京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18644号 / 医博第3943号 / 新制||医||1006(附属図書館) / 31558 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 福山 秀直, 教授 渡邉 大 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Les gliomes, tumeurs cérébrales primaires du système nerveux central, sont souvent de pronostic défavorable, d'autant plus que l'absence de critères indiscutables pour les identifier rend leur diagnostic et leur prise en charge particulièrement difficiles. L’analyse conjointe, d’une cohorte française de 64 patients porteurs de gliomes et d’une cohorte internationale de 671 patients issus du TCGA, a permis de mettre en évidence deux groupes pronostiques constitués par un panel d’expression différentielle de 26 gènes (p = 0,007). Cette stratification en deux groupes pronostiques a été confirmée quels que soient le grade et le groupe moléculaire de la tumeur (p < 0,0001). Nous avons établi une nouvelle stratégie diagnostique à partir de la classification moléculaire des gliomes en intégrant deux biomarqueurs pronostiques CHI3L1 et NTRK2. L’analyse multivariée confirme que ces biomarqueurs sont indépendants du statut IDH et du grade tumoral. Si nous avons mis en évidence par l’analyse protéique de CHI3L1 une concordance avec les transcrits, les résultats divergent pour TrkB. Ainsi, une expression élevée de TrkB et son corécepteur p75NTR serait liée à l’agressivité tumorale indépendamment du statut IDH. Enfin, TrkB et p75NTR sont présents aussi bien dans les exosomes issus du plasma de témoins sains et de patients atteints de gliomes mais leur expression augmente en fonction de l’agressivité de la tumeur / Gliomas, primary brain tumours of the central nervous system, are often of poor prognosis.The absence of clear criteria to identify them makes their diagnosis and management particularly difficult. The combined analysis of a cohort of 64 glioma patients and an international cohort of 671 patients from the TCGA revealed two prognostic groups of a differential expression panel of 26 genes (p = 0.007). This stratification into two prognostic groups was confirmed independently of the grade and molecular group of the tumor (p <0.0001). We have established a new diagnostic strategy based on the molecular classification of gliomas by integrating two prognostic biomarkers CHI3L1 and NTRK2. Multivariate analysis confirms that these biomarkers are independent of IDH status and tumor grade.While we have demonstrated by the protein analysis of CHI3L1 concordance with the transcripts, the results are different for TrkB. Therefore, a high expression of TrkB and its p75NTR co-receptor would be associated with tumor aggressiveness regardless of IDH status. Lastly, TrkB and p75NTR are present in exosomes from plasma of healthy controls and glioma patients, but their expression increases with the aggressiveness of tumor.

Bakgrund: Primär malign hjärntumör medför en tung symtombörda som yttrar sig i en stor variation av fysiska, kognitiva och neurologiska symtom som berör patientens funktionsförmåga och psykiska välmående. Utöver den emotionella och existentiella påfrestningen av att leva med en cancersjukdom ingår hos hjärntumörsjuka patienter även en sviktande kognitiv komponent. Syfte: Syftet med denna litteraturöversikt var att belysa psykologiska påfrestningar för vuxna patienter med primär malign hjärntumör. Metod: Studien utfördes som en allmän litteraturöversikt där tiovetenskapliga kvalitetsgranskades och analyserades för att sedan delas in i tre stycken övergripande teman. Resultat: Det första temat, Osäkerheten i prognosen, belyser den ovisshet som uppstod till följd en oförutsägbar framtid och behovet av mer information gällandes behandlingsmöjligheter och vilka symtom som kan väntas drabba dem. Temat Psykosociala konsekvenser beskriver hur patienter kände att de förlora sig själva i sjukdomen på grund av minnespåverkan, personlighetsförändringaroch en oförmåga att upprätthålla den livsstil som de tidigare haft. Gemensamt bland de sjuka var en rädsla för att vara en börda för dem i patientens närhet och en oro om att förlora sin självständighet. Den existentiella konfrontationen talar om de oundvikliga tankarna om döden och om hoppets betydelse. / Background: Primary malignant brain tumor carries a heavy symptom burden that presents itself in a big variation of physical, cognitive and neurological symptoms that affects the patients functioning and psychological wellbeing. Along with the emotional and existential stress of living with cancer, patients diagnosed with brain cancer also suffer from cognitive dysfunction. Purpose: The aim of this study was to illustrate the psychological strain of adult patients living with primary malignant brain tumor. Method: The study was executed as a general literature review based on ten scientific articles. The articles were quality-tested and analyzed to later be sorted into three main themes. Results: The first theme, The uncertainty in the prognosis, illuminate the uncertainty that occurred due to an unpredictable future and the need of information concerning treatment options and what symptoms to expect. The theme The psychosocial consequences, describes how the patients felt as though they had lost themselves to the disease due to memory loss, personality disorders and the inability to maintain the lifestyle they previously had. The patients shared a fear of being a burden to the people around them and a concern of losing their independency. The existential confrontation speaks about the inevitable thoughts of death and the importance of hope.

