Lynch syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC) is the most common hereditary syndrome predisposing to colorectal cancer, accounting for 1-3% of all colorectal cancer. This multi-organ cancer predisposition syndrome is caused by mutations in the mismatch repair (MMR) genes, especially MLH1 and MSH2, and to lesser extents MSH6 and PMS2, which lead to widespread genetic instability and thus microsatellite instability (MSI). Hereditary cancer often manifests in two or more tumours in a single individual; 35-40% of Lynch syndrome patients have synchronous or metachronous tumours of the two major Lynch syndrome-related cancers: colorectal and endometrial. The main purposes of the work underlying this thesis were to identify persons at risk of Lynch syndrome or other types of hereditary colorectal cancer, to estimate the cancer risks associated with these predispositions and to identify the underlying genetic causes. A population-based cohort of 78 persons with double primary colorectal or colorectal and endometrial cancer was identified. Cancer risks in their 649 first-degree relatives were estimated in relation to tumour MSI status (positive or negative) and age at diagnosis (before or after 50 years of age) in the probands. The overall standardised incidence ratio was 1.69 (95% CI; 1.39-2.03). The highest risks for Lynch syndrome-associated cancers: (colorectal, endometrial, ovarian and gastric) were found in families with young MSI-positive probands, likely representing Lynch syndrome families. Importantly, no overall risk was found in families with old probands, irrespective of MSI status. Blood samples were available from 24 MSI-positive patients for mutation screening of MLH1, MSH2 and MSH6. Sequence variants or rearrangements predicted to affect protein function were found in 16 patients. Six novel variants were found: two large rearrangements, two truncating and two missense mutations. The missense mutations were found to segregate in the families. Studies of allele frequencies, MSI and loss of immunostaning in tumours from family members further supports the hypothesis that these missense changes play a role in Lynch syndrome, as do the non-conservative nature and evolutionary conservation of the amino acid exchanges. Five families had mutations in MLH1, five in MSH2, and six in MSH6. The unexpectedly large impact of MSH6 was in genealogical studies shown to be due to a founder effect. Cumulative risk studies showed that the MSH6 families, despite their late age of onset, have a high lifetime risk for all Lynch syndrome-related cancers, significantly higher in women (89% by age 80 years) than in men (69%). The gender differences are in part due to high endometrial (70%) and ovarian cancer risk (33%) in addition to the high colorectal cancer risk (60%). These findings are of great importance for counselling and surveillance of families with MSH6 mutations. Finally, in a large family with MSI-negative hereditary colorectal cancer for which the MMR genes and APC had been excluded as possible causes, a genome-wide linkage analysis was performed, resulting in a suggested linkage to chromosome 7. Conclusions: Relatives of probands with MSI-positive, double primary colorectal and endometrial cancer diagnosed before the age of 50 years have significantly increased risks of Lynch syndrome-related cancers. MSH6 mutations, which have unusually high impact in this study population due to a founder effect, confer high cumulative risks of cancer despite the generally late age of onset.

Colorectal cancer (CRC) is a common malignancy which develops due to old age and lifestyle factors, low percent of patients afflicted by a genetic disorders. Half of all colorectal cancer patients are diagnosed after metastasis. The high rate of the late detection, emphasizes on the requirement of convenient and inexpensive diagnostic methods for comprehensive screening programs. The aim of this study was to discover proto-oncogenes mutation and assessment of tumor suppressor genes expression. Formalin fixed paraffin embedded (FFPE) histologically verified colorectal cancer samples were used. APC, KRAS and BRAF mutations were investigated using polymerase chain reaction (PCR) fragments and direct sequencing. Gene expression assessment of MLH1, MGMT and CDKN2A were achieved via quantitative polymerase chain reaction (qPCR). In the present study we could detect a novel transversion heterozygous mutation in APC gene codon 1365 in three patients. BRAF codon 600 mutation were detected in one patient. KRAS