Le cancer du col utérin (CCU) est dans plus de 99% des cas provoqué par une infection avec le virus du papillome humain (VPH), dont le potentiel oncogénique réside dans l'expression des proto-oncogènes viraux E6/E7. Le potentiel carcinogénique de ces protéines virales réside essentiellement dans leurs actions sur les produits des gènes suppresseurs de tumeur p53 et RB. Les produits de ces gènes, p53 et Rb, font parti des voies de signalisation de réponse aux dommages de l'ADN cellulaire (RDA) et leur perte entraine une perte de fonctionnalité qui mène à une instabilité génomique. À long terme et en présence de d'autres facteurs ceux-ci mèneront au développement d'un cancer. Les protéines E6 et E7 sont constitutivement exprimées dans les cellules du CCU ainsi que dans les cellules de tout autre cancer induit par le VPH et seulement dans ces dernières. La prise en charge des cas avancés de ces cancers se fait principalement par radiothérapie et chimiothérapie concomitante. La chimio-radiothérapie utilisée en traitement est efficace mais résulte en un taux élevé de morbidité et un nombre important de patientes récidiveront. Nous proposons que l'exploitation de l'expression spécifique d’E6 et d’E7 dans les cellules du CCU permette d’envisager une stratégie de létalité synthétique afin d'amplifier l'effet létal de l'irradiation sur les cellules CCU. Ceci permettrait potentiellement d'augmenter l'efficacité du traitement et de diminuer les récidives, ainsi que la morbidité liée au traitement. En s'appuyant sur cette hypothèse, notre objectif est d’identifier des composés dont l'action seule ou couplée à l'irradiation provoquerait préférentiellement la mort des cellules exprimant les protéines E6 et E7 du VPH. Les cellules testées comprennent des cellules isogéniques humaines issues de kératinocytes normaux que nous avons modifiées séquentiellement pour obtenir les modifications associées aux cellules CCU (hTERT, E6 et E7), ainsi que les lignées de cellules de CCU HeLa et CaSki .Nous avons procédé à la mise au point et à la validation du protocole de criblage et des méthodes d’évaluation de la sensibilisation, qui se définit comme une perte de viabilité, un arrêt ou ralentissement de la croissance, par détection d’ATP ainsi que par coloration d’ADN génomique au DRAQ5. Suite à un criblage ciblé impliquant des inhibiteurs connus de la voie de réparation des dommages à l’ADN, nous avons identifié l’inhibiteur de mdm2, Nutlin-3, comme étant un composé sensibilisant et radio-sensibilisant préférentiellement les cellules exprimant E6 et E7 du VPH. La Nutlin-3 a été testée sur des cellules HEKn-hTERT-E6-E7, des cellules CaSki et HeLa. L’effet de sensibilisation et de radio-sensibilisation a été confirmé dans ces trois lignées. Tel que suggéré par son action sur mdmd2, la Nutlin-3 permet la stabilisation de p53 dans les cellules HEKn-hTERT-E6-E7 et CaSki et sa réactivation dans les lignées cellulaires HeLa et CaSki. Malgré cette stabilisation de p53, de façon surprenante, l’effet de la Nutlin-3 sur la sensibilisation et la radio-sensibilisation des cellules HeLa et CaSki semble indépendant de p53, tel qu’observé en utilisant des cellules HeLa-GSE et CaSki-GSE dont le p53 est déficient. In vivo la Nutlin-3a montre dans un essai préliminaire l’inhibition de la croissance tumorale des xénogreffes HeLa chez des souris RAG2γc. Ce résultat reste à confirmer avec un essai impliquant un nombre d’échantillons plus grand. À plus long terme, nous comptons étudier l’implication de mdm2 dans l’effet de sensibilisant de la Nutlin-3 dans les cellules CCUs, ainsi que les autres cibles pouvant être impliquées dans la création de cet effet sensibilisant observé. / More than 99% of uterine cervical cancer (UCC) are caused by human papillomavirus (HPV) infections. The oncogenic potential of this virus lies in the expression of the proto-oncogenes E6/E7. These viral proteins are considered carcinogenic because of their effects on tumor suppressor proteins p53 and Rb. E6 and E7 promote p53 and Rb inactivation resulting in a loss of function in the DNA damage response pathways (DDR), genomic instability, and cancer development. The E6 and E7 proteins are expressed constitutively and specifically in cervical cancer cells and in the cells of other HPV-induced cancers. The treatment of advanced UCC is based on simultaneous