Glioblastoma multiforme (GBM) is the most common primary brain tumor. Studies have shown that targeting the DNA damage response can sensitize cancer cells to DNA damaging agents. Ataxia telangiectasia mutated (ATM) is involved in signaling DNA double strand breaks. Our group has previously shown that ATM inhibitors (ATMi) sensitize GBM cells and tumors to ionizing radiation. This effect is greater when the tumor suppressor p53 is mutated. The goals of this work include validation of a new ATM inhibitor, AZ32, and elucidation of how ATMi and p53 status interact to promote cell death after radiation. We propose that ATMi and radiation induce mitotic catastrophe in p53 mutants by overriding cell cycle arrest. We tested this hypothesis in human colon carcinoma and glioma cells that differ only in p53 status. We found that AZ32 effectively inhibits phosphorylation of ATM targets. In addition, AZ32 significantly sensitizes glioma cells to ionizing radiation. While HCT116 colon carcinoma cells fail to arrest the cell cycle after radiation, their response to ATMi differs from that in gliomas. Indeed, wild type HCT116 cells were more sensitive than p53 mutants to ionizing radiation in the presence of ATMi. In contrast, ATMi significantly radiosensitized glioma cells in which p53 is knocked down. Live cell imaging confirmed that radiation and ATMi preferentially induce mitotic catastrophe in p53-deficient cells. We conclude that p53-deficient cells rely on ATM signaling for G2/M cell cycle arrest. We propose a model of G2/M arrest whereby ATM and p53-dependent signaling pathways converge to ultimately inhibit Cdc25 phosphatases.

Le gliome infiltrant du tronc cérébral est une tumeur rare, non opérable et inéluctablement fatale. En raison du manque de ressource biologique disponible, aucun progrès dans la compréhension de la biologie de ces tumeurs n’a été fait jusqu’à ces dernières années, laissant la radiothérapie pour seul traitement efficace, et seulement transitoirement. Enfin, grâce à la mise en place de collecte d’échantillons de gliomes infiltrant du tronc cérébral au diagnostic ou à l’autopsie, un nombre sans précédent d’analyses biologiques et génomiques a pu être mené et améliorer la connaissance de ces tumeurs. Si ces études ont montré que ces gliomes pédiatriques étaient bien différents de ceux de l’adulte, elles ont aussi fait apparaître la présence d’anomalies génétiques récurrentes spécifiques de ces tumeurs sous-tentorielles. Ainsi le Platelet-Derived Growth Factor Receptor Alpha (PDGFRα) est apparu comme cible prédominante dans ces tumeurs compte tenu des nombreuses anomalies génétiques constatées. La recherche d’un médicament efficace pouvant inhiber cette voie nous a conduit à évaluer l’effet du dasatinib qui est un inhibiteur multi-ciblé. Nous en rapportons ici l’efficacité in vitro sur de nouvelles lignées cellulaires de gliomes infiltrants du tronc cérébral établies à partir de biopsies stéréotaxiques réalisées au diagnostic. Sachant néanmoins que les thérapies ciblées restent peu efficaces en clinique quand elles sont utilisées seules, nous mettons en évidence l’intérêt de combiner le dasatinib avec un inhibiteur de MET, 2ème oncogène fréquemment amplifié dans ces tumeurs. D’autre part, une stratégie originale de criblage médicamenteux a été mise en œuvre. Celle-ci a permis de définir de manière fonctionnelle de nouveaux médicaments potentiellement efficaces dans les gliomes infiltrants du tronc cérébral, incluant les inhibiteurs d’Histone deacetylases (HDAC), les inhibiteurs des Cyclin-Dependent Kinases (CDK) ou encore les inhibiteurs du protéasome. Enfin par la technique de séquençage génome-entier, de nouvelles anomalies génétiques jamais rencontrées dans aucun autre cancer ont été détectées. Parmi celles-ci se trouvent des mutations d’histone H3K27M dont la fréquence élevée (80%) suggère leur rôle fondamental dans la genèse de ces tumeurs. Des mutations activatrices d’ACVR1/ALK2 ont été également mises en évidence. Celles-ci représentent désormais de nouvelles cibles à explorer.Ce travail de thèse rapporte la recherche de nouvelles cibles thérapeutiques d’une part, via une approche exploratoire par criblage médicamenteux et recherche d’anomalies génétiques par séquençage « génome-entier », et d’autre part, via une approche de validation préclinique