Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 53-56).

Increased HIV susceptibility has been associated with the progesterone-dominant luteal phase of the menstrual cycle and the use of progesterone-only contraceptives, yet the mechanism is poorly understood. Here, we performed mass spectrometry-based analyses of cervicovaginal fluids collected from women with differing ovarian hormone levels as demonstrated by menstrual cycle phase or exogenous progesterone-only contraceptive use. We found that proteins associated with maintaining the integrity of epithelial barrier were enriched during times of high estradiol, whereas during times of high progesterone, there was a loss of barrier integrity proteins and an enrichment of proteins with known roles in inflammatory processes including leukocyte infiltration. Progesterone-based proteomic profiles were also strongly associated with neutrophil signatures with some evidence of CD4+ T cell signatures. This study generates new hypotheses about the potential mechanisms of hormone-associated HIV susceptibility including a weakened epithelial barrier and increased HIV target cell recruitment during times of increased progesterone. / February 2016

Cardiovascular disease (CVD) causes 45% of on-duty firefighter fatalities, a high fraction even when compared to the risk of CVD found in other first-responder professions like police work and emergency medical services. Monitoring and managing firefighter cardiac health is important for both individual health and public safety. In our study, we are interested in assessing the utility of the most commonly used risk assessment scoring, known as the Framingham Risk Score, in evaluating the atherosclerotic risk in asymptomatic firefighters. To this end we determined FRS for 159 male firefighters from Gwinnett County, Georgia, and compared their risk categorization against their known atherosclerotic burden as determined by CIMT and CAC. While the 20% FRS threshold, corresponding to medium risk, had a high specificity for both CAC and CIMT, it also had a low sensitivity (17% and 40%, respectively), indicating that a large percentage of individuals with clinically significant atherosclerosis are being misclassified. By adjusting the FRS threshold downward, we were able to raise the sensitivity greatly with only a modest loss of specificity. Following percutaneous transluminal coronary angioplasty for the treatment of coronary artery disease, stents are commonly implanted at the treatment site to prevent recoil and negative remodeling. To combat in-stent restenosis, an arterial healing response that results in luminal loss in stented arteries, anti-restenotic drugs like sirolimus (SES) and zotarolimus (ZES) are commonly eluted by stents to suppress cell proliferation at the treatment site. While comparative studies have revealed significant difference between bare metal stents (BMS), SES, and ZES in both clinical and histological arterial response, the molecular basis of these differences remains poorly understood. We conducted a comparative gene expression profiling study using microarrays to examine differences in gene expression and pathway function in coronary arteries exposed to ZES, SES, and BMS in a porcine animal model. These molecular profiles suggest a model of delayed restenosis, resulting from a drug-induced suppression of inflammatory responses and proliferative processes, rather than an elimination of restenosis. microRNAs play a regulatory role in metastasis-related epithelial to mesenchymal transitions and mesenchymal to epithelial transitions in ovarian cancer cells. We previously showed that over-expression of miR-429 in ovarian cancer cells drove a transition from mesenchymal phenotypes to epithelial phenotypes both in morphology and expression of markers like ZEB1, ZEB2, and E-cadherin. Our study represents the first time course analysis of miR-429-induced MET in ovarian cancer cells. We transfected Hey cells with miR-429 and assayed gene expression over the course of 144 hours at regular intervals. The cell morphology and gene expression of our transfected cells changed to become more epithelial-like at 24 and 48 hours and then became more mesenchymal-like by 144 hours. By 144 hours the average gene expression levels for 98.6% of our genes were not significantly different from the levels they started from at 0 hours when we adjusted for baseline expression changes observed in our negative control treated cells. This suggests the use of microRNAs as cancer therapies and driving cancer cells to a more drug susceptible state.

