Justificativa: A recidiva do Carcinoma Hepatocelular (CHC) é um fator limitante da sobrevida nos indivíduos submetidos a transplante hepático (TxH). Além do número e tamanho do tumor, invasão vascular e grau de diferenciação, compreender a biologia tumoral e os biomarcadores relacionados é um passo importante para prever a recidiva e estabelecer estratégias terapêuticas. Objetivos: Analisar a expressão e valor prognóstico do receptor do Fator de Crescimento Epidérmico (EGFr) e sua relação com outros fatores implicados na recidiva no CHC. Pacientes e métodos: Foram analisados retrospectivamente os dados de 59 pacientes cirróticos submetidos a TxH no nosso centro com diagnóstico histopatológico confirmado de CHC no período de 2001 a 2006. Resultados: Foi registrada uma sobrevida global e em 1, 3 e 5 anos de 89,3%, 74,9% e 72,4% respectivamente e uma sobrevida livre de doença em 1, 3 e 5 anos de 84,8%, 69,6% e 69,6% respectivamente. A taxa de recidiva foi de 22,03%. O EGFr foi expresso em 93,2% dos tumores, mas não apresentou relação estatisticamente significatica com risco de recidiva (p=0,147) ou outros fatores de risco. Somente a invasão vascular (p=0,046) e o tamanho > 5 cm (p=0,046) foram capazes de predizer o risco de recidiva. Conclusão: O tamanho tumoral e a invasão vascular foram os principais fatores de risco relacionados à recidiva tumoral, enquanto a expressão do EGFr, embora bastante alta, não tem relação com este risco. / Background: Recurrent Hepatocellular Carcinoma (HCC) is a significant cause of death after liver transplantation (LT). Understanding tumor biology and correlate biomarkers is an important step to predict recurrence and establish new therapies. Purpose: Analyze the expression and prognostic significance of Epidermal Growth Factor receptor (EGFr) on HCC and its relationship with other prognostic factors. Patients and methods: Data from 59 cirrhotic patients who underwent LT between 2001 and 2006 with pathological confirmation of HCC were analyzed retrospectively. Results: The overall survival at 1, 3 e 5 years was 89.3%, 74.9%, 72.4% while recurrence-free was 84.8%, 69.6, 69.6% respectively with a recurrence rate of 22%. EGFr was expressed in 93.2% of tumors, but no statistical relationship with HCC recurrence (p=0.147) were found. Only vascular invasion (p=0.046) and tumor size > 5 cm (p=0.046) predicted tumor recurrence. Conclusion: EGFr was widely expressed on our series of tumors, and, as so, has a poor prognostic value, with no significance among groups (negative, weak and strong expression) considering HCC recurrence. Only tumor size and vascular invasion were significant predictors of tumor recurrence.

Justificativa: A recidiva do Carcinoma Hepatocelular (CHC) é um fator limitante da sobrevida nos indivíduos submetidos a transplante hepático (TxH). Além do número e tamanho do tumor, invasão vascular e grau de diferenciação, compreender a biologia tumoral e os biomarcadores relacionados é um passo importante para prever a recidiva e estabelecer estratégias terapêuticas. Objetivos: Analisar a expressão e valor prognóstico do receptor do Fator de Crescimento Epidérmico (EGFr) e sua relação com outros fatores implicados na recidiva no CHC. Pacientes e métodos: Foram analisados retrospectivamente os dados de 59 pacientes cirróticos submetidos a TxH no nosso centro com diagnóstico histopatológico confirmado de CHC no período de 2001 a 2006. Resultados: Foi registrada uma sobrevida global e em 1, 3 e 5 anos de 89,3%, 74,9% e 72,4% respectivamente e uma sobrevida livre de doença em 1, 3 e 5 anos de 84,8%, 69,6% e 69,6% respectivamente. A taxa de recidiva foi de 22,03%. O EGFr foi expresso em 93,2% dos tumores, mas não apresentou relação estatisticamente significatica com risco de recidiva (p=0,147) ou outros fatores de risco. Somente a invasão vascular (p=0,046) e o tamanho > 5 cm (p=0,046) foram capazes de predizer o risco de recidiva. Conclusão: O tamanho tumoral e a invasão vascular foram os principais fatores de risco relacionados à recidiva tumoral, enquanto a expressão do EGFr, embora bastante alta, não tem relação com este risco. / Background: Recurrent Hepatocellular Carcinoma (HCC) is a significant cause of death after liver transplantation (LT). Understanding tumor biology and correlate biomarkers is an important step to predict recurrence and establish new therapies. Purpose: Analyze the expression and prognostic significance of Epidermal Growth Factor receptor (EGFr) on HCC and its relationship with other prognostic factors. Patients and methods: Data from 59 cirrhotic patients who underwent LT between 2001 and 2006 with pathological confirmation of HCC were analyzed retrospectively. Results: The overall survival at 1, 3 e 5 years was 89.3%, 74.9%, 72.4% while recurrence-free was 84.8%, 69.6, 69.6% respectively with a recurrence rate of 22%. EGFr was expressed in 93.2% of tumors, but no statistical relationship with HCC recurrence (p=0.147) were found. Only vascular invasion (p=0.046) and tumor size > 5 cm (p=0.046) predicted tumor recurrence. Conclusion: EGFr was widely expressed on our series of tumors, and, as so, has a poor prognostic value, with no significance among groups (negative, weak and strong expression) considering HCC recurrence. Only tumor size and vascular invasion were significant predictors of tumor recurrence.

