Whilst progress has been made in reducing mortality in some cancers, mortality rates remain high in many cancers and there is a need to develop novel therapeutic strategies. In this thesis, various pharmacological strategies designed to enhance the activity of existing therapeutic drugs were evaluated. Cancer cells are dependent upon aerobic glycolysis (the Warburg effect) and glutamine uptake. Using clinically approved tyrosine kinase inhibitors and Bortezomib, significant enhancement of chemosensitivity was observed when used in combination with inhibitors of lactate dehydrogenase (Gossypol) and pyruvate kinase dehydrogenase (Dichloroacetate). In contrast, depletion of glutamine from media had to be extensive in order to induce cell death and cell death only occurred after prolonged exposure to glutamine-deprived conditions. This suggests that glutamine depletion strategies alone are unlikely to be successful but may be useful in combination with other agents targeting glutamine addiction in cancer cells. Finally, Temozolomide (TMZ) is an important drug in the treatment of glioblastomas but its activity is reduced by resistance mechanisms including O6 methyl guanine methyltransferase (MGMT) and mismatch repair (MMR). This thesis has identified analogues of TMZ (EA02-45, EA02-59, EA02-64 and EA02-65) that are MGMT and MMR independent in terms of inducing cell kill in vitro. These compounds are promising leads for future development. In conclusion, this thesis has demonstrated that interfering with the metabolic phenotype of cancer can enhance the activity of existing drugs and identified novel analogues of TMZ that circumvent drug resistance mechanisms that hamper the efficacy of TMZ.

Introdução: Os inibidores tirosino-quinase (ITQs) constituem uma nova terapia molecular para o carcinoma medular da tireoide (CMT). O vandetanibe, um ITQ que atua contra os receptores VEGFR, EGFR e RET, inibe a transformação e o crescimento do tumor no CMT. No entanto, os ITQs têm importantes efeitos adversos, incluindo o hipotireoidismo. O aumento da expressão da iodotironina desiodase do tipo 3 (D3/DIO3), uma enzima chave na inativação dos hormônios da tireoide, pode ser um possível mecanismo de indução do hipotireoidismo por estas drogas. Objetivo: Investigar os efeitos dos inibidores tirosino-quinase na expressão da D3 em células derivadas do CMT. Métodos: Estudo experimental in vitro, utilizando linhagem de células humanas oriundas de CMT (células TT). As células foram cultivadas em meio específico e tratadas com diferentes doses do ITQ vandetanibe (0,25; 0,5 e 1μM) ou com DMSO. A proliferação celular foi determinada por contagem em câmara de Neubauer. A expressão do mRNA foi avaliada por meio de PCR em tempo real, a expressão proteica por meio de Western Blot e a atividade da D3 foi avaliada por meio da técnica de cromatografia em colunas de Sephadex LH-20. Resultados: A adição do vandetanibe ao meio de cultura causou diminuição do número de células e seu efeito foi tempo e dose dependente, apresentando uma redução máxima (77%) após 6 dias de tratamento na dose de 1μM. Como esperado, o tratamento com vandetanibe inibiu a fosforilação do ERK. Não foram observadas alterações significativas dos níveis de mRNA da DIO3 após 3 (0,02 vs. 0,02 vs. 0,01 vs. 0,01; P = 0,34) ou 6 dias (0,02 vs. 0,02 vs. 0,03 vs. 0,02; P = 0,33) de tratamento. Consequentemente, a expressão proteica da D3 não aumentou nos grupos tratados. No entanto, observou-se um aumento de 2 a 5 vezes na atividade da D3 após 3 dias de tratamento e um aumento de 1,5 a 2,15 vezes em 6 dias de tratamento. Conclusões: O tratamento com vandetanibe não foi associado com níveis aumentados de expressão do mRNA e da proteína da D3 em células derivadas de CMT, embora tenha sido observado um aumento na sua atividade enzimática. / Background: Tyrosine kinase inhibitors (TKIs) constitute a novel molecular therapy for medullary thyroid carcinoma (MTC). Vandetanib, a TKI that acts against the VEGFR, EGFR and RET receptors, inhibits tumor transformation and growth in MTC. However, TKIs have important adverse effects, including hypothyroidism. Increases in the expression of type 3 iodothyronine deiodinase (D3/DIO3), a key enzyme in the inactivation of thyroid hormones, may be a possible mechanism of induction of hypothyroidism by