We gathered normal and colorectal cancer tissues from 18 patients after tumor surgery. The tumor tissues represent caner stages from T1 to T4 (TNM system).Two-dimensional electrophoresis and MALDI-TOF techniques were utilized to identify the differentially expressed proteins. Our studies showed that there are about 18 differentially expressed proteins in normal and tumor tissues (p<0.05) which 13 proteins increased in tumor were Keratin 8, Protein disuflde isomerase A3 precursor, Keratin 18, Fractalkine precursor, LDH-B, Tropomyosin alpha 4 chain, Tropomyosin alpha 3 chain, chloride intracellular channel protein 1, PTTG1(Pituitary tumor-transforming protein 1),

Colorectal cancer is the third leading cause of cancer-related mortality. Much progress has been achieved in combating this disease with surgical resection and chemotherapy in combination with targeted drugs. However, most metastatic patients develop drug resistance so new modalities of treatment are needed. Notch signaling plays a vital role in intestinal homeostasis, self-renewal, and cell fate decisions during post-development and is activated in colorectal adenocarcinomas. Under debate is its role in carcinomas and metastatic disease. In theory, blocking Notch activation using gamma-secretase inhibitors (GSIs) may show efficacy alone or in combination with chemotherapy in the treatment of colon cancer. In Chapter Three, we tested the capacity for GSIs to synergize with oxaliplatin in colon cancer cell lines and evaluated the underlying molecular mechanisms. GSI alone had no effect on colon cancer cell lines. Surprisingly, we show that GSIs blocked oxaliplatin-induced apoptosis through increased protein levels of the anti-apoptotic Bcl-2 proteins Mcl-1 and/or Bcl-xL. Restoration of apoptosis was achieved by blocking Mcl-1 and/or Bcl-xL with obatoclax (an anti-apoptotic Bcl-2 agonist) or siRNA. An unexpected result was the induction of cell death with the combination of GSI and obatoclax. In Chapter Four, we examined the mechanism of GSI + obatoclax-mediated cell death. We found that apoptosis played a minimal role. Rather, we identified blockage of cytoprotective autophagy played a causative role. Interestingly, we also saw autophagy induction in GSI-treated cells, which could explain the insensitivity of colon cancer cells to GSI. When autophagy was blocked in GSI-treated cells, cells became sensitive to GSI and cell death was elicited. The mechanism by which induction of autophagy occurs in GSI- treated cells is an area for further research. Overall, our work questions the validity of the use of GSIs in the treatment of colorectal cancers. We show that GSIs may block apoptosis and induce cytoprotective autophagy simultaneously, resulting in increased drug resistance and cellular survival. Whether these two cellular survival processes occurs in patients needs to be examined before GSIs can be utilized in a clinical setting. If so, these two hurdles must be overcome.

Oxaliplatin is an anticancer drug widely used in cancer chemotherapy. This thesis evaluates whether a specific dose-banding scheme for oxaliplatin could replace the individual dosing method that is currently used in the oxaliplatin administration. Dose-banding was introduced into UK clinical practice in 2001, as it reduces delays in patients receiving their treatment and, through quality control and end-product testing, safeguards the infusion quality and patient safety. A range of studies were included in this thesis: an extended stability study on oxaliplatin infusions using a sequential temperature cycling design; studies on oxalate, a potential degradation product and metabolite of oxaliplatin which has been linked to oxaliplatin neurotoxicity and the development of an ex vivo pharmacokinetic (PK) simulation model to compare the effect of different oxaliplatin dosing methods on its therapeutic outcomes. The shelf-life of oxaliplatin infusions over a concentration range of 0.2 mg/mL – 0.7 mg/mL is extended to 84 days when stored at 2 – 8℃ plus a further 7 days after being left at room temperature (25℃) for 24 hours. This ensures the unused oxaliplatin infusions are safe to be re-issued to patients, which could reduce drug wastage. The oxalate study suggests that the dose-limiting neurotoxicity of oxaliplatin is unlikely to be directly related to the oxalate produced from oxaliplatin degradation in infusions or from the non-enzymic transformation of oxaliplatin in vivo because the oxalate levels from these routes are minor compared to the endogenous level. The safety and efficacy of dose-banding schemes was demonstrated by comparing the simulated PK characteristics gained from the ex vivo model. Dose-banding with the +10% maximum deviation was selected as the most promising dosing scheme for oxaliplatin. Finally, recommendations are made concerning the introduction of oxaliplatin dose-banding scheme into clinical practice, and on the benefits of harmonised dose-banding schemes.