sur le plan des thérapies ciblées de type inhibiteurs de tyrosine-kinases. / Diffuse Intrinsic Pontine Glioma (DIPG) is a rare, unresectable and universally fatal tumor. Due to the lack of available material, no improvements have been made in the knowledge of the biology of this tumor until recent years, leaving radiotherapy as the only efficient treatment, and only transiently. Recently, the effort engaged for collecting samples in this disease at the diagnosis or at the autopsy resulted in an unprecedented number of analyses consequently improving our knowledge in DIPG. Those studies bring evidences for their differences with adult gliomas, but also with other pediatric supratentorial glioma showing specific genomic alterations. Thus, Platelet-Derived Growth Factor Receptor Alpha (PDGFRα) appeared to be one of the major target given its frequent aberrations found in those tumors. Investigating an effective drug to inhibit this pathway led us to evaluate the effect of dasatinib, which is known as a multi-targeted inhibitor. We report here the in vitro efficacy of dasatinib on new cell lines of DIPG developed from stereotaxic biopsy at diagnosis. Because therapies are largely inefficient in the clinic when they are used as a monotherapy, we bring out our interest on combining dasatinib with an inhibitor of MET, which is the 2nd most common amplified oncogene in these tumors.Additionally, an innovative strategy of pharmacological screening has been successfully tested. New drugs, potentially efficient in DIPG, have been fonctionnaly-defined, including Histone deacetylase inhibitors (HDACi), Cyclin-Dependent Kinases inhibitors (CDKi) and proteasome inhibitors as well.Finally, by using whole genome sequencing (WGS), we have been able to discover new genetic abnormalities, never encountered before in other cancers. Among those, mutations of histone H3K27M with a high frequency of 80% were found, suggesting that they have a fundamental role in tumors genesis. Moreover, ACVR1/ALK2 activating mutations have been identified as well. And this gene now represents a new target to explore. This work reports the research of new therapeutic targets through an exploratory approach using drug screening and WGS on the one hand, and on the other hand through a preclinical validation approach in terms of targeted therapies with tyrosine-kinases inhibitors.

La classification OMS des tumeurs cérébrales de l'enfant distingue les tumeurs gliales des tumeurs glioneuronales, les gliomes circonscrits des infiltrants. Elle représente le meilleur indicateur pronostic mais se heurte pourtant à des limites de reproductibilité. Pour mieux préciser le diagnostic, mieux définir des sous-groupes de pronostic différent, et mieux orienter le thérapeutique, nous avons recherché les profils moléculaires de 108 tumeurs cérébrales circonscrites de l'enfant : astrocytome pilocytique (PA), tumeurs neuroépithéliales dysembryoplasiques (DNT), xanthoastrocytomes pléïomorphes (PXA) et gangliogliomes (GG). Aucune différence n'est retrouvée entre les gliomes corticaux de grade II (GC) et les DNT concernant IDH1 et 2, TP53 et la délétion1p19q. Les DNT non spécifiques et les GC partagent le même profil incluant CD34 et la mutation V600E de BRAF dans 50% des cas. Le PXA exprime la mutation V600E de BRAF dans plus de 50 % des cas et se rapproche du groupe des tumeurs glioneuronales. Concernant le PA, nous confirmons le caractère péjoratif de la topographie hypothalamo-chiasmatique, de l'histologie pilomyxoide, de l'âge inférieur à 36 mois et de l'exérèse partielle. A l'opposé des tumeurs infiltrantes qui appartiendraient au groupe " histones dépendantes", les tumeurs circonscrites pourraient être regroupées sous le terme "MAPKinases dépendantes". On y distinguerait alors les tumeurs avec fusion KIAA1543-BRAF de celles avec mutation V600E de BRAF. Ce travail a permis de mieux caractériser les tumeurs gliales et glioneuronales de l'enfant, reposant sur le transfert en routine de marqueurs moléculaires simples. / The OMS classification for pediatric brain tumors includes glial tumors and mixed glial and glioneuronal tumors, diffuse and no diffuse glioma. All strategic decision making are based on this current classification but it drives to some limits of diagnosis reproductibility.The goal of our study was to define