A análise das proteínas transportadoras de compostos biliares, antes restrita à fisiologia e à fisiopatologia de colestases, recentemente passou a incluir neoplasias hepato-biliares. O presente estudo teve como objetivo caracterizar a expressão das proteínas ABC de transporte biliar BSEP, MDR3, MRP2 e MRP3 em amostras retrospectivamente colecionadas de 80 casos de autópsias de carcinoma hepatocelular (CHC) e 56 casos de ressecção cirúrgica de colangiocarcinoma (CC). Áreas representativas das neoplasias foram organizadas em tissue microarrays e submetidas à pesquisa imuno-histoquímica (IHQ) com o anticorpo policlonal anti-BSEP (HPA019035) e os anticorpos monoclonais anti-BSEP (F6), anti-MDR3 (P3 II-26), anti-MRP2 (M2 III-6) e anti-MRP3 (DTX-1) com amplificação de sinal mediante uso de sistema de polímeros curtos conjugados à peroxidase. A comparação entre a positividade das reações imuno-histoquímicas para cada anticorpo e as variáveis anatomopatológicas foi realizada através dos testes de qui-quadrado de Pearson ou Exato de Fisher. A positividade das reações IHQ cujos anticorpos propiciaram melhor distinção do sinal positivo vs coloração inespecífica de fundo e detecção de casos positivos e/ou melhor capacidade de discriminar as duas neoplasias hepáticas foi comparada com a positividade observada para as reações IHQ com os anticorpos anti-CEA policlonal, anti-Hep-par-1 e anti-Arginase-1. A expressão canalicular de BSEP nos CHC foi observada em 77,3% (58/75) com o anticorpo monoclonal e 75,9% (60/79) com o anticorpo policlonal. Não foi detectada associação significativa da expressão de BSEP em relação ao tamanho, número dos nódulos e grau de diferenciação de CHC, tendo apenas sido significativamente reduzida (P < 0,05) tal reação nos casos de padrão arquitetural mais complexo. A reatividade dos CHC para o anticorpo monoclonal anti-BSEP foi aparentemente menor que a obtida com a expressão canalicular de CEA, Hep-par-1 e Arginase-1 no CHC, mas esses valores não atingiram significância estatística. Todos os casos de colangiocarcinoma foram negativos para reações IHQ para pesquisa de BSEP, resultado significativamente diferente (P=0,0001) do obtido com uso do Ac policlonal anti-CEA (padrão circunferencial) e Hep-par-1, não tendo sido demonstrada diferença significativa (P=0,222) da expressão de BSEP e de Arginase-1. A expressão canalicular de MDR3 foi observada em 56,4% (44/78) dos casos de CHC, não tendo sido detectada associação significativa quanto ao tamanho e número de nódulos. Foi observada expressão significativamente menor de MDR3 nos casos de CHC de padrão mais complexo (P=0,009), e nos casos de maior grau histológico (P=0,005). A expressão de MDR3 em CHC foi significativamente menor que a de CEA, Hep-par-1 e Arginase-1 (P < 0,05). Todos os casos de colangiocarcinoma foram negativos para a avaliação da expressão de MDR3, diferindo significativamente em relação a expressão de CEA (P=0,001), mas não em comparação a Hep-par-1 e Arginase-1 (P > 0,05). As reações IHQ para detecção de MRP2 exibiram positividade canalicular em 92,3% dos casos de CHC e em 96,3% nos casos de CC. A detecção da alta expressão de MRP2 no CHC foi constante (P > 0,05) em comparação ao tamanho, número dos nódulos, padrão arquitetural e grau histológico de diferenciação de CHC assim como, também não apresentou associação (P > 0,05) com a localização, padrão de crescimento e grau de diferenciação do CC. A reação IHQ para MRP3 resultou positiva em 15/80 casos de CH (18,8%). A reatividade IHQ para MRP foi detectada em 24/54 (44,5%) de CC. Diferente dos transportadores descritos acima, a expressão de MRP3 foi preferencialmente basolateral. A positividade para MRP3 não variou (P > 0,05) em relação ao número, tamanho dos nódulos, padrão arquitetural (inclusive os sólidos), e grau de diferenciação (inclusive os menos diferenciados). A proteína MRP3 esteve expressa regularmente (P > 0,05) em todos os casos de CC, apresentando-se reduzida apenas no subtipo histológico ductular (P=0,023). Em conclusão, o excelente contraste de reação, a frequência razoavelmente alta de positividade de CHC e a plena negatividade de CC para BSEP levam-nos a recomendar a introdução do anticorpo monoclonal anti-BSEP no painel adotado para o diagnóstico diferencial dessas duas neoplasias. A alta expressão de MRP2 no CHC e no CC é conservada independentemente dos parâmetros anatomopatológicos avaliados. A expressão do transportador MRP3 mostrou variação dentre os subtipos histológicos de CC, aspecto que torna promissoras pesquisas futuras para avaliação mais detalhada da expressão deste marcador nos colangiocarcinomas / The assessment of biliary transporters, previously restricted to the physiology and pathophysiology of cholestasis, has recently included hepato-biliary neoplasms. The present study