuprofenato, ceto = cetoprofenato e npx = naproxenato), e também do precursor [Ru2(O2CCH3)4Cl], RuAc, com as principais proteínas presentes no soro humano, transferrina e albumina. Os complexos foram sintetizados e caracterizados conforme metodologias desenvolvidas no grupo. A interação destes complexos com a transferrina, em suas formas apo e holo, e com a albumina foi avaliada por técnicas como espectroscopia eletrônica, dicroísmo circular, fluorescência, e realizaram-se estudos de ultrafiltração com análise do aduto formado por ICP-OES e espectrometria de massas. Além disso, fez-se um estudo de captação celular dos complexos RuFaines por células de glioma humano da linhagem U-87. Os resultados demonstraram que os complexos de dirutênio-Faines interagem com ambas as proteínas séricas (transferrina (apo e holo) e albumina), de modo semelhante, mas que é distinto daquele observado para o complexo RuAc. A presença de íons Fe(III) nos sítios específicos da transferrina não afetou a interação dos complexos RuFaines, enquanto que um comportamento diferente foi observado para o RuAc. Verificou-se que todas as proteínas avaliadas (albumina, apo-transferrina e holo-transferrina) apresentam capacidades similares de retenção dos complexos (~ 70% da quantidade de Ru adicionada inicialmente), independentemente da natureza do ligante carboxilato coordenado. Estudos de captação celular mostraram que a interação dos complexos RuFaines com a transferrina não contribuiu para modificar a capacidade de entrada desses complexos na célula, em comparação com os metalofármacos livres. Em alguns casos, inclusive, a formação de aduto com a apo-transferrina teve um efeito contrário, diminuindo a captação de rutênio. Dessa forma, concluiu-se que o ciclo da transferrina provavelmente não é a principal rota de entrada nas células para os complexos estudados. / Ruthenium metallodrugs have shown promising antitumor activity against to several tumor types. Our research group is dedicated to study compounds containing the mixed-valence Ru2(II,III) dimetallic center coordinated to NSAIDs (nonsteroidal anti-inflammatory drugs) derived ligands, and have demonstrated the potential of these complexes against glioma. The understanding of the mode of action of these complexes requires the study of their interactions with biomolecules present in biological environment. In this scenario, the present work aimed to investigate the interaction of three complexes of diruthenium-NSAIDs, or RuNSAIDs, [Ru2(ibp)4Cl], [Ru2(ceto)4Cl] and [Ru2(npx)4(H2O)2]PF6 (ibp = ibuprofenate, ceto = ketoprofenate, npx = naproxenate), and also of the precursor [Ru2(O2CCH3)4Cl], RuAc, with the major proteins present in the human serum, transferrin and albumin. The complexes were synthesized and characterized according to methods developed in our group. The interaction of these complexes with transferrin, in the two forms apo and holo, and with albumin was evaluated by techniques as electronic spectroscopy, circular dichroism, fluorescence, and ultrafiltration studies accompanied by analysis of adducts by ICP-OES and mass spectrometry. Moreover, cellular uptake studies of the RuNSAIDs complexes by U-87 human glioma cells line were performed. The results demonstrated that the diruthenium-NSAIDs complexes interact with both proteins (transferrin (apo and holo) and albumin), in a similar way, but that is distinct of that observed for the RuAc complex. The presence of Fe(III) ions in transferrin specific binding sites did not affect the interaction of the RuNSAID complexes with the protein, while a different behavior was shown by RuAc. All the proteins studied here (albumin, apo-transferrin and holo-transferrin) showed similar capabilities for retention of the complexes (~ 70 % of the initial amount of Ru added), independently of the nature of the coordinated carboxylate ligand. Cellular uptake studies showed that the interaction of the RuNSAIDs complexes with transferrin did not contribute to modify the internalization capacity of these complexes, in comparison with the free metallodrugs. In some cases, the adduct formation with apo-transferrin showed an opposite effect, leading to the decrease of ruthenium uptake. The findings led to the conclusion that transferrin cycle probably is not the main entry way to the cells for the studied complexes.