molecular profils for low grade no diffuse pediatric brain tumors including pilocytic astrocytoma (PA), dysembryoplasic neuroepithelial tumor (DNT), pleiomorphic xanthoastrocytoma (PXA) and benign gangliogliome (GG), to improve the quality of diagnosis, define different subgroups with different prognosis and then to improve treatment strategy decision making.No molecular difference was found between cortical grade II glioma (GC) and DNT regarding IDH1 and 2 TP53 alterations and 1p19q deletion. Similarly 50 % of no specific form of DNT share the same molecular profil with GC with CD34 expression and V600E mutation of BRAF. PXA demonstrated BRAFV600E mutation in 60 % of cases. PXA could then be very close glioneuronal tumors. Finally in PA we confirmed the negative impact of hypothalochiasmatic location, pilomyxoid diagnosis and age lower than 36 months and partial resection. We could work on the elaboration of a new classification and define the group named “Histone dependant” for tumors with histone aberrations and the group named “MAPKinases dependant” for tumors with either KIAA 1543-BRAF fusion or V600E BRAF mutation.In conclusion, this work has led to improve the molecular profil characteristics of glioneuronal tumors of childhood with different easy diagnostic markers that can be used in routine practice, and could potentially replace DNA sequencing.

La barrière hémato-encéphalique (BHE) régule le transport des molécules et des cellules du compartiment sanguin vers le système nerveux central. Pour assurer cette fonction, l’endothélium microvasculaire cérébral bénéficie d’un système particulier d’enzymes, de pompes d’efflux et de jonctions cellulaires spécialisées, qui ensemble contrôlent scrupuleusement le passage des molécules plasmatiques et des cellules circulantes. La VE-cadhérine est une molécule d’adhérence qui occupe une position unique dans l’organisation des jonctions endothéliales et le maintien de l’intégrité vasculaire. Cependant, même si le rôle de la VE-cadhérine est décrit comme fondamental au cours du développement du réseau vasculaire, sa participation dans l’intégrité de la BHE nécessite d’être explorée plus en détail. Le glioblastome, la tumeur cérébrale la plus agressive et la plus létale, est associée à une vascularisation hautement perméable. En outre, ces tumeurs renferment une sous-population de cellules souches gliomateuses (CSG) dérivant d’une fraction de cellules transformées à caractère souche, qui joueraient un rôle dans l’initiation et la progression tumorales, ainsi que dans la résistance aux thérapies conventionnelles. Plus particulièrement, ces cellules ont été retrouvées in situ en interaction directe avec les cellules endothéliales cérébrales. Néanmoins, l’implication des CSG dans la plasticité des cellules endothéliales cérébrales, et notamment la perméabilité vasculaire, n’a pas été étudiée. Au sein de notre équipe, nous avons démontré que les CSG sécrètent la Sémaphorine 3A (S3A), une molécule de répulsion caractérisée par une activité antiangiogénique et pro-perméabilité. La S3A induit une augmentation de la phosphorylation et de l’internalisation de la VE-cadhérine, conduisant à une perte de la fonction de barrière des cellules endothéliales cérébrales. Au niveau moléculaire, nous avons montré que Src, une tyrosine kinase, et Set, un inhibiteur naturel de PP2A, coopèrent pour inhiber l’activité phosphatase de PP2A en réponse à la S3A. Plus particulièrement, PP2A interagit avec la VE-cadhérine bloquant sa phosphorylation, son internalisation et l’ouverture de la barrière endothéliale. PP2A confère ainsi une stabilité à la VE-cadhérine, qui serait perturbée par la S3A produite localement par les CSG. Ce mécanisme pourrait jouer un rôle clé dans les défauts des vaisseaux irriguant les glioblastomes, et d’une manière générale dans la perméabilité vasculaire tumorale. L’ensemble de ces résultats nous permet de mieux caractériser les mécanismes moléculaires mis en jeu au cours de l’angiogenèse tumorale et d’envisager à long terme des molécules à visée thérapeutique, en ciblant par exemple la voie de signalisation activée par la S3A / The blood brain barrier (BBB) regulates the transport of molecules and cells from blood into the central nervous system. This implies that the cerebral microvascular endothelium has developed a