aimed to characterize the expression of BSEP, MDR3, MRP2 and MRP3 biliary transport proteins in retrospectively collected samples from 80 cases of autopsy of hepatocellular carcinoma (HCC) and 56 cases of surgical resection of cholangiocarcinoma (CC). Representative areas of the neoplasms were organized into tissue microarrays and submitted to immunohistochemical (IHC) reaction with polyclonal antibody anti-BSEP (HPA019035) and monoclonal antibodies anti-BSEP (F6), MDR3 (P3 II-26), MRP2 (M2 III-6) and MRP3 (DTX-1). Signal amplification was achieved with a short polymer system conjugated to peroxidase. The comparison between the positivity of the immunohistochemical reactions for each antibody and the pathological variables was performed using the Pearson chi-square test or the Fisher\'s exact test. The performance of antibodies which provided a better distinction of the positive signal vs nonspecific background staining and yield better discrimination between the two hepatic neoplasms was compared with that achieved with the already accepted HCC markers polyclonal anti-CEA, Hep-par-1 and Arginase-1. The canalicular expression of BSEP in HCC was observed in 77.3% (58/75) with the monoclonal antibody and 75.9% (60/79) with the polyclonal antibody. BSEP expression levels were not significantly different according to tumor size, number of nodules and degree of differentiation. The frequency of positive reaction of HCC cases with the monoclonal anti-BSEP was apparently lower than that achieved with the canalicular expression of CEA, Hep-par-1 and Arginase-1, but these values did not reach statistical significance. All cases of cholangiocarcinoma were negative for IHC reactions to BSEP, which was significantly different (P=0.0001) from the results obtained with polyclonal anti-CEA (circumferential pattern) and Hep-par-1, but not from the resultas achieved with Arginase-1 (P=0.222). The canalicular expression of MDR3 was observed in 56.4% (44/78) of HCC cases. Among histological variables, only the finding of more complex architecture (P=0.009) and higher histological grade (P=0.005) of HCC yielded, significantly lower expression of MDR3. The expression of MDR3 in HCC was significantly lower than that of CEA, Hep-par-1 and Arginase-1 (P < 0.05). All cases of cholangiocarcinoma were negative for the evaluation of MDR3 expression, differing significantly with that achieved with polyclonal anti-CEA (P=0.001) but not with that achieved with Hep-par-1 or with Arginase-1 (P > 0.05). The IHC reactions with the MRP2 antibody exhibited canalicular positivity in 92.3% of HCC cases and 96.3% in CC cases. High expression of MRP2 in HCC was constant (P > 0.05) despite changes in size, number of nodules, architectural pattern and histological degree of HCC differentiation, as well as no association (P > 0.05) with the location, pattern of growth and degree of differentiation of CC. The IHC reaction for MRP3 was positive in 15/80 cases of HCC (18.8%) and in 24/54 (44.5%) of CC. Unlike the carriers described above, the hepatocellular expression of MRP3 was preferentially basolateral. Positivity for MRP3 did not vary (P > 0.05) in relation to number, nodule size, architectural standard (including solids), and degree of differentiation. The MRP3 protein was expressed regularly (P > 0.05) in different presentations of CC, but significant lower frequency of positivity was found in the ductular histological subtype (P=0.023). In conclusion, the excellent signal-to-noise ratio, reasonably high frequency of HCC positivity and full negativity of CC to BSEP lead us to recommend the introduction of the anti-BSEP monoclonal antibody in the panel adopted for the differential diagnosis of these two neoplasms. The high expression of MRP2 in HCC and in CC is conserved independently of the pathological parameters evaluated herein. The frequency of expression of the MRP3 transporter varied among the histological subtypes of CC, which makes promising future research for a more detailed assessment of the expression of this marker in the cholangiocarcinomas

La modification post-traductionnelle des chimiokines par la dipeptidyl peptidase-4 (DPP4 ou CD26) régule négativement le trafic des lymphocytes, et son inhibition améliore la migration des lymphocytes T et l'immunité anti-tumorale en préservant la forme fonctionnelle de CXCL10. En étendant ces résultats initiaux aux humains et à un modèle préclinique de carcinome hépatocellulaire, nous avons découvert un nouveau mécanisme par lequel l'inhibition de DPP4 améliore les réponses anti-tumorales par le recrutement des éosinophiles. Plus précisément, l'administration d'inhibiteurs de DPP4 (DPP4i) conduit à des concentrations tumorales plus élevées de CCL11 (ou eotaxine) et à une augmentation de la migration des éosinophiles exprimant CCR3 