Introdução: Mulheres portadoras de mutações germinativas BRCA1 ou BRCA2 apresentam um risco aumentado de câncer de mama e de ovário em comparação com a população geral, enquanto a salpingo-ooforectomia redutora de risco (SORR) reduz significativamente a incidência desses cânceres. O objetivo deste estudo foi analisar as características clínicas e patológicas de uma população franco-canadense que realizou a SORR. A morbidade cirúrgica também foi avaliada. Materiais e Métodos: Entre dezembro de 1999 e dezembro de 2009, todas as pacientes submetidas à SORR foram identificadas. Os prontuários médicos foram revisados. Estatística descritiva, teste exato de Fischer, e teste t de Student foram utilizados para análise. Resultados: Durante o período de estudo, a SORR foi realizada em 119 mulheres. A média de idade no momento da cirurgia foi de 49 anos (35-72 anos); e 63 pacientes (53%) estavam na pré-menopausa. Sessenta e duas mulheres (52%) tinham uma história de câncer de mama in situ ou invasor. Mutações nos genes BRCA1 e BRCA2 estavam presentes em 34 pacientes (29%) e 42 pacientes (35%), respectivamente. Desse modo, 43 pacientes (36%) foram consideradas como tendo um risco aumentado de câncer de mama e de ovário, apesar de um teste negativo para ambos os genes (n = 23) ou desconhecido, porque o paciente recusou teste genético (n = 20). A maioria das pacientes com útero foi submetida a uma histerectomia complementar (65%). Seis complicações ocorreram (3 hematomas, 2 arritmias cardíacas e uma cistostomia). Em uma paciente (0,8%), um carcinoma ovariano de alto grau estadio II foi descoberto no momento da cirurgia. Atipias de tubas de falópio foram identificadas na patologia final em 8 casos (6,7%). Após um acompanhamento médio de 22 meses, 4 mulheres (3,4%) desenvolveram câncer de mama e uma paciente (0,8%) desenvolveu câncer peritoneal. Conclusões: a SORR é altamente eficaz na prevenção de câncer de ovário, tuba de falópio, e de carcinomas de mama em uma população franco-canadense de alto risco, sendo que a morbidade cirúrgica é baixa. / Background: Women with germ line BRCA1 or BRCA2 mutations have a marked increased risk of breast and ovarian cancer compared with the general population, whereas risk-reducing salpingo-oophorectomy (RRSO) significantly lowers the incidence of these cancers. The objective of this study was to review the clinical and pathological characteristics of a French Canadian population undergoing RRSO. Surgical morbidity was also evaluated. Materials and Methods: From December 1999 to December 2009, all women who underwent RRSO at our institution were identified. Medical records were retrospectively reviewed. Descriptive statistics, the Fischer exact test, and the Student t test were used for analysis. Results: During the study period, RRSO was performed on 119 women. Mean age at surgery was 49 years (35-72 years), and 63 patients (53%) were premenopausal. Sixty two women (52%) had a history of in situ or invasive breast cancer. BRCA1 and BRCA2 mutations were present in 34 patients (29%) and 42 patients (35%), respectively, whereas 43 patients (36%) were considered to have an increased risk of breast and ovarian cancer, despite a personal genetic test, which was either negative (n = 23) or unknown because the patient declined genetic testing (n = 20). Most patients with an uterus in place had a complementary hysterectomy (65%). Six complications occurred (3 hematomas, 2 cardiac arrhythmias, and 1 cystotomy). In one patient (0.8%), a high-grade stage II ovarian cancer was discovered at the time of surgery. Fallopian tube atypias were identified on final pathology in 8 cases (6.7%). After a median follow-up of 22 months, 4 women (3.4%) developed breast cancer and one woman (0.8%) developed peritoneal cancer. Conclusions: Risk-reducing salpingo-oophorectomy is highly effective in preventing ovarian, fallopian tube, and breast cancers in a high-risk French Canadian population; and the surgical morbidity is low.

