Introdução: Polimorfismos na região promotora dos genes da insulina, IGF2 e IGF1 podem estar relacionados a uma diminuição da expressão desses genes na vida fetal que, por sua vez, pode causar restrição do crescimento intra-uterino e maior risco de hipospádia. Na vida pós-natal, perda completa ou parcial da expressão desses genes pode resultar em ausência de recuperação estatural e menores concentrações séricas de IGF1 na criança, além de um maior risco de diabetes melito tipo 2 e síndrome de resistência à insulina no adulto. Objetivos: Analisar em crianças nascidas pequenas para idade gestacional (PIG) com ou sem recuperação estatural (RE): 1) a freqüência alélica e genotípica dos polimorfismos VNTR-INS e das repetições CA do gene IGF1; 2) a região promotora P4 do gene IGF2; 3) a influência do VNTR INS e das repetições CA do gene IGF1 na sensibilidade à insulina e nas concentrações séricas de IGF1, respectivamente. Pacientes: Foram estudados 142 indivíduos nascidos PIG com (n= 66) e sem recuperação (n= 76) estatural selecionados de três diferentes centros (HC-FMUSP, Santa Casa de São Paulo e HC-UFPR) e um grupo controle constituído de 297 indivíduos nascidos adequados para idade gestacional (AIG). Métodos: Extração de DNA genômico; amplificação por PCR das regiões contendo os polimorfismos VNTR INS e repetições CA do IGF1 e da região promotora P4; digestão por enzima de restrição; software Genescan; seqüenciamento automático; avaliação bioquímica e hormonal da glicemia, insulina e IGF1, extração de RNA, PCR em tempo real e análise estatística com SPSS 13.0 (Statistical Package fo Social Sciences). Resultados: A média do Z-altura, Z-IMC (índice de massa corpórea), Z-altura paterno e ZEA (estatura alvo) foram maiores nas crianças PIG que tiveram recuperação estatural, com o Z-PC (perímetro cefálico) maior nas crianças sem recuperação estatural. O Z-IGF1 sérico foi significantemente mais elevado em crianças que apresentaram RE (p<0,05). A distribuição e genotipica das repetições CA do gene IGF1 e do VNTR INS foi semelhante estatisticamente entre os grupos AIG e PIG, e entre os PIG com e sem RE; não foi observada associação entre esse polimorfismo e as variáveis clínicas e laboratoriais do estudo. O estudo da região promotora P4 do gene IGF2 identificou um novo polimorfismo de 9-12 repetições C na posição -1982, antes do sítio de início de transcrição do exon 2, e este apresentou distribuição semelhante entre os grupos PIG e AIG. Foi identificada também uma troca C/T em heterozigose no nono nucleotídeo do alelo 11C em quatro crianças nascidas PIG. Contudo, a quantificação da expressão do gene IGF2 em duas dessas crianças não demonstrou perda da expressão desse gene. Conclusões: Não observamos influência dos polimorfismos acima descritos no crescimento pré e pós-natal, na presença de resistência à insulina, nem em concentrações séricas de IGF1 dos indivíduos nascidos PIG. Identificamos uma nova variante na região promotora P4 do gene IGF2, contudo estudos preliminares não demonstraram influência desse polimorfismo sobre o crescimento intra-uterino. / Introduction: Polymorphisms in the promoter region of insulin (INS), IGF2 and IGF1 genes may decrease their expression during fetal life and afterward could be related to intra-uterine fetal growth retardation and greater risk of hypospadia development. In post-natal life, decreased expression of these genes can result in lack of stature recovery and in lower IGF1 serum levels in children, as well as in higher risk for type 2 diabetes mellitus and metabolic syndrome in adults. Objectives: The aims of the present study were: (1) to analyze the allelic and the genotypic frequency of the insulin (INS) gene variable number of tandem repeats (VNTR) and the IGF1 gene CA repeats; (2) to analyze the P4 promoter region of IGF2 gene (3) to test the contribution of INS VNTR, IGF1 gene CA repeats on insulin sensitivity and IGF1 serum levels in children born SGA with and without catch up, respectively. Patients: We studied 142 individuals born SGA with catch up (n = 66) and without catch up (n = 76) selected from three different centers (HCFMUSP, Santa Casa de Sao Paulo and HC-UFPR). The control group consisted of 297 children born appropriate for gestational age (AGA). Methods: Extraction of genomic DNA, PCR-amplification of the VNTR of insulin gene, CA repeats of IGF1 and IGF2 gene P4 promoter region; restriction analysis; Genescan software; automatic sequencing. Blood measurements of serum level of glucose, insulin and IGF1. Statistical analysis (Statistical Package for Social Sciences software). Results: Regarding birth parameters, the average of Z-height, Z-BMI (body mass index) and Z-height paternal and Z- EA (target height) were higher in children born SGA who had catch up. Interestingly, we observed that the Z-PC was higher in children born SGA without catch up. In addition, the Z-IGF1 serum levels were significantly higher in children who had catch up (p <0.05). The molecular analysis of IGF1 gene CA repeats and of INS gene VNTR locus did not show a statistically significant difference in the allelic and genotypic distribution of these polymorphisms between adequate for gestational age (AGA) and SGA groups nor between SGA with and without catch up. Similarly, we have not found an association of these polymorphisms with clinical or laboratory variables of this study. A novel polymorphism in the P4 promoter region of the IGF2 gene was identified. It was characterized by cytosine repeats (9-12) at position -1982 before transcription initiation site of exon 2 of IGF2 gene. Yet, we have identified a heterozygous substitution of cytosine for thymine at the nucleotide position 9 in the allele 11C in four children born SGA. This change was also absent in the control population. Quantization of IGF2 gene expression in two of these children did show loss of expression of this gene in patients carrying the variant 9C/T. Conclusions: We have not observed an association of the above described polymorphisms with pre and post natal growth, or with the occurrence of insulin resistance in individuals born SGA. IGF-1 levels did not seem to be associated with the polymorphisms either. A new variant in the P4 promoter region of IGF2 gene was identified, however preliminary studies showed no influence on intra-uterine growth.