radiotherapy and chemotherapy. Although these strategies are somewhat efficacious, there are still significant co-morbidities and cancer relapses. We hypothesized that the specific expression of E6 and E7 in cervical cancer cells can be exploited in a synthetic lethality strategy to amplify the lethal effect of irradiation. Thus, the efficacy of treatment could be increased, while reducing the cancer recurrence and treatment-related morbidities. Our objective is to identify chemical compounds that if used alone or coupled with irradiation, would preferentially induce the death of cells expressing proteins E6 and E7 of HPV. We used a cellular model of human keratinocytes that were modified to obtain the genetic signature associated with cervical cancer cells (the expression of E6 and E7). We then proceeded to the optimization and validation of the methods used to evaluate the sensitization of the tested cells. To measure sensitization, we evaluated the quantity of cellular ATP by ATPlite assay and the cellular DNA content with the DNA stain DRAQ5. After establishing a screening protocol, we proceeded to a low-density screening to identify a compound that can sensitize or radio-sensitize cervical cancer cells expressing the HPV proteins E6 and E7. We identified Nutlin-3 a mdm2, inhibitor, as a radio-sensitizing component for cells expressing E6 and E7 of HPV. Nutlin-3 was tested and sensitization confirmed in HEKn-hTERT-E6-E7 and in the cervical cancer cell lines HeLa and CaSki. We confirmed by Western-Blot the stabilisation of p53 in HEKn-hTERT-E6-E7 and CaSki cells treated with Nutlin-3. Moreover, Nutlin-3 promotes p53 reactivation in the HeLa and CaSki cell lines. Surprisingly, the effect of Nutlin-3 on the sensitization and radio-sensitization of the HeLa and CaSki cell lines appears to be p53-independent. This is based on the observations made using p53-deficient HeLa-GSE and CaSki-GSE cell lines, which were also sensitized by Nutlin-3. In addition, preliminary experiments showed that Nutlin-3a inhibits in vivo tumor growth, as seen using xenografts of HeLa in mice with a RAG2γc genetic background. This remains to be confirmed using an extended cohort of mice. In the future, it will be important to examine the implication of mdm2 in the sensitization effect of Nutlin-3 in cervical cancer cells and to find others possible targets that may play a role in the sensitization effect of Nutlin-3 observed in cervical cancer cells.

Submitted by Jaqueline Silva (jtas29@gmail.com) on 2014-10-03T21:14:43Z No. of bitstreams: 2 Dissertação - Flávio Silva de Carvalho - 2011.pdf: 2542668 bytes, checksum: 8b150260143e835293c132099b3cbf68 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-03T21:14:50Z (GMT) No. of bitstreams: 2 Dissertação - Flávio Silva de Carvalho - 2011.pdf: 2542668 bytes, checksum: 8b150260143e835293c132099b3cbf68 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-03T21:14:50Z (GMT). No. of bitstreams: 2 Dissertação - Flávio Silva de Carvalho - 2011.pdf: 2542668 bytes, checksum: 8b150260143e835293c132099b3cbf68 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2011-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / As part of a line of research aimed at the pharmacological and toxicological evaluation of new candidates for antitumor drug prototypes, this work was conducted to evaluate pharmacological and toxicological compounds LQFM030, and LQFM031 LQFL032, drawn from nutlins prototypes. Additionally, we also evaluated whether the compounds LQFM004, LQFM005, and LQFM028 LQFM029 initially envisioned as candidates for prototypes of antipsychotic drugs, drawn from LASSBio579. Initially there was a cytotoxic screening all candidates, using the cytotoxicity test of exclusion of Trypan Blue in K-562 cells. Given this, it was observed that the best IC50 values were obtained with the candidates and LQFM030 LQFM029 (0.55 and 0.56 mM, respectively) and from then on had as starting point for these two molecules to a more detailed and thorough cytotoxicity, where it was observed that the molecule had the best LQFM030 cytotoxic profile in the test of exclusion of Trypan blue and the MTT reduction test, at intervals of 24, 48 and 72, compared with LQFM029 the molecule, using the cell line K-562. Given this, the candidate LQFM030 was the target of other studies conducted