O câncer de ovário é uma importante causa de mortalidade. O subtipo seroso de alto grau é o mais frequente e caracteriza-se por comportamento agressivo, com crescimento rápido e metástase precoce. A falta de ferramentas para diagnóstico em estádios iniciais e a insuficiência de resposta à quimioterapia convencional são dois principais obstáculos para o manejo do câncer seroso de ovário. A detecção precoce neste tumor é complicada por sintomas inespecíficos e ausência de biomarcadores confiáveis. Além disso, o desenvolvimento de resistência à quimioterapia é um desafio para o tratamento, que é geralmente baseado na combinação de platina e paclitaxel. A influência do microambiente tumoral na resposta terapêutica ainda é pouco conhecida. No entanto, há evidências crescentes de que a resposta imunológica pré-existente pode estar relacionada com a variação da sensibilidade à quimioterapia. O microambiente imunorreativo foi associado à melhor prognóstico no câncer do ovário seroso de alto grau em recente estudo canadense. Proteínas da família de Transdutores de Sinal e Ativadores da Transcrição (STATs) participam da regulação de citocinas e são determinantes nas respostas imunes no microambiente tumoral, podendo promover ou inibir o crescimento tumoral. Dados recentes mostram que a expressão elevada de um dos reguladores de STAT, STAT1 atua na tumorigênese do câncer de ovário, facilitando a resposta imune e, potencialmente, alterando a resposta à quimioterapia. Para avaliar o papel da expressão de STAT1 como biomarcador preditivo em 65 pacientes brasileiras com câncer seroso de ovário, examinamos os níveis de STAT1 por imunoistoquímica, e analisamos se houve correlação entre expressão dessa proteína e resposta clínica. Alta expressão de STAT1 foi significativamente associada maior intervalo livre de doença (P=0,0256) e maior sobrevida global (P=0,0193). Estes achados da coorte brasileira, com tempo de seguimento maior que cinco anos, confirmam a associação entre alta expressão de STAT1 e melhor resposta à quimioterapia, e fornecem validação adicional desta proteína como um biomarcador preditivo. Além disso, estes resultados chamam atenção para a possibilidade de utilizar a via de STAT1 para o desenvolvimento de novos medicamentos imunomoduladores, que poderiam melhorar a resposta ao tratamento / Ovarian cancer is a major cause of mortality worldwide. The most frequent subtype is high grade serous, which is characterized by aggressive behavior with rapid growth and early metastasis. Lack of early diagnostic tools and failure of response to conventional chemotherapies are two major impediments to serous ovarian cancer management. Early detection in initial stages is complicated by non-specific symptoms and lack of reliable biomarkers. In addition, development of chemotherapy resistance is a challenge for treatment, which is generally based on combination of platinum and paclitaxel. The influence of the microenvironment of the tumor on therapeutic response is still unknown. However, there is increasing evidence that a pre-existing immunological response may be related to variation in chemotherapy sensitivity. The immunoreactive microenvironment has been shown to be associated with better prognosis in high grade serous ovarian cancer in a recent Canadian study. The Signal Transducer and Activator of Transcription (STAT) proteins regulate cytokines and are central in determining whether immune responses in the tumor microenvironment promote or inhibit cancer. Recent data show that high expression of one of the STAT regulators, STAT1, operates in ovarian cancer tumorigenesis, facilitating immune response and potentially altering response to chemotherapy. To evaluate the role of STAT1 expression as a predictive biomarker in 65 Brazilian serous ovarian cancer patients, we examined STAT1 levels by immunohistochemistry to determine if there was correlation between expression of this protein and clinical response. High expression of STAT1 was significantly associated with both improved disease-free survival (P=0,0256) and overall survival (P=0,0193). These findings from a Brazilian cohort after more than five years of follow up confirm the association of high STAT1 expression with better response to chemotherapy, and provide additional validation of this protein as a predictive biomarker. Moreover these results draw attention to the possibility of utilizing the STAT1 pathway for the development new immunomodulator drugs, that could enhance response to treatment

The heat shock response (HSR) is a robust cellular reaction to mitigate protein damage from heat and other challenges to the proteome. This protective molecular program in humans is controlled by heat shock transcription factor 1 (HSF1). Activation of HSF1 leads to the induction of an array of cytoprotective genes, many of which code for chaperones. These chaperones, known as heat shock proteins (HSPs), are responsible for maintaining the functional integrity of the proteome. HSPs achieve this by promoting proper folding and assembly of nascent proteins, refolding denatured proteins, and processing for degradation proteins and aggregates which cannot be returned to a functional conformation. The powerful ability of the heat shock response to promote cell survival makes its master regulator, HSF1, an important point of research. To garner a better understanding of HSF1, we reviewed the role of the highly dynamic HSF1 protein structure and investigated how HSF1 affects cancer cell behavior and drug response. Cancers can be characterized in part by abhorrent replication, self-sufficient growth signaling, invasion, and evasion of apoptosis. HSF1 has been found to promote proliferation, invasion, and drug resistance in several types of cancer; including lung and ovarian cancer. Ovarian cancer has elevated levels of HSF1, but the role of HSF1 in ovarian cancer behavior had not been previously examined. Researching the role of HSF1 in ovarian cancer is merited, because treatment outcomes are poor due to the high frequency of late stage detection and drug resistance. We hypothesized that HSF1 is important in the malignant growth and drug resistance of ovarian cancer. We have created ovarian cancer cell lines with inducible knockdown of HSF1 to investigate how HSF1 contributes to the behavior of ovarian cancer. This allowed us to examine the behavior of cells in the absence HSF1. Both 2D and 3D spheroid tissue culture models were used to study how HSF1 contributes to the growth and invasion of ovarian cancer cells after treatment with the transforming growth factor β (TGFβ) cytokine. Additionally, we studied how HSF1 reduction modulates the response to multiple therapeutic drugs. Our research shows that HSF1 induces epithelial-mesenchymal transition (EMT) in a 3D growth model. Our work also demonstrates that reduction of HSF1 sensitizes ovarian cancer cells to multiple drugs.

