O câncer bucal é uma doença que afeta principalmente homens acima de 40 anos com hábito de fumar e beber. Em geral, esses pacientes têm o diagnóstico da enfermidade realizado tardiamente, acarretando tratamentos complexos, mutilantes e de alto custo tanto financeiro como social e de prognóstico sombrio a ponto do câncer bucal apresentar uma taxa de sobrevida em 5 anos inferior a 50%. O diagnóstico precoce representa uma alternativa importante para alterar esse panorama. Os recursos de que os profissionais da área da saúde, principalmente os cirurgiões-dentistas, dispõem são o diagnóstico clínico de lesões estabelecidas acompanhado da biópsia com exame histopatológico.Outra alternativa para o diagnóstico precoce dos carcinomas espinocelulares ocorre quando estes são precedidos de lesões cancerizáveis. Nas duas últimas décadas, a utilização da citopatologia como método de diagnóstico de danos celulares prévios ao aparecimento de lesões clínicas possibilitou sua utilização em mucosa bucal. Os estudos apresentados tratam especificamente desta aplicação clínica, abordando: a) os aspectos genéticos do câncer bucal; b) a correlação histocitopatológica de lesões cancerizáveis em câncer bucal e na mucosa normal exposta aos carcinógenos; c) a validação das amostras citopatológicas; d) a padronização da técnica de extração de DNA em células esfoliadas da mucosa bucal. / Oral cancer affects mainly men over 40 years who are exposed to tobacco and alcohol. These patients usually receive a late diagnosis, which results in complex, mutilating treatments with high financial and social costs, poor prognosis, and, therefore, a 5-year survival rate lower than 50%. Early diagnosis is critical to change this situation. The resources currently available to healthcare professionals, particularly dentists, are the clinical diagnosis of lesions and biopsies for histopathologic examination. Another alternative for the early diagnosis of squamous cell carcinomas is the identification of precursor lesions. In the last two decades, cytopathology has been used as a method to diagnose cell damage that precedes the appearance of clinical lesions, and this use can be extended to the oral mucosa. The studies reported here deal specifically with this clinical application, and discuss: A) the genetic factors in oral cancer; B) the cytohistologic correlation of cancer precursor lesions and the normal mucosa exposed to carcinogens; C) the validation of cytopathologic samples; D) the standardization of the technique to extract DNA of cells exfoliated from the oral mucosa.

<p>Pancreatic endocrine tumors (PETs) may cause typical syndromes of hormone excess, or appear clinically non-functioning without hormonal symptoms. PETs occur sporadically, in association with the multiple endocrine neoplasia type 1 (MEN1) syndrome, or rarely the von Hippel-Lindau syndrome. Molecular genetic investigations may reveal pathways important for tumor development, and be of clinical use.</p><p>The aim of this thesis was to investigate regulation of different genes involved in cell proliferation, and relate findings to signs of malignancy in PETs.</p><p>The MEN1 gene on chromosome 11q13 was mutated in three out of eleven sporadic malignant PETs. Two nonsense mutations, causing truncation of the protein, and one missense mutation were found.</p><p>Relation of allelic loss at 11q13 and 3p25 to malignant behavior was observed in sporadic PETs. Allelic loss at 18q21 was found in a subset of sporadic and MEN1-associated PETs, and mutation analysis of Smad4 excluded a tumor suppressor gene function.</p><p>In PETs with allelic loss on chromosome 3p25, mutation analysis of WNT7A and HDAC11 excluded function as tumor suppressor genes.</p><p>Menin, encoded by the MEN1 gene, was reported to regulate expression of the cyclin-dependent kinase inhibitors CDKN2C/p18, CDKN1B/p27, and CDKN2B/p15 in mouse pancreatic islet tumor models. Here, the mRNA expression of these genes was not related to MEN1 gene mutations in human PETs.</p><p>Cyclin-dependent kinase 4 (CDK4) and the protooncogene c-Myc were found to be overexpressed regardless of MEN1 gene mutational status of the PETs. The CDK4 gene was neither amplified nor mutated. Targeting of CDK4 may present an alternative to traditional chemotherapy of PETs in the future.</p>