these drugs. Objective: To investigate the effects of vandetanib on D3 expression in MTC-derived cells. Methods: In vitro experimental study using human MTC cell line (TT cells). Cells were cultured in specific medium and treated with different doses of vandetanib (0.25, 0.5 and 1μM) or DMSO. Cell proliferation was determined by counting in Neubauer's chamber. Expression of mRNA was evaluated by real-time PCR, protein expression by Western Blot and D3 activity was evaluated by Sephadex LH-20 column chromatography. Results: The addition of vandetanib to the culture medium caused a time and dose-dependent decrease in the number of cells, with a maximum reduction (77%) after 6 days of treatment at 1μM dose. As expected, vandetanib treatment inhibited ERK phosphorylation. No significant changes in DIO3 mRNA levels were observed after 3 (0.02 vs. 0.02 vs. 0.01 vs. 0.01; P = 0.34) or 6 days (0.02 vs. 0.02 vs. 0.03 vs. 0.02; P = 0.33) of treatment. Accordingly, D3 protein expression did not increase in treated groups. However, we observed a 2 to 5-fold increase in D3 activity after 3 days of treatment and a 1.5 to 2.15-fold increase in 6 days of treatment. Conclusions: Treatment with vandetanib was not associated with increased DIO3 mRNA and D3 protein expression levels in MTC-derived cells, although an increase in enzyme activity has been observed.

The collecting duct of the distal nephron marks the final location where adjustments to Na+ excretion can be made, therefore determining the final concentration of Na+ conserved in the extracellular fluid which plays a role in governing overall blood volume and pressure. This transport of Na+ is subject to hormonal regulation but the signalling pathways underpinning this regulation however, are not fully understood. In this thesis the signalling pathways allowing both basal and insulin-stimulated Na+ absorption were explored in the murine collecting duct cell line, mpkCCDcl4. The effects of two insulin-sensitizing drugs, TZDs, on ENaC-mediated Na+ transport were investigated and the signalling pathways underlying two other hormonal regulators of ENaC, dexamethasone and vasopressin, were also examined. Unstimulated monolayers of mpkCCDcl4 cells generated spontaneous Na+ absorption which was quantified by measuring equivalent short circuit current (Ieq). Selective inhibition of PI3-kinase, mTORC2 and SGK1 left ~80 % of the current intact, indicating these signalling molecules are not required for basal Na+ transport. Acute addition of insulin stimulated Ieq and this occurred with a concomitant increase in mTORC2, SGK1 and Akt activity. Inhibition of PI3-kinase abolished the insulin-stimulated response as well as phosphorylation of downstream substrates, indicating a crucial role of PI3-kinase. Inhibition of mTORC1 with rapamycin did not alter basal or insulin-stimulated Na+ transport. The mTOR inhibitors TORIN1 and PP242 could therefore be used to evaluate the role of mTORC2. These inhibitors greatly reduced insulin-stimulated ENaC-mediated Na+ transport and also abolished SGK1 and mTORC2 activity, indicating a novel role of mTORC2. An inhibitor of SGK1, GSK650394A abolished insulin-stimulated Na+ transport and specifically inhibited SGK1 acitivty demonstrating the importance of SGK1 in insulin signalling. The inhibitor Akti-1/2 also abolished insulin-mediated Na+ transport but this compound inhibited both Akt and SGK1 activity. The TZDs pioglitazone and rosiglitazone did not alter basal or insulin-stimulated Na+ transport and had no effect on SGK1 activity indicating these drugs do not alter Na+ absorption in this cell line. Dexamethasone stimulated ENaC-mediated Na+ transport in a similar manner to insulin and this could be blocked with rapamycin. This drug did not alter phosphorylation of NDRG1 indicating that dexamethasone stimulates Na+ transport in an mTORC1-dependent manner but without altering SGK1 activity. Arginine vasopressin also stimulated Ieq but did so by reducing Rt with an associated depolarisation of Vt. Ieq could be blocked with amiloride and vasopressin-stimulated Ieq was insensitive to TORIN1 and PP242. Vasopressin suppressed SGK1 phosphorylation of NDRG1 but did stimulate protein kinase A (PKA) activity. Therefore vasopressin stimulates Ieq via a PKA-dependent but mTOR- and SGK1-independent pathway.

