Diversas neoplasias podem atingir o sistema nervoso central e dentre elas, os tumores cerebrais são os mais prevalentes. Dentre todos os tumores cerebrais, dois merecem especial atenção: gliomas e meduloblastomas, por serem os mais recorrentes em adultos e crianças, respectivamente. O alfa-bisabolol é um pequeno álcool sesquiterpeno oleoso, que apresenta diversas atividades biológicas dentre elas, citotoxicidade. Apesar dos diversos estudos com essa molécula, pouco se sabe das atividades biológicas de seu análogo natural, o óxido de bisabolol A. Além disso, o sistema purinérgico tem sido relacionado com progressão e desenvolvimento tumoral. Assim, o objetivo deste trabalho foi avaliar os efeitos de dois promissores novos agentes quimioterápicos (alfa-bisabolol e óxido de bisabolol A) e correlacionar esses efeitos com possíveis modulações do sistema purinérgico, que é considerado um novo alvo terapêutico em linhagens de glioma e meduloblastoma. Nós observamos que a atividade da ecto-5’-nucleotidase, importante enzima do sistema purinérgico, é aumentada tanto em linhagens de glioma quanto de meduloblastoma quando estas são tratadas com alfa-bisabolol. Vimos também que esse aumento na atividade deu-se por um efeito direto do tratamento sob a enzima, com uma redução da expressão do mRNA da ecto-5’-nucleotidase em linhagem de glioma e sem alteração no imunoconteúdo dessa enzima em linhagens de meduloblastoma. Em linhagens de glioma, adicionalmente, a atividade citotóxica do alfa-bisabolol foi correlacionada com estímulo ao receptor de adenosina A3. Ainda, as linhagens estudadas foram sensíveis aos tratamentos com alfa-bisabolol e óxido de bisabolol A. Em conclusão, os dados obtidos nesse trabalho demonstram que tanto o alfabisabolol quanto o óxido de bisabolol A são interesseantes novas possibilidades terapêuticas para os tumores cerebrais e que a atividade citotóxica do primeiro composto envolve modulação do sistema purinérgico. Mais estudos são necessários para entender a efetividade desses tratamentos in vivo e se o tratamento com o óxido de bisabolol A também modula o sistema purinérgico. / Among all the cancers that can affect the central nervous system, the brais tumors are the most prevalent. Two of this tumors deserve special attention: glioma and medulloblastoma once they are the most prevalent in adults and children respectively. Alpha-bisabolol is a small oily sesquiterphene alcohol that presents diverse biological activities, among them, citotoxicity. In despite of the diverse studies using this molecule, little is known about the biological activities of its natural analogue bisabolol oxide A. Besides, the purinergic system has been related to tumor development and progression. Therefore, the objective of this work was to evaluate the effect of two new promising chemotherapic agents (alpha-bisabolol and bisabolol oxide A) and correlate this effects with possible modulations of the purinergic system which is considered an interesting therapeutical target to glioma and medulloblastomas. We observed that the activity of ecto-5’-nucleotidase, an important enzyme of the purinergic system, is increased in both glioma and medulloblastoma cell lines when the cells are treated with alpha-bisabolol. It was also observed that this increase on activity was due to and direct effect of this treatment in the enzyme. Also, the treatment lead to a reduction on mRNA level of ecto-5’- nucleotidase on glioma cell line and no alterations on the imunocontent of the enzyme was observed on medulloblastoma cell lines. Additionally, the citotoxic activity of alpha-bisabolol on glioma cell line was correlated with modulation on A3 adenosine receptor. Moreover, the cell lines used in this work were sensible to the treatments with alpha-bisabolol and bisabolol oxide A. In a conclusion, the data obtained in this work demonstrate that alpha-bisabolol and bisabolol oxide A are both interesting new therapeutical possibilities to brain tumors and the citotoxic activity of the first compound is related with modulations on the purinergic system. More studies are needed to better understand the effectiveness of these treatments in vivo and if the compound bisabolol oxide A also promotes a modulation on the purinergic system.