codon 12 mutation was discovered in one sample and also a novel transition mutation in codon 15 was detected in 6 patients. In 80% of cases, MLH1 and MGMT expression were undetectable, in remaining 20%, MLH1 expression were reduced, but MGMT showed both reduced and increased expression compared to control. In 100% of patients CDKN2A expression was undetectable. The rate of mutations in predetermined hotspot codons and amount of uncommon mutations into APC, BRAF and KRAS in Nepalese patients indicates the requirement of further investigation in CRC patients from that part of the world. Also, the expression rate of MLH1, MGMT, CDKN2A and deficiency of an information source emphasizes the necessity of whole genome CRC expression profiling data to comparison and conclusion. / <p>-</p> / -

LIMA, Marcos Antonio Pereira de. Carcinoma de células escamosas oral: relevância do Papiloma vírus humano (HPV) e do vírus Epstein-Barr (EBV) na expressão de proteinas p16INK4a, E-caderina, COX-2, MLH1, p53 e MYC. 2013. 180 f. : Tese (doudorado) - Universidade Federal do Ceará, Programa de Pós-Graduação em Biotecnologia, Rede Nordestes de Biotecnologia -Renorbio, Fortaleza-CE, 2013. / Submitted by demia Maia (demiamlm@gmail.com) on 2016-05-27T13:30:28Z No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) / Approved for entry into archive by demia Maia (demiamlm@gmail.com) on 2016-05-27T13:30:59Z (GMT) No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) / Made available in DSpace on 2016-05-27T13:30:59Z (GMT). No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) Previous issue date: 2013 / The oral cancer represents a serious world public health problem. The oral squamous cell carcinomas (OSCC) account for up to 94% of the tumors of this anatomic site. The molecular mechanisms involved in the genesis and progression are still not well elucidated. Some evidences have suggested the involvement of viruses in this process. Also, these tumors still lack of reliable markers to determine the aggressiveness profile. In this context, the aim of the present study was to evaluate the expression of the proteins p53, E-cadherin, COX-2, p16, MLH1 and MYC in a serie of OSCC, including the cytoplasmic staining eventually observed for the latter three proteins, confronting the results between them and with demographic and clinico-pathological features. Besides evaluating the prevalence of Human Papillomavirus (HPV) and Epstein-Barr virus (EBV) in the sample and compare them with the expression of the referred proteins. Materials and Methods – One hundred formalin-fixed paraffin-embedded OSCC specimens were submitted to immunohistochemistry for detection of the referred proteins, and to in situ hybridization for HPV and EBV detection. Results – OSCC was associated with a concomitant lack of expression of p16 and MLH1 (p=0.029) and coexpression of p53 and COX-2 (p=0.045). Additionally, COX-2 and nuclear MYC were found to be related to exclusively cytoplasmic staining of MLH1 (p=0.060 and p=0.018, respectively). The combination analyses of the markers revealed five main groups of altered protein expression, which were mostly of the more aggressive tumors, mainly the MLH1(-)/COX-2(+)/p16(-) group. The cases with cytoplasmic staining for p16, MLH1 and/or MYC were more frequent in advanced tumors (p=0.009) and in those with lymph node metastasis (p=0.001). Thirty-one cases showed staining for HPV in tumor tissue. The EBV was not detected in any case investigated, neither in the tumor tissue nor in the non-neoplastic epithelium. The HPV(+) group demonstrated high positivity for nuclear p16 (p=0,029) and cytoplasmic MYC (p=0,039), and an increase of the lack of MLH1 nuclear expression (p=0,031). There was also a trend related to the increase of the COX-2 positivity in the HPV(+) group (p=0,084). Conclusions – The significance between p16 and MLH1 suggests that the lack of this member of mismatch repair system also favors the occurrence of mutations in the p16 gene, culminating in inactivation of this tumor suppressor. The associations of COX-2 and MYC with cytoplasmic MLH1 suggest a blocking mechanism for the entry of MLH1 into the nucleus. The combined analyses of the proteins investigated, as well as the cytoplasmic staining of p16, MLH1 and MYC, may be useful in the evaluation of the aggressive profile and probably prognosis of OSCC. Regarding the viruses, our findings suggest that the HPV is involved in an important portion of OSCC cases and that may promote the expression of the nuclear p16, cytoplasmic MYC and COX-2, and