Introdução: No campo do tratamento cirúrgico de Gliomas, tem se observado um interesse crescente no uso de novas tecnologias de suporte como métodos auxiliares na obtenção do equilíbrio entre radicalidade cirúrgica e preservação da funcionalidade cerebral. Na maior parte dos estudos, a localização tumoral tem sido pouco considerada e a real eficácia das tecnologias de suporte ainda está pouco investigada nos gliomas insulares. Objetivos: avaliar a eficácia da fluorescência intraoperatória com 5-ALA, monitorização neurofisiológica, neuronavegação e tractografia no grau de ressecção tumoral (GRT), escores de funcionalidade, sobrevida global e sobrevida livre de progressão em uma coorte retrospectiva de gliomas insulares. Métodos: revisamos todos os casos de tumores insulares operados no Departamento de Neurocirurgia da Universidade de Tübingen - Alemanha, entre maio de 2008 e novembro de 2013. O grau de ressecção foi avaliado por volumetria. Foram utilizados os testes de Mann Whitney, Qui-quadrado e funções de Kaplan Meier para análise do efeito de cada tecnologia nos desfechos primários e secundários. Resultados: 28 casos - 18 homens (64%) e 10 mulheres (36%); idade média 52,5 anos (12 - 59) - foram inclusos para análise. Gliomas de alto grau corresponderam a 20 casos (71%), com 8 lesões de baixo grau (29%). As tecnologias mais utilizadas foram monitorização neurofisiológica (64%) e neuronavegação (68%). 5-ALA foi a única modalidade associada a taxas de ressecção > 90% (p = 0,05). O uso de tractografia determinou melhora no KPS (50% vs 5%, p = 0,02). Houve associação positiva entre o uso de neuronavegação e sobrevida global (23 vs. 27,4 meses, p = 0,03), mas o uso de 5-ALA se associou a piora na sobrevida global (34,8 vs 21,1 meses, p = 0,01) e sobrevida livre de progressão (24,4 vs. 11,8 meses, p = 0,01). Conclusões: Considerando os gliomas insulares, o presente trabalho demonstra pioneiramente que o uso de 5-ALA tem papel na obtenção de maiores taxas de ressecção, ainda que este achado possa estar associado a piora nas sobrevidas global e livre de progressão. Tractografia e neuronavegação parecem desempenhar papel importante no tratamento dos gliomas insulares, na medida em que determinaram melhor sobrevida global e funcionalidade, respectivamente. Estudos prospectivos com uma amostra mais proeminente e análise multivariada permitirão a avaliação do benefício real destas tecnologias de suporte no tratamento dos gliomas insulares / Introduction: In the field of Glioma surgery, there has been an increasing interest in the use of assistive technologies to overcome the difficulty of preserving brain function while improving surgical radicality. In most reports, tumor localization has seldom been considered a variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula. Objectives: to evaluate the efficacy of fluorescence-guided resection with 5-ALA, intraoperative neurophysiological monitoring (IOM), neuronavigation, and tractography in the Extent of Resection (EOR), functionality scores, overall survival (OS) and progression-free survival (PFS) in a retrospective cohort of insular gliomas. Methods: we reviewed all cases of insular tumors operated on at the Department of Neurosurgery, University Hospital of Tübingen - Germany, between May 2008 and November 2013. EOR was determined by volumetric analysis. Mann Whitney, Chi-square and Kaplan Meier functions were used for assessment of each technology\'s effect on primary and secondary outcomes. Results: 28 cases (18 men (64%) and 10 women (36%); median age at diagnosis: 52.5 years, range 12 - 59) were considered eligible for analysis. High grade and low grade gliomas accounted for 20 (71%) and 8 (29%) cases, respectively. The most used technologies were IOM (64%) and Neuronavigation (68%). 5-ALA was the only technique associated with EOR > 90% (p = 0.05). Tractography determined improvement in the Karnofsky Performance Scale (50% vs 5% cases improved, p = 0.02). There was a positive association between the use of neuronavigation and overall survival (23 vs. 27.4 months, p = 0.03), but the use of 5-ALA was associated with shorter OS (34.8 vs. 21.1 months, p = 0.01) and PFS (24.4 vs. 11.8, p = 0.01). Conclusions: we demonstrate for the first time that for insular gliomas 5-ALA plays a role in achieving higher EOR, although this technology was associated with poor OS and PFS; Also tractography and neuronavigation can be of great importance in the treatment of insular gliomas as they determined better functionality and overall survival in this study, respectively. Prospective studies with a more prominent sample and proper multivariate analysis will help determine the real benefit of these adjuncts in the setting of insular gliomas