Pancreatic endocrine tumors (PETs) may cause typical syndromes of hormone excess, or appear clinically non-functioning without hormonal symptoms. PETs occur sporadically, in association with the multiple endocrine neoplasia type 1 (MEN1) syndrome, or rarely the von Hippel-Lindau syndrome. Molecular genetic investigations may reveal pathways important for tumor development, and be of clinical use. The aim of this thesis was to investigate regulation of different genes involved in cell proliferation, and relate findings to signs of malignancy in PETs. The MEN1 gene on chromosome 11q13 was mutated in three out of eleven sporadic malignant PETs. Two nonsense mutations, causing truncation of the protein, and one missense mutation were found. Relation of allelic loss at 11q13 and 3p25 to malignant behavior was observed in sporadic PETs. Allelic loss at 18q21 was found in a subset of sporadic and MEN1-associated PETs, and mutation analysis of Smad4 excluded a tumor suppressor gene function. In PETs with allelic loss on chromosome 3p25, mutation analysis of WNT7A and HDAC11 excluded function as tumor suppressor genes. Menin, encoded by the MEN1 gene, was reported to regulate expression of the cyclin-dependent kinase inhibitors CDKN2C/p18, CDKN1B/p27, and CDKN2B/p15 in mouse pancreatic islet tumor models. Here, the mRNA expression of these genes was not related to MEN1 gene mutations in human PETs. Cyclin-dependent kinase 4 (CDK4) and the protooncogene c-Myc were found to be overexpressed regardless of MEN1 gene mutational status of the PETs. The CDK4 gene was neither amplified nor mutated. Targeting of CDK4 may present an alternative to traditional chemotherapy of PETs in the future.

O câncer bucal é uma doença que afeta principalmente homens acima de 40 anos com hábito de fumar e beber. Em geral, esses pacientes têm o diagnóstico da enfermidade realizado tardiamente, acarretando tratamentos complexos, mutilantes e de alto custo tanto financeiro como social e de prognóstico sombrio a ponto do câncer bucal apresentar uma taxa de sobrevida em 5 anos inferior a 50%. O diagnóstico precoce representa uma alternativa importante para alterar esse panorama. Os recursos de que os profissionais da área da saúde, principalmente os cirurgiões-dentistas, dispõem são o diagnóstico clínico de lesões estabelecidas acompanhado da biópsia com exame histopatológico.Outra alternativa para o diagnóstico precoce dos carcinomas espinocelulares ocorre quando estes são precedidos de lesões cancerizáveis. Nas duas últimas décadas, a utilização da citopatologia como método de diagnóstico de danos celulares prévios ao aparecimento de lesões clínicas possibilitou sua utilização em mucosa bucal. Os estudos apresentados tratam especificamente desta aplicação clínica, abordando: a) os aspectos genéticos do câncer bucal; b) a correlação histocitopatológica de lesões cancerizáveis em câncer bucal e na mucosa normal exposta aos carcinógenos; c) a validação das amostras citopatológicas; d) a padronização da técnica de extração de DNA em células esfoliadas da mucosa bucal. / Oral cancer affects mainly men over 40 years who are exposed to tobacco and alcohol. These patients usually receive a late diagnosis, which results in complex, mutilating treatments with high financial and social costs, poor prognosis, and, therefore, a 5-year survival rate lower than 50%. Early diagnosis is critical to change this situation. The resources currently available to healthcare professionals, particularly dentists, are the clinical diagnosis of lesions and biopsies for histopathologic examination. Another alternative for the early diagnosis of squamous cell carcinomas is the identification of precursor lesions. In the last two decades, cytopathology has been used as a method to diagnose cell damage that precedes the appearance of clinical lesions, and this use can be extended to the oral mucosa. The studies reported here deal specifically with this clinical application, and discuss: A) the genetic factors in oral cancer; B) the cytohistologic correlation of cancer precursor lesions and the normal mucosa exposed to carcinogens; C) the validation of cytopathologic samples; D) the standardization of the technique to extract DNA of cells exfoliated from the oral mucosa.

