Determinar o valor prognóstico e preditivo do VEGF (vascular endothelial growth factor) e do HIF-1? (Hypoxia-inducible factor-1) em relação à sobrevida livre de doença (SLD) e sobrevida global (SG) em pacientes com carcinoma de mama localmente avançado (CMLA) tratadas primariamente pela quimioterapia neoadjuvante. MATERIAIS E METODOS: VEGF e HIF foram quantificados consecutivamente em plasma de 36 pacientes com CMLA pelo método de ELISA (enzyme labeling immunoassay absorbant) para o VEGF165 e o HIF-1?. O tratamento neoadjuvante foi realizado em todas as pacientes com docetaxel e epirrubicina. O tempo médio de seguimento foi de 56 meses. RESULTADOS: Uma análise univariada demonstrou que o HIF-1? está significantemente relacionado à SLD (P =.0238) e à SG (P = .0121) com as pacientes HER-2 positivas. Não houve diferença significante para a SLD ou SG no que diz respeito aos receptores de hormônio, comprometimento axilar ou grau tumoral. Os valores de VEGF foram maiores no grupo de pacientes RE+ do que no grupo RE negativo (P =.01). Inversamente os valores de HIF-1? foram menores no grupo RE+ comparados ao grupo RE - (P =.02). Pacientes com recorrência óssea apresentaram uma tendência a apresentarem valores de VEGF menores (media, 175.7 pg/ml) do que aquelas com recorrência visceral (441 pg/ml). Uma análise multivariada demonstrou o comprometimento axilar (P =.0004), receptores de estrógeno (ER) (P < .0001), e tamanho do tumor (P = .0085) como fatores independentes de SLD. O HIF-1? foi tido como um fator independente preditivo de SG (P =.0180). Não houve diferença estatisticamente significante entre os valores plasmáticos de HIF-1? ou VEGF nos períodos pré e pós quimioterapia. CONCLUSÕES: Os resultados sugerem que o nível plasmático do HIF-1? é preditivo de SLD e SG nas pacientes com CMLA apresentando uma sobreposição as pacientes HER-2 positivas. As dosagens de VEGF podem ser preditivas de resposta e prognóstico no tratamento neoadjuvante, mas são necessários novos estudos prospectivos comparados ao HIF-1? para conclusões mais consistentes. / To determine the predictive and prognostic value of vascular endothelial growth factor (VEGF) and Hypoxia-inducible factor-1 (HIF-1?) for relapse-free survival (RFS) and overall survival (OS) in locally advanced breast cancer (LABC) primarily submitted to neoadjuvant chemotherapy. MATERIALS AND METHODS: VEGF and HIF were quantitatively measured in plasma sample from 36 consecutive patients with LABC using an enzyme immunoassay for human VEGF165 and HIF-1?. Neoadjuvant treatment was given to all patients as docetaxel and epirrubicin. The follow-up median time was 56 months. RESULTS: Univariate analysis showed that HIF-1? is a significant predictor of RFS ( P = .0238) and OS (P = 0121) in HER-2 positive patients. No significant difference was seen in RFS or OS related to hormonal receptor, axillary status or tumoral grade. The VEGF level was higher in the group of patients who ER was positive than ER negative (P = .01). On the other hand, the HIF-1? level is higher in ER negative patients than ER positive ( P=.02). Patients with bone recurrences tended to have lower VEGF plasma level (median, 175.7 pg/ml) than patients with visceral metastasis (441 pg/ml). Multivariate analysis showed nodal status (P = .0004), estrogen receptor (ER) status (P < .0001), and tumor size (P = .0085) to be independent predictors of RFS. HIF-1? was found to be an independent predictor of OS (P = .0180). No statistically differences were observed related to pre and post chemotherapy period in HIF-1? or VEGF measurements. CONCLUSION: The results suggest that high level of plasma HIF-1? is associated to HER-2 over expression and they are major predictive factors of RFS and OS in LABC. VEGF content might also predict outcome after neoadjuvant treatment, however further studies in a prospective setting with HIF-1? homologous treatments are required.