A micróglia é essencial para a homeostase do Sistema Nervoso Central (SNC), função neuro-imune inata, e exerce papel importante na neurodegeneração, envelhecimento cerebral e tumorigênese. Gliomas difusos são tumores cerebrais primários caracterizados por crescimento infiltrativo e altas taxas de heterogeneidade, o que torna a doença praticamente incurável. Avanços em análises genéticas caracterizaram alterações moleculares relacionadas ao tempo de sobrevida e à resposta clínica desses pacientes, especialmente em glioblastomas (GBM). No entanto, a tumorigenicidade dos gliomas não é controlada unicamente por suas alterações genéticas. As interações entre as células tumorais, a micróglia residente e os macrófagos/monócitos infiltrados desempenham um papel crucial na modulação do crescimento e agressividade do glioma. Neste estudo, analisamos o fenótipo de ativação da micróglia/macrófagos em gliomas, incluindo astrocitomas e oligodendroglimas de diferentes graus de malignidade, apresentamos o perfil de expressão gênica da população pura de micróglia cortical e do tecido cerebral total correspondente. Usando sequenciamento de DNA de alta performance, classificamos as amostras de GBM em Proneural, Clássico e Mesenquimal. Em seguida, avaliamos os status de ativação da micróglia/macrófagos dessas amostras. Apesar do alto grau de heterogeneidade, pudemos observar níveis mais altos dos marcadores mielóides (IBA1, CD11b and CD68) em tumores astrocíticos comparados a tumores de origem oligodendrocítica e ao tecido não-neoplásico. Marcadores de anti-inflamação, como CD163, foram mais abundantes em astrocitomas, bem como em GBMs do subtipo Mesenquimal e Clássico; enquanto que marcadores de pró-inflamação, como IL1-beta, mostraram uma expressão mais heterogênea entre as amostras. Em seguida, micróglia foi isolada de 25 amostras de córtex parietal provenientes de autópsia de indivíduos cognitivamente preservados e foi feito o RNA-seq. Os resultados foram comparados à micróglia de camundongo e a outras células mielóides. Boa parte dos genes expressos pela micróglia humana foram similares àqueles expressos pela micróglia murina, como CX3CR1, P2YR12 e ITGAM. Porém, foram identificados genes de característica imune, abundantemente expressos na micróglia humana e não identificados na micróglia de camundongos, como TLR, Fcy, receptores do tipo SIGLEC, e fatores de transcrição NLRC5 e CIITA. A comparação dos dados de expressão gênica da micróglia com monócitos e macrófagos identificou novos marcadores que distinguem a micróglia humana de outras células mielóides. Nossos dados sobre a micróglia em gliomas sugerem características de imunossupressão e de pró-crescimento em tumores de pior prognóstico, ligado a um fenótipo específico de ativação das células mielóides. Este é o primeiro estudo a identificar o transcriptoma da micróglia humana pura, demonstrando que ela é claramente diferente da micróglia murina e de outras células mielóides. Esses resultados abrem portas para estudos de populações específicas de células mielóides em gliomas / Microglia are essential for central nervous system (CNS) homeostasis and innate neuroimmune function, and play important roles in neurodegeneration, brain aging and tumorigenesis. Diffuse gliomas are primary brain tumors characterized by infiltrative growth and high heterogeneity, which renders the disease mostly incurable. Advances in genetic analysis have characterized molecular alterations leading to impact on patients\' overall survival and clinical outcome, particularly in glioblastoma (GBM). However, glioma tumorigenicity is not controlled uniquely by its genetic alterations. The crosstalk between tumor cells, resident microglia and infiltrating monocytes/macrophages plays a crucial role in modulating glioma growth and aggressiveness. Here, we assess the activation status of microglia/macrophages in gliomas,including astrocytomas and oligodendrogliomas of different grades of malignancy, and present the gene expression profile of pure cortical human microglia and corresponding unsorted brain tissue. Using high-throughput DNA sequencing, we have classified GBM samples in Proneural, classical and mesenchymal. Next, we evaluated the activation status of microglia/macrophages