to study the survival, safety tests (Capture the Neutral Red dye, Acute Toxicity Oral), cell cycle, cell death mechanism of apoptosis and antioxidant activity. The data showed that the molecule LQFM030 increased life expectancy of the animals, and an IC50 value commensurate with the value of Nutlins found in literature, on the evaluation of acute toxicity, according to OECD 423, the molecule was rated 5 or non- classified according to the classification GSH, the cell cycle was observed an increase in G2 / M phase (73%) and sub-G1 phase (73.6%), and a decrease in S phase (40.9%) ; to assess the mechanism of cell death was characterized increased expression of Bax (8 times compared to untreated group), and a decrease of Bcl-2 (84%) as well as an increase in membrane potential and a decrease of ROS (reactive oxygen species), where there was not a change in protein expression of TNF and NFκβ; antioxidant activity did not show a significant effect, and before the candidate cyclic voltammetry showed only the presence of peak oxidation, not being characterized as a good redox system. When tested for safety in basal cell 3T3, the candidate presented a cytotoxicity with IC50 value of approximately 0.14 mM Thus, the candidate prototype antitumor drug LQFM030 presented as a good candidate for antitumor prototype with important data for such purpose, and the need for further detailed studies to better conceptualization. / No âmbito de uma linha de pesquisa que visa a avaliação farmacológica e toxicológica de novos candidatos a protótipos de fármacos antitumorais, foi realizado neste trabalho a avaliação farmacológica e toxicológica dos compostos LQFM030, LQFM031 e LQFL032, desenhados a partir dos protótipos nutlins. Adicionalmente, também avaliou-se os compostos LQFM004, LQFM005, LQFM028 e LQFM029, inicialmente idealizados como candidatos a protótipos de fármacos antipsicóticos, desenhados a partir do LASSBio579. Inicialmente realizou-se uma triagem citotóxica com todos os candidatos, utilizando o teste de citotoxicidade de Exclusão do Azul de Tripano, em células K-562. Diante disto, observou-se que os melhores valores de IC50 foram obtidos com os candidatos LQFM030 e LQFM029 (0,55 e 0,56 mM, respectivamente) e a partir de então teve-se como ponto de partida essas duas moléculas para um estudo mais detalhado e aprofundado da citotoxicidade, onde observou-se que a molécula LQFM030 apresentou o melhor perfil citotóxico no teste de Exclusão do Azul de Tripano e para o teste de Redução do MTT, no intervalos de tempo de 24, 48 e 72h, quando comparado com a molécula LQFM029, utilizando a linhagem celular K-562. Frente a isso, o candidato LQFM030 foi alvo dos demais estudos realizados visando estudo de sobrevida, ensaios de segurança (Captura do Corante Vermelho Neutro, Toxicidade Aguda Oral), ciclo celular, mecanismo de morte celular por apoptose e atividade antioxidante. Os dados mostraram que a molécula LQFM030 aumentou a expectativa de vida dos animais, e um valor de IC50 compatível com o valor dos Nutlins encontrado na literatura; diante da avaliação da toxicidade aguda, segundo a OECD 423, a molécula teve classificação 5 ou não-classificada de acordo com a classificação GSH; no ciclo celular observou-se um aumento da fase G2/M (73%) e da fase sub-G1 (73,6%), e uma diminuição da fase S (40,9%); para a avaliação do mecanismo de morte celular foi caracterizado um aumento da expressão da proteína Bax (8 vezes em relação ao grupo não-tratado), e uma diminuição de Bcl-2 (84%), assim como um aumento do potencial de membrana e uma diminuição de ROS (espécie reativa de oxigênio), onde não observou-se uma variação na expressão das proteínas TNF e NFκβ; porém um aumento da modulação da proteína citocromo-c de 85%; a atividade antioxidante não apresentou um efeito significativo, e perante a voltametria ciclica o candidato mostrou apenas a presença do pico de oxidação, não sendo caracterizado como um bom sistema de oxirredução. Para o ensaio de segurança, em célula basal 3T3, o candidato apresentou uma citotoxicidade com o valor de IC50 de 0,14 mM aproximadamente. Assim, o candidato a protótipo a fármaco antitumoral LQFM030 apresentou como um bom candidato a protótipo antitumoral com dados importantes para tal finalidade, e a necessidade de estudos ainda mais aprofundados para uma melhor conceituação.