dans les tumeurs. Un meilleur contrôle de la croissance tumorale a été observé lors du traitement par DPP4i, un effet conservé chez les souris Rag2–/– mais abrogé uniquement lors de la déplétion des éosinophiles ou de l'inhibition de leur dégranulation. Nous avons également démontré que l'expression tumorale d’IL-33 était nécessaire et suffisante pour une réponse anti-tumorale médiée par les éosinophiles et que ce mécanisme contribuait à l'efficacité des inhibiteurs de points de contrôle immunitaires. Ces résultats révèlent un nouveau mécanisme par lequel le contrôle tumoral est médiée par IL-33 et les éosinophiles, mécanisme ici révélé lorsque les mécanismes endogènes de régulation immunitaire par DPP4 sont inhibés. / Dipeptidyl peptidase-4 (DPP4 or CD26)–mediated post-translational modification of chemokines has been shown to negatively regulate lymphocyte trafficking, and its inhibition enhances T cell migration and tumor immunity by preserving functional CXCL10. In extending these initial findings to humans and pre-clinical hepatocellular carcinoma models, we discovered a new mechanism whereby DPP4 inhibition improves anti-tumor responses by eosinophil recruitment. Specifically, administration of DPP4 inhibitors (DPP4i) resulted in higher concentrations of CCL11 (or eotaxin) and increased CCR3-mediated eosinophil migration into mouse tumors. Enhanced tumor control was observed upon treatment with DPP4i, an effect strikingly preserved in Rag2–/– mice, and abrogated only upon depletion of eosinophils or inhibition of their degranulation. We further demonstrated that tumor expression of IL-33 was necessary and sufficient for eosinophil-mediated anti-tumor responses, and that this mechanism contributed to checkpoint inhibitor efficacy. These findings provide new insight into IL-33- and eosinophil-mediated tumor control, revealed when endogenous mechanisms of DPP4 immune regulation are inhibited.

O carcinoma hepatocelular (CHC) é a neoplasia maligna primária mais comum do fígado, sendo a quinta mais frequente e a terceira causa de morte por câncer no mundo. Atualmente, nenhum protocolo com resultados satisfatórios no tratamento de CHC foi preconizado. Neste estudo foi determinado o potencial regenerativo e imunomodulador das células-tronco mesenquimais (CTM) associadas ou não aos quimioterápicos doxorrubicina e gencitabina, no modelo ortotópico de CHC em camundongos C57BL/6J. Foi realizado in vitro a determinação da atividade citotóxica dos quimioterápicos doxorrubicina e gencitabina em células de CHC murino (Hepa1c1c7), quantificação da peroxidação de lipídeos da membrana celular (TBARS) e análise das fases do ciclo celular e a expressão de marcadores por citometria de fluxo. A IC50% em células de carcinoma hepatocelular murino (Hepa1c1c7) foi de 1,85 uM para doxorrubicina e 20,8 ?M para gencitabina. A quantificação de TBARS na linhagem celular de CHC murino (Hepa1c1c7) tratados com os quimioterápicos doxorrubicina e gencitabina demonstrou efeito deletério apenas quando tratados nas concentrações (55 a 250 uM) com a doxorrubicina e (1,75 a 7 uM) com gencitabina. Após tratamento com os quimioterápicos, ocorreram modificações nas populações celulares, com o aumento da fase sub-G1 e G0/G1 e diminuição fases S e G2/M. As CTM, apresentaram-se aderentes aos frascos de cultura com morfologia semelhante a fibroblastos e expressão positiva para marcadores CD44, CD73, CD90 e CD105 e negativa para células-tronco hematopoiéticas da medula óssea: CD11b, CD45 e CD117. O modelo experimental tumoral ortotópico de CHC foi estabelecido no 21° dia após a inoculação das células tumorais. Os efeitos da terapêutica com a CTM mostraram aspectos significativos na redução da massa tumoral (30,5%), os demais grupos experimentais tratados com quimioterapia sistêmica associada à terapia celular também evidenciaram resultados significativos na redução da massa tumoral e atenuação dos efeitos de toxicidade sistêmica. As células tumorais extraídas dos tumores hepáticos encontram-se preferencialmente na fase sub-G1 nos grupos de animais tratados com CTM em associação aos quimioterápicos gencitabina (29%) e doxorrubicina (21%), enquanto o tratamento isolado com a doxorrubicina foi de 22% e de 15% para a gencitabina, além de induzir significativamente diminuição das fases S e G2/M. No grupo de animais tratado com CTM em associação ao quimioterápico gencitabina há um aumento da expressão das caspases 3 e 8, e dos marcadores CD44 e IL-1R. O grupo de animais tratados com CTM apresentou aumento na expressão dos marcadores CD90 e CD14. Os resultados obtidos no tratamento do modelo ortotópico de CHC com CTM associadas aos quimioterápicos doxorrubicina e gencitabina apresentaram eficácia na redução da massa tumoral e atenuação dos efeitos colaterais causados pelo tratamento