Aims: This thesis had three aims: to review evidence evaluating the effectiveness of decision aids at increasing cancer patients’ treatment-related knowledge and reducing decisional conflict; to explore the decision-making processes of ovarian cancer patients who had opted for or against CA-125 testing during post-treatment surveillance; and to elicit patients’ and health professionals’ views on the proposed development of a decision aid aimed at helping women decide for or against CA-125 testing during post-treatment surveillance for ovarian cancer. Methods: A systematic review was conducted of evidence relating to the effectiveness of cancer treatment-related decision aids at increasing treatment-related knowledge and reducing decisional conflict. In the qualitative study, semi-structured interviews were conducted with ovarian cancer patients (n = 18) and health professionals (n = 6) in an outpatient gynecological oncology clinic. Framework analysis was used to identify themes in the qualitative data. Results: Overall, results from the systematic review supported previous research where decision aids were found to improve patient knowledge and reduce decisional conflict across a range of cancer treatment-related decisions. However, the lack of psychometric support for the treatment-related knowledge measures used in the majority of the studies compromised their ability to address the review question. In the qualitative study, accurate knowledge about CA-125 testing in post-treatment surveillance was found to greatly influence participants’ decision-making processes. Most women with less knowledge about the test chose to have testing based on the false belief that earlier detection of recurrence would lead to earlier treatment and prolonged survival. There was strong enthusiasm from patients and health professionals for the development of the proposed decision aid to assist women facing this treatment decision. Conclusions: The systematic review findings add to previous research supporting the use of decision aids in cancer-related treatment decisions and advocate for their continued development, evaluation and implementation into the healthcare system. The need for a decision aid to ensure accurate knowledge about CA-125 and to aid decision-making for women with ovarian cancer was supported. As well as assisting women with this decision, the proposed decision aid may ultimately support health professionals in practicing shared decision-making regarding CA-125 testing with ovarian cancer patients.

Mammalian ovulation is a complex, hormone-dependent developmental program in which several events must take place in an ordered progression to ensure that the oocyte is competent for fertilization. This process requires the coordinated expression of many genes which must be turned on and off in the right place at the right time for proper development of the follicle. While the hormone signals from the brain that initiate ovulation are known, the master control genes which regulate this process are not well known. Homeobox proteins are potential candidates to perform as master regulators. Homeobox proteins are DNA-binding proteins that regulate the transcription of downstream genes and thereby control biological events. We recently identified a new homeobox gene cluster on the mouse X chromosome that are only expressed in reproductive tissues. These reproductive homeobox (Rhox) homeobox genes are expressed in the ovary, placenta, testis, and epididymis, and thus are good candidates to regulate both male and female reproductive tissue development and physiology. Rhox gene expression fell into three categories: Class I exhibited peak expression prior to ovulation (0-8 hours after hCG), Class II were predominantly expressed during ovulation (8-16 hours after hCG), and Class III peaked after ovulation. The slightly overlapping windows of peak Rhox gene expression suggest that these genes may regulate specific events during the ovulatory cycle. The founding member of the cluster, Rhox5, is highly expressed in granulosa cells of pre-ovulatory follicles. We previously reported that Rhox5-null female mice are viable and fertile, suggesting that RHOX5 is either not essential for ovulation, or that one of the other RHOX factors may compensate functionally in granulosa cells. In order to identify potentially redundant RHOX factors, we examined the expression patterns of all 32 Rhox genes using an eCG primed, hCG induced superovulation model, in wild-type, Rhox5-null, and heterozygous littermate mice. Expression levels of Rhox1, exhibited peak expression prior to being hormonal primed, was reduced in the Rhox5-null animal. However, Rhox8 mRNA and protein were reduced at 2h and 4h post hCG, but recovered once the follicles passed the antral stage of development. Conversely, in progesterone receptor knockout mice (PRKO), Rhox8 exhibited normal stimulation by eCG, but failed to reach its peak mRNA level at 8h post-hCG found in WT mice. This suggests a model in which Rhox8 transcription is dependent upon RHOX5 during early folliculogenesis and progesterone during the periovulatory window when RHOX5 normally wanes. Subsequent promoter analysis in granulosa cells revealed essential homeobox binding and progesterone response elements within Rhox8's 5'-flanking region. Transfection of RHOX5 and PGR expression plasmids stimulated, whereas dominant negative and mutant constructs inhibited, Rhox8 promoter activity. At present, the specific impact of misregulation of Rhox5 and Rhox8 during early folliculogenesis is not known. However, follicle counts from serially sectioned ovaries, extirpated from normal cycling animals, indicated that Rhox5-null mice possess ~50% fewer follicles than heterozygous littermates. Loss of RHOX5 in Sertoli cells results in male subfertility characterized by poor germ cell survival due in part to the misregulation of metabolism promoting genes. One of these genes, Ins2, is also stimulated by RHOX5 and RHOX8 in granulosa cells, suggesting impaired insulin signaling may contribute reduced follicle development in Rhox5-null ovaries.

