Yes / Malignant pleural mesothelioma (MPM) is associated with an extremely poor prognosis, and most patients initially are or rapidly become unresponsive to platinum-based chemotherapy. MicroRNA-31 (miR-31) is encoded on a genomic fragile site, 9p21.3, which is reportedly lost in many MPM tumors. Based on previous findings in a variety of other cancers, we hypothesized that miR-31 alters chemosensitivity and that miR-31 reconstitution may influence sensitivity to chemotherapeutics in MPM. Reintroduction of miR-31 into miR-31 null NCI-H2452 cells significantly enhanced clonogenic resistance to cisplatin and carboplatin. Although miR-31 re-expression increased chemoresistance, paradoxically, a higher relative intracellular accumulation of platinum was detected. This was coupled to a significantly decreased intranuclear concentration of platinum. Linked with a downregulation of OCT1, a bipotential transcriptional regulator with multiple miR-31 target binding sites, we subsequently identified an indirect miR-31-mediated upregulation of ABCB9, a transporter associated with drug accumulation in lysosomes, and increased uptake of platinum to lysosomes. However, when overexpressed directly, ABCB9 promoted cellular chemosensitivity, suggesting that miR-31 promotes chemoresistance largely via an ABCB9-independent mechanism. Overall, our data suggest that miR-31 loss from MPM tumors promotes chemosensitivity and may be prognostically beneficial in the context of therapeutic sensitivity.

全文データ差替え待ち / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20268号 / 医博第4227号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 道行, 教授 武藤 学, 教授 原田 浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DAM

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京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13292号 / 論社医博第13号 / 新制||社医||10(附属図書館) / (主査)教授 川上 浩司, 教授 平井 豊博, 教授 伊達 洋至 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Le mésothéliome pleural malin (MPM) est une tumeur primitive de la plèvre, rare, très agressive, avec un pronostic sombre. Nous avons souhaité au cours de ce travail de thèse, identifier de nouveaux biomarqueurs du MPM en testant l’influence de l’inactivation des membres de la famille RASSF/Hippo sur la survie des 448 patients inclus dans l’essai clinique MAPS (IFCT-GFPC-0701). Nous souhaitions également comprendre quelles fonctions et signalisations essentielles à l’homéostasie cellulaire, auxquelles participe la voie de signalisation RASSF/Hippo, sont perturbées lors du processus de transformation des cellules mésothéliales. L’inactivation des membres de la voie a été étudiée par PCR spécifique de méthylation (MS-PCR) et leur influence sur la survie des 448 patients inclus dans l’essai clinique MAPS testée en analyse uni- et multivariée avant d’être validée par boostrap. D’autre part, nous avons mimé in cell, l’inactivation par ARN interférence de plusieurs membres de la voie Hippo dans des cellules de lignées mésothéliales humaines (MSTO-211H, H2452, H28 et H2052). Nous avons pu identifier plusieurs biomarqueurs du MPM : i) la kinase MST1 dont l’inactivation est un facteur de mauvais pronostic, ii) l’amphiréguline dont l’expression cytoplasmique est au contraire un facteur de bon pronostic et enfin iii) le CD44 dont l’expression élevée constitue un outil diagnostique du MPM. Les approches in cell, nous ont permis de démontrer que les altérations de la voie RASSF/Hippo induisent une activité inappropriée de l’effecteur terminal YAP : le moins bon pronostic des patients présentant une inactivation de MST1 s’explique ainsi par le fait qu’en régulant l’activité de YAP, MST1 contrôle la balance apoptose/prolifération et prévient l’invasion et la croissance sans adhésion. En son absence, ces processus cellulaires sont dérégulés. Ce travail démontre l’importance de l’axe CD44/RASSF1A/MST1 dans le contrôle d’une activité appropriée de YAP et de l’homéostasie des cellules mésothéliales. La compréhension des désordres cellulaires induits par la dérégulation de le voie RASSF/Hippo, désigne YAP comme cible thérapeutique potentielle chez les patients atteints de MPM et présentant des altérations de cette voie de signalisation. / Malignant pleural mesothelioma (MPM) is a rare, very aggressive, primary tumor with a poor prognosis. During this thesis, we wanted to identify new biomarkers of MPM by testing the influence of the RASSF/Hippo pathway inactivation on the survival of the 448 patients included in the clinical trial MAPS (IFCT- GFPC-0701). We also wanted to understand which functions and signals essential to cellular homeostasis, linked to RASSF/Hippo signaling pathway, are disturbed during the mesothelial cell transformation process. Inactivation of RASSF/Hippo members was studied by methylation-specific PCR (MS-PCR) and their influence on the survival of the 448 patients included in the MAPS clinical trial tested in uni- and multivariate analysis before being validated by bootstrap. We also mimed in cell, by RNA interference, several members of the Hippo pathway inactivation in human mesothelial cells lines (MSTO-211H, H2452, H28 and H2052). We have identified several biomarkers of MPM: i) MST1 kinase whose inactivation is a factor of poor prognosis, ii) amphiregulin whose cytoplasmic expression is on the contrary a factor of good prognosis and finally iii) CD44 whose high expression is a diagnostic tool for MPM. In cell we demonstrate that RASSF/Hippo pathway alterations induce an inappropriate activity of YAP, one Hippo end effector: the poorer prognosis of patients with inactivation of MST1 is thus explained by the fact that, by regulating YAP activity, MST1 controls the apoptosis/proliferation balance and prevents invasion and growth without adhesion from mesothelial cells. In its absence, these cellular processes are deregulated. This work finally demonstrates the importance of the CD44/RASSF1A/MST1 axis in controlling appropriate YAP activity and mesothelial cell homeostasis. The understanding of the cellular disorders induced by the of the RASSF/Hippo pathway deregulation designates YAP as a potential therapeutic target in patients with MPM and presenting alterations of this signaling pathway.