within these samples. Despite the great heterogeneity, we observed higher levels of myeloid markers (IBA1, CD11b and CD68) in astrocytic tumors compared to oligodendrocytic ones and to non-neoplastic (NN) tissue. Anti-inflammation markers, such as CD163, are also more abundant in astrocytomas, as well as in the mesenchymal and classical GBM subtypes, while pro-inflammation markers, such as IL1-beta, show a more widespread expression throughout samples. Next, microglia were isolated from the parietal cortex of 25 autopsy samples of cognitively preserved humans and RNA sequenced. Overall, genes expressed by human microglia are similar to mouse microglia, such as CX3CR1, P2YR12, and ITGAM. Interestingly, a number of immune genes, not identified as mouse microglia signature genes, were abundantly expressed in human microglia, such as TLR, Fcy and SIGLEC receptors and NLRC5 and CIITA transcription factors. Comparison of microglia to monocyte and macrophage expression data underscored the CNS-specific functions of microglia and new markers were identified that distinguish human microglia from other myeloid cells. Our glioma-related data suggests an immune-suppressive and growth supportive characteristic for tumors with worse clinical outcome, linked to an activation profile of myeloid cells. This data is the first comprehensive pure human microglia gene expression profile; human microglia clearly differ from mouse microglia and other myeloid cells. These results will help further studies focusing on pure myeloid cells populations in glioma

Os gliomas apresentam comportamento amplamente infiltrativo e a invasão para o tecido cerebral sadio adjacente ao tumor o tornam um grande desafio para intervenções clínicas agressivas. Estudos recentes dos mecanismos de invasão de gliomas sugerem que as metaloproteinases (MMPs) desempenham papel crítico neste processo. As MMPs são super-expressas em quase todos os tumores humanos e vastos dados pré-clínicos as apontam como contribuintes do desenvolvimento maligno; portanto, a inibição de atividade de MMPs poderia ser adotada como uma estratégia de terapêutica anti-câncer. A atividade inibitória de MMP-2 e MMP-9 do extrato liofilizado da raiz de P. umbellata foi avaliada em estudos prévios de nosso laboratório por Ropke e colaboradores. Assim, esta dissertação teve como objetivo, primeiramente, explorar a citotoxicidade do extrato de P. umbellata e posteriormente, a avaliar o efeito do 4-neroridilcatecol (o princípio ativo isolado do extrato) quanto à citotoxicidade e potencial de inibição de MMPs durante o processo de invasão de duas linhagens de glioma humano, caracterizadas pelos diferentes níveis de invasividade. Os resultados revelam os índices de citotoxicidade do extrato bruto da raiz de P. umbellata e do composto 4-NC presente nesse extrato. Ensaios de invasão tumoral in vitro em concentrações não citotóxicas mostraram que há forte inibição desse processo pelo composto. Interessantemente, o 4-NC não alterou significativamente a atividade e expressões gênicas e protéicas de MMPs envolvidas na invasão deste tipo de tumor, nem de seus reguladores. O ensaio de fragmentação do DNA nos indica que a morte das células é, em parte, devido à apoptose, além da participação do processo autofágico. Ensaios analisando a expressão de proteínas e genes envolvidos na via de autofagia mostraram que há indução deste processo pelo composto estudado. Quando este processo é inibido farmacologicamente há incremento na morte celular causada pelo 4-NC. Considerando que em câncer, a autofagia é um processo essencial na modulação da resistência a quimioterápicos, descrevemos aqui, que 4-NC, a exemplo de seu poder citotóxico em melanomas, atua no processo invasivo de gliomas e induz morte celular além de desencadear o processo autofágico. / Gliomas present extensive invasive behavior and the invasion to healthy adjacent neural tissue makes this type of tumor a great challenge for aggressive clinical intervention. Recent studies concerning glioma invasion mechanisms suggest that metalloproteinases (MMPs) have a critical role in this process. MMPs are overexpressed in almost all types of human tumors and many pre-clinical data point to them as functional enhancers to malignant development; then, the inhibition of MMP activity could be adopted as an anti-cancer therapeutic strategy. P. umbellate root extract inhibitory activity over MMPs-2 and 9 was previously evaluated in studies from our group by Ropke et al. Thus, this