<p>MAL (myelin and lymphocyte protein), has been implicated in several malignancies including esophageal, gastric, and cervical cancers. We have demonstrated that the MAL protein is expressed in the normal breast epithelium, and aberrantly expressed in breast cancer. Bisulfite sequencing of the MAL promoter CpG island revealed hypermethylation in breast cancer cell lines and 69% of primary tumors analyzed compared with normal breast epithelial cells. Differential methylation between normal and cancer DNA was confined to the proximal promoter region. In a subset of breast cancer cell lines, promoter methylation correlated with transcriptional silencing that was reversible with the methylation inhibitor decitabine. Furthermore, exogenous expression of MAL in breast cancer cell lines resulted in decreased cell proliferation, motility, reduced cell invasion through Matrigel and suppressed anchorage-independent growth in soft agar. In a cohort of 122 primary breast tumors, immunohistochemical analysis revealed that the MAL protein was an independent predictor of benefit from adjuvant chemotherapy. Moreover, overexpression of MAL in triple-negative MDA-MB-468 and BT20 breast cancer cell lines was sufficient to confer sensitivity to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibition and was associated with reduced phosphatidylinositol-3 kinase (PI3K)/Akt signaling. Immunohistochemistry studies conducted on 144 late-stage serous ovarian cancers showed that MAL expression was a significant predictor of survival. Knockdown of MAL expression in the SKOV8 ovarian cancer cell line reduced cell proliferation and resulted in increased sensitivity to the chemotherapeutic drug carboplatin. Thus, we have identified the MAL gene as a novel epigenetically regulated gene in breast cancer with implications for response to chemotherapy in both breast and ovarian cancer. Furthermore, we have shown that the MAL protein has predictive and prognostic value in breast and ovarian cancers, respectively.</p> / Dissertation

Regulation of gene expression is a complex process in mammalian cells with many levels of control. In recent years non-coding RNAs in the form of microRNAs (miRNA) have surfaced as important regulators of protein coding genes, with biologically important roles in development, differentiation and cell growth. In this dissertation the complex interactions between miRNAs and mRNAs in ovarian cancer are investigated using a combination of computational and experimental techniques. In vitro studies and current models predict that increases in levels of miRNA should result in corresponding decreases in the levels of targeted mRNAs due to miRNA induced degradation. Profiling the global miRNA and mRNA expression patterns in epithelial ovarian cancer cells from patients and surface epithelial cells from normal ovaries reveal only ~11% of predicted targets of miRNAs are inversely correlated in vivo. In an effort to dissect the mechanisms behind these unexpected observations single miRNA transfection experiments are carried out followed by gene expression profiling. Analysis of genes altered following these transfections reveal majority of the altered genes are not direct targets of the miRNAs. Network analysis however suggests that miRNAs may target "hub genes" to cause altered expression in downstream transcripts. Pathway enrichment analysis of altered genes demonstrates miRNAs may regulate specific pathways rather than causing random off-target effects. Finally investigation of miRNA regulation reveals miRNAs may also affect the levels of other miRNAs, which may indirectly affect more genes downstream. Together these results provide a detailed view of the mechanisms employed by miRNAs to regulate the expression of hundreds of genes in ovarian cancer cells.

Identification of differential expressions of proteins in proteomic profiles of biological samples shows great potential as a valuable technique for the early diagnosis of various diseases. An important challenge in modern protein profiling approaches is to reduce the complexity of the samples by limiting the number of proteins that need to be evaluated for distinction in the expression between normal and deceased cells. In this research, an affinity based approach for the enrichment of nucleotide and nucleoside binding proteins from a complex cell proteome has been developed. To achieve this goal, new N6-biotinylated-8-azido-adenosine probes (AdoRs) have been designed and synthesized to photolabel the nucleotide and nucleoside binding proteins. These probes contain a reactive group that forms a covalent bond with the target proteins, as well as a biotin tag for affinity enrichment using avidin chromatography. Further, a mass spectrometric protein profiling approach is employed to quantitatively identify small variations in expression of nucleoside and nucleotide binding proteins in samples of interest. Mouse neuroblastoma N18TG2 cell proteome has been used as a model system for the development of the LC-MS/MS based proteomic analysis of these affinity enriched protein fractions. Upon enrichment, the photolabeled proteome exhibited an approximately four-fold abundance of nucleoside and nucleotide binding proteins over nonlabeled proteome. The approach was extended to compare the proteomic profiles of nucleotide and nucleoside binding proteins in cancerous (Hey) and non-cancerous (T-80) human ovarian cell proteome. Certain proteins that were not detected in cell lysate were also identified in labeled proteome, thereby demonstrating the strength of our approach in enriching low abundant proteins. To substantiate the qualitative analysis, we have employed the Stable Isotope Labeling in Amino Acid Cell Culture (SILAC) for the quantitative study of the protein expression in cancerous and non-cancerous human ovarian cells. A modest panel of proteins with differential expressions in these cell lines was identified, a few of which have been correlated to various forms of cancer. Vimentin, stress induced phosphoprotein-1, and heat shock protein 90 that were identified to have altered expressions in these cell lines are among some of the proteins associated with ovarian cancer.