O desenvolvimento de novas terapias para o câncer envolve um processo longo e custoso no qual apenas 5% dos candidatos a fármacos em ensaios clínicos são aprovados. Os ensaios celulares são um importante pilar neste processo, no entanto, eles são geralmente feitos em células cultivadas em monocamada, o que apresenta algumas limitações. Assim, o desenvolvimento e aplicação de modelos tridimensionais (3D) para ensaios pré-clínicos tem sido cada vez mais investigado, devido a suas maiores similaridades com tumores in vivo em relação a características físicas, espaciais e bioquímicas. A via PI3K-AKT-mTOR, que está frequentemente desregulada em diversos cânceres, é uma rota metabólica essencial por integrar fatores de crescimento e sinais internos com a expressão de proteínas relacionadas ao crescimento celular. Sendo assim, novos compostos inibitórios dessa via têm sido estudados pelo grupo NEQUIMED como alternativa terapêutica para essas doenças. Dessa forma, este trabalho teve o objetivo de avaliar o potencial citostático e citotóxico de novos inibidores da via da mTOR em culturas celulares bi e tridimensionais de câncer de próstata e hepatocarcinoma. Para isso, o modelo de cultura 3D foi padronizado para ambas linhagens usando duas técnicas diferentes, além da padronização da técnica de redução da resazurina para a determinação da viabilidade celular em 2D e 3D. No ensaio citotóxico, células em monocamada e esferoides foram tratadas com diferentes concentrações dos fármacos de referência e dos novos inibidores e tiveram sua viabilidade determinada pelo ensaio de redução da resazurina. Já para o ensaio citostático, baixas concentrações de células foram plaqueadas em monocamada e tratadas por até 6 dias, tendo sua viabilidade medida a cada 48 h pelo ensaio de MTT. Os esferoides foram tratados por 9 dias com as mesmas substâncias, tendo seu volume medido a cada 3 dias. No geral, os novos compostos não apresentaram efeitos citotóxicos relevantes, contudo, os compostos Neq0438 e seu análogo, Neq0679, tiveram maior efeito citostático que a Rapamicina em culturas 2D e 3D de HepG2. Além disso, os compostos tiveram maior efeito citostático em esferoides do que em células cultivadas em monocamada para as duas linhagens. Isso pode ser justificado pela alteração na expressão de proteínas da via da mTOR em relação ao modelo de cultura, já que foi demonstrado sua maior ativação nos modelos tridimensionais. Futuramente esses compostos poderão ser testados sozinhos, ou em terapia combinada em modelos animais para melhor avaliação de sua segurança e sua evolução no estudo pré-clínico. / The development of new cancer therapies involves a long and expensive process in which only 5% of the clinical trial candidates for new drugs get approval. Cell assays are an essential pillar in this process; however, they are usually carried out in cells grown as a monolayer, which have some limitations. Thus, the development and application of new tridimensional (3D) models for preclinical trials has been deeply investigated, due to their higher similarities with in vivo tumors, regarding physical, spatial and biochemical features. The PI3K-AKT-mTOR pathway, which integrates growth factors and the expressions of proteins for the cellular growth, is often upregulated in several types of cancer. Hence, the NEQUIMED group is studying new pathway inhibitors as a therapeutic alternative for cancer. Here, the cytotoxic and cytostatic effects of the new PI3K-AKT-mTOR inhibitors were assessed in two and three-dimensional cells models of prostate cancer and hepatocarcinoma. To that end, the 3D culture model was standardized for both cell lines using two different techniques. The resazurin reduction assay was also standardized to determine cell viability in 2D and 3D models. For the cytotoxic assay, cells grown in a monolayer and 3D spheroids were treated with a range of concentrations of the reference drugs and new mTOR inhibitors and had their viability assessed by the resazurin assay. For the cytostatic assay, low cell density was plated on 2D and treated for 6 days, having their viability determined every 48 h using the MTT assay. Spheroids were treated for 9 days with the same substances and had their volume measured every 3 days. Overall, the new mTOR inhibitors did not show relevant cytotoxic effects, however, Neq0438 and its analog Neq0679, had a higher cytostatic effect than Rapamycin for both 2D and 3D cultures of HepG2. Besides, all mTOR inhibitors had a higher cytostatic effect on 3D cultures when compared to monolayers, which can be related to the overexpression of the mTOR pathway in this culture system, already reported on the literature. Based on these results, Neq0438 and Neq0679 should now be used alone or in combination using in vivo models to investigate their antitumoral effects.