Un tiers de la population européenne est touché par au moins un trouble du cerveau. En effet, la maladie d’Alzheimer, et les gliomes, représentent respectivement le syndrome de démence et les tumeurs cérébrales les plus fréquentes chez l’homme. Plusieurs études épidémiologiques ont montré l’existence d’une corrélation inverse entre le risque de développer une maladie neurodégénérative et un cancer cérébral. Ceci suggère la présence de dénominateurs moléculaires communs entre ces pathologies. Dans les deux cas, un dysfonctionnement mitochondrial est rapporté, représentant une caractéristique partagée par ces deux troubles neurologiques. La protéine kinase mitochondriale PINK1 responsable, lorsqu’elle est mutée, d’une forme précoce et familiale de Parkinson, est particulièrement impliquée dans les processus de maintien de l’homéostasie mitochondriale. Par conséquent, les mécanismes moléculaires régulant PINK1 ainsi que leurs impacts au cours des désordres mitochondriaux répertoriés dans la maladie d’Alzheimer et les tumeurs cérébrales, ont suscité un intérêt central, lors de ma thèse. Au cours de ce travail, nous avons examiné certaines des fonctions mitochondriales de PinK1, associées au maintien de l’homéostasie mitochondriale dans un contexte « Alzheimerisé ». Nous mettons en évidence le rôle de la γ-secretase dans la physiologie mitochondriale en contrôlant la régulation transcriptionnelle de PINK1 par l’AICD, le fragment généré conjointement avec le peptide amyloïde toxique Aβ, à partir du précurseur βAPP. Nous montrons de surcroît, l’initiation de cette régulation par la parkine. / One third of the European populations is affected by a brain disorder. Thus, Alzheimer’s disease and gliomas represent the most frequent human brain dementia syndrome and tumor type, respectively. Several epidemiological studies have shown an inverse relationship between the risk of developing a neurodegenerative disease and a brain tumor, suggesting the existence of common molecular denominators between these pathologies. Interestingly, both pathologies are characterized by a mitochondrial dysfunction. The mitochondrial kinase associated to autosomal recessive Parkinson’s disease, PINK1, is particularly implicated in the control of mitochondrial homeostasis. The main objective of my thesis was to study the molecular mechanisms underlying PINK1 gene regulation and their link with the mitochondrial dysfunction observed in either Alzheimer’s disease or gliomas. Thus, during my thesis we have examined the ability of PINK1 to control mitochondria homeostasis in an Alzheimer’s pathological context. We demonstrate that AICD, a cleavage product of the trans-membrane protein βAPP by γ-secretase, impacts mitochondrial physiology via its ability of positively controlling PINK1 transcription. In addition, we show that the signaling cascade linking γ-secretase and PINK1 is initiated by parkin transcriptional regulation of presenilins, the main component of γ-secretase catalytic complex. Finally, we also establish that the tumor suppressor p53 can negatively regulate PINK1 transcription in vitro and in vivo suggesting that the misregulated autophagic response associated to brain tumors development may be caused by defective p53-PINK1 interplay.