Abstract Although the critical role of the small GTPases Ras and Ral in oncogenesis has been well documented, much remains to be investigated about the molecular mechanism by which these GTPases regulate malignant transformation. The work under this thesis made two major contributions to this field. The first is the discovery that K-Ras, RalA and/or RalB are required for the maintenance of the high levels of the anti-apoptotic protein survivin in some human cancer cells, and the second is the demonstration that down regulation of K-Ras, RalA and/or RalB, but not Raf-1 or Akt1/2, stabilizes the tumor suppressor p53 and reactivates it to inhibit malignant transformation in human cancer cells with mutant K-Ras and wild type p53. Here we found that depletion of K-Ras leads to decreased survivin levels in human cancer cells that harbor mutant K-Ras but not those with wild type Ras. The mechanism by which this occurs involves ubiquitination and subsequent proteasome-mediated degradation of survivin. The presence of mutant K-Ras alone was not sufficient to predict the effects of RalA/B depletion on survivin levels. Indeed, depletion of RalA and/or RalB reduces survivin levels in human cancer cells with wild type p53 and mutant K-Ras, but not in those with mutant p53 and/or wild type K-Ras. The functional relevance of these findings to malignant transformation was further supported by the demonstration that compromising the expression of survivin by siRNA leads to reduction of mutant K-Ras-driven invasion and anchorage-independent growth. Furthermore, in this thesis, we have discovered that down regulation of K-Ras, RalA and/or RalB using siRNA leads to increased levels of functional p53 that is capable of regulating its target genes. The mechanism by which depleting K-Ras, RalA and RalB increases the levels of p53 involves an increase in the half-life of the p53 protein concurrent with an increase in the phosphorylation of serine-15 of p53, a marker of p53 stability. Finally, we demonstrated that depletion of K-Ras, RalA and/or RalB interferes with cell cycle progression, anchorage-independent growth and invasion in a p53-dependent manner. In summary, the studies suggest that mutant K-Ras contributes to the maintenance of the aberrantly-high survivin levels by regulating its stability, and that the ability of mutant K-Ras to induce malignant transformation is, at least in part, dependent of these high levels of survivin. The work of this thesis also suggests that the expression of K-Ras, RalA and/or RalB proteins is critical to maintain low levels of p53, and that down regulation of these GTPases reactivates p53 by significantly enhancing its stability, and this contributes to suppression of malignant transformation.

<p>Ovarian cancer is the fifth leading cause of cancer-related death in the United States and the most lethal gynecologic malignancy. Patients with ovarian cancer are generally diagnosed at stage III or IV, when ascites fluid becomes a common symptom. The volume of ascites positively correlates with the extent of ovarian cancer metastasis and negatively with prognosis; however, the mechanisms explaining their effect are unknown. </p><p>We hypothesize that ascites enriches for cancer stem-like cells. Our present study demonstrates that mice injected with ID8 cells, a murine epithelial ovarian cancer line, have remarkably shortened survival, when injected together with ascites supernatant derived from tumor-bearing mice. Moreover, compared to their counterparts cultured in regular medium, ID8 cells cultured in ascites fluid, or isolated directly from ascites, show an increased expression of stem cell markers Oct4 and CD133. These cells also exhibit enhanced self-renewing ability in sphere assay, suggesting that ascites enriches for stem-like cells. </p><p>Furthermore, we demonstrate that ascites enriches for cells expressing cell surface GRP78, a stress-inducible endoplasmic reticulum chaperone which also appears on the plasma membrane (memGRP78) of aggressive cancers. MemGRP78 + cells correlate with stem cell properties of self-renewal and tumor initiation, suggesting GRP78 is a novel stem cell marker. Importantly, antibodies against the COOH terminal domain of GRP78 significantly reduce the self-renewing ability of murine and human ovarian cancer cells pre-incubated with ascites.</p><p>In conclusion, our study demonstrates that ascites enriches for stem-like cells in ovarian cancer cell lines. Furthermore, the inhibitory effect of antibodies against the COOH terminal domain of GRP78 suggests that memGRP78 is a logical therapeutic target for ovarian cancer.</p> / Dissertation