Nitric oxide (NO) is the principal mediator of erectile function. NO is released from the nerves and endothelium of small arteries in the penis and diffuses into surrounding smooth muscle to vasodilate through activation of soluble guanylate cyclase (sGC). Erectile dysfunction (ED) occurs in 50% of men between the ages of 40 and 70. It is likely that the pathology of ED results from impairment of NO formation or bioavailability in penile tissue. Iatrogenic nerve damage occurring during prostatectomy can attenuate neurotransmission and release of vasodilators from cavernosal nerves. Oxidative stress from chronic conditions such as diabetes and cardiovascular disease generates reactive oxygen species that can oxidize NO and decrease the molecule's bioavailability. The "gold standard" treatment for ED involves use of oral PDE-5 inhibitors that rely on an intact NO-signaling mechanism for efficacy. Although these therapies are easy to use, they are not effective in many patients suffering from ED associated with pathological conditions of decreased NO bioavailability. Rho-kinase inhibitors, sGC stimulators and sGC activators offer three new interventions that may demonstrate efficacy in treating ED associated with low NO bioavailability. Our results suggest that erectile responses to Rho-kinase inhibitors are not modulated by muscarinic receptor blockade, soluble guanylate cyclase inhibition or cavernosal nerve injury in the rat and that Rho-kinase inhibitors are additive and do not potentiate the endogenous NO-mediated erectile response. Our results with BAY 41-8543 show that this sGC stimulator has significant erectile activity and can potentiate erectile responses to low levels of exogenous and endogenously released NO. These results suggest that BAY 41-8543 would be useful in the treatment of ED occurring following nerve damage from prostatectomy. The sGC activator BAY 60-2770 has very potent erectile activity that is enhanced significantly in conditions of oxidative stress when erectile responses to endogenous NO or sGC stimulators are severely diminished. In oxidizing conditions erectile activity of sGC activators may be enhanced further with concomitant PDE-5 inhibitor therapy, providing evidence that sGC activators may be used alone and in combination with existing treatments to improve erectile function in patients who are non-responsive to standard therapeutic options for ED. / acase@tulane.edu

Multidrug resistance (MDR), a phenomenon in which tumors that were initially sensitive, recur and start showing resistance not only to the initial chemotherapeutic agent but also to various anticancer drugs that are structurally and functionally different from the initial drug, constitutes one of the main reasons for the failure of chemotherapy. An important mechanism of MDR is the enhanced cellular efflux of anticancer agents due to an overexpression of ATP-binding cassette (ABC) transporters (i.e. efflux transporters), especially P-glycoprotein (Pgp), Multidrug Resistance-associated Protein 1 (MRP1) and Breast Cancer Resistance Protein (BCRP), in cancer cells. In order to reverse this resistance, there has been a lot of emphasis on the development of Pgp, MRP1 and BCRP inhibitors. Although this search has been ongoing for three decades, there are still no clinically available efflux transporter modulators. Tyrosine kinase inhibitors (TKIs) are a novel, rapidly growing class of anticancer agents that have a target-based mechanism of action, and their use transformed cancer chemotherapy due to higher specificity and enhanced safety profiles compared to conventional chemotherapeutic agents. Despite their tremendous success in treating various types of tumors, patients develop resistance to TKIs over time. Most of the FDA- approved TKIs are substrates of Pgp and/or BCRP, and as a result, these efflux transporters are also an important cause of conferred resistance against TKIs in cancer cells. Additionally, none of the 31 approved TKIs have an indication for use in brain tumors and interestingly, this may also due to the presence of Pgp and BCRP at the blood-brain barrier (BBB) and in the tumor cells, which prevent the TKI from crossing the BBB and reaching its target tumor site. Since Pgp- and BCRP- mediated TKI efflux has been shown to be involved in TKI resistance, the inhibition of these transporters could represent a potential TKI resistance reversal