Introdução: Crianças nascidas pequenas para a idade gestacional (PIG) apresentam maior risco de permanecerem com baixa estatura na vida adulta. Os fatores de crescimento insulino-símile tipo 1 e 2 (IGF-1 e IGF-2) são os principais fatores endócrinos determinantes do crescimento fetal. A maioria das ações conhecidas do IGF-1 e 2 é mediada via um receptor tirosina quinase, conhecido como IGF-1R. Recentemente, a insensibilidade ao IGF-1 foi identificada como uma das causas de retardo de crescimento em crianças nascidas PIG que não apresentaram recuperação espontânea do crescimento na vida pós-natal. Crianças afetadas apresentavam níveis elevados de IGF-1, IGFBP-3 além de microcefalia. O papel de defeitos pósreceptor na sinalização do IGF-1 como causa de retardo de crescimento pré e pós-natal ainda não foi investigado. Objetivo: Analisar in vitro a ação do IGF-1 em fibroblastos de crianças nascidas PIG. Material e métodos: Desenvolvemos cultura de fibroblastos de 2 controles (C1 e C2) e de 4 pacientes nascidos PIG (SGA1, SGA2, SGA3 e SGA4) com suspeita de insensibilidade ao IGF-1 por ausência de recuperação do crescimento na vida pós natal, resposta insatisfatória ao tratamento com hGH apesar de níveis normais/elevados de IGF-1. Foi confirmado do ponto de vista molecular que um dos pacientes (SGA1) apresenta Síndrome de Sílver- Russell com perda da metilação do alelo paterno da região ICR1 (imprinting center region 1) importante para a expressão do IGF-2. Defeitos no gene do IGF1 e IGF1R foram afastados por sequenciamento direto. As ações do IGF- 1 foram determinadas por ensaios de proliferação, análise da produção de IGFPB-3 em meio de cultura e estudos de fosforilação de proteínas da via de sinalização do IGF-1 em fibroblastos (AKT e ERK). Resultados: As linhagens SGA1, SGA2 e SGA3 proliferaram respectivamente 31%, 60% e 78% a menos sob estímulo de IGF-1 em relação ás linhagens controles. Já a linhagem SGA4 apresentou comportamento semelhante ás linhagens controles. No estudo da expressão do RNAm do IGF1R por PCR em tempo real, não foi observada diferença significativa na expressão do IGF1R nas diversas linhagens PIG em relação aos controles, assim como o conteúdo total da proteína IGF-1R. Em relação á ativação da via MAPK, todas as linhagens dos pacientes PIGs apresentaram menor fosforilação ERK1/2 basal e após estímulo com IGF-1, quando comparadas com as linhagens controles (p < 0.001) apesar do conteúdo total de ERK1/2 ser semelhante. Já em relação a ativação da via PI3K, as linhagens SGA1, SGA2, SGA3 e SGA4 não diferiram significantemente em relação aos fibroblastos controles quanto à ativação de AKT pelo IGF-1. O conteúdo total de AKT também foi semelhante em todas as linhagens estudadas. O estudo da expressão de IGFBP3 mostrou um aumento da expressão deste peptídeo na linhagem de fibroblastos do paciente SGA1 (14X). O conteúdo de IGFBP-3 intracelular não sofreu alteração, porém comprovamos que a linhagem SGA1 secretava 2x mais IGFBP-3 para o meio de cultura. Apesar de apresentarem estrutura, expressão e conteúdo de IGF1R normais, essas mesmas 3 linhagens celulares que apresentaram menor proliferação também apresentaram diminuição na fosforilação de ERK após tratamento com IGF-1. Mesmo sob o estímulo com desIGF-1 (um análogo do IGF-1 com baixa afinidade por IGFBPs mas que preserva sua capacidade de ativar o receptor IGF-1R) a ativação de ERK e a proliferação celular se manteve abaixo dos das linhagens controles. O estudo do conteúdo total de GRB10 foi semelhante em todas as linhagens celulares. Conclusão: Três dos 4 pacientes PIG estudados apresentaram insensibilidade pós-receptor ao IGF-1. A linhagem celular SGA1, obtida de um paciente com hipometilação do ICR1 11p15 causando SSR, demonstramos um aumento da expressão e secreção de IGFBP-3, o qual não se mostrou responsável por inibir a ação do IGF-1 nestes fibroblastos. Novos estudos devem ser desenvolvidos para identificar o defeito molecular responsável pela insensibilidade ao IGF-1 a nível pósreceptor observada nestes pacientes. / Introduction: Children born small for gestational age (SGA) have a higher risk of staying with short stature in adulthood. The insulin-like growth factors (IGF-1 and IGF-2) are the main endocrine factor determining fetal growth. Most of the known actions of IGFs are mediated by IGF-1R, a tyrosine kinase receptor. Recently, the IGF-1 insensitivity was identified causing growth retardation in children born SGA who who did not present spontaneous catch-up growth in postnatal life. Affected children had elevated IGF-1 and IGFBP-3 levels in addition to microcephaly. The role of post receptor defects in IGF-1 signaling on the deficit of growth is still unclear. Objective: To assess IGF-1 action and signaling in vitro in fibroblasts from SGA children. Methods: Fibroblasts cell cultures were developed from 2 controls (C1 and C2) and 4 patients with pre- and post-natal growth retardation (SGA1, SGA2, SGA3 and SGA4). IGF-1 insensitivity was demonstrated by severe pre and postnatal growth impairment without any evident cause, IGF1 SDS > 0 and poor growth response during high doses of hGH treatment. Three SGA patients presented microcephaly. Defects in the gene of the IGF1 and IGF1R were excluded by direct sequencing. One patient (SGA1) presents the Silver- Russell syndrome (SRS) with loss of methylation of the paternal allele in the ICR1 (imprinting center region 1) chromosome 11p15, important for IGF-2 expression. IGF-1 action was assessed by cell proliferation by colorimetric assay. IGF-1 signaling was assessed by AKT and ERK phosphorylation after IGF-1 stimulation through SDS-PAGE of intracellular extract followed by immunoblotting with specific antibodies. The expression of IGF1R and IGFBP3 gene was determined by Real-time quantitative PCR and the levels of the IGF-1R and IGBP-3 protein by direct immunoblotting. Results: The SGA1, SGA2 and SGA3 cell lines proliferated 31%, 60% and 78% less under IGF-1 stimulation in comparison of controls fibroblasts, respectively. The