Areas of hypoxia caused by poor perfusion are a common occurrence in breast cancer. Hypoxia-inducible factors-1 and 2 (HIF1/2) drive the cellular response to hypoxia in such areas, resulting in the upregulation of genes which facilitate the survival of cancer cells and promote growth, invasion, metastasis and angiogenesis, generally leading to more aggressive tumour characteristics. Previous research has demonstrated that growth factor signalling, such as the ligand-mediated activation of HER receptors, can promote the action of HIFs in normoxia, and correlation between HER2 expression and HIFα proteins has been demonstrated in clinical samples of breast cancer. Despite this, little research has been conducted on how the growth factor-driven regulation of HIFα subunits might modify the cellular response to hypoxia. In this thesis, the role of HER2 overexpression in HIFα modulation was assessed in breast cancer cell lines and publically available clinical datasets for breast cancer with the aim of further understanding the implications of hypoxia and HIFα expression in the context of HER2-positive breast cancer. The upregulation of HIF1α and HIF2α by hypoxia was observed across breast cancer cell lines, and the role of HER2 in this process was assessed using an isogenic MCF7 cell line model overexpressing HER2. This demonstrated an increased hypoxic upregulation of HIF2α but not HIF1α when HER2 was overexpressed. The increased upregulation was shown to be facilitated by an increase in normoxic HIF2α, which is driven by a higher transcriptional rate of the EPAS1 (HIF2) gene as a direct result of HER2 overexpression. HER2 overexpression also resulted in the increased hypoxic upregulation of known hypoxia response genes in 2D and 3D culture models. This demonstrates a novel mechanism for growth-factor mediated HIFα regulation in the context of HER2 overexpression, with an important role for HIF2α. Microarray analysis of MCF7 and MCF7-HER2 cells was used to compare the global transcriptional response to acute (24 hrs) and chronic (>10 weeks) hypoxia (0.5% O2) and demonstrated a broadly increased upregulation of hypoxic response genes in the HER2 overexpressing cell line when compared to wild-type MCF7. This included an increase in previously described HIF1 and HIF2 target genes. MCF7-HER2 also illustrated an increased expression of hypoxia response genes in normoxia, and an analysis of the genes involved showed the promotion of a number of pathological processes including proliferation, invasion, angiogenesis and epithelial to mesenchymal transition. Large-scale, publically available expression datasets for breast cancer cell lines and clinical patient data were used to investigate the expression of HIF2α and hypoxia response genes in relation to HER2 expression. A set of pathologically important genes which were primed for hypoxia in MCF7-HER2 were also demonstrated to correlate with HER2 across breast cancer cell lines, suggesting that HER2 may more broadly promote a readiness to respond to hypoxia in breast cancer cells. Assessment of HIF2α in clinical samples has shown its increased expression in the HER2-positive subtype, and HIF2α was shown to be associated with worse disease-specific survival in the context of HER2-positive samples only. To investigate whether HIF2α is a potential target in HER2 overexpressing breast cancer, the effect of HIF2α inhibition through siRNA or HIF2-specific chemical inhibitors was assessed in cell lines with high or low HER2 expression, and this demonstrated an increased sensitivity of HER2 overexpressing cell lines to HIF2α inhibition. This work highlighted HER2 as an important modulator of the cellular response to hypoxia in breast cancer, demonstrating a previously overlooked role for HIF2α in this process. HIF2α expression can be directly driven by HER2 and this differs mechanistically from that previously reported for HIF1α. Finally, further work into the potential for HIF2α as a target for anti-cancer therapy is suggested, as an increased sensitivity of HER2-positive cell lines to anti-HIF2α agents was shown, as well as a HER2-specific relationship between HIF2α expression and worse prognosis. More generally, this work has shown an important interplay between growth factor receptor expression and the cellular response to hypoxia, suggesting that HER2 may promote a stronger response to hypoxia in breast cancer, which may contribute to the increased aggressiveness of HER2-positive tumours.

Rica em compostos bioativos, a própolis é amplamente utilizada na medicina alternativa como agente preventivo e/ou terapêutico. Neste trabalho, avaliamos o impacto de frações ricas em polifenóis de diferentes própolis no processo de angiogênese na aterosclerose. Foram utilizadas as seguintes amostras de própolis: Red (vermelho, Alagoas-Brasil), Green (verde, Minas Gerais-Brasil) e Brown (marrom, Temuco-Chile), com concentrações semelhantes de polifenóis totais (~32%), porém com diferentes perfis de compostos fenólicos. A suplementação (250 mg/Kg/dia) de camundongos knockout para o receptor de LDL (LDLr-/-) com os polifenóis demonstrou que no protocolo de lesão inicial (LI) os grupos suplementados apresentaram menor (p<0,05) área de lesão (Green, 726&#181;m2; Red, 519&#181;m2; Brown, 698&#181;m2) em relação ao controle (GC, 1184&#181;m2). Em contraste, no protocolo de lesão avançada (LA) apenas o grupo Red (1082&#181;m2) apresentou menor (p<0,05) área de lesão em relação ao GC (1598&#181;m2). Em ambos os protocolos (LI e LA) observou-se redução (p<0,05) na expressão de importantes genes envolvidos no processo de angiogênese (VEGF, MMP9, PDGF e PECAM). No entanto, apenas o grupo tratado com a própolis Red foi capaz de aumentar (p<0,05) a expressão de TIMP-1 no protocolo de LI. Todos os tratamentos inibiram (p<0,05), em cerca de 45%, a migração de células endoteliais (CE), bem como cerca de 55% do brotamento de tubos de anéis de aorta, em relação ao controle e ao redor de 50% da formação de novos vasos na membrana corioalantóica de embrião de galinha (CAM). Ao investigar o mecanismo de ação dos polifenóis, observamos que os polifenóis da própolis Red (PRP) mostraram-se mais eficazes em modular a expressão do Fator induzido por Hipóxia-1 alfa (HIF-1&#945;), de modo dose/tempo dependente em células endoteliais. Adicionalmente, os polifenóis da própolis Red (PRP) reduziram a expressão de genes alvos regulados por HIF-1&#945; como GLUT-1 e ADM, além de inibir a expressão gênica e a secreção de VEGF em meio de cultura. Em presença dos PRP, a degradação de HIF-1&#945; foi exarcebada e, utilizando-se células RCC4/pVHL (células de carcinoma renal com VHL reintroduzido), observou-se que PRP induzem a desestabilização de HIF-1&#945; acelerando sua degradação dependente de pVHL. Em células endoteliais, pVHL foi superexpresso devido à inibição de Cdc42, um repressor de pVHL. Conclui-se que os polifenóis oriundos das própolis Green, Red e Brown possuem potencial anti-aterogênico através da inibição da expressão de moléculas