Câncer é a principal causa de morte nos países desenvolvidos e a segunda causa de morte nos países em desenvolvimento. O trabalho de diversos grupos de pesquisa tem sugerido que os tumores estão organizados em uma hierarquia de células, na qual uma pequena fração apresenta propriedades de células-tronco. Essas células tem se mostrado resistentes à quimioterapia convencional, dependentes da sinalização do microambiente tumoral e responsivas à terapia diferenciativa. Aqui nós mostramos que butirato sódico (NaB), um inibidor de desacetilase de histonas, diminui a proliferação celular e a formação de colônias em linhagens celulares de meduoblastoma humano. Estes efeitos foram acompanhados de um aumento da expressão de RNAm Gria2, um marcador de diferenciação neuronal, em duas das três linhagens celulares testadas. A formação de neuroesferas também foi impedida com a exposição de uma linhagem crescida em meio de cultura apropriado para células-tronco e NaB. NaB se mostrou capaz de potencializar os efeitos do quimioterápico etoposídeo e do fator neurotrófico derivado de cérebro (BDNF) na inibição da viabilidade celular de meduloblastoma. Além disso, nós observamos que o tratamento com cisplatina aumenta a proporção de células-tronco tumorais (CTT), identificadas por ALDH+CD44+, em células de carcinoma de cabeça e pescoço, quando tratadas também com interleucina 6 (IL-6), uma citocina liberada pelo nicho perivascular. O mesmo tratamento promoveu a proliferação, sobrevivência e auto-renovação de CTTs in vitro ao aumentar o número de esferas em placas de baixa aderência e a expressão de Bmi-1 em western blots. A fosforilação do transdutor de sinal e ativador de transcrição 3 (STAT3), um indicativo de propriedades de CTTs, induzida por IL-6 não foi afetada pelo tratamento com cisplatina em células de HNSCC, enquanto que a indução de fosforilação de quinases reguladas por sinais extracelulares (ERK), indicativo de processo de diferenciação, por IL-6 foi parcialmente inibido por cisplatina. Células resistentes a baixas doses de cisplatina também expressaram mais Bmi-1 do que células nunca expostas ao quimioterápico. Experimentos in vivo corroboram os achados in vitro, uma vez que tumores humanos induzidos em camundongos imunocomprometidos apresentaram aumentada proporção de células ALDH+CD44+ após tratamento dos animais com cisplatina. O anticorpo contra o receptor de IL-6 foi capaz de reverter a indução de expressão de Bmi-1 por cisplatina e IL-6. Em conjunto, esses resultados sugerem que a modulação de mecanismos epigenéticos das células tumorais e de sinais provenientes do nicho tumoral são novos alvos promissores para o desenvolvimento de terapias adjuvantes contra o câncer. / Cancer is the leading cause of death in economically developed countries and the second cause of death in developing countries. Work from a number of laboratories strongly suggests that tumors are organized as a hierarchy based on a subset of cancer cells that have stem-cell properties. These cells have been shown to be resistant to conventional therapy, dependent on contextual signals within the tumor microenvironment and, to be responsive to differentiation therapy. Here we show that sodium butyrate (NaB), a histone deacetylase inhibitor, decreases cell proliferation and colony formation in human medulloblastoma cell lines. These effects were accompanied by an increased mRNA expression of Gria2, a neuronal differentiation marker, in two out of three cell lines tested. In addition, neurosphere formation was impaired by NaB exposure in a cell line submitted to stem cells proper media. NaB also may potentiate the effect of etoposide chemotherapy and BDNF (Brain-derived neurotrophic factor) on the inhibition of medulloblastoma cells viability. Moreover, we observed that cisplatin treatment increased the proportion of cancer stem cells (CSC), identified by ALDHhighCD44high cells, in head and neck squamous cell carcinoma (HNSCC), when treated together with recombinant human IL-6 (rhIL-6). The same regimen promoted proliferation, self-renewal and survival of CSC in vitro as seen by the increase in orosphere number formed in ultra-low attachment plates, and Bmi-1 expression induction in western blots. IL-6–induced signal transducer and activator of transcription 3 (STAT3) phosphorylation (indicative of stemness) was unaffected by treatment with cisplatin in HNSCC cells, whereas IL-6–induced extracellular signal-transducer kinases (ERK) phosphorylation (indicative of differentiation processes) was partially inhibited by cisplatin. Cells resistant to lower doses of cisplatin also expressed more Bmi-1. In vivo experiments corroborated in vitro findings by showing increased proportion of ALDH highCD44high cells in xenograft tumors of mice treated with cisplatin. An antibody against the receptor of IL-6 was able to revert the induction of Bmi-1 expression seen in cells treated with cisplatin plus IL-6. Taken together, these results suggest that the modulation of the epigenetic states of the cancer cell and modulation of signals provided by the niche are promising new molecular targets for the development of adjuvant therapy for cancer.