expression of IGF1R mRNA and the level of total amount of IGF-1R protein were similar in all SGA and control cell lines. Despite normal IGF-1R structure and quantity, the same 3 SGA cell lines that presented low proliferation response also had 50 to 85% lower ERK phosphorylation after IGF-1 treatment (p <0.001), although the similar total content of ERK1/2. In relation to PI3K pathway activation, all SGA cell cultures presented normal AKT phosphorilation. Fibroblasts from the SGA1 patient presented a 14x increase in IGFBP3 mRNA and 2x more IGFBP-3 secretion to culture serum medium. Treatment with desIGF-1, an IGF-1 analogue with low affinity for IGFBPs although retains its ability to activate the IGF-1R, did not recover cell proliferation or ERK phosphorylation. All cell lines presented similar amount of GRB10 protein Conclusion: Three of 4 SGA patients showed evidence of post-receptor IGF-1 insensitivity. The cell line SGA1, obtained from a SRS patient with ICR1 hypomethylation, showed increased expression and secretion of IGFBP-3, which was not directly responsible for inhibition in IGF- 1 action. Further studies should be developed to identify the molecular cause of IGF-1 post-receptor insensitivity observed in our patients.

As doenças que comprometem o crescimento humano apresentam uma forte influência genética. O objetivo geral do projeto atual é desenvolver e aplicar a tecnologia de sequenciamento paralelo em larga escala para compreensão desses distúrbios de crescimento, com foco principal em crianças nascidas pequenas para idade gestacional (PIG), definida como criança com Escore-Z de comprimento e/ou peso ao nascimento menor ou igual a -2. PIG é uma condição heterogênea, que inclui como causa fatores maternos, placentários e fetal, dentre o qual, destacam-se as alterações genéticas. Crianças nascidas PIG e que não recuperaram seu déficit estatural espontaneamente nos primeiros anos de vida apresentam uma alta probabilidade de serem adultos baixos e costumam evoluir com quadros clínicos complexos, envolvendo retardo de crescimento persistente na vida pós-natal, dismorfismos, anomalias congênitas e distúrbios de desenvolvimento neuropsicomotor. Foi utilizada a tecnologia de sequenciamento Sure Select (Agilent Technologies, CA, USA) para estudar aproximadamente 390 genes escolhidos por pertencerem à via IGFs/IGF1R, principal eixo regulador hormonal do crescimento, genes sabidamente envolvidos em doenças associadas com distúrbio de crescimento, além de genes candidatos identificados em estudos prévios do laboratório, associados à regulação do crescimento, em um grande número de pacientes. Foram sequenciados 80 pacientes, obtendo uma cobertura média de 354 vezes e com mais de 99% da região alvo com cobertura > 10 reads. Nestas amostras foram identificadas 58 variantes, 18 consideradas patogênicas ou provavelmente patogênicas em 19 pacientes, 32 de significado incerto, 7 provavelmente benigna e 1 provavelmente patogênica para condição não associada a distúrbio de crescimento (\"achado acidental\"). Dentre as variantes consideradas patogênicas ou provavelmente patogênicas houve uma grande heterogeneidade entre os genes, sendo identificadas variantes nos genes PTPN11 (x3), BLM (x3), NPR2 (x2), ANKRD11 (x2), SRCAP (x2), FGFR3 (x2), IGF1R, SHOC2, SHOX, NIPBL e deleção 22q11. Podemos concluir que a técnica de sequenciamento paralelo em larga escala de genes alvo é eficiente em estabelecer o diagnóstico molecular de crianças nascidas PIG. Foi possível identificar a etiologia genética em 23,75% da casuística estudada, em sua maior parte, de pacientes com síndromes reconhecidas clinicamente. Contudo, defeitos no sistema IGFs/IGF1R não foram frequentes nesta condição / Diseases affecting human growth are most likely caused by genetic factors. The main goal of this project is to apply the technology of massive parallel sequencing to comprehend growth disturbs in children born small for gestational age (SGA), known as the children with Z-score of height and/or weight at birth less or equal -2. SGA is a heterogeneous condition, and as its causes we can find maternal, placental and fetal factors, of which, the most important are the genetic alterations. Children born SGA that do not have catch-up growth spontaneously up to the second year of life may remain with short stature when adults and they usually present other clinical features, such as dimorphisms, congenital anomalies and neuropsychomotor developmental delay. We used the Sure Select technology (Agilent Technologies, CA, USA) to study approximately 390 genes chosen by participate of the IGFs/IGF1R system, or genes already associated with growth disorders, or candidate genes found in previous studies of aCGH (Array Comparative Genomic Hybridization) or exome sequencing. We sequenced 80 patients, and had a mean coverage of 354x, with more than 99% of the target region with > 10 reads. We found 58 variants, 18 classified as pathogenic or probably pathogenic in 19 patients, 32 variants of unknown significance and 7 probably benign and 1 probably pathogenic for a condition non associated to short stature (``incidental finding``) Among the probably pathogenic and pathogenic we found a great heterogeneity in genes, with variants identified in 10 different genes PTPN11 (x3), BLM (x3), NPR2 (x2), ANKRD11 (x2), SRCAP (x2), FGFR3 (x2), IGF1R, SHOC2, SHOX, NIPBL and a 22q11 deletion. In conclusion, the technique of targeted gene panel sequencing is a useful tool to establish the molecular diagnose in children SGA. We could identify the molecular cause in 23.75% of the casuistic, mostly patients with clinically recognized syndromes. However, variants at IGFs/IGF1R system are not frequently associated with the studied condition