inflamatórias e angiogênicas, principalmente quando suplementados ao início do desenvolvimento da lesão aterosclerótica. Além disso, os polifenóis da própolis Red inibem o processo de angiogênese, aumentando a desestabilização de HIF-1&#945; pelo aumento da degradação via pVHL e induzindo sua expressão em função da repressão de Cdc42. / Propolis is rich in bioactive compounds and widely used in alternative medicine as a preventive agent and/or in therapy. We evaluate the impact of polyphenol-rich fractions of propolis from different origins and types in the angiogenesis process in atherosclerotic lesions. The following samples of propolis were used: Red (red, Alagoas, Brazil), Green (green, Minas Gerais, Brazil) and Brown (brown, Temuco, Chile), with similar concentrations of total polyphenols (~ 32%) but with different profiles of phenolic compounds. Supplementation (250 mg / kg / day) of knockout mice for the LDL receptor (LDLr-/ -) with polyphenols showed that in the initial lesion (LI) protocol supplemented groups had lower (p<0.05) lesion area (Green, 726&#181;m2; Red, 519&#181;m2; Brown 698&#181;m2) compared to control (GC, 1184&#181;m2). In contrast, in the advanced lesions (LA) protocol only the Red group (1082&#181;m2) had smaller lesion area (p<0.05) compared to GC (1598&#181;m2). In both protocols (LI and LA) a reduction (p<0.05 of important genes expression involved in angiogenesis (VEGF, MMP9, PDGF and PECAM) was observed. However, only the group treated with Red propolis was able to increase (p <0.05) the expression of TIMP-1 in the LI protocol. The treatments with all types of propolis inhibited (p<0.05), about 45% the migration of endothelial cells (EC), approximately 55% of tubes formation in aortic rings and almost 50% of formation of new vessels in the chorioallantoic membrane of chick embryo (CAM) compared to the control. While investigating the mechanism of polyphenols action, it was found that polyphenols from Red propolis (PRP) were more effective in modulating the expression of hypoxia-induced factor-1 alpha (HIF-1&#945;) in a dose/time dependent way in EC. Additionally, the polyphenols from red propolis (PRP) reduced the expression of target genes regulated by HIF-11&#945; as GLUT-1, ADM, VEGF besides the VEGF protein secretion in the EC culture medium. In the presence of PRP, the degradation of HIF-11&#945; was exacerbated in RCC4/pVHL cells (renal cell carcinoma with VHL reintroduced); moreover, PRP induced destabilization of HIF-11&#945; accelerating the degradation of this transcription factor by a pVHL-dependent patway. In EC, pVHL was over expressed by inhibition of Cdc42, a repressor of pVHL. We conclude that the polyphenols from Green, Red and Brown propolis have anti-atherogenic potential by inhibiting the expression of angiogenic and inflammatory genes, especially when supplemented at an early stage of the atherosclerotic lesion development. In addition, the polyphenols from Red propolis inhibit the angiogenesis process by increasing the destabilization of HIF-11&#945; via over expression of pVHL-degradation induced by repressed Cdc42 function.

Determinar o valor prognóstico e preditivo do VEGF (vascular endothelial growth factor) e do HIF-1? (Hypoxia-inducible factor-1) em relação à sobrevida livre de doença (SLD) e sobrevida global (SG) em pacientes com carcinoma de mama localmente avançado (CMLA) tratadas primariamente pela quimioterapia neoadjuvante. MATERIAIS E METODOS: VEGF e HIF foram quantificados consecutivamente em plasma de 36 pacientes com CMLA pelo método de ELISA (enzyme labeling immunoassay absorbant) para o VEGF165 e o HIF-1?. O tratamento neoadjuvante foi realizado em todas as pacientes com docetaxel e epirrubicina. O tempo médio de seguimento foi de 56 meses. RESULTADOS: Uma análise univariada demonstrou que o HIF-1? está significantemente relacionado à SLD (P =.0238) e à SG (P = .0121) com as pacientes HER-2 positivas. Não houve diferença significante para a SLD ou SG no que diz respeito aos receptores de hormônio, comprometimento axilar ou grau tumoral. Os valores de VEGF foram maiores no grupo de pacientes RE+ do que no grupo RE negativo (P =.01). Inversamente os valores de HIF-1? foram menores no grupo RE+ comparados ao grupo RE - (P =.02). Pacientes com recorrência óssea apresentaram uma tendência a apresentarem valores de VEGF menores (media, 175.7 pg/ml) do que aquelas com recorrência visceral (441 pg/ml). Uma análise multivariada demonstrou o comprometimento axilar (P =.0004), receptores de estrógeno (ER) (P < .0001), e tamanho do tumor (P = .0085) como fatores independentes de SLD. O HIF-1? foi tido como um fator independente preditivo de SG (P =.0180). Não houve diferença estatisticamente significante entre os valores plasmáticos de HIF-1? ou VEGF nos períodos pré e pós quimioterapia. CONCLUSÕES: Os resultados sugerem que o nível plasmático do HIF-1? é preditivo de SLD e SG nas pacientes com CMLA apresentando uma sobreposição as pacientes HER-2 positivas. As dosagens de VEGF podem ser preditivas de resposta e prognóstico no tratamento neoadjuvante, mas são necessários novos estudos prospectivos comparados ao HIF-1? para conclusões mais consistentes. / To determine the predictive and prognostic value of vascular endothelial growth factor (VEGF) and Hypoxia-inducible factor-1 (HIF-1?) for relapse-free survival (RFS) and overall survival (OS) in locally advanced breast cancer (LABC) primarily submitted to neoadjuvant chemotherapy. MATERIALS AND METHODS: VEGF and HIF were quantitatively measured in plasma sample from 36 consecutive patients with LABC using an enzyme immunoassay for human VEGF165 and HIF-1?. Neoadjuvant treatment was given to all patients as docetaxel and epirrubicin. The follow-up median time was 56 months. RESULTS: Univariate analysis showed that HIF-1? is a significant predictor of RFS ( P = .0238) and OS (P = 0121) in HER-2 positive patients. No significant difference was seen in RFS or OS related to hormonal receptor, axillary status or tumoral grade. The VEGF level was higher in the group of patients who ER was positive than ER negative (P = .01). On the other hand, the HIF-1? level is higher in ER negative patients than ER positive ( P=.02). Patients with bone recurrences tended to have lower VEGF plasma level (median, 175.7 pg/ml) than patients with visceral metastasis (441 pg/ml). Multivariate analysis showed nodal status (P = .0004), estrogen receptor (ER) status (P < .0001), and tumor size (P = .0085) to be independent predictors of RFS. HIF-1? was found to be an independent predictor of OS (P = .0180). No statistically differences were observed related to pre and post chemotherapy period in HIF-1? or VEGF measurements. CONCLUSION: The results suggest that high level of plasma HIF-1? is associated to HER-2 over expression and they are major predictive factors of RFS and OS in LABC. VEGF content might also predict outcome after neoadjuvant treatment, however further studies in a prospective setting with HIF-1? homologous treatments are required.