O câncer bucal é uma doença que afeta principalmente homens acima de 40 anos com hábito de fumar e beber. Em geral, esses pacientes têm o diagnóstico da enfermidade realizado tardiamente, acarretando tratamentos complexos, mutilantes e de alto custo tanto financeiro como social e de prognóstico sombrio a ponto do câncer bucal apresentar uma taxa de sobrevida em 5 anos inferior a 50%. O diagnóstico precoce representa uma alternativa importante para alterar esse panorama. Os recursos de que os profissionais da área da saúde, principalmente os cirurgiões-dentistas, dispõem são o diagnóstico clínico de lesões estabelecidas acompanhado da biópsia com exame histopatológico.Outra alternativa para o diagnóstico precoce dos carcinomas espinocelulares ocorre quando estes são precedidos de lesões cancerizáveis. Nas duas últimas décadas, a utilização da citopatologia como método de diagnóstico de danos celulares prévios ao aparecimento de lesões clínicas possibilitou sua utilização em mucosa bucal. Os estudos apresentados tratam especificamente desta aplicação clínica, abordando: a) os aspectos genéticos do câncer bucal; b) a correlação histocitopatológica de lesões cancerizáveis em câncer bucal e na mucosa normal exposta aos carcinógenos; c) a validação das amostras citopatológicas; d) a padronização da técnica de extração de DNA em células esfoliadas da mucosa bucal. / Oral cancer affects mainly men over 40 years who are exposed to tobacco and alcohol. These patients usually receive a late diagnosis, which results in complex, mutilating treatments with high financial and social costs, poor prognosis, and, therefore, a 5-year survival rate lower than 50%. Early diagnosis is critical to change this situation. The resources currently available to healthcare professionals, particularly dentists, are the clinical diagnosis of lesions and biopsies for histopathologic examination. Another alternative for the early diagnosis of squamous cell carcinomas is the identification of precursor lesions. In the last two decades, cytopathology has been used as a method to diagnose cell damage that precedes the appearance of clinical lesions, and this use can be extended to the oral mucosa. The studies reported here deal specifically with this clinical application, and discuss: A) the genetic factors in oral cancer; B) the cytohistologic correlation of cancer precursor lesions and the normal mucosa exposed to carcinogens; C) the validation of cytopathologic samples; D) the standardization of the technique to extract DNA of cells exfoliated from the oral mucosa.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal. / Le cancer épithélial sporadique des ovaires se situe en quatrième position des causes de décès par cancer chez la femme après ceux du sein, du poumon et du côlon. Nous avons initié et mis au point un modèle pour déterminer les altérations moléculaires dans les cancers ovariens et corréler les résultats aux différentes étapes de la progression clinique de la maladie. Nous avons établi et caractérisé des cultures primaires dérivées d'ovaires normaux et de différentes tumeurs ovariennes qui couvrent différents types histologiques et différentes étapes de la maladie. Plusieurs analyses morphologiques, immunohistochimiques et moléculaires ont démontré que ces cellules sont représentatives des populations cellulaires du matériel clinique initial. Ces cultures représentent un système unique pour mener des analyses de détection de changements du point de vue génétique ou biologique qui jouent un rôle important dans la progression tumorale du cancer épithélial de l'ovaire. De plus nous avons obtenu à partir des cultures primaires des lignées cellulaires immortalisées de façon spontanée en culture. Ces lignées possèdent plusieurs avantages à savoir qu'elles ont été dérivées de tumeurs de patientes n'ayant pas subi de traitements de chimiothérapie et proviennent dans trois cas (TOV21G, TOV-81D et TOV112D) de tumeurs primaires solides et dans un cas (OV-90) d'ascite malin. Ces lignées représentent différents types histologiques du cancer épithélial de l'ovaire. Ce système nous a permis de faire quelques corrélations entre le comportement des cellules in vitro et les paramètres cliniques de la maladie et nous a fourni un indice sur la croissance in vitro qui semble épouser les paramètres cliniques de ces tumeurs. En premier lieu le modèle a été utilisé pour étudier et caractériser les altérations géniques au niveau du bras court du chromosome 3. Nous avons choisi d'étudier ce chromosome en particulier car c'est le plus fréquemment touché dans les cancers d'origine épithéliale, suggérant la présence de gènes suppresseurs de tumeurs dans les régions délétées dont l'inactivation fonctionnelle peut être impliquée dans le cancer épithélial de l'ovaire. Dans cette étude nous avons utilisé 33 biopsies tumorales et 47 cultures primaires ovariennes. Ce large répertoire d'échantillons contient des tumeurs ovariennes bénignes, des tumeurs épithéliales de l'ovaire de faible potentiel de malignité ainsi que des cancers épithéliaux de l'ovaire ou de l'ascite. En utilisant 15 marqueurs polymorphiques nous avons observé des LOH dans 25 (31%) des échantillons analysés: 21 sur 58 échantillons malins, 2 sur 12 de faible potentiel de malignité et 2 sur 10 tumeurs bénignes. Le profil de délétion affiché par ces 25 échantillons a permis la détermination d'au moins deux régions distinctes de délétions communes sur le bras court du chromosome 3 qui s'étendent du marqueur D3S1270 à D3S1597 (Région l) et du marqueur D3S1293 à D3S1283 (Région II). De plus une autre région proximale au marqueur D3S1300 (Région Ill) est délétée dans certains échantillons. Bien que parmi les tumeurs bénignes et malignes des délétions ont été observées dans les trois régions de délétion (Région I, Région II et Région Ill) les tumeurs de faible potentiel de malignité ne démontrent de délétions que seulement dans la région III. D'autre part, ces régions minimales de délétions semblent, à l'exception de RARB et THRB contenus dans la Région II, exclure les gènes VHL, TGFBR2, PTPasey et FHIT comme gènes suppresseurs candidats dans la tumorigénèse du cancer épithélial de l'ovaire.