Less than half of patients with epithelial ovarian cancer (EOC) survive five years following diagnosis, underscoring the imperative need for improved treatment. Many patients, including those with advanced disease, initially respond to platinum agents, which constitute the backbone of therapy. However, tumors ultimately become resistant, rendering further treatment ineffective. Additionally, the poor tolerability of these agents warrants the exploration of more targeted treatments – one such strategy is exploiting synthetic lethal genetic relationships. Recent genomic sequencing efforts have revealed that as many of half of EOCs have homologous recombination (HR) alterations. HR is a critical pathway for the repair of platinum-induced ICLs, thus compromised HR is hypothesized to explain the initial response to chemotherapy in many patients. Accordingly, women whose tumors harbor mutations in the critical HR genes, BRCA1 or BRCA2 (BRCA1/2), demonstrate improved prognosis. BRCA1/2 mutations also confer exquisite sensitivity to inhibitors of the enzyme, poly(ADP-ribose) polymerase 1 (PARPis), hence loss of BRCA1/2 and PARP1 is synthetic lethal. A number of models have been proposed to explain this synthetic lethality, yet a consensus model that accounts for the diverse cellular roles of BRCA1/2 and PARP1 has yet to be established. Delineating the precise molecular underpinnings of PARPi action in BRCA1/2-deficient cells will aid clinicians in identifying the appropriate population of women with EOC likely to benefit from PARPi treatment and provide insight into resistance mechanisms that arise in these patients. Combining this approach with retrospective analysis of PARPi clinical trials will best define the proper indication for PARPi in EOC and other human cancers.

Cancer cells, unlike normal tissue, frequently rely on glycolysis for the production of energy and the metabolic intermediates required for their growth regardless of cellular oxygenation levels. This metabolic reconfiguration, termed the Warburg effect, provides a potential strategy to preferentially target tumours from a therapeutic perspective. The present study sought to investigate the glycolytic phenotype of breast and ovarian cancer, and assess the possibility of exploiting several glycolytic targets therapeutically. Initially the growth dependency of breast and ovarian cancer cells on the availability of glucose was established. An array of 10 compounds reported to inhibit key enzymes of the glycolytic pathway were investigated and compared against an extended panel of breast and ovarian cancer cell line models. All inhibitors investigated, targeted against multiple points of the pathway, were shown to block the glycolytic pathway as demonstrated by glucose accumulation in the culture media combined with decreased lactate secretion, and attenuated breast and ovarian cancer cell proliferation in a concentration dependent manner. Furthermore their mechanism of action was investigated by flow cytometric analysis and their antiproliferative effect was associated with induction of apoptosis and G0/G1 cell cycle arrest. The glycolytic inhibitors were further assessed in combination strategies with established chemotherapeutic and targeted agents and several synergistic interactions, characterised by low combination index values, were revealed. Among them, 3PO (a novel PFKFB3 inhibitor) enhanced the effect of cisplatin in both platinum sensitive and platinum resistant ovarian cancer cells suggesting a strategy for treatment of platinum resistant disease. Furthermore robust synergy was identified between IOM-1190 (a novel GLUT1 inhibitor) and metformin, an antidiabetic inhibitor of oxidative phosphorylation, resulting in strong inhibition of breast cancer cell growth. This combination is proposed for the treatment of highly aggressive triple negative breast tumours. An