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Oncolytic viruses are characterised by their ability to selectively infect and kill tumour cells. Recently it has emerged that they can exert an additional anticancer mechanism stimulating adaptive immune-mediated cancer cell killing. Enadenotucirev (EnAd, formerly known as ColoAd1), is a chimeric Ad11p/Ad3 virus group B oncolytic adenovirus that binds CD46 and is under development for the systemic treatment of metastatic carcinomas. The central aim of this thesis was to to assess whether EnAd provides an adjuvant effect on tumour-associated antigen presenting cells (APCs) that could drive T_H1 polarisation for an effective anti-tumour immune response. This thesis describes the potent oncolytic properties, fast replication and high numbers of virus progeny production by EnAd in cancer cells. Recombinant EnAd variants were engineered to investigate the roles of the mutant regions in the genome of EnAd, and how these influence the modified phenotype. A chemical drug panel was used to identify pathways and cellular factors involved in cellular production of EnAd, finding that several mTOR inhibitors and microtubule inhibitors could improve virus replication. An in vitro system using partially matured human monocyte-derived dendritic cells (DCs), which displayed a similar phenotype to tumour-infiltrating DCs, was used to explore the effect of EnAd on APC responses. EnAd induced a strong adjuvant effect on these cells by up-regulating surface markers and secretion of pro-inflammatory factors. Further mechanistic experiments, alongside a CAR-binding group C adenovirus 5, indicated these adjuvant effects were virus particle-mediated and dependent on CD46 binding. To understand the functional implications downstream of these interactions, T cell activation and phenotype was assessed using a mixed lymphocyte reaction approach. The data indicated EnAd was a good candidate compared to other adenoviruses, that may steer the response of activated T-cells towards a T_H1 phenotype, for an effective immune response. In conclusion, the potent oncolytic properties of EnAd virus may provide an adjuvant effect on tumour-associated APCs, helping to harness an adaptive immune response.

The primary aim of this thesis was to increase healthcare professionals’ understanding surrounding the emotional distress of paediatric oncology patients prior to reaching five-year survivorship status, to inform resource allocation and evidence-based clinical interventions. Paper 1 systematically reviewed the extant literature that has assessed the emotional distress severity of paediatric oncology patients who had not yet reached five-year survivorship status. Contradictory findings were evident from the 21 studies reviewed. These inconsistencies in findings were discussed in relation to methodological limitations present within the studies and the heterogeneous oncology and control groups studied. The review concluded that further multiple-centre studies, using appropriate self-report and parent-proxy standardised measures, and larger, representative samples comprising patients with CNS and non-CNS malignancies at differing points in their treatment journeys, are needed to identify demographic, illness and treatment variables that leave paediatric oncology patients vulnerable to emotional distress. The empirical paper presented in Paper 2 utilised a rigorous methodology to address this need, and additionally explored modifiable psychological risk factors for emotional distress in this population. 74 paediatric oncology patients (aged 12-18 years), who were within five years of treatment completion, completed self-report measures of emotional distress, self-concept and health related quality of life (HRQOL), whilst their parents provided background information regarding patients’ demographics, diagnoses and treatment protocols. 72 parents also provided ratings surrounding patients’ self-concepts and HRQOL. The mean emotional distress rating indicated that the sample was clinically distressed. Demographic, illness and treatment factors explained little variance in emotional distress, whilst global self-concept, global-generic and cancer-specific HRQOL were significant predictors. Provisional analyses indicated that experiencing pain, illness-related worries, communication difficulties and negative self-views in relation to maths abilities, parent relations and opposite-sex peer relations were specific risk factors in the sample studied. Patient- and parent-reports of patients’ self-concepts and HRQOL were highly consistent. These findings suggest that paediatric oncology patients would benefit from frequent routine screening for emotional distress to allow early identification and intervention. Furthermore, prevention-oriented interventions surrounding emotional distress, and indirect interventions targeting global self-concept and HRQOL could be beneficial. Paper 3 critically appraises the systematic review and empirical paper in terms of their methodologies and clinical contexts. It is acknowledged that some of the results are preliminary in nature and need replicating in larger samples. Nevertheless, this research was successful in exploring demographic, illness, treatment and psychological risk factors for emotional distress for paediatric oncology patients prior to reaching five-year survivorship status, providing guidance for future clinical interventions, and making suggestions for future studies, in terms of their aims and methodologies.