Meduloblastoma é um tumor embrionário maligno e invasivo do cerebelo, com manifestação preferencial em crianças, sendo predominantemente de diferenciação neuronal e tendência natural a metastatização por via liquórica. O gene da b-catenina (CTNNB1) está localizado no cromossomo 3p22-p21-3, sendo seu produto uma proteína citoplasmática de 92 kDa, envolvida na adesão celular e na transdução de sinal durante a embriogênese e morfogênese tecidual. A fosforilação da b-catenina é necessária para sua degradação, evitando a associação com o fator de transcrição Tcf (fator de célula T), responsável pela ativação de genes, cujos produtos promovem a proliferação celular. Estudos têm demonstrado a presença da b-catenina no núcleo das células de tumorais, um achado inesperado, pois, tratando-se de uma proteína envolvida na adesão celular, sua expressão seria esperada na membrana celular. Subseqüentemente foram descritas mutações no exon 3 do gene da b-catenina, envolvendo sítios de fosforilação. Este estudo teve como objetivo analisar em meduloblastomas: mutações no gene CTNNB1, o acúmulo da proteína b-catenina, bem como correlacionar ambos os achados entre si e com o tipo histológico e analisar os níveis de expressão relativa de genes envolvidos na via WNT (CTNNB1, AXIN1, WNT1 e APC) e correlaciona-los com o tipo histológico, idade e dados de mutação de CTNNB1 e acúmulo de b-catenina. As amostras de DNA foram extraídas de 67 casos de meduloblastomas. A análise de alterações no exon 3 de CTNNB1 foi realizada pela reação em cadeia da polimerase (PCR) e seqüenciamento direto. A expressão da b-catenina foi analisada pela técnica de imunohistoquímica (IHQ). As análises de expressão relativa de CTNNB1, AXIN1, WNT1 e APC foram realizadas pelo método de PCR quantitativo em tempo real (RQ-PCR) em 31 amostras de meduloblastomas. A freqüência de mutações do exon 3 de CTNBB1 foi de 15%. Foram identificadas 6 mutações missense e em heterozigose em 10 casos: troca de G por A (Asp32Asn) em um caso, troca de C por A (Ser34Tir) em quatro casos, troca de C por G (Ser33Cis) em dois casos, troca G por A (Gli34Arg) em um caso, troca de G por T (Gli34Glu) em um caso e troca de C por A (Ser37Tir) em um caso. Foi observada uma imunorreatividade de ß-catenina no núcleo em 36,4% dos casos analisados. No citoplasma, a ß-catenina estava presente em todos os casos. Não houve correlação entre o tipo histológico e os dados qualitativos e semi-quantitativos de IHQ. Também não houve correlação entre o tipo histológico com os achados de mutações. Não foi observada diferença nos níveis de expressão dos genes CTNNB1, AXIN1 e APC nos meduloblastomas em relação ao tecidos cerebelares não tumorais. Na análise de expressão relativa e a classificação histológica, apenas APC apresentou diferença entre o tipo clássico com o desmoplásico. Não houve diferença dos níveis de expressão relativa em nenhum dos genes com relação à idade do paciente. A presença de mutações de CTNNB1 não afetou a expressão relativa de CTNNB1 e APC. Por outro lado, AXIN1 apresentou uma maior expressão relativa nos casos com mutação. APC apresentou uma menor expressão quanto maior o acúmulo de b-catenina no núcleo. Os dados indicam que outras proteínas da via WNT podem estar envolvidas no acúmulo de b-catenina nas células de meduloblastomas, além do envolvimento de outras diferentes vias. / Medulloblastoma is a malignant invasive embryonal tumor of the cerebellum with a preferential manifestation in children, being predominantly with neuronal differentiation, and a natural tendency to metastasize through spinal fluid pathways. b-catenin gene (CTNNB1) is localized at chromosome 3p22-p21.3 and codifies a cytoplasmatic protein of 92 kDa, involved in cellular adhesion and signal transduction during embriogenesis and tissue morphogenesis. b-catenin phosphorylation is necessary for its degradation, avoiding association with Tcf (T cell factor), responsible for activation of some genes, whose products promote cellular proliferation. Studies have demonstrated the presence of b-catenin in the nucleus of tumoral cells, an unexpected finding because it is a protein involved in cellular adhesion and its normal localization is at the cellular membrane. Subsequentially, mutations in the phosphorylation sites, localized at the exon 3 of b-catenin gene, have been described. The