Le cancer colorectal est un cancer majeur en termes de fréquence et de mortalité. Il s’agit de la deuxième cause de décès par cancer, avec 17 500 décès en France en 2011. Le traitement des stades avancés repose sur différentes molécules anti-cancéreuses telles que l’oxaliplatine. Cependant le développement de résistances entraine des échecs thérapeutiques expliquant le faible taux de survie observé. Il est donc crucial d’identifier les mécanismes de résistance et ses acteurs et de découvrir de nouvelles pistes de traitements.Dans un premier temps, nous nous sommes donc intéressés aux rôles joués par les calpaïnes et NOX1 dans le développement de la résistance à l’oxaliplatine en étudiant des cellules tumorales colorectales résistantes à cette drogue. Ce qui nous a permis d'identifier une voie de signalisation impliquée dans la résistance à cette chimiothérapie.Dans un second temps nous nous sommes intéressés à étudier la réversion de cette résistance à l’oxaliplatine. En criblant différentes chimiothérapies ce qui a permis de mettre en évidence une inversion du statut résistant/sensible dans nos cellules sélectionnées.La première partie de nos données met en évidence de nouvelles régulations de Nox1 qui diffèrent en fonction de la sensibilité des cellules à l’oxaliplatine. Nos résultats montrent aussi que p38 MAPK pourrait être une cible thérapeutique de choix. Dans la deuxième partie nous avons identifié un nouveau traitement permettant l'induction de l'apoptose dans nos cellules résistantes. Ainsi la gemcitabine pourrait être une solution pour traiter les patients ne répondant pas ou plus aux protocoles basés sur l’oxaliplatine / Colorectal cancer is a major cancer in terms of frequency and mortality. This is the second leading cause of cancer death, with 17,500 deaths in France in 2011. The treatment of advanced stages is based on different chemotherapeuties including oxaliplatin. However, the development of resistance leads to therapeutic failures explaining the low survival rate. It is therefore crucial to identify the mechanisms of resistance and the actors involved and to discover new therapeutic approaches. We first investigated the role played by calpains and NOX1 in the development of resistance to oxaliplatin, studying oxaliplatin-resistant colorectal tumor cells. This allowed us to identify a signaling pathway involved in resistance to this chemotherapy.Secondly, we have studied the reversion of this resistance to oxaliplatin. A screening of different chemotherapies revealed a reversal of the resistant / sensitive status in our selected cells In the first part, our data highlight novel Nox1 regulations which differ according to the sensitivity of the cells to oxaliplatin. Our results also show that p38 MAPK could be a therapeutic target for treating colorectal cancers resistant to oxaliplatin. In the second part, we have identified a new treatment to induce apoptosis in our resistant cells. Indeed, gemcitabine may be a solution to treat patients who do not respond to oxaliplatin-based protocols.

No description available.