Introduction Pleural mesothelioma constitutes about 80% of all mesotheliomas. The peak incidence of malignant mesothelioma estimated using the cancer registries was in early 1990 to 2000 in the United States. The disease is primarily associated with asbestos exposure. The latency period between asbestos exposure and the development of malignant pleural mesothelioma (MPM) can range anywhere from 15 to 60 years. Asbestos exposure was peaked during the industrial revolution and World War II due to military and shipyard exposures. It is often difficult for the pathologist to distinguish different histological subtypes; due to the disease's rarity and the inadequate tissue sample obtained. There is no available data on the difference in epidemiology of different subtypes of MPM. Surveillance Epidemiology and End Results (SEER), cancer incidence data include population-based registries covering approximately 34.6% of the U.S. population. Here in our study, we analyze malignant pleural mesothelioma epidemiology in the United States, emphasizing different histological subtypes. Methods SEER data from 2000 to 2016 was used in our study. The primary site of cancer is selected as pleura, and malignant behavior only is selected as the filter. Data were analyzed using the SEER stat program. Overall epidemiology of MPM and epidemiology of epithelioid, fibrous, and biphasic histological subtypes were analyzed separately. We used annual percentage change (APC) to evaluate the trend in the epidemiology of MPM. Results summary A total of 11,857 cases of MPM were included in the primary cohort from the SEER 18 registry from 2000 to 2016. The total prevalence of MPM was highest in 2009 and was lowest in 2016. The APC in MPM incidence during this period is -2.0. After removing 5,989 cases with non-specified histology during the same period, the APC for each histological type is -0.7 for fibrous type, 1.8 for epithelioid type, and 2.9 for biphasic type. Out of 17 regional registries included in the study, the greatest statistically significant change in APC was seen in the Hawaiian registry -4.1. In contrast, the lowest statistically significant difference was seen in Seattle (Puget Sound) registry -1.7. The APC in the incidence of MPM among males during the study period was -2.4 while that of females was -0.9. The Iowa registry showed a statistically significant increase in APC of the epithelioid malignant mesothelioma with a statistically insignificant reduction in the overall MPM APC. Conclusion The overall incidence of MPM in the United States is declining, while the data showed an increase in the incidence of epithelioid and biphasic histological subtypes. The authors believe that these conflicting results can be attributed to improved histological diagnosis and improved biopsy techniques.