aims of this study were to analyze in medulloblastomas: CTNNB1 gene mutations, the protein b-catenin accumulation, as well as to correlate both findings between them and with the histological type and to analyze the relative expression levels of genes involved in the WNT pathway (CTNNB1, AXIN1, WNT1 and APC). DNA samples were extracted from 67 cases of medulloblastoma. Alterations of CTNNB1 exon 3 were analyzed by polymerase chain reaction (PCR) and direct sequencing. The expression of the protein b-catenin was assessed by immunohistochemistry (IHC). The relative expression analyses of CTNNB1, AXIN1, WNT1 and APC were determined by quantitative real time PCR (RQ-PCR) in 31 medulloblastoma samples. The frequency of CTNBB1 exon 3 mutations in the CTNNB1 was 15%. We identified six missense heterozygous mutations in ten cases: a G to A change (Asp32Asn) in one case, a C to A change (Ser34Tyr) in four cases, a C to G change (Ser33Cys) in two cases, a G to A change (Gly34Arg) in one case and a G to T change (Gly34Glu) in one case and a C to A change (Ser37Tyr) in one case. It was observed b-catenin immunoreactivity in the nucleus in 36.4% of all cases analyzed. In the cytoplasm, the ß-catenin was present in all the cases. No correlation between histological type and IHQ qualitative and semi-quantitative. Also, there was no correlation between histological type and mutations. No difference in the expression levels of the genes CTNNB1, AXIN1 and APC were observed in medulloblastomas in relation to normal cerebellum samples by QT-PCR analysis. In the analysis of relative expression and the histological classification, only APC presented significant difference between classic and desmoplastic type. There was no difference of the relative expression levels of any gene with the patient?s age. The presence of CTNNB1 mutations did not affect the relative expression of CTNNB1 and APC. On the other hand, AXIN1 presented a higher relative expression in the cases with mutation. APC expression level was lower when b-catenin nuclear accumulation was higher. Our data indicate that other proteins of WNT pathway can be involved in b-catenin accumulation in medulloblastoma cells, as well as the involvement of other different pathways.

INTRODUÇÃO: O meduloblastoma, tumor maligno do Sistema Nervoso Central mais comum em crianças, foi inicialmente descrito de forma uniforme em 1925 por Bailey e Harvey Cushing. A despeito do avanço diagnóstico e terapêutico, os índices de morbimortalidade persistem altos. Grupos epidemiologicamente semelhantes podem ter desfechos diferentes, e evoluções desfavoráveis ocorrem em pacientes com marcadores de bom prognóstico. Os avanços nas pesquisas em biologia molecular procuram explicar os diferentes comportamentos da doença, e de forma sistemática, buscam identificar genes que sirvam como alvos terapêuticos, já que o tratamento disponível atualmente ainda é bastante insatisfatório e com muitos efeitos colaterais. Simeone e colaboradores identificaram os genes OTX1 e OTX2, presentes em humanos, e cuja função é organizar, compartimentalizar e hierarquizar a formação do sistema nervoso central, especialmente o cerebelo. Os genes OTX1 e OTX2 são expressos no tecido cerebelar em humanos até a nona semana de vida extra-uterina, exclusivamente. Os mesmos autores também identificaram que os mesmos genes são alvo terapêutico do ácido transretinóico, que inibe a expressão gênica. Estudos prévios demonstraram a expressão dos genes OTX1 e OTX2 em meduloblastomas, o que torna o ácido uma potencial terapêutica para estes tumores, assim como os genes OTX1 e OTX2 potenciais alvos para desenvolvimento de novas drogas terapêuticas. OBJETIVOS: Estudar a prevalência dos genes OTX1 e OTX2 em uma amostra de 60 pacientes, e estabelecer correlações entre a expressão gênica e aspectos clínicos, patológicos e de evolução. CASUÍSTICA E MÉTODO: Realizada análise retrospectiva de 60 pacientes com diagnóstico meduloblastoma, operados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e no Hospital do Câncer de Barretos. Organizado um banco de dados de 60 pacientes contendo dados da expressão gênica dos genes OTX1 e OTX2 (obtida através da técnica de PCR em tempo real) e dados clínico-epidemiológicos. Realizados testes estatísticos para se estabelecer correlação entre dados clínico-patológicos e de expressão