This thesis seeks to use mathematical and computational models to develop measures of clinically available data to deepen our understanding, and improve our treatments, of cancer. We consider two broad characteristics of cancer: heterogeneity, in the form of differences in cellular phenotype, and the physical microenvironment; and evolution, which has become accepted as a driver of tumour progression. To ensure that the conclusions drawn are as translatable as possible, we will attempt to use data types that are clinically available. Using a hybrid discrete-cell-based model in two spatial dimensions, we focus on these fundamental aspects of cancer, with the hope of generating new understanding and useful hypotheses to benefit current patients and oncologists. First, we model a tumour growing under the rules of the cancer stem cell hypothesis and a neutral model of evolution, and ask if we can infer the underlying biological proliferative structure. Specifically, we work toward predicting the symmetric division probability of our simulated tumours from clincally relevant observables, as this is a key driving parameter of tumour progression and therapeutic response. We focus on measures of clonal diversity, group size and shape, and a suite of statistical measures of the phylogenetic trees resulting from the tumour's evolution in different regions of parameter space. We find strikingly different patterns in these measures for changing symmetric division probability which hinge on the inclusion of spatial constraints. These results give us insight into differences between solid and liquid tumours, and also generate a number of actionable clinical and biological hypotheses. Second, we explicitly consider the physical microenvironment of tumours invading into healthy tissue, and model oxygen transport, uptake and cellular competition. We then explore the effect of spatial organisation of blood vessels within the tumour on tumour growth kinetics and cellularity. Finding wide variability in the distribution of oxygen across tumours dependent on both vascular organisation and density, we proceed to explore the utility of spatial measures of vessels on radiation efficacy. Our results offer a novel hypothesis as to the failure of vascular normalisation therapy and radiation, and a possible clinical solution.

NKX3.1, a prostate specific homeobox gene is a known marker of prostate epithelium during embryogenesis and is also expressed subsequently through different stages of prostate differentiation. However, all studies on NKX3.1 are focused on its regulation by androgen receptor (AR). The aim of this project is to establish the role of NKX3.1 in differentiation in prostate cancer, independent of AR regulation. In this thesis, I characterize the cell lines in terms of their differentiation capabilities in 3D, expression levels of NKX3.1 and the mismatch repair status. The genes potentially involved in differentiation and regulators of NKX3.1 are also identified using microarray data of the cell lines (<b>Chapter 3</b>). Although NKX3.1 plays a key role in prostate development no studies have been conducted on the effect of NKX3.1 expression on differentiation capabilities of prostate cell lines. In <b>Chapter 4</b>, this was investigated by siRNA mediated knockdown of NKX3.1 in 22Rv1 cell line and overexpression of NKX3.1 in PC3 (designated PC3-Nkx3.1) and PNT1a cells followed by growth in 3D. These functional studies show that the expression of NKX3.1 is vital for lumen formation in 3D, which is used as a measure of differentiation. The microarray data and overexpression of NKX3.1 studies suggest that this gene may also be involved in inhibiting epithelial to mesenchymal transition (EMT). Homeobox B13 (HOXB13) was identified as one of the downstream targets of NKX3.1. NKX3.1 and HOXB13 expression levels are positively correlated not only in the panel of prostate cell lines but also in the NKX3.1 overexpression and knockdown studies (<b>Chapter 5</b>). The results of the work presented in this thesis demonstrate that there is a striking parallel between the function of NKX3.1 in prostate and Caudal-type homeobox 1 (CDX1) in the colon and rectum. In conclusion, NKX3.1 plays a key role as a tumour suppressor in prostate cancer by controlling differentiation of prostate cancer cells.