Despite therapeutic advances, colorectal cancer still has a 45% mortality rate, and one of the most crucial problems is the development of acquired resistance to treatment with anticancer drugs. Thus the aims of this project are to develop drug-resistant colon cancer cell lines in order to identify mechanisms of resistance for the most commonly drugs used in colorectal cancer: 5-fluorouracil, oxaliplatin, and irinotecan. Following evaluation of drug sensitivity to these agents in an initial panel of eight colorectal cancer cell lines, 3 lines (DLD-1, KM-12 and HT-29) were selected for the development of 5-FU (3 lines), oxaliplatin (2) and irinotecan (1) resistant sublines by continuous drug exposure, with resistance confirmed using the MTT assay. Consistently resistant sublines were subject to a „stable isotope labelling with amino acids in cell culture‟ (SILAC) approach and a MudPIT proteomics strategy, employing 2D LC and Orbitrap Fusion mass spectrometric analysis, to identify novel predictive biomarkers for resistance. An average of 3622 proteins was quantified for each resistant and parent cell line pair, with on average 60-70 proteins up-regulated and 60-70 down-regulated in the drug resistant sublines. The validity of this approach was further confirmed using immunodetection techniques. These studies have provided candidate proteins which can be assessed for their value as predictive biomarkers, or as therapeutic targets for the modulation of acquired drug resistance in colorectal cancer.

Background Effective and tolerable chemotherapy with gemcitabine and cisplatin for advanced biliary tract cancer (BTC) has been established recently. However, overall prognosis is still poor, and additional therapeutic approaches are needed for patients with locally advanced, irresectable and/or pretreated tumors. Hepatic arterial infusion (HAI) of chemotherapy represents a safe and well-established treatment modality, but data on its use in patients with BTC are still sparse. Methods Patients with irresectable BTC predominant to the liver were included in a prospective, open phase II study investigating HAI provided through interventionally implanted port catheters. Intraarterial chemotherapy consisted of biweekly oxaliplatin (O) 85 mg/m2 and folinic acid (F) 170 mg/m2 with 5-FU (F) 600 mg/m2. Results Between 2004 and 2010, 37 patients were enrolled. A total of 432 cycles of HAI were applied with a median of 9 (range 1–46) cycles. Objective response rate was 16 %, and tumor control was achieved in 24 of 37 (65 %) patients. Median progression-free survival was 6.5 months (range 0.5–26.0; 95 % CI 4.3–8.7), median overall survival was 13.5 (range 0.9–50.7; 95 % CI 11.1–15.9) months. The most frequent adverse event was sensory neuropathy grade 1/2 in 10/14 patients. Conclusions Using a minimal invasive technique, repetitive HAI with OFF is feasible and results in clinically relevant tumor control with low toxicity in patients with liver predominant advanced BTC.

No description available.

Platinum-based drugs are an important group of alkylating-like agents which are used in cancer chemotherapy treatment. Cisplatin and oxaliplatin in particular are still commonly used today and are the focus of this thesis. As with most chemotherapy drugs, the efficacy of these drugs are limited by toxicity as well as tumour resistance, and therefore by increasing our understanding of these areas it is hoped to one day achieve personalised chemotherapy. The use of ICP-MS in the study of bio-sciences is still relatively new, however it has the ability to provide robust, fast and accurate methods for the quantification of platinum in biological samples. The research presented here utilised mass spectrometry in the study of the formation of Pt-DNA adducts in the clinical samples, the binding of oxaliplatin to short peptides and the effect of selenium supplementation on oxaliplatin in colorectal cancer cell lines. A comparison in the number of Pt-DNA adducts in saliva and leukocyte samples obtained from patients undergoing Pt-based chemotherapy demonstrated a lack of correlation between the two sample types. Samples were taken pre- and post-treatment and analysed via SF-ICP-MS and significant inter-patient variability was observed as expected. In both leukocyte and saliva samples, not only was Pt from previous chemotherapy cycles observed, but Pt was detected in the DNA in both sample types 1 hour after treatment. However a lack of correlation between platinum levels seen in the blood and saliva, combined with unexpected difficulties obtaining patient adherence to the saliva sampling protocol, indicated that saliva does not at present offer a reliable alternative to leukocytes for this assay. The binding of oxaliplatin to short nitrogen and sulfur rich peptides was investigated. Platinum binding to the peptides was observed and no significant differences in the level of binding were observed between the range of N and S rich peptides studied in this investigation. Partly due to the inability to reproduce biological conditions in this study, oxaliplatin was observed as a whole molecule, and furthermore dimers and multimers were also observed. The effect of selenium supplementation on the total cellular uptake of platinum was investigated in cultured cells via ICP-MS and LA-ICP-MS. It was observed that selenium decreased the amount of Pt taken up by the cancer cells. This was seen in analysis of populations of cells as well as by single cell analysis. Furthermore, while problems were encountered measuring selenium in subcellular experiments, the effect of selenium on the subcellular distribution of platinum as well as the number of Pt-DNA adducts could be determined.