Introdução: Polimorfismos na região promotora dos genes da insulina, IGF2 e IGF1 podem estar relacionados a uma diminuição da expressão desses genes na vida fetal que, por sua vez, pode causar restrição do crescimento intra-uterino e maior risco de hipospádia. Na vida pós-natal, perda completa ou parcial da expressão desses genes pode resultar em ausência de recuperação estatural e menores concentrações séricas de IGF1 na criança, além de um maior risco de diabetes melito tipo 2 e síndrome de resistência à insulina no adulto. Objetivos: Analisar em crianças nascidas pequenas para idade gestacional (PIG) com ou sem recuperação estatural (RE): 1) a freqüência alélica e genotípica dos polimorfismos VNTR-INS e das repetições CA do gene IGF1; 2) a região promotora P4 do gene IGF2; 3) a influência do VNTR INS e das repetições CA do gene IGF1 na sensibilidade à insulina e nas concentrações séricas de IGF1, respectivamente. Pacientes: Foram estudados 142 indivíduos nascidos PIG com (n= 66) e sem recuperação (n= 76) estatural selecionados de três diferentes centros (HC-FMUSP, Santa Casa de São Paulo e HC-UFPR) e um grupo controle constituído de 297 indivíduos nascidos adequados para idade gestacional (AIG). Métodos: Extração de DNA genômico; amplificação por PCR das regiões contendo os polimorfismos VNTR INS e repetições CA do IGF1 e da região promotora P4; digestão por enzima de restrição; software Genescan; seqüenciamento automático; avaliação bioquímica e hormonal da glicemia, insulina e IGF1, extração de RNA, PCR em tempo real e análise estatística com SPSS 13.0 (Statistical Package fo Social Sciences). Resultados: A média do Z-altura, Z-IMC (índice de massa corpórea), Z-altura paterno e ZEA (estatura alvo) foram maiores nas crianças PIG que tiveram recuperação estatural, com o Z-PC (perímetro cefálico) maior nas crianças sem recuperação estatural. O Z-IGF1 sérico foi significantemente mais elevado em crianças que apresentaram RE (p<0,05). A distribuição e genotipica das repetições CA do gene IGF1 e do VNTR INS foi semelhante estatisticamente entre os grupos AIG e PIG, e entre os PIG com e sem RE; não foi observada associação entre esse polimorfismo e as variáveis clínicas e laboratoriais do estudo. O estudo da região promotora P4 do gene IGF2 identificou um novo polimorfismo de 9-12 repetições C na posição -1982, antes do sítio de início de transcrição do exon 2, e este apresentou distribuição semelhante entre os grupos PIG e AIG. Foi identificada também uma troca C/T em heterozigose no nono nucleotídeo do alelo 11C em quatro crianças nascidas PIG. Contudo, a quantificação da expressão do gene IGF2 em duas dessas crianças não demonstrou perda da expressão desse gene. Conclusões: Não observamos influência dos polimorfismos acima descritos no crescimento pré e pós-natal, na presença de resistência à insulina, nem em concentrações séricas de IGF1 dos indivíduos nascidos PIG. Identificamos uma nova variante na região promotora P4 do gene IGF2, contudo estudos preliminares não demonstraram influência desse polimorfismo sobre o crescimento intra-uterino. / Introduction: Polymorphisms in the promoter region of insulin (INS), IGF2 and IGF1 genes may decrease their expression during fetal life and afterward could be related to intra-uterine fetal growth retardation and greater risk of hypospadia development. In post-natal life, decreased expression of these genes can result in lack of stature recovery and in lower IGF1 serum levels in children, as well as in higher risk for type 2 diabetes mellitus and metabolic syndrome in adults. Objectives: The aims of the present study were: (1) to analyze the allelic and the genotypic frequency of the insulin (INS) gene variable number of tandem repeats (VNTR) and the IGF1 gene CA repeats; (2) to analyze the P4 promoter region of IGF2 gene (3) to test the contribution of INS VNTR, IGF1 gene CA repeats on insulin sensitivity and IGF1 serum levels in children born SGA with and without catch up, respectively. Patients: We studied 142 individuals born SGA with catch up (n = 66) and without catch up (n = 76) selected from three different centers (HCFMUSP, Santa Casa de Sao Paulo and HC-UFPR). The control group consisted of 297 children born appropriate for gestational age (AGA). Methods: Extraction of genomic DNA, PCR-amplification of the VNTR of insulin gene, CA repeats of IGF1 and IGF2 gene P4 promoter region; restriction analysis; Genescan software; automatic sequencing. Blood measurements of serum level of glucose, insulin and IGF1. Statistical analysis (Statistical Package for Social Sciences software). Results: Regarding birth parameters, the average of Z-height, Z-BMI (body mass index) and Z-height paternal and Z- EA (target height) were higher in children born SGA who had catch up. Interestingly, we observed that the Z-PC was higher in children born SGA without catch up. In addition, the Z-IGF1 serum levels were significantly higher in children who had catch up (p <0.05). The molecular analysis of IGF1 gene CA repeats and of INS gene VNTR locus did not show a statistically significant difference in the allelic and genotypic distribution of these polymorphisms between adequate for gestational age (AGA) and SGA groups nor between SGA with and without catch up. Similarly, we have not found an association of these polymorphisms with clinical or laboratory variables of this study. A novel polymorphism in the P4 promoter region of the IGF2 gene was identified. It was characterized by cytosine repeats (9-12) at position -1982 before transcription initiation site of exon 2 of IGF2 gene. Yet, we have identified a heterozygous substitution of cytosine for thymine at the nucleotide position 9 in the allele 11C in four children born SGA. This change was also absent in the control population. Quantization of IGF2 gene expression in two of these children did show loss of expression of this gene in patients carrying the variant 9C/T. Conclusions: We have not observed an association of the above described polymorphisms with pre and post natal growth, or with the occurrence of insulin resistance in individuals born SGA. IGF-1 levels did not seem to be associated with the polymorphisms either. A new variant in the P4 promoter region of IGF2 gene was identified, however preliminary studies showed no influence on intra-uterine growth.