gênica. RESULTADOS: O gene OTX1 foi expresso em 52% da população estudada, e tal expressão variou com a idade (sendo maior em adultos), localização (preferência por hemisfério) e tipo histológico (desmoplásico). O gene OTX2 foi expresso em 62% da população estudada, e tal expressão variou com a idade (sendo maior quanto menor a faixa etária), localização (preferência por vérmis) e tipo histológico (clássico). Houve correlação estatística entre a expressão do gene OTX2 e o desenvolvimento de metástases leptomeníngeas. CONCLUSÕES: Na população estudada, a expressão dos genes OTX1 e OTX2 corrobora a impressão de seu papel importante na patogênese dos meduloblastomas, e é dependente da idade do paciente, da localização tumoral e do tipo histológico. Dada a sensibilidade do gene ao ácido transretinóico, a identificação deste perfil populacional pode significar no futuro novas perspectivas de tratamento. / INTRODUCTION: Medulloblastoma, the most common malignant tumor of the central nervous system in children, was first uniformly described in 1925 by Bailey and Harvey Cushing. Despite the diagnostic and therapeutic advances, the morbidity and mortality rates remain high. Epidemiologically similar groups may have different outcomes, and adverse developments occur in patients with markers of good prognosis. Advances in molecular biology research seeks to explain the different behaviors of the disease, and consistently seek to identify genes that serve as drug targets, since the treatment currently available is still unsatisfactory and with many side effects. Simeone and colleagues identified genes OTX1 and OTX2 in humans, and whose function is to organize, prioritize and compartmentalize the formation of the central nervous system, especially the cerebellum. OTX1 and OTX2 genes are expressed in cerebellar tissue in humans until the ninth week of extra uterine life, exclusively. The same authors also found that the same genes are therapeutic target of trans-retinoic acid, which inhibits gene expression. Previous studies have demonstrated the expression of OTX1 and OTX2 genes in medulloblastomas, which makes the acid a potential therapy for these tumors, as well as the genes OTX2 and OTX1 potential targets for developing new therapeutic drugs. OBJECTIVES: To study the prevalence of OTX1 and OTX2 genes in a sample of 60 patients, and to establish correlations between gene expression and clinical, pathological and follow up aspects. CASUISTICS AND METHODS: A retrospective analysis of 60 patients diagnosed with medulloblastoma, assisted at Hospital of the Faculty of Medicine, University of São Paulo, and the Cancer Hospital of Barretos. Organized a database of 60 patients which contains the gene expression of OTX1 and OTX2 genes (obtained through the technique of real-time PCR) and clinical and epidemiological data. Performed statistical tests to establish a correlation between clinical-pathological and gene expression. RESULTS: The OTX1 gene was expressed in 52% of the population studied, and such expression varied with age (being higher in adults), location (preferably by hemisphere) and histology (desmoplastic). The OTX2 gene was expressed in 62% of the studied population, and such expression varied with age (being higher the younger the age group), location (preferably vermis) and histological type (classical). A statistical correlation between the expression of OTX2 gene and development of leptomeningeal metastases was observed. CONCLUSIONS: In the studied population, the expression of OTX1 and OTX2 genes corroborates the impression of his role in the pathogenesis of medulloblastomas, and is dependent on patient age, tumor location and histological type. Given the sensitivity of the gene-trans retinoic acid, the identification of the population profile in the future will represent new opportunities for treatment.

Medulloblastoma is a common malignant brain tumor in childhood, but a rare disease amongst adults. The tendency to metastasize along cerebrospinal fluid pathways is well known. Extraneural metastases represent only a small number of recurrences and are associated with a poor outcome. Encouraging results of high-dose chemotherapy followed by autologous stem cell transplantation were reported previously in children with recurrent malignant brain tumors.

No description available.

Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa belonging to the family of primitive neuro-ectodermic tumors (PNET). MB generally occurs in pediatric age, but in 14–30% of cases, it affects the adults, mostly below the age of 40, with an incidence of 0.6 per million per year, representing about 0.4–1% of tumors of the nervous system in adults. Unlike pediatric MB, robust prospective trials are scarce for the post-puberal population, due to the low incidence of MB in adolescent and young adults. Thus, current MB treatments for older patients are largely extrapolated from the pediatric experience, but the transferability and applicability of these paradigms to adults remain an open question. Adult MB is distinct from MB in children from a molecular and clinical perspective. Here, we review the management of adult MB, reporting the recent published literature focusing on the effectiveness of upfront chemotherapy, the development of targeted therapies, and the potential role of a reduced dose of radiotherapy in treating this disease.

Children with high-risk SHH/TP53-mut and Group 3 medulloblastoma (MB) have a 5-year overall survival of only 40%. Innovative approaches to enhance survival while preventing adverse effects are urgently needed. We investigated an innovative therapy approach combining irradia- tion (RT), decitabine (DEC), and abacavir (ABC) in a patient-derived orthotopic SHH/TP53-mut and Group 3 MB mouse model. MB-bearing mice were treated with DEC, ABC and RT. Mouse survival, tumor growth (BLI, MRT) tumor histology (H/E), proliferation (Ki-67), and endothelial (CD31) staining were analyzed. Gene expression was examined by microarray and RT-PCR (Ki-67, VEGF, CD31, CD15, CD133, nestin, CD68, IBA). The RT/DEC/ABC therapy inhibited tumor growth and enhanced mouse survival. Ki-67 decreased in SHH/TP53-mut MBs after RT, DEC, RT/ABC, and RT/DEC/ABC therapy. CD31 was higher in SHH/TP53-mut compared to Group 3 MBs and decreased after RT/DEC/ABC. Microarray analyses showed a therapy-induced downregulation of cell cycle genes. By RT-PCR, no therapy-induced effect on stem cell fraction or immune cell inva- sion/activation could be shown. We showed for the first time that RT/DEC/ABC therapy improves survival of orthotopic SHH/TP53-mut and Group 3 MB-bearing mice without inducing adverse effects suggesting the potential for an adjuvant application of this multimodal therapy approach in the human clinic.

Copy number variation (CNV) comprises a recently discovered kind of variation involving deletion and duplication of DNA segments of variable size, ranging from a few hundred basepairs to several million. By altering gene dosage levels or disrupting proximal or distant regulatory elements CNVs create human diversity. They represent also an important factor in human evolution and play a role in many disorders including cancer. Array-based comparative genomic hybridization as well as expression arrays are powerful and suitable methods for determination of copy number variations or gene expression changes in the human genome. In paper I we established a 32K clone-based genomic array, covering 99% of the current assembly of the human genome with high resolution and applied it in the profiling of 71 healthy individuals from three ethnic groups. Novel and previously reported CNVs, involving ~3.5% of the genome, were identified. Interestingly, 87% of the detected CNV regions overlapped with known genes indicating that they probably have phenotypic consequences. In papers II through IV we applied this platform to different tumor types, namely two collections of brain tumors, glioblastoma (paper II) and medulloblastoma (paper III), and a set of bladder carcinoma (paper IV) to identify chromosomal alterations at the level of DNA copy number that could be related to tumor initiation/progression. Tumors of the central nervous system represent a heterogeneous group of both benign and malignant neoplasms that affect both children and adults. Glioblastoma and medulloblastoma are two malignant forms. Glioblastoma often affects adults while the embryonal tumor medulloblastoma is the most common malignant brain tumor among children. The detailed profiling of 78 glioblastomas, allowed us to identify a complex pattern of aberrations including frequent and high copy number amplicons (detected in 79% of samples) as well as a number of homozygously deleted loci. These regions encompassed not only previously reported oncogenes and tumor suppressor genes but also numerous novel genes. In paper III, a subset of 26 medulloblastomas was analyzed using the same genomic array. We observed that alterations involving chromosome 17, especially isochromosome 17q, were the most common genomic aberrations in this tumor type, but copy number alterations involving other chromosomes: 1, 7 and 8 were also frequent. Focal amplifications, on chromosome 1 and 3, not previously described, were also detected. These loci may encompass novel genes involved in medulloblastoma development. In paper IV we examined for the presence of DNA copy number alterations and their effect on gene expression in a subset of 21 well-characterized Ta bladder carcinomas, selected for the presence or absence of recurrences. We identified a number of novel genes as well as a significant association between amplifications and high-grade and recurrent tumors which might be clinically useful. The results derived from these studies increase our understanding of the genetic alterations leading to the development of these tumor forms and point out candidate genes that may be used in future as targets for new diagnostic and therapeutic strategies.