Le mésothéliome pleural malin (MPM) est un cancer au pronostic sombre, en lien avec des traitements décevants. Quand la chirurgie fait partie d’un traitement multimodal, il est essentiel de l’associer avec un traitement adjuvant local pour tuer les cellules tumorales résiduelles. Récemment, la thérapie photodynamique (PDT) intrapleurale intra-opératoire, après exérèse tumorale chirurgicale, est apparue comme un traitement prometteur. Son succès repose sur l’illumination la plus complète et homogène de la cavité pleurale, contrôlée par une dosimétrie de lumière. Celle utilisée aujourd’hui en pratique clinique aux Etats-Unis repose sur la dosimétrie ponctuelle de sept capteurs intrathoraciques, mais ne permet pas d’avoir un reflet de la lumière délivrée sur l’ensemble des surfaces pleurales. Mon projet de recherche se décline sur un axe clinique et un axe expérimental : 1) mettre en place un essai de clinique de phase II au CHRU de Lille, associant la PDT intrapleurale au traitement multimodal du MPM, 2) développer une méthode de dosimétrie de lumière peropératoire innovante par la caractérisation du dispositif lumineux et l’utilisation de l’imagerie.L’essai clinique a démarré en Février 2016, en utilisant la dosimétrie de référence avec les sept capteurs en suivant le protocole américain. Une baguette lumineuse innovante a été conçue au laboratoire, ainsi que le système de dosimétrie. Quatre patients ont bénéficié d’une pleurectomie/décortication suivie d’une PDT intrapleurale (avec le photosensibilisateur Photofrin®) et d’une chimiothérapie adjuvante, sans toxicité majeure. Concernant le projet expérimental, un profil d’illumination de la baguette lumineuse a été défini en combinant les mesures de puissance ponctuelles (Watt) et celles de pixel à partir d’une photographie digitale. Un coefficient d’atténuation effectif a été calculé : µeff = 0,705 cm-1. A l’aide d’un système de repérage spatial électromagnétique (TrackStar®), la position de la baguette lumineuse est connue à l’intérieur de la cavité pleurale en temps réel, et ses coordonnées spatiales sont projetées sur le TDM thoracique en 3D. Après avoir intégré le profil d’illumination de la baguette au système de repérage, un logiciel dédié permet la représentation spatiale sur imagerie de la dose cumulée de lumière délivrée. Ce travail a été réalisé et validé sur un fantôme de cavité thoracique intra opératoire, puis notre méthode de dosimétrie a été comparée à celle de référence.Les perspectives sont de pouvoir tester la faisabilité cette nouvelle méthode de dosimétrie chez l’homme et de développer des dispositifs lumineux innovants pour une meilleure standardisation de la PDT pour le MPM. / Malignant pleural mesothelioma (MPM) is a cancer with a poor prognosis due to deceiving treatments. When surgery is part of a multimodal treatment for MPM, it is crucial to combine it with a local adjuvant treatment to kill residual tumour cells. Recently, intrapleural photodynamic therapy (PDT) after surgical resection has appeared to be a promising treatment for MPM. Its success relies essentially on the most complete and homogeneous illumination of the pleural cavity, monitored by light dosimetry. The dosimetry method used today in the United States, with intrathoracic probes collecting the light at 7 strategic locations, does not give information about the light delivered on the whole pleural surface. This research project has a clinical and experimental axis: 1) to set up a phase II clinical trial in Lille University Hospital, combining intrapleural PDT to surgery within a multimodal treatment, 2) to develop an innovative peroperative light dosimetry method by the characterization of a light device and use of imaging.Clinical trial has started in February 2016, with the seven probes dosimetry method of reference, following the American protocol. An innovative light wand was conceived within the laboratory, as well as the dosimetry sytem. Four patients have undergone pleurectomy/decortications, intrapleural PDT (with photosensitizer Photofrin®) and adjuvant chemotherapy, without major toxicity. Regarding the experimental project, an illumination profile of the light wand was defined using two complementary methods: power measurements (Watt) and pixel intensity from digital photography. An effective attenuation coefficient was calculated: µeff = 0.705 cm-1. With an electromagnetic spatial tracking system (TrackStar®), we localized in real time the position of the light wand within the pleural cavity and projected its spatial coordinates to the 3D CT scan images. After having inserted the illumination profile of the light wand to the tracking system, a dedicated software allowed the spatial representation on CT images of the cumulated light dose. This work has been completed on an intraoperative thoracic cavity phantom. Our dosimetry method was validated on this phantom and compared to the one of reference.The perspectives are to test the feasibility of this new dosimetry method in humans, and to develop alternative light devices for a better standardization of the intrapleural PDT technique for MPM.