Hintergrund Die Strahlentherapie ist neben der radikalen Prostatektomie eine Standardtherapie zur Behandlung von Prostatatumoren und führt zu sehr guten Ergebnissen für die lokale Tumorkontrolle und für das Überleben. Allerdings ist, wie bei der Operation auch, dabei das Risiko eines Rezidivs für fortgeschrittene Tumoren im Gegensatz zu Tumoren in früheren Stadien relativ hoch. Daher besteht eine hohe Dringlichkeit zur Verbesserung der Strahlentherapie vor allem bei fortgeschrittenen Tumoren. Ein Ansatz hierfür ist die Kombination der Bestrahlung mit molekularen Therapien. Ziel dabei ist es, bestimmte Zielproteine zu blockieren, um die Strahlensensibilität der Prostatakarzinomzellen zu erhöhen. Ein potentielles Target könnte hierbei die Blockade des VEGF-C/NRP-2/Akt-Signalwegs (VEGF-C – vascular endothelial growth factor C; NRP-2 – Neuropilin 2; Akt – Proteinkinase B) sein. Im Prostatakarzinom sind die Konzentrationen von VEGF-C und NRP-2 im Vergleich zu normalen Prostatazellen erhöht. Aus Untersuchungen ist bekannt, dass beide Proteine eine progressive Wirkung auf die Tumorgenese haben. In Vorarbeiten zeigen Muders et al. (2009) zudem eine Aktivierung von Akt über die VEGF-C/NRP-2-Achse und eine darüber vermittelte Resistenz gegenüber oxidativem Stress durch H2O2. Akt wirkt in verschiedenen Tumorentitäten außerdem protektiv gegenüber Bestrahlung. Es besteht die Annahme, dass dies auch für Prostatakarzinomzellen gilt. Zielstellung Im Rahmen dieser Arbeit wurde untersucht, ob und über welchen Mechanismus VEGF-C, NRP-2 und Akt die Strahlenresistenz in Prostatakarzinomzelllinien beeinflussen. Methoden Es wurden in vitro- und in vivo-Experimente in den humanen Prostatakarzinomzelllinen PC-3, DU145, LNCaP sowie in PC-3-Xenografts durchgeführt. Der Einfluss von VEGF-C und NRP-2 auf die Strahlenresistenz wurde in vitro nach Herunterregulierung der entsprechenden Gene mittels siRNA beziehungsweise nach Supplementierung mit humanem rekombinanten VEGF-C in Koloniebildungsassays untersucht. Zur Ermittlung des Einflusses von VEGF-C und von NRP-2 auf mögliche Zellüberlebensmechanismen wurden der autophagische Flux nach Blockade der Autophagie mit Bafilomycin A1 mittels Western Blot, die DNA-Doppelstrangbruch-Reparatur mittels Quantifizierung der γH2AX Foci sowie die Zellzyklusverteilung mittels Durchflusszytometrie untersucht. Die Signalweiterleitung von VEGF-C über Akt sowie, als weitere Möglichkeit, die Signalweiterleitung über ERK1/2 wurden nach siRNA-Transfektion mit und ohne Bestrahlung mittels Western Blot geprüft. Weitere Versuche zu Akt erfolgten in vitro und in vivo mit dem PI3K/Akt-Inhibitor Nelfinavir in PC-3-Zellen. Der in vitro Effekt von Nelfinavir auf die Strahlenresistenz wurde dabei mithilfe eines Koloniebildungsassays nach Behandlung der Zellen mit 10 µM Nelfinavir getestet. In vivo wurde die Wirkung von Nelfinavir ohne sowie in Kombination mit Bestrahlung in PC-3-Xenografts in Nacktmäusen untersucht. Für die Bestimmung der Tumorwachstumszeit wurden die Mäuse mit 80 mg Nelfinavir/kg Körpergewicht 30 mal innerhalb von 6 Wochen behandelt. In einem weiteren Versuch wurde die lokale Tumorkontrolle bei gleichzeitiger fraktionierter Bestrahlung mit Gesamtdosen von 30 bis 120 Gy und einer Nachbeobachtungszeit von 180 Tagen bestimmt. Ergebnisse Die Untersuchungen zur Strahlenresistenz über den VEGF-C/NRP-2/Akt-Signalweg haben ergeben, dass in den drei Prostatakarzinomzelllinien PC-3, DU145 und LNCaP VEGF-C signifikant Strahlenresistenz vermittelt. Für NRP-2 hingegen wurde festgestellt, dass es in Abhängigkeit von der Zelllinie entweder zur Strahlenresistenz (DU145) oder zur Strahlensensibilisierung (PC-3) führt. Weiterhin wurde nachgewiesen, dass durch VEGF-C in PC-3 und DU145 weder über Akt noch über ERK1/2 Strahlenresistenz vermittelt wird. Die Versuche zu Strahlenresistenz vermittelnden Mechanismen ergaben, dass VEGF-C in unbestrahlten PC-3-Zellen die Autophagie fördert, NRP-2 jedoch nicht. Unter Bestrahlung war ein Effekt von VEGF-C und NRP-2 auf die Autophagie nicht reproduzierbar nachweisbar. Ein weiterer Versuch hat gezeigt, dass in PC-3 Autophagie keinen Einfluss auf das klonogene Überleben nach Bestrahlung hat. Außerdem wurde festgestellt, dass VEGF-C in PC-3 die DNA-Doppelstrangbruch-Reparatur nicht beeinflusst. Darüber hinaus wurde nachgewiesen, dass eine Verminderung des VEGF-C-Gehalts in PC-3 zum G2/M-Arrest führt. In DU145 konnte