quimioterápico sistêmico, além do seu potencial efeito imunomodulador / Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, the most frequent fifth and the third leading cause of cancer death in the world. Currently, no protocol with satisfactory results in the treatment of CHC was recommended. In this study we determined the regenerative potential immunomodulatory and mesenchymal stem cells (MSCs) associated or not to chemotherapy doxorubicin and gemcitabine, in the orthotopic model of CHC in C57BL / 6J mice. Was determined in vitro the cytotoxic activity of doxorubicin and gemcitabine chemotherapy in a murine cells (Hepa1c1c7), quantification of cell membrane lipid peroxidation (TBARS) and analysis of the phases of the cell cycle and expression of markers by flow cytometry. IC50% in murine carcinoma cells (Hepa1c1c7) was 1.85 uM and 20.8 uM for doxorubicin to gemcitabine. The quantification of TBARS in cell line (Hepa1c1c7) treated with the chemotherapeutic doxorubicin and gemcitabine showed a deleterious effect only when treated at concentrations (55-250 uM) doxorubicin and (1.75 to 7 uM) with gemcitabine. After treatment with chemotherapeutic agents, there were changes in the cell population, with increased phase sub-G1 and G0 / G1 phase and reduced S and G2 / M. MSC presented to adhere to culture flasks with morphology similar to fibroblasts and positive expression of markes: CD44, CD73, CD90 and CD105 and negative hematopoietic stem cells from bone marrow: CD11b, CD45 and CD117. The tumor orthotopic experimental model of HCC was established on day 21 after tumor cell inoculation. The effects of therapy CTM showed significant aspects in reducing the tumor mass (30.5%), the other experimental groups treated with systemic chemotherapy associated with cell therapy also showed significant results in reducing the tumor mass and mitigation of systemic toxicity effects. The extracted tumor cells of liver tumors are preferably in the sub-G1 phase in groups of animals treated with MSC in association with gemcitabine (29%) and doxorubicin (21%) chemotherapy, whereas the single treatment with was 22% doxorubicin and 15% for gemcitabine in addition to significantly induce reduction of phases S and G2 / M. In the group of animals treated with MTC in combination with gemcitabine chemotherapy there is an increased expression of caspase 3 and 8 and IL-1R and CD44. The group of animals treated with MSCs showed increased markers expression of CD90 and CD14. The results obtained in the treatment of orthotopic HCC model with MSC associated with the chemotherapeutic doxorubicin and gemcitabine showed efficacy in reducing tumor burden and attenuation of the side effects caused by systemic chemotherapy, as well its potential immunomodulatory effect

Justificativa: A recidiva do Carcinoma Hepatocelular (CHC) é um fator limitante da sobrevida nos indivíduos submetidos a transplante hepático (TxH). Além do número e tamanho do tumor, invasão vascular e grau de diferenciação, compreender a biologia tumoral e os biomarcadores relacionados é um passo importante para prever a recidiva e estabelecer estratégias terapêuticas. Objetivos: Analisar a expressão e valor prognóstico do receptor do Fator de Crescimento Epidérmico (EGFr) e sua relação com outros fatores implicados na recidiva no CHC. Pacientes e métodos: Foram analisados retrospectivamente os dados de 59 pacientes cirróticos submetidos a TxH no nosso centro com diagnóstico histopatológico confirmado de CHC no período de 2001 a 2006. Resultados: Foi registrada uma sobrevida global e em 1, 3 e 5 anos de 89,3%, 74,9% e 72,4% respectivamente e uma sobrevida livre de doença em 1, 3 e 5 anos de 84,8%, 69,6% e 69,6% respectivamente. A taxa de recidiva foi de 22,03%. O EGFr foi expresso em 93,2% dos tumores, mas não apresentou relação estatisticamente significatica com risco de recidiva (p=0,147) ou outros fatores de risco. Somente a invasão vascular (p=0,046) e o tamanho > 5 cm (p=0,046) foram capazes de predizer o risco de recidiva. Conclusão: O tamanho tumoral e a invasão vascular foram os principais fatores de risco relacionados à recidiva tumoral, enquanto a expressão do EGFr, embora bastante alta, não tem relação com este risco. / Background: Recurrent Hepatocellular Carcinoma (HCC) is a significant cause of death after liver transplantation (LT). Understanding tumor biology and correlate biomarkers is an important step to predict recurrence and establish new therapies. Purpose: Analyze the expression and prognostic significance of Epidermal Growth Factor receptor (EGFr) on HCC and its relationship with other prognostic factors. Patients and methods: Data from 59 cirrhotic patients who underwent LT between 2001 and 2006 with pathological confirmation of HCC were analyzed retrospectively. Results: The overall survival at 1, 3 e 5 years was 89.3%, 74.9%, 72.4% while recurrence-free was 84.8%, 69.6, 69.6% respectively with a recurrence rate of 22%. EGFr was expressed in 93.2% of tumors, but no statistical relationship with HCC recurrence (p=0.147) were found. Only vascular invasion (p=0.046) and tumor size > 5 cm (p=0.046) predicted tumor recurrence. Conclusion: EGFr was widely expressed on our series of tumors, and, as so, has a poor prognostic value, with no significance among groups (negative, weak and strong expression) considering HCC recurrence. Only tumor size and vascular invasion were significant predictors of tumor recurrence.