Le facteur de transcription HIF-1 est un hétérodimère composé d’une sous-unité α et d’une sous-unité ß. HIF-1 est capable de reconnaître une séquence consensus appelée HRE (HIF Response Element) et de réguler l’expression de plus de 200 gènes cibles impliqués dans divers mécanismes cellulaires. Nous nous intéressons à étudier le rôle de HIF-1α dans la peau, d’une part dans la régulation des enzymes de la réparation de l’ADN suite à l’irradiation UVB, d’autre part dans la physiologie cutanée.Nos résultats montrent bien que HIF-1α régule l’expression des gènes participant à la réparation de l’ADN (XPC et XPD). Ces gènes contiennent dans leurs régions promotrices des HRE de HIF-1α. La quantification de l’immunoprécipitation de chromatine révèle des HRE putatifs dans les gènes codant pour d'autres protéines de la réparation de l'ADN (XPB, XPG, CSA et CSB), ce qui suggère que HIF-1α est un régulateur clé de la machinerie de réparation de l'ADN. Nous avons prouvé que HIF-1α est indispensable à l’adhésion des kératinocytes par sa régulation exercée sur la laminine-332 et les intégrines (α6 et ß1). L’absence de l’expression de HIF-1α empêche aussi la reconstruction des épidermes à partir des kératinocytes humains. Nos résultats ont montré que les souris invalidées pour HIF-1α développent avec l’âge un phénotype d’inflammation dans plusieurs régions. Ces souris sont très sensibles au moindre stress consécutif à une blessure et une irradiation UVB. L’induction de l’inhibition de HIF-1α dans des souris inductibles avec le tamoxifène indique un détachement de l’épiderme au niveau des couches supra-basales. Ces souris meurent deux semaines après injection du tamoxifène / The transcription factor HIF-1 is a heterodimer composed of an α and ß subunit. HIF-1 is capable of recognizing a consensus sequence called HRE (hypoxia Response Element) and regulate the expression of more than 200 target genes involved in various cellular mechanisms. We are interested in studying the role of HIF-1α in the skin physiology.Our results show that HIF-1α regulates the expression of two main factors (XPC and XPD) involved in nucleotide excision repair through binding on HRE in their promoter regions. Quantitative chromatin immunoprecipitation assays further revealed putative HREs in the genes encoding other DNA repair proteins (XPB, XPG, CSA and CSB), suggesting that HIF-1α is a key regulator of the DNA repair machinery. We proved that HIF-1α is essential for keratinocyte adhesion through its regulation exerted on laminin-332 and integrins (α6, ß1). The lack of HIF-1α expression also prevents the reconstruction of epidermis by human keratinocytes. Our results showed that mice constitutively depleted for HIF-1α in their epidermis develop with age a phenotype of inflammation in several regions. These mice are very sensitive to the stress resulting from wound injury and UVB irradiation. HIF-1α depletion in the epidermis of inducible mice using tamoxifen results in a detachment of the epidermis in suprabasal layers. These mice die within two weeks after injection of tamoxifen

Le pancréas est une glande mixte à composantes endocrine et exocrine. Le tissu endocrine, essentiellement composé de cellules bêta productrices d’insuline, joue un rôle prépondérant dans le maintient de l’homéostasie glucidique. La perte qualitative ou quantitative des cellules bêta conduit au développement de pathologies caractérisées par une hyperglycémie chronique et connues sous le nom de diabète. Le développement de stratégies thérapeutiques innovantes, thérapie cellulaire ou médecine régénérative, pour guérir le diabète repose sur une connaissance précise des mécanismes développementaux impliqués dans la formation des cellules bêta. Ainsi, au delà de l’intérêt cognitif, il est primordial de comprendre au mieux les évènements cellulaires et moléculaires qui régissent l’organogénèse pancréatique pour offrir des thérapies alternatives. Le développement embryonnaire s’effectue dans un environnement où la pression partielle en oxygène (pO2) est faible. Par ailleurs, une étude menée au sein du laboratoire a montré que la pO2 influence la différenciation des cellules bêta pancréatique in vitro. En effet, lorsque des pancréas embryonnaires sont cultivés sur filtre en hypoxie (pO2=3%), le développement des cellules bêta est drastiquement diminué comparativement à une condition de 21% d’O2. Le facteur de transcription HIF-1 (Hypoxia Inducible Factor-1), composé d’une sous-unité alpha sensible au niveau d’oxygène et d’une sous-unité bêta constitutivement présente, permet à la cellule de s’adapter à un environnement pauvre en O2, notamment en favorisant la formation de nouveaux vaisseaux sanguins au cours d’un processus appelé angiogénèse. L’objectif de ma thèse était d’étudier le rôle de HIF-1alpha au cours du développement embryonnaire du pancréas in vivo. Pour cela, nous avons utilisé des lignées murines génétiquement modifiées permettant de stabiliser constitutivement la protéine HIF-1alpha dans l’épithélium pancréatique. En utilisant ce modèle murin, nous avons montré que la différenciation endocrine et le développement des cellules bêta est altéré dans les pancréas mutants comparativement aux contrôles. Par ailleurs, en utilisant une approche pharmacologique in vitro conduisant à l’ablation des cellules endothéliales du pancréas, nous avons pu restaurer une différenciation endocrine comparable aux contrôles. Ce travail a permis d’éclaircir le rôle de HIF-1 et de la vascularisation au cours du développement embryonnaire