We evaluate the changes in fluorescence from endogenous fluorophores such as amino acids, structural proteins and enzymatic co-factors to predict malignancy and risk of developing ovarian cancer. 249 ovarian biopsies of the surface epithelium were interrogated in vitro, over 270-550 nm excitation, and fluorescence was collected from 290-700nm. Spectroscopic data was analyzed using parallel factor analysis (PARAFAC) to determine excitation and emission spectra of the underlying fluorophores that contribute to the total detected fluorescence intensity. Using multivariate normal distribution fits and cross-validation techniques, sensitivity (SN) and specificity (SP) of 88 and 93 percent, respectively, were achieved when classifying malignant samples versus others, while 88 and 80 percent, respectively, were achieved when classifying normal post menopausal patients as being either at low- or high-risk of developing ovarian cancer based on their personal and family history of cancer. Also, the performance of classifying cancer increases when the normal group excludes benign neoplasm and endometriosis samples, while the performance of low- v. high-risk decreases when both pre- and post-menopausal samples are included. These results could potentially be useful in screening women at increased risk of developing ovarian cancer. This motivated our study to investigate similar changes in ovarian autofluorescence in vivo. 40 patients were recruited and a total of 189 samples were imaged using a fiber optic bundle and biopsied. Using PARAFAC, the factors computed from in vitro data analysis and in vitro data as a training set; pathology from each in vivo site biopsied was compared to calibrated tissue-fluorescence. It resulted in a SN and SP of 100 and 94 percent, respectively, for classifying normal versus malignant. In the case of risk assessment, cross validated in vivo data gave a SN and SP of 68 and 93%. Results obtained were consistent with those obtained in vitro, except for the presence of blood absorption peaks which affected risk assessment. Assessing endogenous fluorescence has diagnostic potential and if adapted to trans-vaginal access, would make the screening procedure less costly and less invasive, and would be most useful and economical in women at increased risk of developing ovarian cancer and might determine the ideal time to undergo an oophorectomy.

The first real-time uorescence confocal microlaparoscope has been de- veloped that provides instant in vivo cellular images, comparable to those provided by histology, through a nondestructive procedure. The device in- cludes an integrated contrast agent delivery mechanism and a computerized depth scan system. The instrument uses a fiber bundle to relay the image plane of a slit-scan confocal microlaparoscope into tissue. The confocal laparoscope was used to image the ovaries of twenty-one patients in vivo using uorescein sodium and acridine orange as the uorescent contrast agents. The results indicate that the device is safe and functions as designed. A Monte Carlo model was developed to characterize the system performance in a scattering media representative of human tissues. The results indicate that a slit aperture has limited ability to image below the surface of tissue. In contrast, the results show that multi-pinhole apertures such as a Nipkow disk or a linear pinhole array can achieve nearly the same depth performance as a single pinhole aperture. The model was used to determine the optimal aperture spacing for the multi-pinhole apertures. The confocal microlaparoscope represents a new type of in vivo imaging device. With its ability to image cellular details in real time, it has the potential to aid in the early diagnosis of cancer. Initially, the device may be used to locate unusual regions for guided biopsies. In the long term, the device may be able to supplant traditional biopsies and allow the surgeon to identify early stage cancer in vivo.

Ovarian cancer is a fatal disease because of the lack of symptoms and markers for early detection. Most ovarian neoplasms resemble and are classified according to the complex characteristics of Mullerian duct epithelia. We tested the hypothesis that Mullerian epithelial characteristics influence early ovarian neoplastic progression. The most common type of ovarian cancer is the serous carcinoma which resembles Mullerian-derived oviductal epithelium. We discovered that oviduct-specific glycoprotein (OVGP1), a tubal differentiation marker, was present in inclusion cysts, which are the preferential sites for malignant transformation, and in most low grade serous tumors, but absent in ovarian surface epithelium and most high grade carcinomas. OVGP1 was almost entirely limited to ovarian neoplasms with the notable exception of endometrial hyperplasia and carcinoma. A new antibody against OVGP1 detected elevated serum levels from most women with low grade ovarian cancers compared to normal controls. OVGP1 also identified a subset of patients with high grade serous carcinomas who had a more favorable outcome. To examine whether the differentiated phenotype of early ovarian neoplasms alters invasiveness, we established the first permanent cell line for serous borderline ovarian tumors (SBOT), which are differentiated but noninvasive. The results revealed a striking phenotypic similarity between two lines regardless of their cytogenetic diversity. They retained Mullerian epithelial characteristics in vitro, as demonstrated by their morphologic appearance and the differentiation markers keratin, E-cadherin, CA125 and OVGP1. Neither disruption of the growth pattern nor manipulations of the cadherin profile induced invasivenesss. Induction of invasiveness by SV40 early genes was associated with a loss in morphologic differentiation and of differentiation markers but increased motility. MMP secretion was independent of the invasion status. Our findings indicate that OVGP1 is an indicator of early ovarian epithelial neoplasia. It can be detected in the sera from women with early ovarian cancer, and thus, may be a new promising diagnostic marker for the early detection of ovarian cancer. In addition, the results show that Mullerian differentiation does not directly prevent invasiveness, but it diminishes in parallel with invasion caused by other factors. The lack of invasiveness by SBOT cells may depend on factors that regulate motility.