dissertation has as an objective to evaluate the cytotoxic effect of 4-nerolidylcatechol (a compound purified from the P. umbellate extract), and its potential for MMP inhibition during the invasive process of two human glioma cell lines, characterized for their different invasive levels. Our results show the cytotoxic levels of the crude extract from the root of P. umbellate and from the 4-NC isolated from the extract. In vitro tumor invasion assay in non-cytotoxic drug concentrations indicate a strong inhibition of this process by the compound. Interestingly, 4-NC did not significantly alter enzyme activity, genetic or proteic expression of the MMPs involved in glioma invasion, or its regulators. The DNA fragmentation assay shows that cells die, in part, due to apoptosis, but autophagy pathway is also involved in cell death. Assays showing expression of proteins and genes involved in the autophagy pathway showed an increase of this process by the compound studied. Pharmacological inhibition of this process leads to an increase in cell death caused by 4-NC. Considering that in cancer, autophagy plays an essential role in the modulation of chemoresistance, we describe here that 4-NC, as described previously for melanomas, acts on glioma invasive process, induces cell death and is capable of up-regulating autophagic process.

A galectina-3 (gal-3) pertence a uma família de proteínas com domínios de ligação a beta-galactosídeos e está relacionada com diversos aspectos tumorais, como proliferação e adesão celular, angiogênese e proteção contra morte celular. Estudos mostram sua relação com o fenômeno da hipóxia, característica de diversos tumores sólidos que apresentam altas taxas de proliferação celular. A adaptação à hipóxia é mediada principalmente pelo Fator Induzido por Hipóxia (HIF-1), a qual atua na indução de diversos genes de sobrevivência em ambientes com baixas concentrações de oxigênio. Além de HIF, outros fatores são importantes nesse processo, como NF-kB, por exemplo, sendo um fator de transcrição responsivo a diversos estresses celulares, entre eles, a hipóxia. Alguns modelos tumorais apresentam-se ideais para o estudo dos efeitos da hipóxia no microambiente tumoral, como os glioblastomas. Estes são tumores do sistema nervoso central com altas taxas de letalidade, são refratários aos principais métodos de tratamento por sua plasticidade, crescimento infiltrativo e heterogeneidade. Histologicamente, estes tumores apresentam atipia nuclear, altas taxas de mitose e áreas de pseudopaliçada. Postula-se que estas áreas sejam compostas por células migrantes de ambientes necróticos, os quais são também hipóxicos devido a sua distância de vasos sanguíneos e é demonstrado que estas células expressam tanto HIF-1alfa quanto gal-3. Ensaios in vitro realizados por nosso grupo demonstraram que a gal-3 é positivamente regulada pela hipóxia em uma linhagem de glioma híbrido, NG97ht, além de demonstrar que esta proteína é um fator chave na proteção destas células contra a morte celular induzida pela privação de oxigênio e nutrientes, mimetizando condições necróticas de pseudopaliçada in vivo, destacando-se as habilidades antiapoptóticas desta proteína. Embora uma de suas possíveis funções tenha sido elucidada, os mecanismos de atuação e de indução da gal-3 ainda são obscuros. Deste modo, este projeto visa explorar os papéis pró-tumorais da gal-3, podendo torná-la um possível alvo em terapias anti-neoplásicas, entendendo melhor seus mecanismos de proteção contra a morte celular e controle de expressão em ambientes hipóxicos, além de estudar suas possíveis funções in vivo no desenvolvimento de tumores, e também estendendo seus estudos para outras linhagens de glioblastoma. Nossos resultados demonstraram que a gal-3 está co-localizada com mitocôndrias nestas linhagens de glioma, podendo sofrer alterações pós-traducionais em hipóxia, como a fosforilação e que houve acúmulo de HIF-1alfa nuclear nestas células em hipóxia. Vimos também que a gal-3 na linhagem NG97ht apresentou-se proveniente de dois alelos diferentes e que fatores intermediários deveriam ser expressos previamente pela célula antes da indução de gal-3 em hipóxia. Também demonstramos que houve dependência de NF-kB na indução transcricional de gal-3 nestas condições. Estes experimentos também demonstraram que a exposição de células à hipóxia e privação de nutrientes é capaz de induzir tanto espécies reativas de oxigênio como o aumento da autofagia nestas células, fatores importantes na