du pancréas. Nos résultats indiquent que ces paramètres doivent être pris en compte pour améliorer les protocoles actuels permettant de générer des cellules bêta in vitro. / The pancreas is an endoderm-derived organ which is composed by both an exocrine and an endocrine compartment. Within the endocrine tissu, insulin-producing beta-cells are essential for the regulation of glucose homeostasis. The loss of beta-cells can lead to pathologies such as diabetes. Currently, people suffuring from diabetes can be treated but not permanently cured. The development of innovating therapeutical approaches, like cellular therapy or regenerative medecine, relies on the precise knowledge of the mechanisms regulating the ontogenesis of pancreatic beta-cells. Different studies have linked proper embryonic development and low-oxygen tension (pO2). Specifically, when embryonic pancreases are cultured in vitro under a hypoxic condition (pO2=3%), the beta-cells development is impaired compared to a normoxic condition (pO2=21%). Different pathways are involved in the cell adaptation to hypoxia, such as the ubiquitous Hypoxia Inducible Factor 1-alpha (HIF-1alpha). The aim of my PhD project was to elucidate the role of HIF-1alpha during pancreatic development in vivo. To do so, we used genetically modified mice allowing the constitutive stabilization of HIF-1alpha in pancreatic epithelial cells. We have shown that HIF-1alpha stabilization leads to a reduction of endocrine differentiation and beta-cells development. Moreover, using a pharmacological approach in vitro consisting in deleting endothelial cells, we rescued the endocrine differentiation in the mutant pancreases. In conclusion, my data demonstrated the negative influence of both HIF-1 and endothelial cells on endocrine differentiation processes.

Abstract Breast cancer is the most common cancer affecting the female population of the Western world. It is a heterogeneous disease entity that encompasses tumors with remarkably different forms of behaviour, and it is therefore vital to distinguish patients with good and poor prognoses. The classical prognostic and predictive factors for breast cancer serve as tools for clinical oncologists when planning treatment, but the growing awareness of breast cancer biology is bringing about a need for novel prognostic and predictive biomarkers. This thesis examines the prognostic significance of hypoxia response and cell cycle regulators in ductal breast cancer and in triple-negative breast cancer (negative for hormone receptors and human epidermal growth factor receptor 2), concluding that PHD2 and PHD3 are associated with a good prognosis, while the role of PHD1 is controversial, as it is associated with proliferation in ductal breast cancer but with node-negative status in triple-negative breast cancer. In our experiments HIF-1&#945; redeemed its role as a marker of an adverse prognosis, whereas the role of HIF-2&#945; appeared to be the opposite. Our data suggest that PHDs can have other targets than the HIF-&#945;s, and that triple-negative breast tumors express more HIF-1&#945; and less HIF-2&#945; and PHD3 than those with a good prognosis. Furthermore, we identified cyclin D1 as a biomarker with independent prognostic significance in ductal breast cancer, being associated with good prognostic factors and a better outcome, whereas the opposite was seen in triple-negative breast cancer. CDK4 was associated with high proliferation in triple-negative breast cancer. In addition, high levels of p16 correlated with increased survival in breast cancer patients independently of receptor status. / Tiivistelmä Rintasyöpä on naisten yleisin syöpä läntisessä maailmassa. Rintasyöpä on heterogeeninen tautiryhmä, jossa kasvaimet vaihtelevat biologiselta käyttäytymiseltään huomattavasti. Tästä syystä on tärkeää erottaa hyvä- ja huonoennusteiset potilaat. Syöpälääkärit käyttävät klassisia ennustetekijöitä hoitopäätöksiä tehdessään, mutta lisääntynyt tieto rintasyövän biologiasta on saanut aikaan tarpeen löytää uusia ennustetekijöitä. Tässä väitöskirjatyössä tutkimme hypoksiavasteen ja solusyklin säätelijöiden ennusteellisuutta duktaalisessa rintasyövässä sekä kolmoisnegatiivisessa (ei ilmennä hormonireseptoreita eikä epidermaalikasvutekijäreseptoria) rintasyövässä. PHD2 ja PHD3:n vahva ilmentyminen liittyi parempaan ennusteeseen, mutta PHD1:n esiintymisen vaikutus oli ristiriitainen. PHD1:n ilmentyminen liittyi lisääntyneeseen solujakautumiseen duktaalisessa rintasyövässä, mutta kolmoisnegatiivisessa rintasyövässä sen esiintyminen liittyi vähentyneeseen imusolmukemetastasointiin. Tutkimuksessamme HIF-1&#945; osoittautui huonon ennusteen merkiksi. Sitä vastoin HIF-2&#945;:n ilmentymisen vaikutus näytti liittyvän parempaan ennusteeseen. Tuloksemme osoittavat, että PHD-entsyymeillä on mahdollisesti muitakin kohteita kuin HIF-&#945;:t. Osoitimme myös, että HIF-1&#945;:n ilmentyminen on yleisempää ja HIF-2&#945;:n sekä PHD3:n ilmentyminen vähäisempää kolmoisnegatiivisessa kuin duktaalisessa rintasyövässä. Lisäksi totesimme, että sykliini D1 on itsenäinen ennustetekijä liittyen parempaan ennusteeseen duktaalisessa rintasyövässä. Huomioitavaa on kuitenkin, että kolmoisnegatiivisessa rintasyövän alaryhmässä sykliini D1:n esiintyminen oli huonon ennusteen merkki. CDK4 osoittautui voimakkaan proliferaation merkiksi kolmoisnegatiivisessa rintasyövässä. Lisäksi osoitimme, että p16:n ilmentyminen liittyy parempaan ennusteeseen sekä duktaalisessa rintasyövässä että kolmoisnegatiivisessa rintasyövässä.

