Tsang, Chi Keung. / "November 2011." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 103-116). / Abstracts in English and Chinese. / Abstract --- p.I / 摘要 --- p.III / Acknowledgement --- p.IV / Table of content --- p.V / List of Figures --- p.VIII / List of Tables --- p.XI / Abbreviations --- p.XII / Chapter Chapter 1: --- INTRODUCTION --- p.1 / Chapter 1.1. --- Hepatocellular carcinoma --- p.2 / Chapter 1.1.1. --- Etiological factors --- p.11 / Chapter 1.1.1.1. --- Chronic Hepatitis and Liver Cirrhosis --- p.13 / Chapter 1.1.1.2. --- HBV --- p.13 / Chapter 1.1.1.3. --- HCV --- p.17 / Chapter 1.1.1.4. --- Male gender --- p.20 / Chapter 1.1.1.5. --- Aflatoxin B1 exposure --- p.21 / Chapter 1.2. --- Genomic abnormalities in HCC --- p.23 / Chapter 1.3. --- GEF-H1 --- p.24 / Chapter 1.4. --- RhoA --- p.26 / Chapter 1.5. --- Epithelial-Mesenchymal Transition (EMT) --- p.29 / Chapter 1.6. --- Aims of Thesis --- p.31 / Chapter Chapter 2: --- MATERIALS AND METHODS --- p.32 / Chapter 2.1. --- Materials --- p.33 / Chapter 2.1.1. --- Chemicals and Reagents --- p.33 / Chapter 2.1.2. --- Buffers --- p.35 / Chapter 2.1.3. --- Cell Culture --- p.37 / Chapter 2.1.4. --- Nucleic Acids --- p.38 / Chapter 2.1.5. --- Enzymes --- p.39 / Chapter 2.1.6. --- Equipments --- p.40 / Chapter 2.1.7. --- Kits --- p.41 / Chapter 2.1.8. --- Antibodies --- p.42 / Chapter 2.1.9. --- Software and Web Resources --- p.43 / Chapter 2.2. --- Fluorescence In Situ Hybridization (FISH) --- p.44 / Chapter 2.2.1. --- Probe Preparation --- p.44 / Chapter 2.2.1.1. --- Human Bacterial Artificial Chromosome (BAC) probe preparation --- p.44 / Chapter 2.2.1.2. --- Nick translation --- p.44 / Chapter 2.2.2. --- Hybridization --- p.45 / Chapter 2.3. --- Genomic DNA extraction --- p.47 / Chapter 2.4. --- Copy number analysis --- p.48 / Chapter 2.5. --- Exon Sequencing analysis --- p.49 / Chapter 2.5.1. --- PCR amplification of GEF-H1 exons --- p.49 / Chapter 2.5.2. --- Cycle sequencing --- p.49 / Chapter 2.6. --- Ectopic expression of GEF-H1 in immortalized hepatocyte cell line --- p.52 / Chapter 2.6.1. --- Construction of GEF-H1 expressing vector --- p.52 / Chapter 2.6.2. --- Sub-cloning --- p.52 / Chapter 2.6.3. --- Transfection and clonal selection --- p.53 / Chapter 2.7. --- Gene Expression Analysis by Quantitative RT-PCR --- p.55 / Chapter 2.7.1. --- Total RNA extraction --- p.55 / Chapter 2.7.2. --- qRT-PCR analysis for gene expression --- p.55 / Chapter 2.8. --- Western blot --- p.58 / Chapter 2.9. --- Functional Analysis --- p.60 / Chapter 2.9.1. --- Cell viability (MTT) assay --- p.60 / Chapter 2.9.2. --- Cell proliferation assays (BrdU-incorporation) --- p.60 / Chapter 2.9.3. --- Mitomycin C treatment --- p.61 / Chapter 2.9.4. --- Migration and Invasion assays --- p.63 / Chapter 2.9.5. --- Wound healing assay --- p.65 / Chapter 2.9.6. --- Transient knock-down of RhoA --- p.65 / Chapter 2. --- 10. Immuno-fluorescent imaging --- p.66 / Chapter 2. --- 11. In vivo tumorigenic study of GEF-H1 by subcutaneous injection --- p.68 / Chapter 2. --- 12. Statistical analysis --- p.69 / Chapter Chapter 3: --- RESULTS --- p.70 / Chapter 3.1. --- Verifying copy number gain of GEF-H1 in high GEF-H1 expressing HCC --- p.71 / Chapter 3.2. --- Verifying if there is any GEF-H1 exon point mutation in HCC --- p.75 / Chapter 3.3. --- Functional roles of GEF-H1 in HCC --- p.77 / Chapter 3.4. --- GEF-Hl-induced functions were RhoA independent --- p.83 / Chapter 3.5. --- GEF-H1 Induction of Epithelial-mesenchymal transition in HCC --- p.88 / Chapter 3.6. --- GEF-H1 induced tumorigenicity of MIHA cells --- p.95 / Chapter Chapter 4: --- DISCUSSIONS --- p.96 / Chapter 4.1. --- GEF-H1 in HCC and other cancers --- p.97 / Chapter 4.2. --- GEF-H1 promotes cell motility --- p.98 / Chapter 4.3. --- GEF-H1 induced tumorigenicity --- p.100 / Chapter Chapter 5: --- CONCLUSIONS AND PROPOSED FUTURE INVESTIGATIONS --- p.101 / Chapter Chapter 6: --- REFERENCES --- p.103