indução da morte celular, além de demonstrar que na linhagem NG97ht a indução da morte nestas condições ocorreu por necrose, sem apresentar apoptose celular. Expandimos esta teoria da participação da gal-3 como molécula protetora contra a morte em hipóxia e privação de nutrientes para outra linhagem de glioma humano, a T98G. E finalmente, demonstramos que a diminuição da expressão de gal-3 em células tumorais da linhagem U87MG levou a diminuição das taxas de estabelecimento e crescimento tumoral in vivo / Galectin-3 (gal-3) belongs to a family of proteins with beta-galactoside binding domains and is related to various tumoral aspects, such as cell proliferation and adhesion, angiogenesis and protection against cell death. Studies show its relationship with the hypoxia phenomenon, a characteristic of many solid tumors that have high cell proliferation rates. The adaptation to hypoxia is mainly mediated by Hypoxia Induced Factor (HIF-1), which acts in the induction of several survival genes in environments with low oxygen concentrations. In addition to HIF, other factors are important in this process, such as NF-kB, for example, which is a transcription factor responsive to various cellular stresses, including hypoxia. Some tumor models are ideal for studying the effects of hypoxia in the tumor microenvironment, e.g. glioblastomas. These central nervous system tumors with high mortality rates are refractory to the main treatment methods due to their plasticity, heterogeneity and infiltrative growth. Histologically, these tumors exhibit nuclear atypia, high mitotic rates and pseudopalisading areas. It is postulated that these areas are composed of migrating cells out of necrotic microenvironments, which are also hypoxic due to their distance from the blood vessels and it is shown that these cells express both HIF-1alfa and gal-3. In vitro assays performed by our group demonstrated that gal-3 is positively regulated by hypoxia in a hybrid glioma cell line, NG97ht, and demonstrated that this protein is a key factor in protecting these cells against cell death induced by oxygen and nutrient deprivation conditions mimicking necrotic pseudopalisading areas in vivo, highlighting the pro-survival abilities of this protein. Although one of its possible functions has been elucidated, gal-3 mechanisms of action and induction are still unclear. Thus, this project aims to explore the gal-3 pro-tumoral effects, which may make it a possible target for anti-neoplastic therapies, better understanding the mechanisms of protection against cell death and expression in hypoxic environments, and also study its possible functions in vivo, extending these studies to other glioma cell lines. Our results demonstrated that gal-3 is located within the mitochondria in these glioma cell lines and may undergo posttranslational modifications in hypoxia, such as phosphorylation and that there is accumulation of nuclear HIF-1alfa in these cells under hypoxia. We have also seen that gal-3 in the NG97ht cell line presents two different alleles and that intermediate factors must be expressed previously by the cell before gal-3 induction in hypoxia. We also demonstrated that there is dependence on the NF-kB transcriptional factor for the gal-3 induction under these conditions. These experiments also demonstrated that exposure of cells to hypoxia and nutrient deprivation is capable of inducing reactive oxygen species and increased autophagy in these cells, which are important factors in the induction of cell death. In addition, we demonstrated that the induction of the NG97ht cell death in these conditions is due to necrosis. We expanded this theory of the participation of gal-3 as a protective molecule against cell death in hypoxia and nutrient deprivation to another human glioma cell line, T98G. And finally, we demonstrated that decreased expression of gal-3 in the U87MG glioma cell line leads to lower tumor establishment rates and decreased growth in vivo