Einleitung: Ein häufiger Befund in routinemäßig untersuchten Bioptaten equiner Endometrien sind degenerative Alterationen der Blutgefäße in Form von Angiosklerosen. Sie stellen die Ursache einer endometrialen Minderperfusion dar und bedingen Fruchtbarkeitsstörungen. Ziele der Untersuchungen: Der Inhalt dieser Arbeit war die Untersuchung equiner Endometriumproben mit graduell vari-ablen Angiosklerosen. Die Hypothese ist, dass degenerative Gefäßwandveränderungen die Ursache für einen hypoxischen Zustand darstellen. Anhand der Expression von so genannten Hypoxiemarkern sollte das Vorliegen eines potenziellen Sauerstoffmangels in Folge einer Minderperfusion durch degenerative Blutgefäßwandveränderungen überprüft und immunhis-tologisch dargestellt werden. Des Weiteren sollten Zusammenhänge zu anderen Einflussfak-toren wie zum Beispiel dem Zyklusstand, dem Vorliegen einer Trächtigkeit, dem Alter oder einer Endometrose untersucht werden. Tiere, Material und Methoden: Grundlage für diese Untersuchungen waren vor allem equine Endometriumbioptate aus der Routinediagnostik des Instituts für Veterinär-Pathologie. Anhand mittels Pikrosiriusrot gefärb-ter Bioptate wurden Gruppen ohne Alterationen von maximal 5-jährigen Maidenstuten (n = 10) sowie mit ausschließlich graduell variablen Angiosklerosen (jeweils n = 10 mit dezenter, geringgradiger, gering- bis mittelgradiger, mittelgradiger und mittel- bis hochgradiger sowie n = 8 mit hochgradiger Angiosklerose) gebildet. Des Weiteren wurden aus dem Sektionsgut des Instituts Endometriumproben von tragenden Stuten (n = 6), eine weitere Uterusprobe einer trächtig geschlachteten Stute, Bioptate mit gering- bzw. hochgradiger Endometrose in Kombi-nation mit gering- bzw. hochgradiger Angiosklerose (jeweils n = 6) und Bioptate, die an defi-nierten Zyklustagen (Östrus, früher bzw. später Diöstrus) entnommen wurden (jeweils n = 2) entsprechend graduiert. Alle Proben wurden nach erfolgreicher methodischer Etablierung der Antikörper gegen hypo-xia-inducible factor 1α (HIF-1α), Glucosetransporter 1 (GLUT1), vascular endothelial growth factor A (VEGF A) und vascular endothelial growth factor receptor 2 (VEGF-R2) hinsichtlich der Expression dieser Hypoxiemarker immunhistologisch untersucht. Für unterschiedliche Zellpopulationen (luminales Epithel und Zellen der Drüsenausführungsgänge, oberflächliche, mittlere und basale glanduläre Epithelzellen, Stromazellen) und die arteriellen und venösen Blutgefäße (jeweils getrennt nach Intima, Media und Adventitia) wurde markerweise der Im-munreaktive Score (IRS) aus jeweils 10 nebeneinander liegenden Gesichtsfeldern bei 400-facher Vergrößerung (Zellpopulationen) bzw. jeweils 5 Arterien, Arteriolen, Venen und Venulen bestimmt. Die statistische Untersuchung erfolgte mit dem Statistikprogramm SPSS 22 (SPSS Software-GmbH, München). Die Datenvisualisierung wurde mit GraphPad Prism 8 (Graphpad Software Inc., San Diego, Kalifornien, USA) durchgeführt. Ergebnisse: Eine Expression der Hypoxiemarker lässt sich in unterschiedlichen Zellpopulationen darstel-len. HIF-1α ist in nahezu allen Proben im luminalen Epithel, in den Drüsenepithelzellen und in Intima und Media von vor allem arteriellen Gefäßen nachweisbar. Ein nicht signifikanter Trend zu einem höheren IRS zeigt sich erst ab mittel- bis hochgradigen Angiosklerosen in den Drüsenepithelzellen. Demgegenüber lässt sich eine verminderte Expression in der Media von arteriellen Gefäßen erkennen, die für vier Angiosklerose-Gruppen auch statistisch signifikant ist. GLUT1 kann vor allem im Bereich des luminalen Epithels und der Zellen der Drüsenaus-führungsgänge sowie vereinzelt auch in Drüsenepithelzellen nachgewiesen werden. Die ins-gesamt graduell variable Expression sinkt tendenziell mit steigendem Angiosklerosegrad, al-lerdings nicht statistisch signifikant. VEGF A wird von nahezu allen untersuchten Zellpopulati-onen sowie Blutgefäßen und in nahezu allen Proben relativ konstant hoch exprimiert. Zu einer vermehrten Expression kommt es ab Vorliegen einer mittelgradigen Angiosklerose vor allem in den glandulären Epithelzellen, welche bei hochgradiger Angiosklerose auch als statistisch signifikant anzusehen ist. Eine VEGF-R2-Expression lässt sich ebenfalls vorrangig im glan-dulären und luminalen Epithel erkennen, wenngleich sie sich überwiegend geringgradig dar-stellt. Deutliche Unterschiede lassen sich hier in keiner untersuchten Zellpopulation erkennen. Im Zusammenhang mit einer Trächtigkeit zeigen sich Unterschiede in der Expression bei dreien der vier Marker im Bereich des luminalen Epithels und der Zellen der Drüsenausfüh-rungsgänge, also der Schicht, die an der Bildung der feto-maternalen Verbindung beteiligt ist. Im Vergleich zwischen normalen und endometrotischen Drüsen zeigen sich für alle Marker Unterschiede im Expressionsverhalten, die allerdings nicht statistisch signifikant sowie scheinbar unabhängig vom Angiosklerosegrad