strategy. Over the last three decades, a large number of Pgp and/or BCRP inhibitors have been identified, but none of them have successfully made it to the clinic. It was observed that most drugs identified as inhibitors were either unable to achieve Pgp and BCRP inhibitory concentrations in-vivo without imparting severe toxicity, or did not possess adequate bioavailability and tissue distribution profiles in order to reach the tumor site. From these identified candidate inhibitors, after much thought and consideration, we chose to investigate TKIs and methylated flavones as modulators of efflux transporter-mediated TKI resistance. The overall goal of this project was to investigate the promising chemosensitizing potential of TKIs and methylated flavones in efflux transporter-mediated TKI resistance, both in-vitro and in-vivo. To identify potent efflux transporter inhibitor TKIs, we evaluated the effect of various TKIs on the accumulation of afatinib, the model TKI substrate, in Pgp- and BCRP- overexpressing cell lines. Afatinib was chosen as the model TKI substrate for our study because it undergoes very minimal metabolism in several species. Afatinib is a substrate of both Pgp and BCRP, but is not a substrate of uptake transporters. Therefore, it was anticipated that an in-vivo efflux transporter-mediated interaction with afatinib would most likely not be confounded or masked by other factors influencing its disposition. From the in-vitro cell uptake studies, we found that nilotinib is a potent inhibitor of both Pgp and BCRP, and it reversed Pgp- and BCRP- mediated afatinib efflux. Subsequently, an in-vivo study was carried out in mice to investigate the interaction between afatinib and nilotinib; and also the impact of nilotinib on the pharmacokinetics and tissue distribution of afatinib. Afatinib exposure in the plasma and in most tissues, namely liver, lung, kidney, heart, muscle, fat, and skin, was found to be significantly increased when nilotinib was coadministered with afatinib. Further, the nilotinib concentrations in most mice tissues was above that needed for Pgp and BCRP inhibition. These results showed that nilotinib could be a potent chemosensitizing agent for Pgp- and BCRP- mediated TKI resistance. Additionally, a significant increase in afatinib brain exposure was observed in the mice which were administered afatinib in combination with nilotinib. This is an interesting and important finding that could potentially be very useful in the treatment of primary and metastasized brain tumors. We also developed a physiologically based pharmacokinetic model of afatinib to characterize its tissue disposition in mice organs, and this model was then scaled up to humans. The developed model accurately predicted afatinib plasma exposure in healthy volunteers and patients with solid malignant tumors, renal impairment, and hepatic impairment. To investigate the chemosensitizing potential of methylated flavones in efflux transporter-mediated TKI resistance, the Bcrp1 inhibitory effect of 5,7-DMF and its effect on sorafenib accumulation was evaluated in-vitro. 5,7- DMF was found to be a potent inhibitor of Bcrp1 and consequently, its impact on the pharmacokinetics and tissue distribution of sorafenib was evaluated in mice. Results showed that co-administration with 5,7-DMF led to significantly greater sorafenib exposure in plasma and in most tissues collected. This indicated that 5,7-DMF may represent a promising chemosensitizing agent for Bcrp1-mediated TKI resistance due to its low toxicity and potent Bcrp1 inhibition. Our results may have important clinical implications as TKIs are currently the most widely used anticancer agents. 5,7-DMF may show great potential in reversing MDR in tumors expressing BCRP. On the other hand, TKI-TKI combination therapy, especially with nilotinib as the perpetrator, is an attractive strategy to combat both Pgp- and BCRP-mediated TKI resistance. Additionally, since nilotinib has a wide volume of distribution and can reach various tissues at concentrations sufficient enough to inhibit Pgp and BCRP; it could potentially be used as a chemosensitizer in the treatment of numerous types of cancers. Furthermore, its chemosensitizing potential could particularly be useful in the treatment of primary and metastatic brain tumors. Further studies are warranted to assess the chemosensitizing effect of nilotinib in tumor xenograft models.