Le mésothéliome pleural malin (MPM) est une tumeur rare et agressive qui se développe au niveau de la plèvre.L'Adrénomedulline (AM) est un peptide de 52 acides aminés. Il intervient dans plusieurs processus physiologiques et physiopathologiques. Il est surexprimé dans plusieurs tumeurs où il joue un rôle important dans la croissance tumorale.Dans un premier temps nous avons montré que l'AM et ses récepteurs sont exprimés dans des biopsies de patients atteints de MPM suggérant son implication dans la croissance tumorale du MPM. In vitro l'incubation de lignées de MPM: H2452 et MSTO_211H avec des anticorps αAM ou αAMR inhibent la prolifération, l'invasion et la migration cellulaires. In vivo, le traitement avec un anticorps αAM ou l'antagoniste AM22-52, inhibe la croissance tumorale des xénogreffes de MSTO_211H par rapport au groupe contrôle. L'analyse histologique montre une augmentation significative de l'apoptose et une diminution importante de la vascularisation chez les tumeurs traitées par rapport aux tumeurs contrôles. Ces résultats démontrent le rôle important joué par l'AM dans la croissance tumorale du MPM et fait du système de l'AM une cible thérapeutique potentielle.Dans un deuxième temps, Nous avons émis l'hypothèse de la transactivation de l'EGFR par l'AM. Notre hypothèse s'est concrétisée dans la mesure où L'inhibition de l'EGFR par un inhibiteur spécifique l'AG1478 abolie l'activation de ERK par l'AM,La phosphorylation de l'EGFR par l'AM,La neutralisation de l'EGFR avec son propre anticorps inhibe la phosphorylation par l'AM suggérant une activation ligand dépendante. Ces résultats nous permettent de mieux comprendre le mécanisme d'action de l'AM. / Malignant pleural mesothelioma (MPM) grows aggressively in the thoracic cavity without curative possibilities, underlining the need for new therapeutic targets. Adrenomedullin (AM), a multifunctional peptide, is highly expressed in several tumors and plays an important role in angiogenesis and tumor. In the first part of our work, QRT-PCR showed an increase of AM mRNA levels in MPM when compared to normal pleura tissue. Immunohistochemically, AM and its receptors were localized in the carcinomatous epithelial compartment of MPM. The MPM cell lines H2452 and MSTO_211H expressed AM with a significant increase under hypoxia. The proliferation, migration and invasion of MPM cells are decreased by anti-AM and anti-AM receptors antibodies (αAM and αAMR) supporting that MPM cells can be regulated by AM. In vivo, αAM and AM22-52 antagonist therapies of MSTO_211H xenografts blocked angiogenesis and stimulated apoptosis, resulting in tumor regression. Histologic examination of treated tumors showed evidences of disruption of tumor vasculature. These findings highlight the implication of the AM pathway in the MPM growth and in neovascularization by supplying/amplifying signals essential for pathologic neoangiogenesis and lymphangiogenesis.In the second part of this work, we reported that the EGFR becomes rapidly tyrosine-phosphorylated upon stimulation of lung cancer cells lines with AM, suggesting that there is an intracellular mechanism for transactivation. Specific inhibition of EGFR function by the AG1478 or EGFR blocking antibody suppressed MAPK activation. These results suggest strongly a ligand-dependent mechanism of EGFR transactivation by AM.

Malignant pleural mesothelioma (MPM) is a form of aggressive tumour that is almost always associated with prior exposure to asbestos. Currently responsible for over 47,000 deaths worldwide each year and rising, it poses a serious threat to global public health. Many clinical studies of MPM, including its diagnosis, prognostic planning, and the evaluation of a treatment, necessitate the accurate quantification of tumours based on medical image scans, primarily computed tomography (CT). Currently, clinical best practice requires application of the MPM-adapted Response Evaluation Criteria in Solid Tumours (MPM-RECIST) scheme, which provides a uni-dimensional measure of the tumour's size. However, the low CT contrast between the tumour and surrounding tissues, the extensive elongated growth pattern characteristic of MPM, and, as a consequence, the pronounced partial volume effect, collectively contribute to the significant intra- and inter-observer variations in MPM-RECIST values seen in clinical practice, which in turn greatly affect clinical judgement and outcome. In this thesis, we present a novel computer-assisted approach to evaluate MPM patient response to treatments, based on the volumetric segmentation of tumours (VTA) on CT. We have developed a 3D segmentation routine based on the Random Walk (RW) segmentation framework by L. Grady, which is notable for its good performance in handling weak tissue boundaries and the ability to segment any arbitrary shapes with appropriately placed initialisation points. Results also show its benefit with regard to computation time, as compared to other candidate methods such as level sets. We have also added a boundary enhancement regulariser to RW, to improve its performance with smooth MPM boundaries. The regulariser is inspired by anisotropic diffusion. To reduce the required level of user supervision, we developed a registration-assisted segmentation option. Finally, we achieved effective and highly manoeuvrable partial volume correction by applying a reverse diffusion-based interpolation. To assess its clinical utility, we applied our method to a set of 48 CT studies from a group of 15 MPM patients and compared the findings to the MPM-RECIST observations made by a clinical specialist. Correlations confirm the utility of our algorithm for assessing MPM treatment response. Furthermore, our 3D algorithm found applications in monitoring the patient quality of life and palliative care planning. For example, segmented aerated lungs demonstrated very good correlation with the VTA-derived patient responses, suggesting their use in assessing the pulmonary function impairment caused by the disease. Likewise, segmented fluids highlight sites of pleural effusion and may potentially assist in intra-pleural fluid drainage planning. Throughout this thesis, to meet the demands of probabilistic analyses of data, we have used the Non-Parametric Windows (NPW) probability density estimator. NPW outperforms the histogram in terms of its smoothness and kernel density estimator in its parameter setting, and preserves signal properties such as the order of occurrence and band-limitedness of the sample, which are important for tissue reconstruction from discrete image data. We have also worked on extending this estimator to analysing vector-valued quantities; which are essential for multi-feature studies involving values such as image colour, texture, heterogeneity and entropy.