additional objective of this research was to investigate the effect of the oxygen level on sensitivity to glycolysis inhibition. Breast cancer cells were found to be more sensitive to glycolysis inhibition in high oxygen conditions. This enhanced resistance at low oxygen levels was associated with upregulation of the targeted glycolytic enzymes as demonstrated at both the mRNA (by gene expression microarray profiling, Illumina BeadArrays) and protein level (by Western blotting). Manipulation of LDHA (Lactate Dehydrogenase A) by siRNA knockdown provided further evidence that downregulation of this target was sufficient to significantly suppress breast cancer cell proliferation. Finally, the expression of selected glycolytic targets was examined in a clinical tissue microarray set of a large cohort of ovarian tumours using quantitative immunofluorescence technology, AQUA. The role of the glycolytic phenotype in ovarian cancer was suggested and interesting associations between the glycolytic profile and clear cell and endometrioid ovarian cancers revealed. Increased PKM2 (Pyruvate kinase isozyme M2) and LDHA expression were demonstrated in clear cell tumours and also low expression of these enzymes was significantly correlated with improved survival of endometrioid ovarian cancer patients. Taken together the findings of this study support the glycolytic pathway as a legitimate target for further investigation in breast and ovarian cancer treatment.

Les cancers de l’ovaire représentent la première cause de décès par cancer gynécologique. L’échec des traitements, lié à l’apparition d’une chimiorésistance, implique de trouver de nouvelles stratégies thérapeutiques. Dans ce cadre, le laboratoire a mis en évidence la coopération de deux molécules anti-apoptotiques surexprimées dans les cancers de l’ovaire, Mcl-1 et Bcl-xL, qui empêchent alors le déclenchement de la mort cellulaire par apoptose. L’inhibition de ces cibles est alors mise en place. Un BH3-mimétique inhibiteur de Bcl-xL a été développé par la société Abbvie, l’ABT-737, qui possède un dérivé administrable par voie orale l’ABT-263 en essai clinique. En revanche, aucun inhibiteur de Mcl-1 n’est actuellement en clinique. L’inhibition de cet anti-apoptotique est donc l’un des objectifs du laboratoire. Sachant que Mcl-1 est extrêmement régulée, que l’inhibition de la voie de signalisation PI3K/Akt/mTOR conduit à l’inhibition de cet anti-apoptotique, et que le calcium est capable de moduler cette voie, nous nous sommes demandés si la modulation des flux calciques permettait l’inhibition de Mcl-1 dans nos cellules. Ces travaux de thèse ont pu montrer dans un premier temps que la chélation calcique par le BAPTA-AM permettait d’inhiber Mcl-1 via la voie mTORC1 et de sensibiliser les cellules à l’ABT-737. Dans un second temps, l’étude de l’effet d’un inhibiteur des flux calciques en essais cliniques, le carboxyamidotriazole a permis de mettre en évidence que l’inhibition des canaux calciques capacitifs pouvait entraîner l’inhibition de Mcl-1 de nouveau en inhibant mTORC1 et induire la mort cellulaire en combinaison avec l’ABT-737. Enfin des observations morphologiques ont montré que le CAI induisait un changement morphologique aboutissant à la mort des cellules. Ce type de mort semble être lié à une perturbation du métabolisme des cellules cancéreuses IGROV1-R10 et se rapprocherait d’une mort récemmement décrite dans la littérature : l’autosis. / Ovarian cancer is the leading cause of death from gynecological cancer. There is an urgent need to find new therapeutic strategies due to failure of treatments associated to development of chemoresistance. In this context, the laboratory has shown the cooperation of two anti-apoptotic proteins overexpressed in ovarian cancer, Mcl-1 and Bcl-xL, for preventing apoptotic cell death. ABT-737, a Bcl-xL inhibitor BH3-mimetic, was developed by Abbvie