Uveal melanoma is the most common primary malignant intraocular tumour in adults and despite advances in treatment of the primary tumour, the 10-year survival rate remains unchanged. The most frequent cause of death for patients of this disease is liver metastases. Removal of the primary tumour before clinical presentation of metastases, however, has no effect on patient outcome. / In order to understand the interactions between single malignant cells or sub-clinical metastases and affected organs, we have successfully developed a novel animal model of uveal melanoma. We utilized the unique properties of green fluorescent protein, a skin-flap in vivo imaging technique, and nude mice to accomplish this goal. The precision of green fluorescent protein imaging has allowed us to observe single cells interacting with organ tissues and reveal that these malignant cells are only capable of surviving in the liver.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 6 uppsatser.

No description available.

No description available.

INTRODUÇÃO: O transplante (TX) de fígado corresponde ao tratamento de escolha em pacientes com cirrose e carcinoma hepatocelular (CHC) precoce irressecável. A recidiva do CHC pós-transplante, entretanto, ainda apresenta impacto na sobrevida dos pacientes transplantados com este tumor. As taxas de recidiva, nos estudos mais recentes, variam de 8 a 20%. O tamanho e número de nódulos, a presença de invasão vascular e de nódulos satélites no explante, são fatores de risco relacionados à recidiva tumoral pós-transplante. No Brasil, observamos um crescimento importante do número de transplantes de fígado, inclusive por CHC. Entretanto, existem poucos estudos nacionais analisando os resultados do transplante hepático por CHC. Os objetivos do nosso estudo foram analisar as características demográficas, clínicas e a evolução dos pacientes submetidos a transplante hepático com CHC no Brasil, avaliando os fatores prognósticos relacionados com a recidiva do CHC pós-transplante e sobrevida e estudar o desempenho dos critérios de seleção para transplante utilizados no nosso país, os \"Critérios de Milão Brasil\" (CMB). MÉTODOS: Estudo de coorte retrospectivo, multicêntrico, para analisar os resultados do transplante de fígado em pacientes com CHC, após a implantação do sistema MELD. Foram incluídos 1.119 pacientes transplantados com CHC, de 07/2006 até 07/2015, em 13 centros de transplante, no Brasil. Características clínicas, demográficas, exames laboratoriais e de imagem e dados anatomopatológicos, foram retrospectivamente analisados e correlacionados com a sobrevida e recidiva do CHC pós-transplante. RESULTADOS: A maioria dos pacientes era do sexo masculino (81%), com uma idade média no TX de 58 anos. A etiologia mais associada ao tumor foi a Hepatite C (VHC), presente em 60% dos casos. O tempo médio de espera em lista foi de 9,8 meses. Setenta e oito pacientes (8%) foram incluídos por \"Down-staging\". Nos exames de imagem do diagnóstico, a maioria dos casos (67%) apresentava um nódulo, com tamanho médio de 30 mm; 85% estavam dentro dos Critérios de Milão (CM), 8% fora dos CM, mas dentro dos \"Critérios de Milão Brasil\" (CMB) e 7% fora de ambos os critérios. O tratamento do CHC em lista foi realizado em 67% dos pacientes. Na análise do explante, 44% apresentavam tumor uninodular, com tamanho médio de 26 mm e a maioria (71%) tinha CHC moderadamente diferenciado. A invasão vascular foi observada em 26% dos casos e nódulos satélites em 22%. No explante, 70% dos pacientes estavam dentro dos CM, 20,5% fora dos CM, mas dentro dos CMB e 9,5%fora de ambos os critérios. A sobrevida global foi de 79% em 1 ano, 72,5% em 3 anos e 63%, em 5 anos, com um tempo médio de seguimento de 28 meses. Excluindo os pacientes que foram a óbito no pós-operatório ( < 30 dias