sind. Eine deutliche Zyklusabhängigkeit konnte nicht nachgewiesen werden. Schlussfolgerungen: Mittels der durchgeführten Untersuchungen wird deutlich, dass insbesondere schwere Angi-osklerosen für immunhistologisch darstellbare hypoxische Zustände sorgen. Ferner zeigen die eigenen Untersuchungen, dass sich die endometrialen Zellpopulationen hinsichtlich der Ex-pression der untersuchten Marker unterscheiden. Dabei wird außerdem deutlich, dass es nicht zwangsläufig zu dem erwarteten Anstieg der Expression der Hypoxiemarker kommen muss. Aus diesem Grund sollte zur Beurteilung des Vorliegens einer Hypoxie eine Untersu-chung der Expression mehrerer derartiger Marker erfolgen. Ein gänzlicher Ausschluss von anderen Einflussfaktoren als Hypoxie auf die Expression der untersuchten Marker kann im verwendeten Studienaufbau nicht erfolgen. Zukünftige Untersuchungen sollten zum einen einen größeren Probenumfang (insbesondere bei der Untersuchung anderer Faktoren als Angiosklerose) aufweisen sowie zum anderen weitere Hypoxiemarker umfassen. Die unter-suchten Marker spielen wahrscheinlich eine Rolle bei besonderen physiologischen (z. B. Trächtigkeit) als auch pathologischen Prozessen (z. B. Endometrose) im equinen Endometri-um und stellen somit interessante pharmakologische Targets zur positiven Beeinflussung der Reproduktionsleistung oder für die Therapie der equinen Endometrose dar. / Introduction: Degenerative alterations of the blood vessels, especially angiosclerosis, are a common finding in equine endometrial biopsies. They are the cause of an insufficient endo-metrial blood supply and therefore result in fertility problems. Objectives: The subject of this thesis was the examination of equine endometrial specimens with variable degrees of angiosclerosis. The hypothesis is that degenerative changes of the vessel wall are the cause of a hypoxic environment. The presence of a potential lack of oxygen as a result of hypoperfusion because of degenerative changes in the blood vessels was assessed via im-munohistochemistry by examining the expression of so-called markers of hypoxia. In addi-tion, the possible relationship to other factors such as the stage of the estrous cycle, pregnan-cy, age or endometrosis was considered. Animals, material and methods: This study is based on equine endometrial biopsies submitted to the diagnostic service of the Institute of Veterinary Pathology. By the means of picrosirius red stain, biopsy groups without any alterations of maiden mares with a maximum age of 5 years (n = 10) as well as biopsies with solely gradually variable angiosclerosis (n = 10 with minimal, mild, mild to moderate, moderate and moderate to severe, as well as n = 8 with severe angiosclerosis, respecively) have been established. In addition, specimens of pregnant mares from necropsied (n = 6) and slaughtered (n = 1) horses, biopsies with mild and severe endometrosis in combination with mild and severe angiosclerosis (n = 6, respectively) and biopsies taken on certain days of the estrous cycle (estrous as well as early and late diestrous, n = 2, respectively) have been graduated likewise. After their successful methodical establishment, all specimens have been examined im-munohistochemically via antibodies against hypoxia-inducible factor 1α (HIF-1α), glucose transporter 1 (GLUT1), vascular endothelial growth factor A (VEGF A) and vascular endothe-lial growth factor receptor 2 (VEGF-R2) in regard to the expression of those markers for hy-poxia. The immunoreactive score (IRS) for each marker has been determined by examining 10 adjacent high-power fields (400-fold magnification) for the different endometrial cell popu-lations (luminal epithelium and cells of glandular ducts, superficial, mid and basal glandular epithelial cells, stromal cells), and 5 arteries, arterioles, veins, and venules, respectively, sepa-rated by intima, media and adventitia. The statistical analysis has been performed via data analysis software SPSS 22 (SPSS Software-GmbH, Munich). The visualisation of data has been done with GraphPad Prism 8 (Graphpad Software Inc., San Diego, California, USA). Results: Expression of the markers of hypoxia was demonstrated in different cell populations. HIF-1α could be detected in almost every specimen in the luminal and glandular epithelia as well as in the intima and media of blood vessels. A non significant trend towards increased IRS was observed in biopsies with at least moderate to severe angiosclerosis in the endometrial glands. In contrast, a diminished expression was identified in the media of arterial vessels, which was significant in four of the angiosclerosis groups. GLUT1 was detected in the luminal epithelium and the cells of glandular ducts as well as in some glandular epithelial cells. In total the ex-pression was variable, with a trend towards lower levels in cases with higher degrees of angi-osclerosis. VEGF A was constantly