Abstract Ovarian cancer is the fifth leading cause of cancer-associated death in women in Finland. Although ovarian cancer is relatively common, the precise mechanism of its development is still unknown. Additionally, it appears that the modes of pathogenesis differ depending on histotype. Although the initial response to platinum-based chemotherapy is usually good, the majority of ovarian cancer patients relapse and develop platinum resistance. This is a major problem in the treatment of ovarian cancer. Reactive oxygen species (ROS) are metabolites of oxygen. They are continuously formed in normal cells as a by-product of aerobic respiration and they play an important role in normal cell functions. Oxidative stress occurs when ROS formation overrides the antioxidative defence system. Oxidative stress is associated with carcinogenesis. A small proportion of cancer cells are stem cells that survive initial chemotherapy. These cells are suspected of being associated with the development of platinum resistance. To evaluate the significance of oxidative stress in ovarian cancer we examined ROS-derived damage and antioxidant regulators in benign and borderline ovarian tumours and ovarian cancer samples by immunohistochemistry and analysis of serum samples. The existence of cancer stem cell markers was also assessed in ovarian cancer samples. The expression levels of various markers were compared with clinicopathological parameters. Our results confirm that oxidative stress (8-hydroxydeoxyguanosine) exists in benign tumours and antioxidant enzymes, such as peroxiredoxins and thioredoxin are widely expressed in benign and borderline tumours. Oxidative stress was associated with poor survival, higher stage and platinum resistance in ovarian cancer. Oxidative stress markers were more strongly expressed in certain histotypes of ovarian cancer, such as serous and endometrioid type. Cancer stem cell markers were found in ovarian cancer and they were associated with the development of platinum resistance. These observations are beneficial in understanding the pathobiology of ovarian cancer and help in the design of new treatment options. / Tiivistelmä Munasarjasyöpä on yksi merkittävistä syöpäkuolleisuuden aiheuttajista naisilla Suomessa. Se on kohtalaisen yleinen, mutta sen perimmäinen syntymismekanismi on vielä epäselvä. Lisäksi näyttää siltä, että eri histologioilla syntymekanismit poikkeavat toisistaan. Vaikka yleensä platinapohjaisella solunsalpaajahoidolla saadaan hyvä vaste, suurimmalla osalla hoidetuista potilaista tauti uusii ja kehittyy vastustuskyky platinapohjaisille solunsalpaajille. Tämä on suuri ongelma munasarjasyövän hoidossa. Vapaat radikaalit ovat hapen johdannaisia. Niitä muodostuu jatkuvasti soluissa soluhengityksen sivutuotteena, ja niillä on tärkeä merkitys normaaleissa solun toiminnoissa. Jos vapaiden radikaalien tuotanto ylittää antioksidatiivisen puolustusjärjestelmän, syntyy oksidatiivinen stressitilanne. Oksidatiivisen stressin on todettu olevan yhteydessä useiden syöpien syntymiseen. Osaa syövän soluista kutsutaan kantasoluiksi. Nämä solut voivat selvitä solunsalpaajahoidoista ja niiden epäillään olevan yhteydessä vastustuskyvyn kehittymisessä platinapohjaisia sytostaatteja kohtaan. Tutkimuksessamme arvioimme oksidatiivisen stressin merkitystä munasarjakasvaimissa. Tutkimme vapaiden radikaalien aiheuttamia vaurioita ja antioksidatiivisia säätelijöitä hyvänlaatuisissa, rajalaatuisissa sekä munasarjasyöpä kasvaimissa immunohistokemiallisesti ja seeruminäytteistä. Lisäksi selvitimme syövän kantasolumerkkiaineiden esiintymistä munasarjasyövässä. Tutkittujen merkkiaineiden pitoisuuksia verrattiin kliinisiin potilastietoihin. Tutkimustuloksemme mukaan oksidatiivista stressiä (8-hydroxydeoxyguanosine) esiintyi jo hyvänlaatuisissa kasvaimissa. Myös antioksidatiiviset entsyymit, kuten peroksiredoksiinit ja tioredoksiini, esiintyivät jo hyvänlaatuisissa ja rajalaatuisissa kasvaimissa. Oksidatiivinen stressi oli yhteydessä huonompaan tautiennusteeseen ja platinakohtaisen vastustuskyvyn kehittymiseen. Oksidatiivista stressiä oli enemmän seroosissa ja endometrioidissa munasarjasyöpätyypissä. Syövän kantasolumerkkiaineita esiintyi munasarjasyövässä, ja ne olivat yhteydessä huonontuneeseen hoitovasteeseen platinapohjaisille solunsalpaajille. Tulokset auttavat ymmärtämään munasarjasyövän syntymekanismeja ja suunnittelemaan uusia hoitovaihtoehtoja erityyppisissä munasarjasyövissä.