Radiotherapy has been shown to increase the subsequent risk of heart disease among survivors of breast cancer, but little is known about factors, other than the dose of radiation delivered to the heart, which determine the magnitude of the risk. In addition, survivors of teenage and young adult cancer are internationally acknowledged as an understudied population, and limited information is available on their late health risks. This thesis sought to utilise the largest observational datasets available to date for these populations: the Collaborative Group on Observational Studies of Breast Cancer Survivors and the Teenage and Young Adult Cancer Survivor Study. These were used to firstly characterise the radiation-related risks of heart disease and lung cancer, and secondly to provide an overview of the long-term risk of heart disease for the entire spectrum of cancers diagnosed in teenagers and young adults aged 15 to 39. Initially, a methodology study and systematic review demonstrated that selection effects and other biases can be very problematic during analyses of observational cohorts, particularly when using a radiotherapy comparison. However, in the case of heart disease and lung cancer, one can take advantage of the breast being a paired organ and use a laterality comparison, particularly when laterality played little effect in treatment selection. This comparison was used throughout the analyses of breast cancer patients. This thesis demonstrated that adjuvant radiotherapy for breast cancer significantly increased the risk of heart disease among women with left-sided breast cancer and those patients with ipsilateral lung cancer. Interestingly, younger women were at the highest risk of heart disease, and a progressive proportional decrease in risk with increasing age at diagnosis was found, which has not been shown before. It also suggested that radiotherapy and chemotherapy combined may further increase the risk of heart disease among breast cancer patients. Survivors of teenage and young adult cancer, particularly Hodgkin lymphoma, were at a significantly raised cardiac mortality risk compared to the matched general population. The findings of this thesis provide evidence to support continued follow-up for cancer patients, as survivors were found to be at a substantial risk into the second or third decade after treatment. It has permitted the detection of groups of individuals at particularly increased risks, for example younger patients and survivors of Hodgkin lymphoma diagnosed in teenagers and young adults, for whom closer monitoring for late effects or measures to reduce the risk, such as adaptations to treatment, may be appropriate. Finally, evidence was also presented to support the development of clinical follow-up guidelines specifically for survivors of teenage and young adult cancer.

Cancer testis antigens (CTA) represent attractive targets for targeted radiotherapy and imaging as their expression is restricted to cancer and germ cells. NY-ESO-1, a member of the CTA family, is highly immunogenic and expressed in multiple tumor types including carcinoma of bladder, liver lung. The aim of this study was to develop radioimmunoconjugates (RIC) to target NY-ESO-1 protein in cancer cells. Anti-NY-ESO-1 antibodies were modified by addition of DTPA for 111In-labelling or, in the presence of Iodogen, were 123I-labelled. Delivery of radiolabeled immunoconjugates across the cell membrane was achieved using a protein transfection (PT) reagent (SAINT-PhD) and by chemical linkage with the cell-penetrating and nuclear-localizing peptide, TAT (YGRKKRRQRRR). Cellular internalization, distribution and efflux of 111In-DTPA-anti-NY-ESO-1-TAT-PT and 123I-anti-NY-ESO-1-TAT-PT were investigated in cell fractionation and retention assays. It was shown that protein transfection reagent has promoted the cellular uptake of RICs into SK-MEL-37 and both of 111In-DTPA-anti-NY-ESO-1-TAT-PT and 123I-anti-NY-ESO-1-TAT-PT was retained longer in SK-MEL-37 cells in comparison to their isotope control RIC. In clonogenic assays, 111In-DTPA-anti-NY-ESO-1-TAT-PT significantly reduced surviving fraction of SK-MEL-37 cells. Cytotoxicity was inversely proportional to specific activity and the concentration of cells exposed to 111In-DTPA-anti-NY-ESO-1-TAT-PT. siRNA knock down of NY-ESO-1 resulted in partial reversal of 111In-DTPA-anti-NY-ESO-1-TAT-PT associated cytotoxicity. These promising results obtained from the in vitro study has brought the probe further into in vivo study. In preliminary biodistribution studies in SK-MEL-37 xenograft-bearing mice, tumour:muscle ratio for 111In-DTPA-anti-NY-ESO-1-TAT-PT was statistically significant compared to the control RIC 48 h post injection. This clearly indicated that the probe can be delivered into tumour in in vivo model and the successful uptake of radioactivity increased the chance of causing cytotoxicity to tumour cells through DNA damage. All of these findings have suggested that intracellular cancer associated antigen NY-ESO-1 can be reached by protein transfection reagent and cell penetrating peptide and initiates DNA damage through radio-isotope mediated cytotoxicity. Therefore, it represents a novel approach to the treatment of CTA-expressing cancers.