A invasão de células tumorais para o tecido cerebral sadio é a marca patológica dos gliomas e contribui para o fracasso das modalidades terapêuticas atuais (cirurgia, radioterapia e quimioterapia). As células da glia transformadas apresentam os padrões clássicos do processo invasivo, incluindo adesão celular aos componentes da matriz extracelular (MEC), locomoção celular e a capacidade de remodelar o espaço extracelular. As metaloproteases de matriz (MMPs) são essenciais para o remodelamento adequado da MEC e para a invasão. O proteína supressora de tumor e metástase RECK regula pelo menos três diferentes membros da família das MMPs, especificamente: MMP-2, MMP-9 e MMP-14. Com o propósito de mimetizar o processo invasivo in vivo, as linhagens celulares de glioma humano A172 e T98G, respectivamente não invasiva e invasiva, foram plaqueadas em plástico (controle), colágeno tipo 1 ou Matrigel - membrana basal reconstituída, e incubadas por 3 e 7 dias, para estabelecer o processo invasivo. Nossos resultados mostram uma diminuição das taxas de proliferação e alterações morfológicas quando estas células foram cultivadas na presença de colágeno ou Matrigel. Microscopia eletrônica de transmissão das células T98G, cultivadas por 7 dias em colágeno, evidenciam invaginações de membrana similares ao que foi recentemente descrito como podossomos. Este novo tipo de estrutura é encontrado tipicamente em células que precisam cruzar barreiras teciduais, já que são sítios de degradação da MEC. A presença destas estruturas reforça o caráter invasivo da linhagem T98G. Ensaios de PCR em tempo real revelaram maior expressão de mRNA de RECK nas células A172, quando comparadas às células T98G, nas três condições de cultivo. Interessantemente as células A172 apresentaram maior expressão de RECK no colágeno tipo 1, enquanto a T98G demonstra uma tendência de aumento na expressão de RECK para colágeno tipo 1 e Matrigel. As MMPs são mais expressas e possuem maior atividade nas células T98G, e também são induzidas pelo substrato de colágeno. Estes resultados sugerem: 1) a expressão de RECK é diminuída pelo caráter invasivo apresentado por T98G, 2) o uso de substratos de MEC, como colágeno tipo 1 (A172 e T98G) e Matrigel (T98G), permite modular a expressão de RECK nestas linhagens de glioma. Como foi estabelecida uma correlação positiva entre a expressão de RECK e a taxa de sobrevida de pacientes para vários tipos tumorais, nossos resultados podem contribuir para o esclarecimento dos complexos mecanismos do processo invasivo no modelo de gliomas / The invasion of neoplastic cells into healthy brain tissue is a pathologic hallmark of gliomas and contributes to the failure of current therapeutic modalities (surgery, radiation and chemotherapy). Transformed glial cells display the common attributes of the invasion process, including cell adhesion to extracellular matrix (ECM) components, cell locomotion, and the ability to remodel the extracellular space. Matrix metalloproteinases (MMPs) are essential for proper ECM remodeling and invasion. The tumor and metastasis suppressor RECK protein regulates at least three members of the matrix metalloproteinase (MMPs) family, namely: MMP-2, MMP-9 and MMP-14. In order to mimic the in vivo invasion process, A172 and T98G, respectively, non-invasive and invasive human glioma cell lines were plated onto either plastic (control), or collagen type I gel or Matrigel™-basement membrane reconstituted, and incubated for 3 and 7 days, to establish the invasion process. Our results indicate decreased growth rates and morphological alterations regarding the invasive phenotype when these cell lines are cultured onto collagen gel and Matrigel™. Electronic transmission microscopy of T98G cells, cultured for 7 days onto collagen, pointed out membrane invaginations that are similar to what was recently described as podosomes. These new structures are typically found in cells that have to cross tissue boundaries, since they are sites of ECM degradation. The presence of these structures reinforces the invasive behavior of T98G cell line. Real time PCR assays revealed higher RECK mRNA expression in A172 cells, when compared to T98G cells in all three different substrate conditions. Interestingly, A172 cells displayed the upregulation of RECK expression in collagen gel, while in T98G high RECK expression was observed both in collagen and in Matrigel™. MMPs appear more expressed and more active for T98G cells, and are also upregulated by collagen. These results suggest that: 1) RECK expression is downregulated in the invasion process displayed by T98G cells, 2) coating of the substrate with ECM elements, such as collagen in the case of A172, and Matrigel™ and Collagen for T98G cells, can modulate RECK expression in glioma cell lines. Since positive correlation between RECK expression and survival of patients has been noted in several types of tumors, our preliminary results can contribute to elucidate the complex mechanisms of the glioma invasiveness process.