particular system of enzymes, efflux pumps and specialized cell junctions, which together carefully control the passage of plasma molecules and circulating cells. Vascular endothelial (VE)-cadherin is an adhesion molecule that occupies a unique position in the organization of endothelial junctions and the maintenance of vascular integrity. In particular, phosphorylation and internalization of VE-cadherin destabilizes cell-cell contacts and increases permeability. However, though VE-cadherin is fundamental in the development of the vascular network, its participation in the integrity of the BBB needs to be further explored. Glioblastoma is the most aggressive and the most lethal brain tumor, which is characterized by a highly leaky vasculature. Furthermore, these tumors contain a subpopulation of glioma stem cells (GSC), which derive from a fraction of transformed stem cells. GSCs play a role in the tumor initiation, progression and resistance to conventional therapies. Notably, these cells were found in direct interaction with cerebral endothelial cells in situ. However, the involvement of GSCs in the plasticity of cerebral endothelial cells, including vascular permeability, has not been studied. Our team has demonstrated that GSCs secrete semaphorin 3A (S3A), a repulsive molecule characterized by anti-angiogenic and pro-permeability activity. S3A increased phosphorylation and internalization of VE-cadherin in cerebral endothelial cells, leading to a loss of barrier integrity. At the molecular level, Src, a tyrosine kinase, and Set, a natural inhibitor of PP2A, cooperate to inhibit the phosphatase activity of PP2A, in response to S3A. Specifically, we demonstrated that PP2A interacts with VE-cadherin at the basal level. This interaction blocks VE-cadherin phosphorylation and internalization and thereby prevents opening of the endothelial barrier. Thus, PP2A stabilizes VE-cadherin, and we further showed that this complex could be disrupted by S3A produced by GSCs. This mechanism could play a key role in the dysfunctions of the vessels supplying glioblastoma, and in tumor vascular permeability in general

Les gliomes malins sont les tumeurs les plus fréquentes du système nerveux central. Les glioblastomes représentant plus de 50% des gliomes, constituent la forme la plus agressive et sont particulièrement résistants à la radiochimiothérapie. Au sein de ces tumeurs réside une sous-population de cellules souches tumorales (CSG) qui pourrait être responsable de leurs initiation, progression et résistance aux traitements. Ces processus sont gouvernés par des voies de signalisation, pour la plupart activées de manière constitutive et dont l’étude est nécessaire afin de mieux comprendre les mécanismes impliqués dans la gliomagenèse. L’objectif de ces travaux de thèse consistait en l’exploration des voies de signalisation STAT3 et Hippo dans les gliomes dans le but d’identifier de nouveaux marqueurs pronostiques et de nouvelles cibles thérapeutiques potentielles. La première partie de ces travaux a montré que la phosphorylation S727 de STAT3 jouait un rôle important dans la radioresistance des CSG et que son inhibition pharmacologique induisait leur radiosensibilisation. Dans un second temps, ces travaux ont montré que deux effecteurs de la signalisation Hippo, YAP1 et TEAD3, sont associés à un mauvais pronostic et qu’ils seraient impliqués dans la prolifération cellulaire et le phénotype des CSG notamment par inhibition de la signature proneurale. Ainsi, ces travaux visent à proposer de nouvelles pistes thérapeutiques, d’une part l’inhibition de la pS727-STAT3 afin de potentialiser les effets de la radiothérapie et d’autre part, les effecteurs de la signalisation Hippo comme biomarqueurs pronostiques et potentielles cibles thérapeutiques. / Malignant gliomas are the most common tumors of central nervous system. Glioblastomas represent more than 50% of all glioma and constitute the most aggressive form of the tumor which is particularly resistant to radiotherapy. The presence of the subpopulation of glioblastoma stem cells (GSC) could be involved in tumor initiation, progression and therapeutic resistance. Hence, these processes are governed by signaling pathways which are mostly constitutively activated and their study is necessary for a better understanding of gliomagenesis. The