pós-transplante), a sobrevida global foi de 89% em 1 ano e 75%, em 5 anos. A recidiva do CHC pós-TX ocorreu em 8% (86/1.119) dos casos, em um tempo médio de 12 meses. A sobrevida livre de recidiva (SLR) foi de 94,4% em 1 ano e 88,3%, em 5 anos. A recidiva do CHC foi extra-hepática em 55% dos casos, hepática em 27% e hepática e extra-hepática em 18%. Os pacientes transplantados que evoluíram com recidiva tumoral apresentaram alta mortalidade, com uma sobrevida em 1 ano de 34% e em 5 anos de 13%. Em relação aos fatores prognósticos, os pacientes transplantados dentro dos Critérios de Milão apresentaram melhor sobrevida e SLR quando comparados aos pacientes transplantados fora dos CM, mas dentro dos CMB, tanto quando analisamos os dados do diagnóstico, quanto através da análise do explante. Os pacientes transplantados após realização de \"Down-staging\" apresentaram taxas de recidiva e sobrevida semelhantes aos pacientes transplantados sem \"Down-staging\". Os níveis séricos elevados de alfa-fetoproteína (AFP) foram um fator prognóstico importante de sobrevida e recidiva tumoral. Os melhores pontos de corte de AFP encontrados para avaliação do risco de recidiva e sobrevida foram: AFP > 400 ng/ml, no momento do diagnóstico e AFP > 200 ng/ml pré-transplante. Realizamos, também, uma comparação dos \"Critérios de Milão Brasil\" com os Critérios de Milão, através do índice IDI (Integrated Discrimination Index) e os CMB apresentaram performance inferior aos CM, na capacidade de classificar corretamente os pacientes em relação ao risco de recidiva tumoral. Os níveis séricos elevados de AFP, o estádio fora dos Critérios de Milão no momento do diagnóstico e no explante e a presença e invasão vascular no explante, foram fatores de risco independentes de recidiva do CHC pós-transplante e pior sobrevida. A idade > 60 anos e a etiologia da hepatopatia (VHC), também foram fatores prognósticos negativos de sobrevida. CONCLUSÕES: A presença de recidiva tumoral teve grande impacto na sobrevida do paciente transplantado com CHC. O estadiamento tumoral no diagnóstico e no explante, avaliado através dos Critérios de Milão, os níveis séricos elevados de AFP e a presença de invasão vascular no explante foram fatores prognósticos importantes de recidiva do CHC pós-transplante e sobrevida. Os pacientes transplantados após \"Down-staging\" apresentaram evolução pós-transplante semelhante a dos pacientes transplantados sem \"Down-staging\". Os pacientes transplantados fora dos CM, mas dentro dos CMB, apresentaram pior sobrevida, quando comparados aos pacientes dentro dos CM. Os CMB apresentaram desempenho inferior aos CM na capacidade de classificar corretamente os pacientes em relação ao risco de recidiva tumoral / INTRODUCTION: Liver transplantation (LT) is the treatment of choice for patients with cirrhosis and unresectable early hepatocellular carcinoma (HCC). HCC post-transplant recurrence, however, still has an impact on survival. In recent studies, the incidence of HCC recurrence after transplantation ranged from 8% to 20%. Tumor number, size, vascular invasion and satellite nodules have emerged as risk factors for HCC recurrence. In Brazil, in the last decade, we observed a significant increase in the number of liver transplants performed, including in patients with HCC. However, there are few national studies analyzing the results of liver transplantation for HCC. The aim of this multicentric study was to analyze the demographic characteristics, clinical features and outcomes of patients submitted to liver transplantation with HCC in Brazil, evaluate prognostic factors related to HCC post-transplant recurrence and survival, and study the performance of the national selection criteria for liver transplantation, the \"Brazilian Milan Criteria\" (BMC). METHODS: We conducted a national, multicentric, retrospective study to analyze the results of liver transplantation