The efficient treatment of cancer with chemotherapy is challenged by the limited penetration of drugs into the tumor. Nanoparticles (10 – 100 nanometers) have emerged as a logical choice to specifically deliver chemotherapeutics to tumors, however, their transport into the tumor is also impeded owing to their bigger size compared to free drug moieties. Currently, monolayer cell cultures, as models for drug testing, cannot recapitulate the structural and functional complexity of in-vivo tumors. Furthermore, strategies to improve drug distribution in tumor tissues are also required. In this study, we hypothesized that hyperthermia (43°C) will improve the distribution of silica nanoparticles in three-dimensional multicellular tumor spheroids. Tumor spheroids mimic the functional and histomorphological complexity of in-vivo avascular tumors and are therefore valuable tools to study drug distribution. Ovarian cancer (Skov3) and uterine sarcoma (MES-SA/Dx5) spheroids were generated using the liquid overlay method. The growth ratio and cytotoxicity assays showed that the application of adjuvant hyperthermia with Doxorubicin (DOX) did not yield higher cell killing compared to DOX therapy alone. These results illustrated the role of spheroids in resistance to heat and DOX. In order to study the cellular uptake kinetics of nanoparticles under hyperthermia conditions, the experimental measurements of silica nanoparticle uptake by cells were fitted using a novel inverse estimation method based on Bayesian estimation. This was coupled with advection reaction transport to model nanoparticle transport in spheroids. The model predicted an increase in Area Under the Curve (AUC) and penetration distance (W1/2) that were validated with in-vitro experiments in spheroids. Based on these observations, a novel multifunctional theranostic nanoparticle probe was created for generating highly localized hyperthermia by encapsulating a Near Infrared (NIR) dye, IR820 (for imaging and hyperthermia) and DOX in Organically modified silica nanoparticles (Ormosil). Pegylated Ormosil nanoparticles had an average diameter of 58.2±3.1 nm, zeta potential of -6.9 ± 0.1 mV and high colloidal stability in physiological buffers. Exposure of the IR820 within the nanoparticles to NIR laser led to the generation of hyperthermia as well as release of DOX which translated to higher cell killing in Skov3 cells, deeper penetration of DOX into spheroids and complete destruction of the spheroids. In-vivo bio-distribution studies showed higher fluorescence from organs and increased plasma elimination life of IR820 compared to free IR820. However, possible aggregation of particles on laser exposure and accumulation in lungs still remain a concern.