aim of this PhD thesis was to assess STAT3 and Hippo signaling pathways in glioma to identify new prognostic markers and potential therapeutic targets. The first part on this work showed that pS727 phosphorylation of STAT3 could be involved in radioresistance and its inhibition induced GCS radiosensitization. Additionally, this work showed that YAP1 and TEAD3, two effectors of Hippo signaling, are associated with poor patient survival and could be involved in GSC proliferation and phenotype maintenance by inhibiting proneural gene signature. Thereby, this work aims to offer new therapeutic avenues, on the one hand the inhibition of pS727-STAT3 for radiotherapy potentiation and on the other hand the effectors of Hippo signaling as prognostic biomarkers and potential therapeutic targets.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-08-07T13:32:58Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_AvaliacaoIntegridadeGenomica.pdf: 3262220 bytes, checksum: 24d59a5c29a5adba9fe98c186808c670 (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-08-08T12:38:22Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_AvaliacaoIntegridadeGenomica.pdf: 3262220 bytes, checksum: 24d59a5c29a5adba9fe98c186808c670 (MD5) / Made available in DSpace on 2017-08-08T12:38:22Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_AvaliacaoIntegridadeGenomica.pdf: 3262220 bytes, checksum: 24d59a5c29a5adba9fe98c186808c670 (MD5) Previous issue date: 2016-12-14 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / O câncer se caracteriza pela a rápida proliferação de células anormais que crescem além dos seus limites habituais, podendo invadir partes adjacentes ou à distância. O câncer do SNC representa 2% de todas as neoplasias no mundo, sendo ligeiramente mais alta em homens que em mulheres. As mitocôndrias, responsáveis pela produção da maior parte do ATP celular através da oxidação fosforilativa (OXPHOS), pode também atuar através da glicólise com a mesma finalidade, não necessitando exclusivamente de oxigênio. Esta opção é característica das células cancerosas, conhecida como efeito Warburg. Uma hipótese para explicar essa alteração metabólica pode estar relacionada aos defeitos no DNA mitocondrial (mtDNA) causados pela OXPHOS, onde essas mutações podem induzir as células cancerosas à glicólise. Foram analisadas oito regiões do mtDNA (D-LOOP, ND1, ND3, CO I, CO II, CO III, ATPase 6 e ATPase 8) em tecidos neoplásicos de pacientes acometidos por câncer de células da glia na população paraense, relacionando os dados obtidos com as características clínicas e patológicas dos pacientes. Dentre as alterações encontradas, as do complexo I parecer ser determinantes para a progressão dos tumores de alto grau, assim como, as alterações indel parecem comprometer estruturas importantes para a OXPHOS. As deleções 4977 pb, quando associadas a outras alterações no ND1/ND3 ou a heteroplasmias, sugerem mau prognostico, porém, parecem ter uma redução no risco quando as alterações nos ND1 e ND3 são simultâneas. / Cancer is characterized by fast abnormal cells proliferation which grow beyond their normal limits and may invade adjacent or distant tissue. Cancer CNS represents 2% of all cancers in the world, being slightly higher in men than in women. Mitochondria are responsible for producing most of the cellular ATP by oxidative phosphorylation (OXPHOS), may also act through glycolysis for same purpose, not requiring only oxygen. This option is a particular cancer cell property, also known as the Warburg effect. One hypothesis to explain this metabolic change may be related to mitochondrial DNA (mtDNA) defects caused by OXPHOS where these mutations can lead cancer cells to glycolysis. Eight mtDNA regions (D-LOOP, ND1, ND3, CO I, CO II CO III, ATPase 6 and ATPase 8) were analyzed in patients’ neoplastic tissues with glial cell cancer in Pará population, relating the data with the pathological and clinical characteristics of the patients. Among the changes found, the complex I seem to be decisive for the progression of high-grade tumors, as well as changes indel seem compromising important structures for OXPHOS. Deletions 4977 bp, when combined with other changes in ND1 / ND3 or heteroplasmias suggest poor prognosis, however, seem to have a reduced risk when changes in ND1 and ND3 are simultaneous.