Os gliomas apresentam comportamento amplamente infiltrativo e a invasão para o tecido cerebral sadio adjacente ao tumor o tornam um grande desafio para intervenções clínicas agressivas. Estudos recentes dos mecanismos de invasão de gliomas sugerem que as metaloproteinases (MMPs) desempenham papel crítico neste processo. As MMPs são super-expressas em quase todos os tumores humanos e vastos dados pré-clínicos as apontam como contribuintes do desenvolvimento maligno; portanto, a inibição de atividade de MMPs poderia ser adotada como uma estratégia de terapêutica anti-câncer. A atividade inibitória de MMP-2 e MMP-9 do extrato liofilizado da raiz de P. umbellata foi avaliada em estudos prévios de nosso laboratório por Ropke e colaboradores. Assim, esta dissertação teve como objetivo, primeiramente, explorar a citotoxicidade do extrato de P. umbellata e posteriormente, a avaliar o efeito do 4-neroridilcatecol (o princípio ativo isolado do extrato) quanto à citotoxicidade e potencial de inibição de MMPs durante o processo de invasão de duas linhagens de glioma humano, caracterizadas pelos diferentes níveis de invasividade. Os resultados revelam os índices de citotoxicidade do extrato bruto da raiz de P. umbellata e do composto 4-NC presente nesse extrato. Ensaios de invasão tumoral in vitro em concentrações não citotóxicas mostraram que há forte inibição desse processo pelo composto. Interessantemente, o 4-NC não alterou significativamente a atividade e expressões gênicas e protéicas de MMPs envolvidas na invasão deste tipo de tumor, nem de seus reguladores. O ensaio de fragmentação do DNA nos indica que a morte das células é, em parte, devido à apoptose, além da participação do processo autofágico. Ensaios analisando a expressão de proteínas e genes envolvidos na via de autofagia mostraram que há indução deste processo pelo composto estudado. Quando este processo é inibido farmacologicamente há incremento na morte celular causada pelo 4-NC. Considerando que em câncer, a autofagia é um processo essencial na modulação da resistência a quimioterápicos, descrevemos aqui, que 4-NC, a exemplo de seu poder citotóxico em melanomas, atua no processo invasivo de gliomas e induz morte celular além de desencadear o processo autofágico. / Gliomas present extensive invasive behavior and the invasion to healthy adjacent neural tissue makes this type of tumor a great challenge for aggressive clinical intervention. Recent studies concerning glioma invasion mechanisms suggest that metalloproteinases (MMPs) have a critical role in this process. MMPs are overexpressed in almost all types of human tumors and many pre-clinical data point to them as functional enhancers to malignant development; then, the inhibition of MMP activity could be adopted as an anti-cancer therapeutic strategy. P. umbellate root extract inhibitory activity over MMPs-2 and 9 was previously evaluated in studies from our group by Ropke et al. Thus, this dissertation has as an objective to evaluate the cytotoxic effect of 4-nerolidylcatechol (a compound purified from the P. umbellate extract), and its potential for MMP inhibition during the invasive process of two human glioma cell lines, characterized for their different invasive levels. Our results show the cytotoxic levels of the crude extract from the root of P. umbellate and from the 4-NC isolated from the extract. In vitro tumor invasion assay in non-cytotoxic drug concentrations indicate a strong inhibition of this process by the compound. Interestingly, 4-NC did not significantly alter enzyme activity, genetic or proteic expression of the MMPs involved in glioma invasion, or its regulators. The DNA fragmentation assay shows that cells die, in part, due to apoptosis, but autophagy pathway is also involved in cell death. Assays showing expression of proteins and genes involved in the autophagy pathway showed an increase of this process by the compound studied. Pharmacological inhibition of this process leads to an increase in cell death caused by 4-NC. Considering that in cancer, autophagy plays an essential role in the modulation of chemoresistance, we describe here that 4-NC, as described previously for melanomas, acts on glioma invasive process, induces cell death and is capable of up-regulating autophagic process.