in patients with HCC, in \"MELD era\". Medical records of 1,119 transplanted patients with HCC between 07/2006 and 07/2015, from 13 transplant centers in Brazil, were collected. Patient and tumor characteristics, radiologic and pathologic data were retrospectively analyzed and correlated with post-transplant HCC recurrence and survival. RESULTS: Of the 1,119 HCC transplanted patients, median age was 57 years and 81% were male. Etiology of liver disease was HCV in 60%. Median time on transplant list was 9.8 months. Seventy-eight patients (8%) were included after \"Down-staging\". At diagnosis, most patients had uninodular HCC (67%) and median tumor burden was 30 mm. At diagnosis, in imaging studies, 85% of patients were within the Milan criteria (MC), 8% out of the MC but within the \"Brazilian Milan Criteria\" (BMC) and 6% out of both criteria. During the waiting list period, HCC treatment was performed in 67%. In explant analysis, tumor was uninodular in 46% and moderately differentiated in the majority of cases (71%). Median HCC size was 26 mm. Vascular invasion and satellite nodules were observed in 26% and 22% of patients, respectively. In explant, 70% of patients were within Milan Criteria, 20.5% outside MC but within BMC and 9.5% out of both criteria. Mean follow-up was 28 months, an overall survival was 79% in 1 year, 72.5% in 3 years and 63% in 5 years. Excluding patients who died within 30 days after surgery, overall survival was 89% in 1 year and 75% in 5 years. HCC post-transplant recurrence occurred in 86/1,119 (8%) cases, at a mean time of 12 months. Recurrence-free survival (RFS) was 94.4% in 1 year and 88.3% in 5 years. Sites of recurrence were extrahepatic in 55%, hepatic in 27% and both hepatic and extrahepatic in 18%. Transplanted patients with tumor recurrence presented high mortality, with 1-year survival rate of 34% and 5-year survival rate of 13%. Analyzing the prognostic factors, patients transplanted under Milan Criteria, in radiologic or explant analysis, presented better survival and RFS when compared to patients transplanted outside MC, but within BMC. Patients submitted to liver transplantation after \"Down-staging\" present long-term survival and RFS similar to patients transplanted without \"Down-staging\". Alpha-fetoprotein (AFP) levels were an important pre-transplant prognostic factor for tumor survival and recurrence. The best AFP cut off points found for relapse risk and survival assessment were: AFP at diagnosis > 400 ng / ml and AFP pre-transplant > 200 ng / ml. We also performed a comparison of the \"Brazilian Milan Criteria\" with the Milan Criteria through the Integrated Discrimination Index (IDI). The BMC presented a lower performance than the MC, in the ability to correctly classify patients in relation to the risk of relapse. Elevated AFP levels before liver transplantation, tumor outside Milan Criteria at diagnosis and in explant, and vascular invasion, were independent risk factors for post-transplant HCC recurrence and worse survival. Age > 60 years and etiology of liver disease (HCV), were also negative prognostic factors for survival. CONCLUSIONS: The presence of tumor recurrence had a major impact on survival of transplanted patients with HCC. Tumor staging, evaluated by Milan Criteria on imaging studies or explant analysis, high serum AFP levels and presence of vascular invasion in explant were important prognostic factors for post-transplant HCC recurrence and survival. Patients transplanted after Down-staging presented long-term outcomes similar to patients transplanted under conventional criteria. Patients transplanted outside Milan Criteria, but within \"Brazilian Milan Criteria\" presented worse survival, when compared to patients within MC. The BMC showed lower performance than MC in the ability to correctly classify patients in relation to the risk of tumor recurrence