jedoch kein Effekt beobachtet werden. In den Untersuchungen zum Einfluss von Akt auf die Strahlenresistenz unabhängig von VEGF-C und NRP-2 wirkte Nelfinavir inhibierend auf die Akt-Phosphorylierung am Ser473 und beeinflusste das klonogene Überleben von PC-3-Zellen minimal. In PC-3-Xenografts führte Nelfinavir zu keiner Tumorwachstumsverzögerung und wirkte in vitro und in vivo nicht strahlensensibilisierend. Schlussfolgerung In den Versuchen konnte gezeigt werden, dass VEGF-C in Prostatakarzinomzellen Strahlenresistenz vermittelt. Diese Erkenntnis könnte als ein Forschungsansatz zur Entwicklung einer kombinierten Therapie aus VEGF-C-Blockade und Bestrahlung dienen. Ein potentieller Mechanismus, über den VEGF-C die Strahlenresistenz vermittelt, ist, in Abhängigkeit von der Zelllinie, die Aufhebung des G2/M-Arrests. NRP-2 wirkt in der Vermittlung von Strahlenresistenz beziehungsweise sensibilität je nach Zelllinie unterschiedlich. Hierzu sollten weitere Untersuchungen bezüglich möglicher Interaktionen innerhalb anderer Signalwege mit strahlensensibilisierendem Einfluss erfolgen. Innerhalb des untersuchten Signalwegs konnte weiterhin festgestellt werden, dass VEGF-C Strahlenresistenz nicht über Akt vermittelt. Die vorliegende Arbeit enthält die erste Studie sowohl zur Untersuchung des Einflusses von Nelfinavir in Kombination mit Bestrahlung auf das Überleben von Prostatakarzinomzellen in vitro als auch auf die Tumorwachstumszeit und die lokale Tumorkontrolle in vivo. Hierin konnte keine strahlensensibilisierende Wirkung von Nelfinavir nachgewiesen werden. Da Nelfinavir in Zellen anderer Tumorentitäten strahlensensibilisierend wirkt und außerdem bekannt ist, dass es in eine Reihe von Signalwegen eingreift, die das Zellüberleben fördern oder hemmen, sollte weiter geklärt werden, ob Tumorzellen mit einem bestimmten genetischen Profil besser auf die Behandlung mit Nelfinavir ansprechen.:Abkürzungsverzeichnis VIII 1 Einleitung und Zielstellung 1 2 Grundlagen 3 2.1 Zelluläre Auswirkungen der Bestrahlung 3 2.2 Überlebensfördernde Signalwege 6 2.3 Zellüberlebensstrategien 9 2.3.1 Autophagie 10 2.3.2 DNA-Doppelstrangbruch-Reparatur 12 2.3.3 Zellzyklusarrest 13 2.4 Reaktionen von Tumoren auf Bestrahlung 14 2.5 Nelfinavir als Akt-Inhibitor 15 3 Material und Methoden 17 3.1 Material 17 3.1.1 Zelllinien 17 3.1.2 Reagenzien und Substanzen 17 3.1.3 Kits 19 3.1.4 Primäre Antikörper 19 3.1.5 Sekundäre Antikörper 20 3.1.6 siRNA 20 3.1.7 Primer 20 3.1.8 Materialien und Hilfsmittel 20 3.1.9 Geräte 21 3.1.10 Software 22 3.2 Methoden 22 3.2.1 Zellkultur 22 3.2.2 siRNA-Transfektion 23 3.2.3 Bestrahlung 24 3.2.4 Koloniebildungsassay 24 3.2.5 Autophagischer Flux 26 3.2.6 Semiquantitative Proteinbestimmung 27 3.2.7 mRNA-Quantifizierung 29 3.2.8 γH2AX Foci-Assay 31 3.2.9 Zellzyklusanalyse 33 3.2.10 Tierversuch 34 3.2.11 Statistische Auswertung 37 4 Ergebnisse 39 4.1 Einfluss von VEGF C und NRP 2 auf die Strahlenresistenz 39 4.1.1 Betrachtung der VEGF C- und NRP 2-Gehalte in den Zelllinien PC 3, DU145 und LNCaP 39 4.1.2 Etablierung der VEGF C- und NRP 2-siRNA-Transfektionen 39 4.1.3 Einfluss von VEGF C und NRP 2 auf die Klonogenität bestrahlter Zellen 40 4.2 Einfluss von VEGF C und NRP 2 auf überlebensfördernde Signalwege unter Bestrahlung 42 4.2.1 Aktivierung des Akt-Signalwegs 43 4.2.2 Aktivierung des ERK1/2-Signalwegs 45 4.3 Untersuchungen zum Einfluss von VEGF C und NRP 2 auf die Strahlenresistenz beeinflussende zelluläre und molekulare Prozesse 46 4.3.1 Einfluss von VEGF C und NRP 2 auf die Autophagie und deren Bedeutung für die Strahlenresistenz 46 4.3.2 Einfluss von VEGF C auf die Reparatur von DNA-Doppelstrangbrüchen 48 4.3.3 Der Einfluss von VEGF C auf den Zellzyklus 50 4.4 Inhibierung der Aktivierung von Akt durch Nelfinavir 52 4.4.1 Einfluss von Nelfinavir auf die Klonogenität in vitro 53 4.4.2 Tumorwachstumsverzögerung 54 4.4.3 Lokale Tumorkontrolle 56 5 Diskussion 59 5.1 VEGF C- und NRP 2-Expression und -Herunterregulierung 59 5.2 Der Einfluss von VEGF-C auf die Strahlenresistenz 59 5.3 Die Funktion von NRP-2 als Co-Rezeptor für VEGF-C bei der Vermittlung von Strahlenresistenz 60 5.4 VEGF C-abhängige Akt- und ERK1/2-Regulierung unter Bestrahlung 62 5.5 Der Einfluss der Autophagie auf die Strahlenresistenz 62 5.6 Der Einfluss von VEGF C auf die DNA-Doppelstrangbruch-Reparatur 63 5.7 Der Einfluss von VEGF C auf den Zellzyklus 64 5.8 Der Einfluss von Nelfinavir