Manual segmentation of brain tumours is a time consuming process, results often show high variability, and there is a call for automation in clinical practice. In this thesis the use of deep convolutional networks for automatic glioma segmentation in MRI is investigated. The implemented networks are evaluated on data used in the brain tumor segmentation challenge (BraTS). It is found that 3D convolutional networks generally outperform 2D convolutional networks, and that the best networks can produce segmentations that closely resemble human segmentations. Convolutional networks are also evaluated as feature extractors with linear SVM classifiers on top, and although the sensitivity is improved considerably, the segmentations are heavily oversegmented. The importance of the amount of data available is investigated as well by comparing results from networks trained on both 2013 and the greatly extended 2014 data set, but it is found that the method of producing ground-truth was also a contributing factor. The networks does not beat the previous high-scores on the BraTS data, but several simple improvement areas are identified to take the networks further. / Manuell segmentering av hjärntumörer är en tidskrävande process, segmenteringarna är ofta varierade mellan experter, och automatisk segmentering skulle vara användbart för kliniskt bruk. Den här rapporten undersöker användningen av deep convolutional networks (ConvNets) för automatisk segmentering av gliom i MR-bilder. De implementerade nätverken utvärderas med hjälp av data från brain tumor segmentation challenge (BraTS). Studien finner att 3D-nätverk har generellt bättre resultat än 2D-nätverk, och att de bästa nätverken har förmågan att ge segmenteringar som liknar mänskliga segmenteringar. ConvNets utvärderas också som feature extractors, med linjära SVM som klassificerare. Den här metoden ger segmenteringar med hög känslighet, men är också till hög grad översegmenterade. Vikten av att ha mer träningsdata undersöks också genom att träna på två olika stora dataset, men metoden för att få fram de riktiga segmenteringarna har troligen också stor påverkan på resultatet. Nätverken slår inte de tidigare rekorden på BraTS, men flera viktiga men enkla förbättringsområden är identifierade som potentiellt skulle förbättra resultaten.

Malignant gliomas belong to a highly aggressive class of tumours. Average patient survival time generally does not exceed 15 months. Despite intensive research, no therapeutic strategies capable of significantly extending the lives of those affected by the disease have been established to date. One potentially viable area of research into possible therapeutic targets in cancer therapy focuses on cell surface proteases. This group of proteins includes dipeptidyl peptidase IV (DPP-IV). Changes to DPP-IV expression have been established in the case of various cancer types including malignant gliomas. Understanding the role of DPP-IV in the biological processes of this malignant disease may thus contribute to the development of new therapeutic modalities. This thesis is therefore dedicated to establishing an orthotopic xenograft model as well as a genetically engineered model (GEM) of the glioma. The effects of DPP-IV on the growth of an experimental glioma were subsequently examined, as was the ratio of catalytic and non- catalytic mechanisms in this process. The GEM model was used for monitoring enzymatic activity and DPP-IV distribution. Non-invasive fluorescence imaging was employed in order to monitor the intraexperimental dynamics of experimental gliomas. The results indicated that DPP-IV...

Hedgehog-signalling in malignant gliomas The Hedgehog signalling pathway is important for the development of the central nervous system. On the other hand, aberrant induction is observed in different tumors. Immunofluorescence and real-time qRT-PCR confirmed that in some gliomas, specifically in Glioblastoma multiforme (GBM), Gli1, a transcription factor activated by signalling, is present. In general, the hedgehog pathway is initiated by binding of extracellular ligands to the transmembrane receptor Patched and leads finally to the activation of the transcription factors Gli1, Gli2, Gli3 and Gli4. Whereas Gli1 acts as an activator, Gli2 appears to be an activator but retains some repressor activities and Gli3 and Gli4 are believed to act only as inhibitors. Therefore, the determination of hedgehog activity at the level of transcription requires additional experiments measuring gene activation. For that reason, cells isolated from 13 tumors of patients with glioblastoma (WHO Grade IV) and cells from two different glioma cell lines were transfected with reporter genes. These reporter genes carried the luciferase gene from Gaussia princeps under the control of two promoters (pT109 and pT81) conjugated to Gli binding sites. The activity of the reporter genes was compared to a control plasmid with mutant Gli-binding sites. In addition reporter gene activity was analysed in the absence and presence of the hedgehog signalling inhibitor cyclopamine and the effect of cyclopamine on cellular metabolism was studied. The analysis revealed that the two cell lines and cells from 6 glioblastomas exhibited enhanced reporter gene activity compared to the activity mutant control. This points towards an enhanced expression of Gli1. In three cultures a repression was detected suggesting that Gli3 may be active in these cells. Four cultures did neither show activation nor repression. This could provide evidence that Gli1 and Gli3 effects cancel each other out or that there is no effect at all. Enhanced luciferase activity in cells from the line T98G and in cells from four primary cultures was not influenced by the hedgehog inhibitor cyclopamine, whereas one cell line significantly responded to its presence with a decreased activity. Interestingly, ATP level was suppressed by cyclopamine in cells from the line T98G and also in cells from one primary culture that responded to the inhibitor. This may point towards an effect of cyclopamine independent of smo. Since cyclopamine is a potential new substance for the treatment of tumors, the observed effect of this inhibitor even in cells without an indication of hedgehog signalling activity should be investigated in further experiments in more detail. / Der Hedgehog (Hh) -Signalweg spielt während der Embryonalentwicklung eine wichtige Rolle, so auch bei der Entstehung des zentralen Nervensystems (Varjosalo & Taipale 2008). Andererseits führt seine unregulierte Aktivität zur Ausbildung verschiedenster Tumore (Bailey et al. 2009; Fiaschi et al. 2009; Shaw et al. 2009; Velcheti & Govindan 2007). Vorausgegangene Studien wiesen durch Immunfluoreszenz und real-time qRT-PCR nach, dass auch in Gliomen, speziell in Glioblastoma multiforme, dem agressivsten Hirntumor des Menschen, Effektoren des Signalweges (Gli1) überexprimiert werden (Wang et al. 2010). Die Aktivierung des Signalweges geschieht über Bindung des Hh-Liganden an den Rezeptor Ptch und endet mit der Aktiverung der Transkriptionsfaktoren der Gli Familie (Kinzler & Vogelstein 1990; Stone et al. 1996). Die aktuell bekannten Vertreter dieser Familie sind der Aktivator der Transkription Gli1, Gli2, der als Aktivator und Repressor agieren kann sowie Gli3 und Gli4, die die Transkription inhibieren (Marine et al. 1997; Ruppert et al. 1988). Ziel dieser Arbeit war es, herauszufinden, inwieweit die Transkriptionsfaktoren der Gli-Familie in Zellen von Glioblastoma multiforme aktiv sind. Dafür wurden Zellen aus Tumormaterial isoliert und daraus Primärkulturen hergestellt. In diese 13 Primärkulturen, wie auch in zwei Gliom-Zelllinien, wurden mittels transienter Transfektion Reporterplasmide eingebracht. Diese enthielten ein Gen der Gaussia-Luciferase, das unter der Kontrolle zweier verschiedener Promotoren (pT109 und pT81) mit Bindungsmotiven für die Transkriptionsfaktoren der Gli-Familie stand. Weiterhin wurde der Einfluss des Inhibitors des Hh-Signalweges Cyclopamin auf die Gli-Aktivität und die Metabolische Aktivität der Zellen untersucht. Die Beobachtungen ergaben, dass die zwei Zelllinien und sechs der primären Kulturen eine erhöhte Luciferaseaktivität und damit gesteigerte Aktivität von Gli1 zeigten. Weiterhin wiesen vier Kulturen eine verminderte Luciferaseaktivität auf. Dies ließ darauf schließen, dass in diesen Zellen Gli3 aktiv war. In den restlichen vier Kulturen zeigte sich keine Veränderung der Luciferaseaktiviät, was für einen Aufhebungseffekt von Gli1 und Gli3 oder gar keinen Effekt spricht. Weiterhin konnte gezeigt werden, dass die Luciferaseaktivität und damit die Aktivität von Gli1 in Zellen der Zelllinie T98G und von vier Primärkulturen nicht durch Cyclopamin beeinflusst wird. Lediglich eine Probe der Primärkulturen reagierte mit einer Abnahme der Luciferaseaktivität. Außerdem konnte Cyclopamin die ATP-Produktion sowohl in Zellen von T98G als auch in Zellen der Zelllinie, deren Gli-Aktivität durch Cyclopamin vermindert wurde, senken. Dies sprach für eine Smo unabhängige Wirkung des Cyclopamins. Da Cyclopamin ein potenzielles Pharmakon für die Antitumortherapie ist, bedarf dieser Umstand näherer Untersuchungen.