Le carcinome hépatocellulaire (CHC) présente des mutations génétiques qui altèrent les principales voies de signalisation, notamment la voie Wnt/β-caténine. En absence de mutation génétique, certains CHC peuvent montrer une activité Wnt exacerbée suite à une inactivation épigénétique d’inhibiteurs ou à une surexpression de ligands Wnts ou de ses récepteurs. De plus, le remodelage de la matrice extracellulaire favorise la progression du CHC. Nous avons montré une association entre l’activation du signal Wnt et le remodelage de la matrice extracellulaire (MEC) dans les cirrhoses et le CHC. Puis modélisé in vitro, les effets des stimuli Wnt extracellulaires sur le phénotype de cellules hépatiques, en absence de mutation de la β-caténine. En effet, les cellules HepaRG ne présentent pas de mutations de la β-caténine, de l’axine et de p53. Ainsi, la stimulation Wnt3a des cellules HepaRG induisait la formation de palissades de cellules fusiformes. De plus, les cellules traitées exprimaient des taux élevés de αSMA, COLIV, c-MYC, CK19 et LGR5 suggérant un phénotype myofibroblastique, en accord avec l’expression des marqueurs de transition épithélio-mésenchymateuse (TEM), SNAIL et TWIST. Ces données sont en faveur du rôle déterminant du microenvironnement Wnt activé dans la progression du CHC entrainant les cellules vers un phénotype progéniteur plus agressif via une TEM. En outre, l'analyse in silico de la signature transcriptomique de l'activation non mutationnelle de la voie Wnt a révélé un réseau de gènes impliqués dans le remodelage de la MEC, la TEM et la différenciation cellulaire. Les résultats suggèrent le rôle de HAPLN1 qui affecterait la migration cellulaire et l'expression des gènes de la MEC. De plus, LGR5 semble favoriser la dédifférenciation des hépatocytes. Au total, 8 gènes marqueurs obtenus in vitro ont été validés in vivo dans une série de 81 CHC humains, par qPCR et immunohistochimie en utilisant des tissus micro-array (78 CHC et 5 foies contrôles). Au total, l'ensemble des données suggère que HAPLN1 a une valeur pronostique sur la récidive et la survie globale du CHC. HAPLN1semble être indépendant du statut mutationnel la β-caténine et des variables cliniques. De plus, sa valeur pronostique est additive avec celle de CK19 + EpCAM et il semble agir en synergie avec NOG. / Hepatocellular carcinoma (HCC) displays signaling pathway disorders, including Wnt/β-catenin. Up-regulation of extracellular Wnt pathway agonists and down-regulation of extracellular Wnt pathway inhibitors result in non-mutational activation of Wnt signaling. In addition, increased extracellular matrix remodeling fosters HCC progression. Thus, we showed that enhanced Wnt signaling is associated with extracellular matrix remodeling in human cirrhosis and cancer. To further investigate non-mutational Wnt pathway activation, we established a model of Wnt activation in HepaRG human HCC progenitor cells carrying wild-type β-catenin, axin and p53. HepaRG progenitor cells treated with Wnt3a became fusiform and grew in palisades with enhanced expression of αSMA, COLIV, CK19, c-MYC, LGR5, SNAIL and TWIST, suggesting that enhanced extracellular Wnt signaling may drive HCC cells toward a more aggressive progenitor and epithelial mesenchymal transition (EMT) phenotype. Moreover, in silico analysis of the transcriptomic signature of non-mutational Wnt activation revealed a gene network involved in ECM remodeling, EMT and cell fate. Results suggest a role of HAPLN1, affecting extracellular matrix gene expression and cell migration and of LGR5 in hepatocyte dedifferentiation. Eight genes among the HepaRG gene expression dataset were validated in vivo in a collection of 81 human HCC samples and controls by qPCR and immunohistochemistry using tissue micro-arrays (78 HCC samples and 5 normal livers) in the light of β-catenin activation and mutational status. In conclusion, data suggest that HAPLN1 has a prognostic value on overall survival and recurrence of HCC. HAPLN1 appears to be independent of clinical features and β-catenin mutationnal status. Moreover, HAPLN1 appears to have an additive prognostic value with CK19 + EpCAM and act synergistically with NOG.