Environ 5 à 10 % des cancers du sein et de l’ovaire sont liés à des prédispositions génétiques héréditaires. Les principaux gènes responsables de telles prédispositions sont BRCA1 et BRCA2. Depuis plusieurs années, l’analyse de ces gènes est proposée dans un cadre clinique. Aux Hôpitaux Universitaires de Genève (HUG) en Suisse, une consultation d’oncogénétique a été mise sur pied dès 1994 pour les personnes concernées par leurs antécédents personnels et familiaux de cancer. Jusqu’en 2009, le seul laboratoire suisse assurant l’analyse des gènes BRCA1/BRCA2 était établi aux HUG. Ce travail de thèse intègre, d’une part, des études en lien avec la démarche clinique de conseil génétique pour les formes familiales et héréditaires de cancer du sein et de l’ovaire et, d’autre part, une évaluation détaillée des données moléculaires résultant des analyses (n= 1'163) des gènes BRCA1/BRCA2 réalisées aux HUG entre 1996 et 2009. Des perspectives quant au développement de l’oncologie prédictive aux HUG et en Suisse, et à l’activité de conseillère en génétique particulièrement dans ce domaine, sont finalement présentées. / Genetic predispositions are responsible for 5 to 10 % of all breast and ovarian cancers. The main breast/ovarian cancer predisposing genes are BRCA1 and BRCA2. For some years, the screening of pathogenic mutations in BRCA1/BRCA2 genes is provided in a clinical setting. At the Hôpitaux Universitaires de Genève (HUG, Geneva, Switzerland), a consultation in predictive oncology has been set up since 1994 for individuals concerned by the evaluation of their familial cancer risk and the probability to carry a genetic predisposition to cancer. Until 2009, the single national laboratory for BRCA1/BRCA2 testing was established in the HUG. The objectives of this work were to evaluate different aspects of the consultation process for breast/ovarian cancer predisposition syndromes provided in our Unit and to review all BRCA1/BRCA2 complete screenings (n=1’163) performed between 1996 and 2009. Results of the present study will certainly influence future activity in predictive oncology, particularly regarding the role of the genetic counselor.

Contexte: Le cancer de l'ovaire est le cancer gynécologique le plus meurtrier chez les Canadiennes. Compte tenu de son mauvais pronostic et de ses méthodes de dépistage précoce limitées, il est nécessaire de mener des recherches pour identifier les facteurs susceptibles d'empêcher le cancer de l'ovaire de se développer. L’alcool est un facteur de risque pour de nombreux cancers, mais sa relation avec le cancer de l’ovaire demeure floue. Nous avons décidé d’étudier la relation entre la consommation d'alcool au cours de la vie et le risque de cancer de l'ovaire. Méthodes: Dans une étude cas-témoins basée sur la population à Montréal (2011-2016), 497 cas et 904 témoins ont rapporté leur consommation au cours de leur vie de vin rouge, de vin blanc, de bière et de spiritueux, ainsi que d'autres variables. Pour la consommation totale d'alcool et pour chaque type d'alcool spécifique, les rapports de cotes ajustés (OR) et les intervalles de confiance (IC) à 95% pour l'association avec le risque de cancer de l'ovaire ont été estimés à l'aide de la régression logistique inconditionnelle. Résultats: Le lien entre la consommation totale d'alcool au cours de la vie et le risque de cancer de l'ovaire explicitait une relation en forme de U: comparées à celles qui n'ont jamais bu, l’OR (IC à 95%) était de 0,72 (0,52-0,99) pour les participantes qui buvaient >0 à <1 consommation par semaine, de 0,83 (0,61-1,15) pour 1 à <3 consommations/semaine et de 0,98 (0,72-1,33) pour ³3 consommations/semaine. Une relation en forme de U a été suggérée pour la consommation de bière et de spiritueux au cours de la vie, mais les OR étaient plus proches de la valeur nulle. Les analyses par comportement tumoral ont suggéré que la consommation totale d'alcool au cours de la vie était associée à un risque réduit de cancer de l'ovaire invasif, mais à un risque accru de cancer de l'ovaire limite. Une tendance similaire a été observée pour la consommation de bière, mais pas pour les spiritueux, le vin rouge ou le vin blanc. Conclusion: La consommation d'alcool pourrait être associée de manière non linéaire au cancer de l'ovaire et cette association pourrait varier en fonction du comportement tumoral. / Background: Ovarian cancer is the deadliest gynecological cancer among Canadian women. Given its poor prognosis and limited methods of early detection, research is necessary to identify factors that may prevent ovarian cancer from occurring in the first place. Alcohol is a risk factor for many cancer sites, but its relationship with ovarian cancer remains unclear. We investigated the relation between lifetime alcohol consumption and ovarian cancer risk. Methods: In a population-based case-control study in Montreal (2011-2016), 497 cases and 904 controls reported their lifetime consumption of red wine, white wine, beer and spirits and other variables. For total alcohol intake and each specific alcohol type, adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association with ovarian cancer risk were estimated using unconditional logistic regression. Results: The association between lifetime total alcohol intake and ovarian cancer risk was U-shaped: compared to lifetime never drinkers, the OR (95% CI) was 0.72 (0.52-0.99) for drinking >0 to <1 drink/week, 0.83 (0.61-1.15) for 1-<3 drinks/week and 0.98 (0.72-1.33) for 3+ drinks/week. A Ushaped relationship was suggested with lifetime consumption of beer and spirits but ORs were nearer the null value. Analyses by tumour behaviour suggested that lifetime total alcohol intake was associated with a reduced risk of invasive ovarian cancer but an increased risk of borderline ovarian cancer. A similar pattern was observed for intake of beer, but not spirits, red or white wine. Conclusion: Alcohol consumption may be non-linearly associated with ovarian cancer and the association may vary by tumour behaviour.