suppress the nuclear expression of MLH1. About EBV, it was not detected the EBV-encoded small RNAs (EBERs) in the sample. / O câncer oral representa um sério problema de saúde pública mundial. Entre os tumores deste sítio anatômico, os carcinomas de células escamosas orais (CCEO) respondem por até 94% do total. Os mecanismos moleculares envolvidos na gênese e desenvolvimento tumoral ainda não estão completamente elucidados. Algumas evidências têm sugerido a participação viral neste processo. Além disso, estes tumores ainda carecem de marcadores confiáveis para determinar o perfil de agressividade. Neste contexto, o presente estudo teve como objetivo avaliar a expressão das proteínas p53, E-caderina, COX-2, p16, MLH1 e MYC numa série de CCEO, considerando também a marcação citoplasmática eventualmente observada para as últimas três proteínas, confrontando os resultados entre elas e com as características demográficas e clínico-patológicas. Além de avaliar a prevalência do Papilomavírus Humano (HPV) e do Vírus Epstein-Barr (EBV) na amostra e compará-las com a expressão das referidas proteínas. Materiais e Métodos – Cem espécimes de CCEO, fixados em formalina e incluídos em blocos de parafina, foram submetidos à imunohistoquímica para a detecção das referidas proteínas e à hibridação in situ para detecaçõ de HPV e EBV. Resultados – Foi observada associação referente à perda de expressão concomitante de p16 e MLH1 (p=0,029) e na coexpressão de p53 e COX-2 (p=0,045). Ademais, foi verificado que a COX-2 e o MYC nuclear estavam relacionados com a marcação citoplasmática de MLH1 (p=0,060 e p=0,018; respectivamente). A análise combinada dos marcadores revelou cinco grupos principais de expressão alterada que eram constituídos, em sua maioria, de tumores mais agressivos, principalmente o grupo MLH1(-)/COX-2(+)/p16(-). Os casos com marcação citoplasmática para p16, MLH1 e/ou MYC foram mais frequentes em tumores avançados (p=0,009) e naqueles com metástases em linfonodos (p=0,001). Trinta e um casos demonstraram marcação para HPV em tecido tumoral. O EBV não foi detectado em nenhum dos casos investigados, nem no tecido tumoral nem no epitélio não neoplásico. O grupo HPV(+) exibiu elevada positividade para o p16 nuclear (p=0,029) e MYC cytoplasmático (p=0,039), também uma maior perda de expressão nuclear de MLH1 (p=0,031). Houve ainda uma tendência referente ao aumento da positividade de COX-2 no grupo infectado (p=0,084). Conclusões – As significâncias verificadas entre p16 e MLH1 sugerem que a ausência do membro do sistema de reparo de encaixe (MMR) também favoreça a ocorrência de mutações no gene p16, culminando na inativação deste supressor tumoral. As associações de COX-2 e MYC com o MLH1 de expressão citoplasmática suscitam um mecanismo de bloqueio de entrada de MLH1 no núcleo. A análise combinada das proteínas, bem como, a marcação citoplasmática de p16, MLH1 e MYC, podem representar indicadores úteis na avaliação do perfil de agressividade e, provavelmente, de prognóstico em CCEO. Acerca dos vírus, nossos achados sugerem que o HPV esteja envolvido em uma importante parcela de casos de CCEO e que possa promover a expressão de p16 nuclear, MYC citoplasmático e COX-2, e suprimir a expressão nuclear de MLH1. Quanto ao EBV, não foram detectados EBERs (EBV-encoded small RNAs) na amostra.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-17T23:12:48Z No. of bitstreams: 1 AnaRafaelaDeSouzaTimoteo_TESE.pdf: 3659954 bytes, checksum: d2c8b061166b6be5547b4452cf6fed7b (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-20T21:54:51Z (GMT) No. of bitstreams: 1 AnaRafaelaDeSouzaTimoteo_TESE.pdf: 3659954 bytes, checksum: d2c8b061166b6be5547b4452cf6fed7b (MD5) / Made available in DSpace on 2017-04-20T21:54:51Z (GMT). No. of bitstreams: 1 AnaRafaelaDeSouzaTimoteo_TESE.pdf: 3659954 bytes, checksum: d2c8b061166b6be5547b4452cf6fed7b (MD5) Previous issue date: 2016-12-12 / A S?ndrome de c?ncer de mama e ov?rio heredit?rio corresponde a 10-15% de todos os casos diagnosticados de c?ncer de mama no mundo. A maioria das muta??es germinativas s?o identificadas nos genes BRCA1 e BRCA2, contudo, a aplica??o de pain?is multig?nicos tem aumentado o n?mero de variantes patog?nicas detectadas em outros genes supressores de tumor. De acordo com a vers?o atual do protocolo americano NCCN (National Comprehensive Cancer Network), as muta??es em BRCA1 e BRCA2, TP53 e PTEN conferem alto risco de desenvolver c?ncer de mama, e muta??es em CDH1, CHEK2, PALB2, ATM e BRIP podem aumentar em 20% o risco para o desenvolvimento desta