Philosophiae Doctor - PhD / To ameliorate Hepatitis C Virus (HCV) therapeutic and diagnostic challenges requires robust intervention strategies, including approaches that leverage the plethora of rich data published in biomedical literature to gain greater understanding of HCV pathobiological mechanisms. The multitudes of metadata originating from HCV clinical trials as well as low and high-throughput experiments embedded in text corpora can be mined as data sources for the implementation of HCV-specific resources. HCV-customized resources may support the generation of worthy and testable hypothesis and reveal potential research clues to augment the pursuit of efficient diagnostic biomarkers and therapeutic targets. This research thesis report the development of two freely available HCV-specific web-based resources: (i) Dragon Exploratory System on Hepatitis C Virus (DESHCV) accessible via http://apps.sanbi.ac.za/DESHCV/ or http://cbrc.kaust.edu.sa/deshcv/ and(ii) Hepatitis C Virus Protein Interaction Database (HCVpro) accessible via http://apps.sanbi.ac.za/hcvpro/ or http://cbrc.kaust.edu.sa/hcvpro/.DESHCV is a text mining system implemented using named concept recognition and cooccurrence based approaches to computationally analyze about 32, 000 HCV related abstracts obtained from PubMed. As part of DESHCV development, the pre-constructed dictionaries of the Dragon Exploratory System (DES) were enriched with HCV biomedical concepts, including HCV proteins, name variants and symbols to enable HCV knowledge specific exploration. The DESHCV query inputs consist of user-defined keywords, phrases and concepts. DESHCV is therefore an information extraction tool that enables users to computationally generate association between concepts and support the prediction of potential hypothesis with diagnostic and therapeutic relevance.Additionally, users can retrieve a list of abstracts containing tagged concepts that can be used to overcome the herculean task of manual biocuration. DESHCV has been used to simulate previously reported thalidomide-chronic hepatitis C hypothesis and also to model a potentially novel thalidomide-amantadine hypothesis.HCVpro is a relational knowledgebase dedicated to housing experimentally detected HCV-HCV and HCV-human protein interaction information obtained from other databases and curated from biomedical journal articles. Additionally, the database contains consolidated biological information consisting of hepatocellular carcinoma(HCC) related genes, comprehensive reviews on HCV biology and drug development,functional genomics and molecular biology data, and cross-referenced links to canonical pathways and other essential biomedical databases. Users can retrieve enriched information including interaction metadata from HCVpro by using protein identifiers,gene chromosomal locations, experiment types used in detecting the interactions, PubMed IDs of journal articles reporting the interactions, annotated protein interaction IDs from external databases, and via “string searches”. The utility of HCVpro has been demonstrated by harnessing integrated data to suggest putative baseline clues that seem to support current diagnostic exploratory efforts directed towards vimentin. Furthermore,eight genes comprising of ACLY, AZGP1, DDX3X, FGG, H19, SIAH1, SERPING1 and THBS1 have been recommended for possible investigation to evaluate their diagnostic potential. The data archived in HCVpro can be utilized to support protein-protein interaction network-based candidate HCC gene prioritization for possible validation by experimental biologists.