Les lymphocytes B (LB) et les plasmocytes (PC) émergent comme des cellules importantes dans la surveillance immunitaire des tumeurs, même si leur rôle pro- ou anti-tumoral reste activement débattu. Nous avons émis l’hypothèse que cette dualité fonctionnelle de la réponse B pourrait être dictée par l'identité des sous-populations de LB infiltrant la tumeur et/ou par la nature des anticorps (Ac) qu’ils produisent. Dans ce contexte, nous avons montré que les tumeurs du sein et de l’ovaire sont souvent infiltrées par des LB mémoires et des PC exprimant/produisant principalement des IgG ou des IgA. Les IgA sont fortement enrichis dans les tumeurs mammaires in situ, plus précoces, et dans 15-20% des tumeurs invasives, suggérant un rôle différentiel des IgG et des IgA dans la progression tumorale. Les IgA, pouvant être monomériques ou dimériques dans les tumeurs, ciblent en général des antigènes (Ags) différents de ceux des IgG. Nous montrons de plus que les Ags ciblés par les IgA et les IgG sont souvent impliqués dans des fonctions de développement des tissus et d’interaction avec l’ADN, et sont parfois partagés entre patients et entre les types de tumeurs, suggérant leur importance dans la réponse anti-tumorale. En parallèle, grâce à l’étude des tumeurs de patientes souffrant d’un syndrome neurologique paranéoplasique, nous avons pu montrer que l’induction concomitante de PC à IgG et de LT CD8+ cytotoxiques dans la tumeur était liée à des amplifications et/ou des mutations dans les gènes des Ags tumoraux. Ces résultats mettent en évidence l’important des LB et des Ig dans la réponse anti-tumoral, et ouvre des pistes pour rechercher des cibles thérapeutiques en immunothérapie / B and plasma cells are rising as crucial cells in the immune surveillance of tumors, even though their pro- or anti-tumor role is still debated. We argue that this dual functionality of B cells could depend on the identity of tumor-infiltrating B cell subsets and/or by the nature of the antibodies they produce. With that knowledge, we showed that breast and ovarian tumors are usually infiltrated by memory B cells and plasma cells that express and/or produce mainly IgG or IgA. This last class of Ig in highly enriched in in situ carcinomas of the breast, corresponding to earlier tumors, and in 15-20% of invasive tumors, suggesting a differential role of IgG and IgA in tumor progression. IgA, that can be monomeric or dimeric in tumors, often target antigens that differ from those targeted by IgG. We also show that antigens targeted by IgA and IgG in the tumor are often involved in functions related to the development of tissues and DNA interactions, and can be share amongst patients and between breast and ovarian tumors, suggesting their importance in the anti-tumor immune response. In parallel, using tumors from patients suffering from a paraneoplastic neurological syndrome, we established that the concomitant induction of IgG PC and CD8+ cytotoxic T cells in the tumor is associated wth amplifications and/or mutations in the genes of tumor antigens. These results highlight the importance of B cells and Ig in the anti-tumor immune response and give leads to look for new targets in immunotherapy

Les cancers de l’ovaire demeurant particulièrement meurtriers du fait de leur capacité à développer une résistance aux chimiothérapies conventionnelles, il est donc indispensable de mettre en place de nouvelles stratégies thérapeutiques susceptibles de surmonter la chimiorésistance pour améliorer leur prise en charge. Les travaux antérieurs de l’Unité ont démontré que les protéines anti-apoptotiques Bcl-xL et Mcl-1 coopèrent pour protéger les cellules cancéreuses ovariennes contre l’apoptose et que leur inhibition concomitante conduit à la mort des cellules chimiorésistantes. A ce jour, seuls les inhibiteurs de Bcl-xL/Bcl-2 ont démontré une efficacité en clinique, en particulier l’ABT-263 (Navitoclax). En revanche, l’inhibition de Mcl-1 reste problématique dans un contexte clinique. La recherche d’outils pharmacologiques conduisant à l’inhibition ou à l’inactivation de Mcl-1, utilisables en clinique, reste donc un enjeu majeur, d’autant que cette protéine est désormais désignée comme une cible thérapeutique prioritaire dans de nombreuses localisations tumorales. C’est dans ce contexte que mon projet de thèse s’est inscrit, l’objectif étant d’identifier