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Les gliomes sont les tumeurs cérébrales de l’adulte les plus fréquentes, dont l’étiologie reste encore largement inconnue. Plusieurs études épidémiologiques ont montré l’existence d’une corrélation entre maladies neurodégénératives et cancers cérébraux. Nous avons émis l’hypothèse qu’il existait des dénominateurs moléculaires communs entre ces pathologies. Je me suis particulièrement intéressé au rôle de la parkine (PK), une ubiquitine ligase responsable des formes génétiques de la maladie de Parkinson (MP). En effet, plusieurs arguments soutiennent l'implication de la PK dans les gliomes.Des études ont montré que la PK présente une expression altérée dans les cas de cancers du sein et de la prostate. La PK possède également une fonction de facteur de transcription. Elle est capable de se fixer à l’ADN de p53 et inhibe sa transcription. p53 est un suppresseur de tumeur fréquemment inactivé (50% des cancers). Une étude a mis en évidence l'existence de mutations somatiques de la PK spécifiques des cancers cérébraux. Mon projet s'est articulé autour de trois axes. 1- PK et Maladie d’Alzheimer. Elle active la transcription de la préséniline 1 et d’inhiber celle de la préséniline 2. 2- PK et MP. La PK par l’intermédiaire de p53 régule XBP-1, un facteur de transcription notamment activé par le stress du réticulum, qui à son tour régule l’expression de DJ-1. 3- PK et gliomes. Nous avons observé une diminution d’expression de la PK corrélé à l’augmentation d’expression de p53 dans des biopsies de gliomes. Nous avons alors montré que p53 est capable d’activer la synthèse de la PK, effet aboli par des mutations de p53 dans les gliomes. / Gliomas are the most common form of brain tumor, the etiology of which remains unknown. Several epidemiological studies have shown the existence of a correlation between neurodegenerative diseases and brain tumor. We hypothesis that these two pathology share common molecular denominators. Here I study the role of parkin (PK) an ubiquitin ligase responsible of early onset Parkinson diseases. Several arguments support the involvement of PK in glioma. Studies have shown that PK expression is alterated in many types of cancers. PK is also a transcription factor which can bind to p53 DNA and inhibits its transcription. P53 is a tumor suppressor often find inactivate in cancers (50%). There is evidence of specific somatic mutations found in glioma. My work was organize according to three axes 1- PK and Alzheimer disease: PK activates préséniline 1 expression and inhibits préséniline 2. 2- PK through XBP-1 regulates p53, a transcription factor activated by reticulum stress, which in turn regulates the expression of DJ-1. 3- PK and Glioma: There is a decrease in parkin expression that can be correlated to p53 expression increase in glioma biopsies. I show that p53 is able to activate PK synthesis, a mechanism abolish by p53 mutations in tumors.

abstract: The main objective of mathematical modeling is to connect mathematics with other scientific fields. Developing predictable models help to understand the behavior of biological systems. By testing models, one can relate mathematics and real-world experiments. To validate predictions numerically, one has to compare them with experimental data sets. Mathematical modeling can be split into two groups: microscopic and macroscopic models. Microscopic models described the motion of so-called agents (e.g. cells, ants) that interact with their surrounding neighbors. The interactions among these agents form at a large scale some special structures such as flocking and swarming. One of the key questions is to relate the particular interactions among agents with the overall emerging structures. Macroscopic models are precisely designed to describe the evolution of such large structures. They are usually given as partial differential equations describing the time evolution of a density distribution (instead of tracking each individual agent). For instance, reaction-diffusion equations are used to model glioma cells and are being used to predict tumor growth. This dissertation aims at developing such a framework to better understand the complex behavior of foraging ants and glioma cells. / Dissertation/Thesis / Doctoral Dissertation Applied Mathematics 2019