<p>Grade 2 gliomas are malignant brain tumours affecting otherwise healthy adults. Although the long-term prognosis is poor, many patients are well and may have a high quality of life for several years. There is, however, a large variability in the natural course of the disease which makes it essential to identify patients who might benefit from early surgery or radio-therapy. The aim of the present thesis was to define new and clinically useful prognostic markers that may assist in the initial treatment decision and in patient follow-up.</p><p>A retrospective study of 189 patients with gliomas WHO grade 2 showed no advantage in survival of early tumour resection or radiotherapy, and confirmed that histological subtype and patient age are the most important predictors of survival (I). In 89 patients, the pre-treatment uptake of 11C-methionine (MET) measured with positron emission tomography (PET) was identified as a prognostic marker for survival (II). At the time of tumour progression, irradiated tumours demonstrated signs of a residual radiotherapeutic effect that correlated with the pre-treatment uptake of MET (III). Pre-treatment uptake of MET may, therefore, be important both in predicting the natural course of the disease and the response after treatment. Immunohistochemical staining of 40 tumour samples showed an inverse association between the number of tumour cells expressing platelet-derived growth factor alpha receptor (PDGFRa) and survival (IV). Also, a reduction was observed in the number of receptor-positive cells after malignant transformation, supporting the prognostic value of PDGFRa.</p><p>Lumbar puncture was performed in eight patients with newly diagnosed low-grade gliomas to identify three important growth factors in tumour development. Neither PDGF nor vascular endothelial growth factor (VEGF) were detected in the cerebrospinal fluid (CSF), and fibroblast growth factor 2 (FGF-2) was measurable at extremely low concentrations in two of the patients (V). A proteome screening of the CSF, using two-dimensional gel electrophoresis and mass spectrometry, detected alpha 2-HS glycoprotein at significantly higher concentrations than in a control group (VI). This glycoprotein emerges as a novel substance in glioma research and may be of great interest because of its suggested involvement in the embryonic development of the neocortex.</p>

Even though anti‐cancer chemotherapy has been continuously improved during the last decades. problems with adverse effects and drug resistance still constitutes a considerable obstacle and sets a demand for new effective treatment options. Tissue homeostasis in multi‐cellular organisms is maintained through intrinsic cell death, apoptosis, which removes unwanted or damaged cells. Disrupted apoptosis is an important factor in tumorgenesis and drug resistance, therefore induction or restoration of apoptotic pathways is also important for the treatment of cancer. Several naturally occurring bacterial toxins have the ability to induce apoptosis and could thus be candidates to complement or improve the therapeutic effect of other anticancer drugs. The bacterial toxins, adenylate cyclase (AC) toxin from Bordetella pertussis, α‐toxin from Staphylococcus aureus and verotoxin‐1 (VT‐1) from Escherichia coli were investigated for their ability to induce apoptosis in different tumor cell lines. Toxin induction of cell death was investigated by cell viability assays, end‐stage apoptosis induction by DNA‐fregmentation (TUNEL) assay. Toxin receptor expression and signal transduction pathways to apoptosis were investigated by flow cytometry, caspase enzyme activity assays and western blot. Immunohistochemistry was used for identification of toxin receptor expression in tumor tissue samples. AC‐toxin was cytotoxic and induced apoptosis in cultured malignant plural mesothelioma (MPM) and small‐cell lung cancer (SCLC) cells. Low‐toxic concentrations of AC‐toxin enhanced cisplatin cytotoxicity and apoptosis in both cell lines. MPM‐cells with acquired cisplatin resistance were more sensitive to