and has a clinically derivative named ABT-263. In contrast, no Mcl-1 inhibitor is currently available in clinic. The inhibition of this anti-apoptotic protein is therefore one of the objectives of the laboratory. Since inhibition of PI3K / Akt / mTOR signaling pathway leads to inhibition of Mcl-1 expression and calcium is able to modulate this pathway, we wondered if the modulation of calcium fluxes allowed the inhibition of Mcl-1 in ovarian cancer cells. First we were able to show that calcium chelation by BAPTA-AM allowed to inhibit Mcl-1 expression via mTORC1 pathway and to sensitize the cells to ABT-737. In a second step, we investigated the effect of an inhibitor of calcium fluxes that is evaluated in clinical studies, carboxyamidotriazole. We show that the inhibition of capacitive calcium channels could lead to Mcl-1 down-expression via inhibition of mTORC1 and promote apoptosis in combination with ABT-737. Finally, we observed that CAI induces a morphological change resulting in cell death. This type of death seems to be related to disruption of metabolism in IGROV1-R10 cancer cells and would be close to a cell death recently described in the literature: autosis.

Objetivo: Investigar a influência do tamanho dos fragmentos ovarianos na preservação dos folículos primordiais e primários pós-congelamento. Desenho: Experimento laboratorial controlado. Foram realizadas análises histológicas comparativas em grupos controle e pós-congelamento de fragmentos de ovários bovinos. No grupo dos fragmentos menores, a menor das medidas era de 2mm e no grupo dos fragmentos maiores, todos as medidas eram maiores de 2mm. Local de Realização: Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Veterinária da UFRGS e Centro de Reprodução Humana Nilo Frantz, Porto Alegre, RS, Brasil. Animais: Foi utilizado um ovário de vaca raça Hereford. Resultados Principais: Nos fragmentos congelados com medida de 2mm, e com medidas maiores de 2mm, a percentagem de folículos normais foi de 56% e 34%, respectivamente. O risco relativo para a manutenção dos folículos normais póscongelamento nos fragmentos com de 2mm e maiores de 2mm foi de 0,63 e de 0,47, respectivamente. A comparação desse dois riscos relativos mostrou, de forma significativa (qui-quadrado de heterogeneidade p=0,022), que o impacto do congelamento na redução das taxas de sucesso foi maior nos fragmentos com espessuras maiores de 2mm. Conclusões principais: Este estudo mostrou que há um comprometimento maior na preservação folicular em fragmentos ovarianos criopreservados com espessuras maiores de 2mm. / Aims of the study: To assess the effect of different tissue sizes on the morphology of primordial and primary follicles after cryopreservation. Desing: Laboratorial controlled experiment. Comparative histological evaluations were performed of fresh control and cryopreserved tissue strips. Two groups were analyzed. In the group of the smaller fragments, the major face measure 2mm and in the group of the larger fragments, all the faces measure more than 2mm. Setting: Veterinary School of the Federal University of Rio Grande do Sul and Nilo Frantz Assisted Reproduction Clinic, Porto Alegre, RS, Brazil. Animal (s): One ovary from a Hereford cow. Main results: The percentages of normal follicles in large ovarian fragments cut into 2mm and >2mm slices were 56% and 34%, respectively. The relative risks to obtain normal follicles in the 2mm and >2mm strips after cryopreservation were 0.63 and 0.47, respectively. The comparison of the two relative risks shows significantly (heterogeneity qui-square p=0.022) that the effect of freezing on reducing success rate was higher in large tissue fragments that are cut >2mm. Conclusion(s): The present study shows that there is an increased risk of damage to primary and primordial follicles when the cryopreserved fragment has all its measures larger than 2mm.