auf das Wachstum und auf die Strahlenresistenz von PC 3-Zellen in vitro und in vivo 65 5.9 Schlussfolgerung und Ausblick 67 6 Zusammenfassung 69 7 Abstract 72 8 Literaturverzeichnis 75 9 Abbildungsverzeichnis 89 10 Tabellenverzeichnis 90 Danksagung 92 Anhang 93 Anlage 1 94 Anlage 2 96 / Background In addition to radical prostatectomy, radiotherapy is a standard therapy for the treatment of prostate tumours and leads to good results for local tumour control and survival. However, as with the resection, the risk of recurrence for advanced tumours is relatively high compared to tumours in earlier stages. Therefore, there is a high urgency to improve radiotherapy especially for advanced stages. One approach is the combination of irradiation with molecular therapies. The aim is to block certain target proteins to increase the radiosensitivity of the prostate carcinoma cells. A potential target could be the blockade of the VEGF-C/NRP-2/Akt signalling pathway (VEGF-C – vascular endothelial growth factor C; NRP-2 – neuropilin 2; Akt – protein kinase B). In prostate cancer the concentrations of VEGF-C and NRP-2 are increased compared to normal prostate cells. Studies have shown that both proteins have a progressive effect on tumourigenesis. In preliminary work Muders et al. (2009) also showed the activation of Akt via the VEGF-C/NRP-2 axis and a resistance to H2O2 induced oxidative stress. Akt also has a protective effect against irradiation in various tumour entities. It is assumed that this also applies to prostate carcinoma cells. Aim of the study Within the framework of this thesis, it was investigated whether and via which mechanism VEGF-C, NRP-2, and Akt affect the radioresistance in prostate carcinoma cell lines. Methods In vitro and in vivo experiments were performed in the human prostate carcinoma cell lines PC-3, DU145, LNCaP, as well as in PC-3 xenografts. The influence of VEGF-C and NRP-2 on the radioresistance was examined in vitro after knock down of the corresponding genes using siRNA or after supplementation with human recombinant VEGF-C in colony formation assays. In order to determine the influence of VEGF-C and NRP-2 on possible cell survival mechanisms, the autophagic flux was examined after the blockade of autophagy with bafilomycin A1 using western blot, the DNA double strand break repair by quantification of the γH2AX foci, and the cell cycle distribution by flow cytometry. The signal transduction of VEGF-C via Akt as well as, as a further possibility, the signal transduction via ERK1/2 were tested after siRNA transfection with and without irradiation using western blot. Further experiments on Akt were performed in vitro and in vivo with the PI3K/Akt inhibitor nelfinavir in PC-3 cells. The in vitro effect of nelfinavir on radioresistance was tested using a colony formation assay after treatment of the cells with 10 μM nelfinavir. In vivo, the effect of nelfinavir without and in combination with irradiation in PC-3 xenografts was investigated in nude mice. For the determination of the tumour growth time, the mice were treated with 80 mg nelfinavir/kg body weight 30 times within 6 weeks. In a further experiment, the local tumour control was determined with simultaneous fractionated irradiation with total doses of 30 to 120 Gy and a follow-up time of 180 days. Results The investigations on radioresistance via the VEGF-C/NRP-2/Akt signalling pathway showed that in the three prostate carcinoma cell lines PC-3, DU145, and LNCaP VEGF-C significantly mediates radioresistance. For NRP-2 however, it was found that, depending on the cell line, it either leads to radioresistance (DU145) or radiosensitization (PC-3). Further, it was shown that in PC-3 and DU145 VEGF-C does not mediate radioresistance via Akt or ERK1/2. The experiments on radioresistance mediating mechanisms revealed that VEGF-C promotes autophagy in untreated PC-3 cells, but NRP-2 does not. Under irradiation, an effect of VEGF-C and NRP-2 on autophagy could not be detected reproducibly. A further experiment has shown that in PC-3 autophagy has no influence on the clonogenic survival after irradiation. In addition, it was found that VEGF-C does not affect the DNA double strand break repair in PC-3. Furthermore, it was shown that a reduction in the VEGF-C content leads to a G2/M arrest in PC-3. However, no effect could be observed in DU145. In studies regarding the influence of