Le caryotype moléculaire permet d’identifier un CNV chez 10-14% des individus atteints de déficience intellectuelle et/ou de malformations congénitales. C’est pourquoi il s’agit maintenant de l’analyse de première intention chez ces patients. Toutefois, le rendement diagnostique n’est pas aussi bien défini en contexte prénatal et l’identification de CNVs de signification clinique incertaine y est particulièrement problématique à cause du risque d’interruption de grossesse. Nous avons donc testé 49 fœtus avec malformations majeures et un caryotype conventionnel normal avec une micropuce CGH pangénomique, et obtenu un diagnostic dans 8,2% des cas. Par ailleurs, des micropuces à très haute résolution combinant le caryotype moléculaire et le génotypage de SNPs ont récemment été introduites sur le marché. En plus d’identifier les CNVs, ces plateformes détectent les LOHs, qui peuvent indiquer la présence d’une mutation homozygote ou de disomie uniparentale. Ces anomalies pouvant être associées à la déficience intellectuelle ou à des malformations, leur détection est particulièrement intéressante pour les patients dont le phénotype reste inexpliqué. Cependant, le rendement diagnostique de ces plateformes n’est pas confirmé, et l’utilité clinique réelle des LOHs n’est toujours pas établie. Nous avons donc testé 21 enfants atteints de déficience intellectuelle pour qui les méthodes standards d’analyse génétique n’avaient pas résulté en un diagnostic, et avons pu faire passer le rendement diagnostique de 14,3% à 28,6% grâce à l’information fournie par les LOHs. Cette étude démontre l’utilité clinique d’une micropuce CGH pangénomique chez des fœtus avec malformations, de même que celle d’une micropuce SNP chez des enfants avec déficience intellectuelle. / Molecular karyotyping identifies a CNV in 10-14% of individuals affected with intellectual disability and/or congenital abnormalities. Therefore, it is now the first-tier analysis for these patients. However, the diagnostic yield is not as clear in the prenatal context, and the risk of pregnancy termination makes the detection of variants of uncertain clinical significance particularly problematic. We tested 49 fetuses with major malformations and a normal karyotype, using a pangenomic CGH array, and obtained a diagnosis in 8.2% of cases. Furthermore, high-resolution microarrays combining molecular karyotyping and SNP genotyping were recently introduced on the market. In addition to identifying CNVs, these platforms detect LOHs, which can indicate the presence of a homozygous mutation or of uniparental disomy. Since these abnormalities can be associated with intellectual disability or congenital abnormalities, their detection is of particular interest for patients whose phenotype remains unexplained. However, the diagnostic yield obtained with these platforms is not confirmed, and the real clinical value of LOH detection is not yet established. We tested 21 children affected with intellectual disability for whom standard genetic analyses failed to provide a diagnosis, and were able to increase the diagnostic yield from 14.3% to 28.6% as a result of the information provided by LOHs. This study shows the clinical usefulness of pangenomic CGH arrays in fetuses with malformation(s), as well as that of SNP arrays in children with intellectual disability.