Epithelial ovarian cancer is the most lethal gynecologic malignancy, with a 5-year survival rate of less than 40%. This is due in part to a lack of early detection markers and lack of specific symptoms during early disease. The laying hen is the only accessible animal model which develops epithelial ovarian cancer spontaneously, with features closely resembling the human disease. It has been estimated that approximately 30% of all cancers can be prevented with diet, exercise, and maintenance of an optimal weight, and the chronic low-grade inflammation that accompanies obesity is implicated as a causal factor in the development of cancer. Flaxseed, a rich plant source of anti-inflammatory omega-3 fatty acids and lignans which act as phytoestrogens and antioxidants, exhibits chemosuppressive effects against the development and progression of ovarian cancer. We have shown that a diet of 10% flaxseed reduces the incidence and severity of ovarian cancer when fed to laying hens over 4 years, due in part to the ability of flaxseed to suppress the production of proinflammatory PGE2 in the ovary by decreasing expression of COX enzymes. To investigate other potential specific mechanisms by which flaxseed acts to suppress ovarian cancer, we examined expression and activity of pathways known to be involved in the etiology and progression of human epithelial ovarian cancer in ovarian cancer in the laying hen, and determined whether flaxseed affected these pathways during cancer development. We investigated the effect of flaxseed and its individual components upon oxidative stress in the normal ovary and in ovarian cancer by analyzing expression of target genes of the NRF2 transcription factor. The NRF2 pathway is a "master switch" that regulates expression of ROS-responsive detoxification genes. Results revealed that expression of four genes was significantly downregulated in then ovaries of hens on the defatted flaxmeal (DFM) and whole flaxseed (WF) diets compared to hens on diets that are high in pro-inflammatory omega-6 fatty acids, suggesting that flaxseed decreases oxidative stress in the ovary. Conversely, one target gene was upregulated in ovarian cancer compared to normal ovaries, and this observation was not affected by flaxseed. Additionally, nuclear accumulation Nrf2 protein was not observed in tumor cells, suggesting that flaxseed does not exert chemosuppressive effects by modulating NRF2 signaling in ovarian cancer. To further investigate pathways potentially regulated by flaxseed, we performed a microarray with 44k features and found that a set of genes involved in branching morphogenesis was upregulated in ovarian cancer and significantly decreased by flaxseed, including E-cadherin and miR-200, suggesting that flaxseed impedes the activity of an aberrantly activated developmental program that controls gland formation during ovarian cancer progression. Lack of nuclear accumulation of ZEB1 protein in tumor cells suggests that this decrease in expression is likely not due to EMT. Finally, due to its known roles in controlling developmental programs such as EMT as well as regulating cell growth and proliferation, we performed a set of experiments to examine activity of the TGF-beta pathway. PCR array analysis revealed that SMAD target genes, ligands, receptors, and co-regulatory proteins were upregulated in ovarian tumors from hens on both diet groups, suggesting TGF-beta signaling is enhanced in ovarian cancer. However, expression of SMAD6 and SMAD7 was upregulated in tumors from hens on the flaxseed diet but not control diet, with SMAD7 protein being expressed in both epithelial tumor cells and intratumoral stromal cells. Additionally, immunohistochemical staining for pSMAD2/3 was decreased in epithelial tumor cells and absent from intratumoral stromal cells in tumors from hens on the flaxseed diet compared to tumors from hens on the control diet, and these data together suggest that flaxseed may inhibit pro-oncogenic TGF-beta signaling in ovarian cancer. Finally, flaxseed prevents the downregulation of expression of p15 and the upregulation of CCNA and CCNE in ovarian tumors, suggesting that flaxseed may slow cell cycle progression. Data from these studies provides preliminary evidence that flaxseed exerts pleiotropic effects upon gene expression to negatively regulate pathways driving the progression of ovarian cancer, including aberrant TGF-beta signaling and glandular development. These studies provide groundwork for in vitro studies to test the specific effects of flaxseed upon proteins involved in TGF-beta signaling and upon the expansion of tumor epithelia.