α‐toxin than the less resistant parental MPM cell line. A low‐toxic concentration of α‐toxin re‐sensitized resistant MPM cells to cisplatin cytotoxicity by apoptosis induced through the mitochondrial pathway without detectable activation of common up‐stream apoptosis signalling proteins. VT‐1 was highly cytotoxic and induced apoptosis in globotriosylceramide (Gb3) ‐expressing glioma, breast cancer and non‐small‐cell lung cancer (NSCLC) cells but was not cytotoxic to non‐Gb3‐expressing cells. PPMP, an inhibitor of glucosylceramide synthesis which makes exposed cells unable to synthesize Gb3 rendered Gb3‐expressing cells resistant to VT‐1. MPM cells with acquired‐cisplatin resistance expressed Gb3 in contrast to the absent of expression in the less resistant parental cell line. Gb3, could however be up‐regulated by cisplatin in Gb3‐negative MPM‐cells. Presence of a low‐toxic concentration of VT‐1 potentiated cisplatin‐induced cytotoxicity and apoptosis in the cisplatin‐resistance MPM cell line. VT‐1 was a potent inducer of apoptosis, probably via stress‐induced Mitogen‐activated protein kinase (MAPK)‐signaling involving c‐Jun N‐terminal kinase (JNK) and p38, leading to disruption of the mitochondrial membrane integrety, activation of caspase‐9 and ‐3, and ultimately DNA fragmentation and cell death. Gb3 expression was demonstrated in clinical specimens of glioblastoma and breast cancer making these tumor types interesting for further VT‐1 studies. We conclude that bacterial toxins may be used to induce apoptosis in several types of cancer cells. Low concentrations of verotoxin‐1 and α‐toxin may potentially be used to overcome acquired cisplatin‐resistance in cancer patients.

Grade 2 gliomas are malignant brain tumours affecting otherwise healthy adults. Although the long-term prognosis is poor, many patients are well and may have a high quality of life for several years. There is, however, a large variability in the natural course of the disease which makes it essential to identify patients who might benefit from early surgery or radio-therapy. The aim of the present thesis was to define new and clinically useful prognostic markers that may assist in the initial treatment decision and in patient follow-up. A retrospective study of 189 patients with gliomas WHO grade 2 showed no advantage in survival of early tumour resection or radiotherapy, and confirmed that histological subtype and patient age are the most important predictors of survival (I). In 89 patients, the pre-treatment uptake of 11C-methionine (MET) measured with positron emission tomography (PET) was identified as a prognostic marker for survival (II). At the time of tumour progression, irradiated tumours demonstrated signs of a residual radiotherapeutic effect that correlated with the pre-treatment uptake of MET (III). Pre-treatment uptake of MET may, therefore, be important both in predicting the natural course of the disease and the response after treatment. Immunohistochemical staining of 40 tumour samples showed an inverse association between the number of tumour cells expressing platelet-derived growth factor alpha receptor (PDGFRa) and survival (IV). Also, a reduction was observed in the number of receptor-positive cells after malignant transformation, supporting the prognostic value of PDGFRa. Lumbar puncture was performed in eight patients with newly diagnosed low-grade gliomas to identify three important growth factors in tumour development. Neither PDGF nor vascular endothelial growth factor (VEGF) were detected in the cerebrospinal fluid (CSF), and fibroblast growth factor 2 (FGF-2) was measurable at extremely low concentrations in two of the patients (V). A proteome screening of the CSF, using two-dimensional gel electrophoresis and mass spectrometry, detected alpha 2-HS glycoprotein at significantly higher concentrations than in a control group (VI). This glycoprotein emerges as a novel substance in glioma research and may be of great interest because of its suggested involvement in the embryonic development of the neocortex.

No description available.