The DNA Mismatch repair (MMR) pathway is responsible for the repair of base-base mismatches and insertion/deletion loops, formed during DNA replication. Mutations in MMR genes significantly increase the predisposition to cancer with MMR deficiency estimated to be present in 15-17 % of all colorectal cancers. 5-fluorouracil is the main treatment for advanced colorectal cancer however the majority of studies suggest that MMR deficient tumours are more resistant to 5-fluorouracil than MMR proficient tumours. Therefore, there is a critical clinical need to identify novel therapeutics to treat these tumours. To this end, we have performed a high-throughput compound screen, to identify compounds that cause selective lethality in MMR deficient cell lines. We identified the potassium-sparing diuretic drug, Triamterene, as selectively lethal in vitro and in vivo in MMR deficient cell lines. Our data suggest that this selectivity is through its antifolate activity, leading to the accumulation of reactive oxygen species and DNA double strand breaks in MMR deficient cells. Interestingly, we identified a requirement, for thymidylate synthase expression, the only de novo enzyme for dTTP synthesis for the Triamterene cytotoxicity. NRF2 and NRF2-induced antioxidants were regulated upon Triamterene treatment and thymidylate synthase silencing, therefore suggesting a role for the antioxidant response in Triamterene toxicity. Taken together, our results suggest Triamterene as a promising novel therapeutic for the treatment of MMR deficient cancers. In order to identify novel therapeutics to treat MMR deficient tumours, we have also performed a high-throughput siRNA screen, to identify genes that cause selective lethality in MMR deficient cell lines. We identified AURKA gene as synthetically lethal in MSH6 deficient cell lines which suggests AURKA as a promising novel therapeutic target for the treatment of MMR deficient cancers. Taken together, in this PhD thesis we have identified two novel therapeutic strategies for the treatment of MMR deficient cancers.

The active form of Vitamin D (VD3) has been shown to induce pro-apoptotic and anti-proliferative effects in several mammalian cancer cell types. The molecular mechanisms of tumor suppression, however, are not clearly understood. Previous research has shown that head and neck squamous cell carcinoma (HNSCC) responds to VD3. This thesis used both in vivo and in vitro models to examine the effect of VD3 in HNSCC. Former work in the Albala laboratory showed that hamsters that received systemic VD3 and topical treatment of 7,12-dimethylbenz(a)anthracene (DMBA) to the buccal pouch showed no or delayed carcinogenesis over the 14-week study compared to DMBA-only treated hamsters. This research further investigated the effect of VD3 in this hamster model. Using immunohistochemical (IHC) and western blot analysis, we demonstrate that systemic application of VD3to hamsters downregulates Rad51 expression in the buccal pouch and hinders the onset of tumor formation. Rad51 is a protein that plays a critical role in cell proliferation and homologous recombinational DNA repair. In the in vitro model, we show that Rad51 expression decreased in response to 100nM VD3 in HNSCC cell lines. The dose and time-dependence of VD3 on these cells was also examined. Western blot analysis and comet assay investigations confirmed that the SCC25 cell line is most sensitive to 100nM VD3 than to other doses tested, and that VD3 impairs the DNA-damage response. SiRNA and co-immunoprecipitation studies examined the potential of Chk 1 and p38 MAPK as upstream regulators of Rad51. Rad51 protein expression was found to be associated with early carcinogenesis from HNSCC cancer patients using IHC studies of human carcinomas from the oral cavity. This study focused on further identifying the role of Rad51 in response to VD3 in HNSCC.