<p>Protein kinases are enzymes that catalyse the phosphoryl transfer from the g-phosphate of ATP to acceptor amino acids in proteins. The specificity of selected model protein kinases was studied at three different levels using a) novel bi-substrate-analogue inhibitors, b) synthetic peptide substrates and c) mutated protein substrate analogues. </p><p>A new class of protein kinase bi-substrate-analogue inhibitors was designed on the basis of adenosine-5’-carboxylic acid derivatives, where a short arginine containing peptide was attached to the 5'-carbon atom of the adenosine sugar moiety via a linker chain. These compounds showed high inhibitory potential against two basophilic protein kinases, the protein kinase A (PKA) and protein kinase C (PKC), with IC50 values in the nanomolar range, but no inhibitory activity towards the acidophilic kinases CK1 and CK2. The inhibitors were efficiently applied for affinity purification of PKA using MgATP as well as L-arginine as eluting agents. </p><p>Ca2+-dependent protein kinase (CDPK-1) was purified from maize seedlings and its substrate specificity was studied using a set of synthetic peptides. These were derived from the phosphorylatable sequence RVLSRLHS(15)VRER of maize sucrose synthase 2 (SuSy2), and a consensus sequence motif A/LXRXXSXRZR (where X denotes a position with no strict amino acid requirements and Z a position strictly not tolerating arginine) was defined from a study using arrays of systematically varied peptides attached to cellulose membrane (SPOTs^TM membranes). The SuSy2 derived peptides were also found to be efficient substrates for mammalian PKC, but showed low reactivity in the case of PKA. On the basis of this peptide motif, a positionally oriented peptide library approach based on ESI-MS detection of phosphopeptides in initial velocity conditions was designed for quantitative kinetic characterization of protein kinase specificity profiles. On the basis of the obtained data an optimal peptide substrate for PKC, FRRRRSFRRR, was designed. </p><p>The specificity of protein kinase A was studied using site-directed mutagenesis in the phosphorylation site of L-type pyruvate kinase (L-PK), and comparison of the obtained data with the data from previous studies on structurally altered peptide substrates revealed that amino acid alterations in short peptide substrates cause stronger effects on the phosphorylation rate than the corresponding alterations in the protein substrate L-PK.</p>

Protein kinases are enzymes that catalyse the phosphoryl transfer from the g-phosphate of ATP to acceptor amino acids in proteins. The specificity of selected model protein kinases was studied at three different levels using a) novel bi-substrate-analogue inhibitors, b) synthetic peptide substrates and c) mutated protein substrate analogues. A new class of protein kinase bi-substrate-analogue inhibitors was designed on the basis of adenosine-5’-carboxylic acid derivatives, where a short arginine containing peptide was attached to the 5'-carbon atom of the adenosine sugar moiety via a linker chain. These compounds showed high inhibitory potential against two basophilic protein kinases, the protein kinase A (PKA) and protein kinase C (PKC), with IC50 values in the nanomolar range, but no inhibitory activity towards the acidophilic kinases CK1 and CK2. The inhibitors were efficiently applied for affinity purification of PKA using MgATP as well as L-arginine as eluting agents. Ca2+-dependent protein kinase (CDPK-1) was purified from maize seedlings and its substrate specificity was studied using a set of synthetic peptides. These were derived from the phosphorylatable sequence RVLSRLHS(15)VRER of maize sucrose synthase 2 (SuSy2), and a consensus sequence motif A/LXRXXSXRZR (where X denotes a position with no strict amino acid requirements and Z a position strictly not tolerating arginine) was defined from a study using arrays of systematically varied peptides attached to cellulose membrane (SPOTsTM membranes). The SuSy2 derived peptides were also found to be efficient substrates for mammalian PKC, but showed low reactivity in the case of PKA. On the basis of this peptide motif, a positionally oriented peptide library approach based on ESI-MS detection of phosphopeptides in initial velocity conditions was designed for quantitative kinetic characterization of protein kinase specificity profiles. On the basis of the obtained data an optimal peptide substrate for PKC, FRRRRSFRRR, was designed. The specificity of protein kinase A was studied using site-directed mutagenesis in the phosphorylation site of L-type pyruvate kinase (L-PK), and comparison of the obtained data with the data from previous studies on structurally altered peptide substrates revealed that amino acid alterations in short peptide substrates cause stronger effects on the phosphorylation rate than the corresponding alterations in the protein substrate L-PK.

Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome, a minute chromosome that leads to the creation of the fusion gene BCR/ABL and the transcription of the fusion protein BCR/ABL in transformed cells. The constitutively active tyrosine kinase BCR/ABL confers enhanced proliferation and survival on leukemic cells. CML has in only a few decades gone from being a disease with very bad prognosis to being a disease that can be effectively treated with oral tyrosine kinase inhibitors (TKIs). TKIs are drugs inhibiting BCR/ABL as well as other tyrosine kinases. In this thesis, the focus has been on the immune system of CML patients, on immune escape mechanisms present in untreated patients and on how these are affected by TKI therapy. We have found that newly diagnosed, untreated CML patients exert different kinds of immune escape mechanisms. Patients belonging to the Sokal high-risk group had higher levels of myeloid-derived suppressor cells (MDSCs) as well as high levels of the programmed death receptor 1 (PD-1)-expressing cytotoxic T cells compared to control subjects. Moreover, CML patients had higher levels of myeloid cells expressing the ligand for PD-1, PD-L1. CML patients as well as patients with B cell malignacies had high levels of soluble CD25 in blood plasma. In B cell malignacies, sCD25 was found to be released from T regulatory cells (Tregs). Treatment with the TKIs imatinib or dasatinib decreased the levels of MDSCs in peripheral blood. Tregs on the other hand increased during TKI therapy. The immunostimulatory molecule CD40 as well as NK cells increased during therapy, indicating an immunostimulatory effect of TKIs. When evaluating immune responses, multiplex techniques for quantification of proteins such as cytokines and chemokines are becoming increasingly popular. With these techniques a lot of information can be gained from a small sample volume and complex networks can be more easily studied than when using for example the singleplex ELISA. When comparing different multiplex platforms we found that the absolute protein concentration measured by one platform rarely correlated with the absolute concentration measured by another platform. However, relative quantification was better correlated.

The first end point of this study was to identify specific pro-apoptotic or anti-proliferative factors in the breast cancer cell secretome. To this end, we designed an in vitro screen that effectively cross-cultured 20 breast cancer cell lines in each other's conditioned media. We selected the strongest pro-apoptotic hits and performed further proteomic and biochemical characterization in order to analyze their composition. We determined that the pro-apoptotic activity resided in the soluble, exosome-free secreted fraction of triple negative breast cancer cell conditioned medium and used proteomic insights in order to narrow down the list of possible candidate molecules responsible for the apoptotic effect. The second endpoint of this study was to evaluate the particulate fraction found in breast cancer cell conditioned media for diagnostically significant molecules. We isolated cancer exosomes, employing a serial ultracentrifugation protocol, and were able to establish that the exosome cell surface receptors identically reflect the molecular identity of their cell lines of origin. However, downstream protein kinases within exosomes display patterns of depletion or enrichment in comparison to the corresponding cell lines. Overall, we found that the exosome protein composition in breast cancer is informative enough to guide the choice of specific inhibitor treatment in a clinical setting. / Engineering and Applied Sciences