Résumé en français : Notre équipe étudie les mécanismes de l’apoptose induite par la nutline-3, une molécule capable de se fixer sur MDM2 et d’activer la p53, dans différents types de lymphomes associés au virus d’Epstein-Barr (EBV) comme le lymphome de Burkitt (LB) ou syndromes lymphoprolifératifs post-transplantation (PTLD). Nos résultats montrent que la nutline-3 induit l’apoptose des cellules de LB EBV (-) alors que les cellules EBV (+) en latence de type III sont résistantes. Mon travail de thèse a consisté à étudier les mécanismes impliqués dans ce phénomène de résistance afin de mettre en place des stratégies pour les contourner. Une première étude initiée par les résultats d’une analyse transcriptomique, effectuée après traitement avec la nutline-3 de deux lignées qui ne diffèrent que par leur statut EBV, nous a permis de montrer que : 1) l’autophagie est induite en réponse au traitement dans les cellules EBV (+) en latence de type III ; 2) ces cellules expriment fortement Bécline-1 et présentent une activation constitutive de l’autophagie ; 3) l’autophagie contribue à la résistance de ces cellules à l’apoptose. Par ailleurs, nos résultats indiquent que la protéine anti-apoptotique Bcl-2 est également impliquée dans la résistance de ces cellules et que l’utilisation d’ABT-737, un inhibiteur de Bcl-2, restaure leur sensibilité à la nutline-3. L’efficacité de ce composé a donc été évaluée in vivo, seul ou en combinaison avec des traitements conventionnels (Cyclophosphamide pour le LB et Rituximab pour les PTLD). Les résultats obtenus lors de ces études pré-cliniques montrent que : 1) ABT-737 réduit considérablement la croissance tumorale et augmente la survie de souris xénogreffées avec des cellules d’une lignée lymphoblastoïde (LCL, utilisées comme modèle pour les PTLD) alors qu’il n’a pas d’effets chez les souris xénogreffées avec une lignée de LB ; 2) la combinaison BT-737/Cyclophosphamide permet de limiter la croissance tumorale durant le traitement mais n’améliore pas la survie des souris xénogreffées avec une lignée de LB ; 3) l’association ABT-737/Rituximab est très efficace et induit une rémission complète chez 70% des souris xénogreffées avec la lignée de LCL / - Résumé en anglais : Our team is working on the mechanisms of apoptosis induced by nutlin-3, a small molecule which binds to MDM2 and activates p53, in different lymphomas associated with Epstein-Barr virus such as Burkitt lymphoma (BL) or Post-transplant lymphoproliferative disorder (PTLD). Our results show that nutlin-3 strongly induce apoptosis in EBV (-) cells whereas EBV (+) latency III cells are much more resistant. The aim of my PhD project was to study the mechanisms involved in the resistance of EBV (+) latency III cells to apoptosis and to develop new therapeutic strategies to bypass these mechanisms. A transcriptomic analysis was realized after treatment with nutlin-3 of two cell lines which only differs by their EBV status. Based on the results obtained, a study was performed which allow us to show that: 1) autophagy is induced after nutlin-3 treatment in EBV (+) latency III cells; 2) these cells strongly expressed beclin-1 and present a constitutively high level of autophagy; 3) autophagy is involved in the resistance of apoptosis observed in these cells. Furthermore, our results demonstrate that Bcl-2 also contributes to the resistance of EBV (+) latency III cells and that treatment with ABT-737, a Bcl-2 inhibitor, restores their susceptibility to nutlin-3 treatment. We thus assessed the efficiency of this compound in vivo, in monotherapy or associated with conventional treatments (Cyclophosphamide for BL and Rituximab for PTLD). Results obtained during these pre-clinical studies show that: 1) ABT-737 reduces tumor growth and increase the overall survival of mice xenografted with a lymphoblastoïd cell line (LCL, used as a model for PTLD studies) but has no effects on mice xenografed with BL cell lines; 2) the association ABT-737/Cyclophosphamide reduces tumor growth during treatment but doesn’t improve the overall survival of mice xenografed with BL cell lines; 3) the association ABT-737/Rituximab is very efficient and induces 70% of complete remission in mice xenografted with LCL.