Akt on radioresistance independent of VEGF-C and NRP-2, nelfinavir inhibited Akt phosphorylation at Ser473 and minimally affected the clonogenic survival of PC-3 cells. In PC-3 xenografts, nelfinavir did not lead to any tumour growth delay and did not have a radiosensitizing effect in vitro or in vivo. Conclusion In the experiments, it was shown that VEGF-C mediates radioresistance in prostate cancer cells. This finding could serve as a research approach for the development of a combined therapy of a VEGF-C blockade and irradiation. A potential mechanism by which VEGF-C mediates radioresistance is the reverse of the G2/M arrest, depending on the cell line. NRP-2 acts differently in the mediation of radioresistance or radiosensitivity, depending on the cell line. On this, further investigations should be carried out with regard to possible interactions within other signalling pathways with a radiosensitizing influence. Within the investigated signalling pathway, it was further shown that VEGF-C does not mediate radioresistance via Akt. The present work contains the first study examining the effect of nelfinavir in combination with irradiation on prostate cancer cell survival in vitro as well as on growth time and local tumour control in vivo. Herein no radiosensitizing effects of nelfinavir could be detected. Since nelfinavir radiosensitizes cells of other tumour entities and is also known to interfere with a series of signalling pathways that promote or inhibit cell survival, it should be clarified whether tumour cells with a particular genetic profile are more responsive to treatment with nelfinavir.:Abkürzungsverzeichnis VIII 1 Einleitung und Zielstellung 1 2 Grundlagen 3 2.1 Zelluläre Auswirkungen der Bestrahlung 3 2.2 Überlebensfördernde Signalwege 6 2.3 Zellüberlebensstrategien 9 2.3.1 Autophagie 10 2.3.2 DNA-Doppelstrangbruch-Reparatur 12 2.3.3 Zellzyklusarrest 13 2.4 Reaktionen von Tumoren auf Bestrahlung 14 2.5 Nelfinavir als Akt-Inhibitor 15 3 Material und Methoden 17 3.1 Material 17 3.1.1 Zelllinien 17 3.1.2 Reagenzien und Substanzen 17 3.1.3 Kits 19 3.1.4 Primäre Antikörper 19 3.1.5 Sekundäre Antikörper 20 3.1.6 siRNA 20 3.1.7 Primer 20 3.1.8 Materialien und Hilfsmittel 20 3.1.9 Geräte 21 3.1.10 Software 22 3.2 Methoden 22 3.2.1 Zellkultur 22 3.2.2 siRNA-Transfektion 23 3.2.3 Bestrahlung 24 3.2.4 Koloniebildungsassay 24 3.2.5 Autophagischer Flux 26 3.2.6 Semiquantitative Proteinbestimmung 27 3.2.7 mRNA-Quantifizierung 29 3.2.8 γH2AX Foci-Assay 31 3.2.9 Zellzyklusanalyse 33 3.2.10 Tierversuch 34 3.2.11 Statistische Auswertung 37 4 Ergebnisse 39 4.1 Einfluss von VEGF C und NRP 2 auf die Strahlenresistenz 39 4.1.1 Betrachtung der VEGF C- und NRP 2-Gehalte in den Zelllinien PC 3, DU145 und LNCaP 39 4.1.2 Etablierung der VEGF C- und NRP 2-siRNA-Transfektionen 39 4.1.3 Einfluss von VEGF C und NRP 2 auf die Klonogenität bestrahlter Zellen 40 4.2 Einfluss von VEGF C und NRP 2 auf überlebensfördernde Signalwege unter Bestrahlung 42 4.2.1 Aktivierung des Akt-Signalwegs 43 4.2.2 Aktivierung des ERK1/2-Signalwegs 45 4.3 Untersuchungen zum Einfluss von VEGF C und NRP 2 auf die Strahlenresistenz beeinflussende zelluläre und molekulare Prozesse 46 4.3.1 Einfluss von VEGF C und NRP 2 auf die Autophagie und deren Bedeutung für die Strahlenresistenz 46 4.3.2 Einfluss von VEGF C auf die Reparatur von DNA-Doppelstrangbrüchen 48 4.3.3 Der Einfluss von VEGF C auf den Zellzyklus 50 4.4 Inhibierung der Aktivierung von Akt durch Nelfinavir 52 4.4.1 Einfluss von Nelfinavir auf die Klonogenität in vitro 53 4.4.2 Tumorwachstumsverzögerung 54 4.4.3 Lokale Tumorkontrolle 56 5 Diskussion 59 5.1 VEGF C- und NRP 2-Expression und -Herunterregulierung 59 5.2 Der Einfluss von VEGF-C auf die Strahlenresistenz 59 5.3 Die Funktion von NRP-2 als Co-Rezeptor für VEGF-C bei der Vermittlung von Strahlenresistenz 60 5.4 VEGF C-abhängige Akt- und ERK1/2-Regulierung unter Bestrahlung 62 5.5 Der Einfluss der Autophagie auf die Strahlenresistenz 62 5.6 Der Einfluss von VEGF C auf die DNA-Doppelstrangbruch-Reparatur 63 5.7 Der Einfluss von VEGF C auf den Zellzyklus 64 5.8 Der Einfluss von Nelfinavir auf das Wachstum und auf die Strahlenresistenz von PC 3-Zellen in vitro und in vivo 65 5.9 Schlussfolgerung und Ausblick 67 6 Zusammenfassung 69 7 Abstract 72 8 Literaturverzeichnis 75 9 Abbildungsverzeichnis 89 10 Tabellenverzeichnis 90 Danksagung 92 Anhang 93 Anlage 1 94 Anlage 2 96