et d’évaluer de nouveaux inhibiteurs pharmacologiques de Mcl-1 synthétisés par des équipes de chimistes. Dans cette optique, mon projet de thèse s’est scindé en deux parties : Dans une première étude, je me suis attachée à cribler in vitro des molécules appartenant à différentes familles chimiques (Oligopyridines dérivées du Pyridoclax, « Lead » de la première génération des oligopyridines précédemment identifié par notre équipe, ou analogues de MIM1) dans le but d’identifier de nouveaux inhibiteurs de Mcl-1 plus actifs que les molécules dont ils dérivent. Ce travail a permis d’identifier la MR31367, une molécule issue du Pyridoclax qui présente une activité pro-apoptotique plus forte que ce dernier sur plusieurs lignées tumorales ovariennes chimioresistantes. Nous avons également pu mettre en évidence sur ces mêmes modèles que plusieurs molécules issues de MIM1 exhibaient une activité pro-apoptotique amplifiée. Cette étude nous a également permi de mettre en évidence une relation structure activité permettant de classer ces molécules en inhibiteurs spécifiques de Mcl-1 et « dual-inhibiteur » de Mcl-1 et Bcl-xL. Dans une seconde étude, mon travail a consisté en l’évaluation préclinique du sel de Pyridoclax. Nous avons étudié l’effet de différentes doses de Pyridoclax administré par différentes voies d’administration, en agent seul ou en combinaison avec l’ABT-263 sur différents modèles tumoraux établis à partir des lignées chimiorésistantes de cancers ovariens. Nous avons ainsi pu mettre en évidence un effet anti-tumoral du Pyridoclax (20 mg/kg/j) administré par voie IV en agent seul sur des 2 modèles des 3 modèles de xénogreffes, et cela sans toxicité avérée. Ces résultats prometteurs ouvrent des perspectives intéressantes quant à l’utilisation d’inhibiteurs pharmacologiques de Mcl-1 pour le traitement des cancers de l’ovaire / Ovarian cancer is the most leading cause of death from gynecologic malignancies because of its late diagnosis and its ability to develop chemoresistance to conventional therapies. It is now essential to develop new therapeutic strategies to overcome this chemoresistance and improve patient care. Our laboratory has demonstrated the overexpression of the Bcl-2 anti-apoptotic proteins Bcl-xL and Mcl-1 and their cooperation to protect ovarian cancer cells from apoptosis. Currently, the clinically relevant pharmacologic inhibition of Bcl-xL is available using ABT-263 (Navitoclax). However, selective direct Mcl-1 inhibition remained a challenge. This protein is one of the most important anti-apoptotic member which is expressed in multiple cancer types and is at the origin of the acquired resistance to chemotherapy and Bcl-2 family inhibitors (Navitoclax, Venetoclax). Thus, Mcl-1 inhibition represents a major challenge for the clinical success of the Bcl-2 family inhibitors. In this context, I was interested in identifying and evaluating new Mcl-1 inhibitors designed and synthetized by different chemistry research teams. My project was focused on two aspects. In the first part, we have evaluated the cytotoxic effect of different molecules derived from 2 Mcl-1 inhibitors, the Pyridoclax from the oligopyridine family and MIM1. The screening of 8 Noxa-mimetic molecules derived from Pyridoclax allowed us to identify MR31367, one of the most potent oligopyridine molecules that shows a stronger anti-apoptotic activity than Pyridoclax (15μM) and sensitizes different chemoresistant ovarian cancer cell lines (IGROV1-R10, SKOV-3 and A2780) to anti-Bcl-xL strategies (ABT-737, siRNA). Furthermore, we have evaluated the pro-apoptotic activity of 14 MIM1 derivative molecules using the same cellular model. This study has demonstrated that most of these derivatives have greater pro-apoptotic activity than MIM1. We have also established the structure-activity relationship leading to classify these molecules as “Mcl-1 inhibitors” or as “dual inhibitors” of Mcl-1 and Bcl-xL.The second part of my project was focused on the preclinical evaluation of Pyridoclax hydrochlorid. We have analyzed the antitumor activity of Pyridoclax hydrochlorid in several subcutaneous xenografts derived from human ovarian cancer cell lines (IGROV1-R10, SKOV-3 and A2780). Different routes of Pyridoclax hydrochlorid administration were tested (oral, IV and IT) and its antitumor effect was analyzed at different doses as single agent or in combination with ABT-263 (100mg/kg). This study highlighted an effective antitumor activity of 20mg/kg of Pyridoclax hydrochlorid administered intravenously as single agent in two of three xenograft models without any side effects. This results open up interesting perspectives for the clinical use of Mcl-1 inhibitors to improve the clinical management of ovarian cancer