Le médulloblastome est une des tumeurs les plus fréquentes du système nerveux central chez l’enfant. Son impact clinique, ainsi que les effets secondaires engendrés par les traitements actuels, sont significatifs en matière de morbidité et de mortalité. La caractérisation moléculaire des tumeurs du système nerveux central a grandement évolué, et ce, particulièrement en ce qui concerne le médulloblastome. Des travaux antérieurs ont permis d’établir qu’un des sous-groupes de médulloblastome est caractérisé par l’activation de la voie sonic hedgehog. La mutation la plus fréquente menant à ce sous-type de médulloblastome est la mutation du gène suppresseur de tumeur PTCH1. Grâce au modèle de souris Ptch1+/-, des données issues de notre laboratoire ont permis de caractériser le développement de cette tumeur comme étant en deux étapes. Ce travail porte sur la caractérisation du mécanisme par lequel cette première étape, soit la perte d’hétérozygotie de Ptch1, survient. Tout d’abord, nous revisitons le rôle in vivo du corécepteur Boc dans la tumorigenèse. Selon nos résultats, la modulation de Boc ne semble pas avoir un impact significatif sur le développement tumoral dans des expériences de transplantation orthotopiques. Ensuite, nous démontrons que le ligand Shh augmente le dommage à l’ADN, ce qui mène à une hausse des évènements de recombinaisons qui peuvent causer une perte d’hétérozygotie. Nous tentons de moduler l’activité de Rad51 en observant une tendance non statistiquement significative des évènements de recombinaison avec des inhibiteurs de Rad51. Nous démontrons ensuite qu’un inhibiteur de Cdc7 permet la diminution des évènements de recombinaisons ainsi qu’une diminution du stress réplicatif de l’ADN. En intervenant sur le gène Mcm2 grâce à un modèle de souris transgénique, nous parvenons à prouver qu’une diminution de l’action de Mcm2 permet une diminution du stress réplicatif de l’ADN. En somme, la première étape du développement du médulloblastome sonic hedgehog-activé est la perte d’hétérozygotie de Ptch1. Celle-ci est caractérisée par une augmentation du dommage à l’ADN engendrant une hausse des évènements de recombinaison. Plusieurs cibles potentielles de modulation s’avèrent prometteuses pour un éventuel traitement ciblé. / Medulloblastoma is one of the most common central nervous system tumors of the child. Its clinical impact, as well as the adverse effects caused by current treatments, are significant in terms of morbidity and mortality. The molecular characterization of tumors of the central nervous system has greatly evolved, particularly in the case of medulloblastoma. Previous work has established that one of the medulloblastoma sub-groups is characterized by the activation of the sonic hedgehog (Shh) pathway. The most common mutation leading to this medulloblastoma subtype is the PTCH1 tumor suppressor gene mutation. Working with the Ptch1+/- mouse model, data from our la-boratory characterized the medulloblastoma tumorigenesis as a two-step process. This work focuses on the characterization of the mechanism by which this first step, the loss of heterozygosity of Ptch1, occurs. First, we revisit the in vivo role of the Boc coreceptor in the medulloblastoma tumor-igenesis. According to our results, Boc modulation does not seem to have a significant impact on tumor development. Next, we show that the Shh ligand increases DNA dam-age. This leads to an increase in recombination events which predispose to loss of het-erozygosity. We attempt to modulate Rad51 activity and observe a non-statistically sig-nificant trend to decrease recombination events with Rad51 inhibitors. We then demonstrate that Cdc7 inhibition reduces recombination events as well as DNA replica-tive stress. Using an Mcm2 transgenic mouse model, we demonstrate that a reduction in the action of Mcm2 reduces DNA replicative stress. To conclude, the first step in the development of Shh-activated medulloblastoma is the loss of heterozygosity of Ptch1. This is characterized by an increase in DNA damage leading to an increase in recombination events. Several potential modulation targets hold promise for possible targeted therapy.