There are currently two types of drug formulation in clinical use in the locoregional treatment of intermediate hepatocellular carcinoma (HCC). In the emulsion LIPDOX, the cytostatic agent doxorubicin (DOX) is dissolved in the aqueous phase, which is emulsified with the oily contrast agent Lipiodol® (LIP). In the microparticular system DEBDOX, DOX is loaded into the drug-eluting entity DC Bead™. The overall aim of the thesis was to improve pharmaceutical understanding of the LIPDOX and DEBDOX formulations, in order to facilitate the future development of novel drug delivery systems. In vivo release of DOX from the formulations and the disposition of DOX and its active metabolite doxorubicinol (DOXol) were assessed in an advanced multisampling-site acute healthy pig model and in patients with HCC. The release of DOX and disposition of DOX and DOXol where further analysed using physiologically based pharmacokinetic (PBPK) and biopharmaceutical (PBBP) modelling. The combination of in vivo investigations and in silico modelling could provide unique insight into the mechanisms behind drug release and disposition. The in vivo release of DOX from LIPDOX is not extended and controlled, as it is from DEBDOX. With both formulations, DOX is released as a burst during the early phase of administration. The in vivo release of DOX from LIPDOX was faster than from DEBDOX in both pigs and patients. The release from DEBDOX was slow and possibly incomplete. The in vivo release of DOX from LIPDOX and DEBDOX could be described by using the PBBP model in combination with in vitro release profiles. The disposition of DOX and DOXol was modelled using a semi-PBPK model containing intracellular binding sites. The contrast agent Lipiodol® did not affect the hepatobiliary disposition of DOX in the pig model. The control substance used in this study, cyclosporine A, inhibited the biliary excretion of DOX and DOXol but did not alter metabolism in healthy pigs. The disposition of DOX is similar in healthy pigs and humans, which was shown by the ease of translation of the semi-PBPK pig model to the human PBBP model.

Le premier objectif a été de sélectionner des promoteurs de gènes cellulaires actifs spécifiquement dans les HCC à l’aide d’une recherche bibliographique puis en utilisant la base de donnée UniGene. Leur activité a été vérifiée par RT-qPCR et CHIP dans des lignées modèles HCC et dans des hépatocytes. Ces promoteurs ont été clonés en amont de la luciférase dans la région intergénique 20 du génome HSV-1 afin d’étudier leur force d’activité, 2 types de cinétiques et leur activité différentielle en fonction du type cellulaire et dans le contexte d’une infection virale. Le deuxième objectif a été de construire des virus oncolytiques ciblés pour l’expression de la protéine Us3, une protéine virale impliquée dans le contrôle de la réponse apoptotique induite par HSV-1. L’expression de la protéine Us3 est placée sous contrôle d’un promoteur cellulaire spécifique d’HCC. L’hypothèse est qu’en l’absence d’activité du promoteur cellulaire dans les cellules non HCC, la protéine Us3 ne sera pas synthétisée et, par conséquent, l’apoptose qui ne sera pas réprimée, inhibera le cycle de réplication et par conséquent, la production virale dans les cellules saines. Dans les cellules HCC, le promoteur actif permettra la réplication virale aboutissant à la destruction de lamasse tumorale. Un virus HSV-1 Us3- a été construit en utilisant la technique de recombinaison en plasmide BAC (Bacterial artificial chromosome), puis 2 virus oncolytiques en réintroduisant le gène Us3 sous contrôle du promoteur ANGPTL3 ou du promoteur HRE (hypoxia responsive element). Leur comportement oncolytique a été étudié en réalisant des courbes de croissance sur lignées cellulaires d’HCC et cellules hepatocyte-like. / Our long-term purpose is to develop transcriptionally targeted oncolytic vectors, derived from herpes simplex virus type 1 (HSV-1), designed to eradicate hepatocellular carcinomas (HCC). We have identified several HCC-specific promoters, as well as other cancer-specific promoters, that maintain their specificity when expressed from the virus genome. More precisely, we have demonstrated that these promoters are able to drive reporter gene (luciferase) expression from the virus genome in HCC-derived cells, both in cultured cells and in nude mice, but not in fresh human hepatocytes or in the WRL38 hepatocyte-like cells. HSV-1 infection induces, but then inhibits, a cellular antiviral apoptotic response, and the early virus protein US3 is a key actor in inhibiting apoptosis. We have hypothesized that inhibition of US3 expression in hepatocytes should led to early apoptotic death of these cells, therefore precluding virus multiplication and spread. In contrast, expression of US3 in cancer cells is expected to block apoptosis, leading to the achievement of the virus life cycle, cell lysis, and virus spread within the tumours. We report in this communication the construction and properties of two different potentially oncolytic HSV-1 vectors. One of them expresses US3 protein under the control of the HCC-specific promoter ANGPTL3, while the second promoter contains 9 repeats of the hypoxia responsive elements of vascular-endothelial growth factor (VEGF) (9xHRE promoter). Growth curves of these viruses were performed on different HCC cell lines to show their oncolytic properties.