Bcl-xL et Mcl-1 sont deux protéines anti-apoptotiques de la famille Bcl-2 dont dépendent les cancers de l’ovaire pour leur survie, leur inhibition semble donc être une stratégie pertinente. La molécule BH3-mimétique ABT 737 (ou son analogue oral, l’ABT-263), est un puissant inhibiteur de Bcl-xL mais l’inhibition de Mcl-1 reste problématique. Les voies de signalisation PI3K/Akt/mTOR et MAPK/ERK régulent l’expression et l’activité de cette dernière protéine et de ses partenaires BH3-only (Bim, Puma, Noxa). Nous nous sommes donc intéressés à l’intérêt de leur inhibition pour sensibiliser les cellules cancéreuses ovariennes à l’ABT-737. La première étude menée avec le BEZ235, double inhibiteur PI3K/mTOR développé par le laboratoire Novartis, montre qu’il inhibe l’expression de Mcl-1 et induit celle de Puma, et qu’il sensibilise les cellules cancéreuses ovariennes à l’ABT-737 à condition que l’expression de Bim soit également induite. La deuxième étude a évalué les effets de l’AZD8055, inhibiteur du site actif de mTOR développé par le laboratoire AstraZeneca, et du trametinib, inhibiteur allostérique de MEK développé par le laboratoire GlaxoSmithKline et actuellement en clinique, sur trois lignées cancéreuses ovariennes. L’inhibition de l’expression de Mcl-1 et l’induction de celle de Puma par l’AZD8055 ne permettent pas de diminuer suffisamment le ratio [Mcl-1/protéines BH3-only] pour sensibiliser les cellules à l’ABT-737. En revanche, la forte induction de Bim sous forme active déphosphorylée par le trametinib permet de diminuer suffisamment ce ratio pour sensibiliser deux des trois lignées testées à l’ABT-737. C’est cependant la triple combinaison AZD8055/trametinib/ABT-737 qui est la plus efficace pour induire une apoptose massive dans les trois lignées. Par ailleurs, de façon intéressante, l’association de l’AZD8055 et du trametinib est cytotoxique sans ABT 737 dans une des lignées testées. Ces résultats mettent en évidence l’efficacité de différentes stratégies thérapeutiques multi-cibles et la nécessité de définir des marqueurs prédictifs de la réponse afin d’évoluer vers un traitement personnalisé pour améliorer la prise en charge des cancers de l’ovaire. / Ovarian cancers depend on Bcl-xL and Mcl-1, two anti-apoptotic protein of the Bcl-2 family, for their survival and their inhibition seems to by a relevant strategy. The BH3-mimetic molecule ABT-737 (or its oral form, ABT-263), is a strong Bcl-xL inhibitor, but Mcl-1 inhibition remains problematic. Signaling pathways PI3K/Akt/mTOR and MAPK/ERK regulate expression and activity of Mcl-1 and its BH3-only partners (Bim, Puma, Noxa). We focused on the interest of their inhibition to sensitize ovarian cancer cells to ABT-737. The first study with BEZ235, a PI3K/mTOR dual inhibitor developed by Novartis, inhibits Mcl-1 expression and induces the one of Puma, and sensitizes ovarian cancer cells to ABT-737 provided that Bim expression is induced. The second study evaluated the effects of AZD8055, mTOR active site inhibitor developed by AstraZeneca, and of trametinib, MEK allosteric inhibitor developed by GlaxoSmithKline and currently in clinic, on three ovarian cancer cell lines. Mcl-1 expression inhibition and Puma expression induction by AZD8055 does not sufficiently reduce [Mcl-1/BH3-only proteins] ratio to sensitize cells to ABT-737. On the other hand, strong Bim induction in its active dephosphorylated form by trametinib sufficiently reduce this ratio to sensitize two of the three cell lines tested to ABT-737. Nevertheless, the triple combination AZD8055/trametinib/ABT-737 is the most efficient to induce massive apoptosis in the three cell lines. Besides, interestingly, AZD8055 and trametinib association is cytotoxic without ABT-737 in one of the tested cell lines. These results highlight the efficacy of different multi-targets therapeutic strategies and the need of predictive marker definition of the response to develop personalized treatment and to improve ovarian cancer management.