1. INTRODUCTION Ovarian cancer is now the most common gynaecological cancer and the fourth the most common cancer among women in Lithuania. Referring to the epidemiological research ovarian cancer has the tendency to become more common: in 1990 there were 345 new cases of ovarian cancer and in 2004 - already 406 new cases. In 2004 ovarian cancer morbidity was 22.2/100 000 of inhabitants in Lithuania. Ovarian cancer is in the fifth position in the structure of death to cancer.Since there are no specific early symptoms and effective diagnostics of ovarian cancer so even 70 percent of diagnosed cases were stages III or IV. After the cytoreduction surgery and adjuvant chemotherapy with cysplatin / cyclophosphamide (CP) the survival among stage III cases was 10-20 percent and among stage IV cases not even 10 percent. In the structure of death to cancer ovarian cancer is in the sixth position - 16.1/100 000 of women. Since there is no effective prevention so the only way to prolong survival of patients is to optimise the treatment. It has been set that the optimal cytoreduction surgery could be performed only for about 50 percent of patients with stages III or IV ovarian cancer. As an alternative to conventional surgery for this group of patients the neoadjuvant chemotherapy - medical cytoreduction was applied. It could lead to the optimal conditions for cytoreduction surgery and further to prolongation of the survival. Referring to the literature the influence of neoadjuvant... [to full text]

Background: The aim of this thesis was to study the relationship of pre-diagnostic circulating concentrations of sex steroid hormones (androgens, estradiol, 17-hydroxyprogesterone, and progesterone), growth factors (insulin-like growth factor-I (IGF-I), placental growth hormone (GH)), sex hormone binding globulin (SHBG), and anti-Müllerian hormone (AMH) with risk of epithelial ovarian cancer (EOC) overall, and by tumor invasiveness and histology. A longitudinal study was used to assess patterns of hormonal changes during a single pregnancy, and in two consecutive pregnancies. Materials &amp; Methods: A case-control study was nested within the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort. A total of 1 052 EOC cases were identified through linkages with the cancer registries in both countries. For each case, 2-3 controls were selected. Cases and controls were matched on cohort, age and date at blood draw, as well as for parity at blood draw and at diagnosis (n=2 695). Odds ratios (OR) and corresponding 95% confidence intervals [CI] were estimated using conditional logistic regression. The longitudinal study was based on 71 pregnant Finnish women, who donated blood samples in each trimester of pregnancy. Results: Higher androgen concentrations were associated with an increased risk of overall EOC (e.g., testosterone ORT3 vs. T1: 1.56 [1.30-1.87], ptrend&lt;0.0001), while the risk of endometrioid tumors increased with higher estradiol concentrations (ORT3 vs. T1: 2.76 [1.04-7.33], ptrend=0.03). Higher IGF-I was associated with a non-significant decrease in risk for invasive (ORT3 vs. T1: 0.79 [0.62-1.02], ptrend=0.07) and endometrioid tumors (ORT3 vs. T1: 0.55 [0.28-1.07], ptrend=0.07). The inverse association between IGF-I levels and risk of invasive EOC was stronger in analyses limited to women aged &lt;55 years at diagnosis (ORT3 vs. T1: 0.74 [0.57-0.96], ptrend=0.03). No associations were observed between pre-diagnostic progesterone, SHBG, placental GH, and AMH with EOC risk overall, or by tumor invasiveness and histology. The longitudinal study showed that hormone concentrations were more strongly correlated between consecutive trimesters of a pregnancy than between the 1st and 3rd trimesters. Further, 3rd trimester hormone concentrations can be estimated from 1st or 2nd trimester measurements. Conclusion: Higher pre-diagnostic androgens, estradiol, and IGF-I are associated with EOC risk, and associations differ by tumor invasiveness and histology.