expressed on relatively high levels by all of the examined cell populations and blood vessels in almost all examined biopsies. There was a trend towards increased expression in cases with moderate angiosclerosis predominantly in the glandular epithelia, reaching statistical significance in endometrial biopsies which are severely altered by angiosclerosis. An expression of VEGF-R2 could be seen in glandular and luminal epitheli-al cells. Nevertheless, no distinct differences were evident. In endometrial specimens of pregnant mares, expressional differences could be identified for three out of the four examined markers, especially in the luminal epithelium and the cells of glandular ducts, which are involved in the development of the feto-maternal connection. The comparison of normal with endometrotic glands revealed a complex expression pattern of all four examined markers which seemed to be independent of the degree of angiosclerosis. A distinct difference in dependence of the phase of the estrous cycle could not be detected. Conclusions: The current study demonstrated that severe angiosclerosis is the cause of an immunohisto-chemically detectable hypoxic condition. Furthermore, this study showed systematic differ-ences in the expression of the examined markers for the different endometrial cell popula-tions. Notably, the employed markers of hypoxia did not always show the expected increase in parallel with increasing grades of angiosclerosis. For that reason, the expression of multiple markers of hypoxia should be assessed to demonstrate a lack of oxygen in tissue samples using immunohistochemistry. The used study design did not allow the complete exclusion of other factors influencing the expression of the examined markers. Therefore, future studies should contain a larger pool of specimens on the one hand (especially while examining other factors than angiosclerosis) and employ a panel of markers of hypoxia. The examined mark-ers seem to play an important role during physiological (e. g. pregnancy) as well as pathologi-cal processes (e. g. endometrosis) and by that might be rewarding pharmacological targets to positively influence reproduction or to possibly treat equine endometrosis.

Adaptation to chronic hypoxia is characterized by a variety of functional changes in order to maintain metabolic and energy homeostasis. It has been known for many years that both humans and animals indigenous or adapted to high-altitude hypoxia are more tolerant to an acute ischemic injury of the heart. HIF1α is found as a primary transcriptional regulator of adaptive response to hypoxia in all tissues, whereas HIF2α is more tissue specific. The activity of HIFα is regualted by prolyl hydoxylases (EGLN). The EGLN1 was shown to be more efficient in HIF1α hydroxylation than in HIF2α. As well as the EGLN3 is more specific for HIF2α . Under hypoxic conditions, HIF activates the transcription of about 70 genes. Hence, HIF1α and HIF2α can play an essential role in pathophysiology of ischemic heart disease. The aim of our study was to determine myocardial expression of HIFs and its regulatory hydroxylases in adult male Wistar rats adapted to continuous normobaric hypoxia (H; FIO2 = 0.1) for 3 weeks. Another two groups of rats were exposed to normobaric hypoxia intermittently for either 8 h/day (INH) or 23 h/day (RH) during the 3-week adaptation period. While H induces protective cardiac phenotype, the later regimen (RH) does not. The protein expression of HIFs, PHDs and FIH were then determined by...

The HIF prolyl 4-hydroxylases (HIF-P4H) control hypoxia-inducible factor (HIF), a powerful mechanism regulating cellular adaptation to decreased oxygenation. The gastrointestinal epithelium subsists in “physiological hypoxia” and should therefore have an especially well-designed control over this adaptation. Thus, we assessed the absolute mRNA expression levels of the HIF pathway components, Hif1a, HIF2a, Hif-p4h-1, 2 and 3 and factor inhibiting HIF (Fih1) in murine jejunum, caecum and colon epithelium using droplet digital PCR.We found a higher expression of all these genes towards the distal end of the gastrointestinal tract. We detected mRNA for Hif-p4h-1, 2 and 3 in all parts of the gastrointestinal tract. Hif-p4h-2 had significantly higher expression levels compared to Hif-p4h-1 and 3 in colon and caecum epithelium. To test the roles each HIF-P4H isoform plays in the gut epithelium, we measured the gene expression of classical HIF target genes in Hif-p4h-1/, Hif-p4h-2 hypomorph and Hif-p4h-3/ mice. Only Hif-p4h-2 hypomorphism led to an upregulation of HIF target genes, confirming a predominant role of HIF-P4H-2. However, the abundance of Hif-p4h-1 and 3 expression in the gastrointestinal epithelium implies that these isoforms may have specific functions as well. Thus, the development of selective inhibitors might be useful for diverging therapeutic needs.