doen?a. Neste estudo foram analisados 157 indiv?duos com hist?rico pessoal e/ou familiar de c?ncer de mama. O DNA gen?mico foi isolado a partir de sangue perif?rico por meio de extra??o ? base de solu??o salina e as amostras foram analisadas usando o sequenciamento de nova gera??o (NGS). Foram identificadas 15 variantes patog?nicas e 4 VUS (Variants of Uncertain Significance) em 27 indiv?duos (27/157; 17%), dos quais tr?s s?o assintom?ticos. Foram identificadas sete novas variantes em 4 genes: BRCA1_c.3409A>G; BRCA2_g.26826_30318del, BRCA2_c.5800C>T; BRCA2_c.5228G>A; BRCA2_c.5305delG; ATM_c.634delT e ATR_c.3043C>T. Sessenta e oito por cento (13/19; 68%) de variantes foi detectada nos genes BRCA1 e BRCA2, enquanto 32% (6/19) foram identificados nos genes de risco moderado ATM (2/19); ATR (1/19); CDH1 (1/19); MLH1 (1/19) e MSH6 (1/19). Os indiv?duos foram separados em dois grupos para a an?lise comparativa: portadores de muta??o nos genes de alto risco e nos genes de risco moderado. Entre os tr?s indiv?duos assintom?ticos, duas variantes est?o presentes nos genes de risco moderado ATM e MLH1. Entre os indiv?duos com c?ncer de mama, dezoito pacientes (18/24; 75%) apresentaram muta??es em genes de alto risco, enquanto seis (6/24; 25%) s?o portadores de muta??es em genes de risco moderado. Ambos os grupos apresentaram alta incid?ncia de c?ncer de mama precocemente (83% dos indiv?duos). O grupo de portadores de muta??o nos genes de alto risco apresentaram maior ocorr?ncia de tumores de alto grau (83% vs 67%, P = 0,0090). No grupo de indiv?duos com muta??es em genes de risco moderado, os tumores apresentaram um fen?tipo mais agressivo com c?ncer bilateral (33% versus 11%, P = 0,0002), ocorr?ncia de met?stases (33% vs 5,6%, P <0,0001) e ?bito (33% vs 5,6%, P <0,0001). Ao todo, 1/3 de variantes foram identificadas em genes de risco moderado em pacientes com c?ncer mais agressivo. Estes resultados refor?am a import?ncia da aplica??o de an?lise multig?nica em indiv?duos em situa??o de risco para c?ncer de mama, especialmente em uma popula??o heterog?nea como brasileira. / Hereditary breast and ovarian cancer (HBOC) corresponds to 10-15% of all diagnosed cases of breast cancer in the world. The majority germline mutations are identified in BRCA1 and BRCA2 genes, however the application of multigene panels has increased the number of pathogenic variations detected in DNA repair genes. According to the current version of NCCN (National Comprehensive Cancer Network) Guideline, mutations in BRCA1, BRCA2, TP53 and PTEN confers high risk to develop breast cancer, and mutations in CDH1, CHEK2, PALB2, ATM and BRIP can increases over than 20% this risk. We analyzed 157 individuals with personal and/or familial breast cancer history. Genomic DNA was isolated from peripheral blood through saline-based extraction and samples were analyzed using next-generation sequencing (NGS). We identified 15 pathogenic variants and 4 VUS (Variants of Uncertain Significance) in 27 individuals (27/157; 17%), in which three are asymptomatic. Seven novel variants in 4 genes were identified: BRCA1_c.3409A>G; BRCA2_g.26826_30318del, BRCA2_c.5800C>T; BRCA2_c.5228G>A; BRCA2_c.5305delG; ATM_c.634delT and ATR_c.3043C>T. Sixty-eight percent (13/19; 68%) of variants was detected in BRCA1 and BRCA2 genes, while 32% (6/19) were identified in moderate risk genes ATM (2/19); ATR (1/19); CDH1 (1/19); MLH1 (1/19) and MSH6 (1/19). The individuals were separated in two groups for comparative analysis: high-risk genes and moderate risk genes. Among three asymptomatic individuals, two present variants in moderate risk genes ATM and MLH1. Among breast cancer individuals, eighteen patients (18/24; 75%) presented mutations in high-risk genes, while six (6/24; 25%) harbored mutations in moderate risk genes. Both groups had a high incidence of early-onset breast cancer, 83%. The group of individuals harboring variants in high-risk genes presented a greater occurrence of high-grade tumors (83% vs. 67%, P= 0.0090). In the group of individuals harboring mutation in moderate risk genes, tumors presented a more aggressive phenotype with bilateral cancer (33% vs. 11%, P= 0.0002), occurrence of metastasis (33% vs. 5.6%, P<0.0001) and incidence of deaths (33% vs. 5.6%, P<0.0001). Altogether, 1/3 of variants were identified in moderate risk genes in patients presenting a more aggressive phenotype. These results reinforce the importance of applying multigene analysis in individuals at-risk for breast cancer, especially in a heterogeneous population as Brazilian.