L’amélioration constante du pronostic des pathologies cancéreuses est le fruit des progrès réalisés dans leur prévention, leur dépistage, leur diagnostic et leur traitement. Malgré l’avènement récent des thérapies ciblées, la chimiothérapie conventionnelle reste souvent le seul recours pour des patients atteints de cancer non opérable ou non éligibles pour ces thérapeutiques novatrices. Certaines chimiothérapies conventionnelles (anthracyclines et oxaliplatine notamment) ont la capacité d’entrainer une mort des cellules tumorales dont les caractéristiques permettent d’induire une réponse immunitaire antitumorale efficace. Cette réponse immunitaire antitumorale spécifique agirait en synergie avec l’effet cytotoxique direct de ces drogues, participant ainsi à leur efficacité. La réponse immunitaire antitumorale induite par la chimiothérapie dépend de plusieurs mécanismes moléculaires et cellulaires clefs identifiés récemment. L’induction d’un stress du réticulum endoplasmique (RE) est à l’origine de l’exposition d’une protéine chaperonne résidente du RE, la calréticuline (CRT), à la surface des cellules mourantes, servant alors de signal de phagocytose pour les cellules dendritiques. La libération dans le milieu extracellulaire de signaux de danger est également essentielle : la protéine nucléaire High Mobility Group Box 1 (HMGB1) sert ainsi de ligand pour le Toll-like récepteur 4 (TLR4), présent à la surface des cellules dendritiques et son activation favorise l’apprêtement et la présentation des antigènes tumoraux aux lymphocytes T cytotoxiques. L’adénosine-5'-triphosphate (ATP) est également libéré par les cellules tumorales, entrainant l’activation des récepteurs purinergiques P2RX7 présents à la surface des cellules dendritiques, activant l’inflammasome NLRP3 et entrainant la libération d’IL-1 par les cellules dendritiques, favorisant alors l’orientation de la réponse immunitaire vers une réponse de type TH1 et la production d’interféron  par les lymphocytes T cytotoxiques. Dans ce travail, nous avons cherché à comparer la capacité de deux drogues issues d’une même classe de chimiothérapie, les sels de platine, à induire une mort cellulaire immunogène des cellules tumorales. Grace à des expériences in vitro et in vivo (modèles murins de vaccination antitumorale et de chimiothérapie sur tumeurs établies), nous avons pu montrer que l’oxaliplatine (OXP), contrairement au cisplatine (CDDP), avait la capacité d’induire une mort immunogène des cellules de cancer colique et que cette différence intra-classe dépendait de la capacité respective de ces deux drogues à entrainer un des phénomènes clés de l’induction d’une mort cellulaire immunogène, l’exposition de la CRT à la surface des cellules tumorales mourantes. Nous avons également pu montrer que l’induction d’une mort cellulaire immunogène des cellules de cancer colique par l’oxaliplatine avait une relevance clinique chez l’homme, l’existence d’un polymorphisme perte-de-fonction du gène tlr4 affectant le pronostic (survie sans progression) de patients traités par chimiothérapie pour un cancer colique métastatique. Par la suite, nous avons mis au point des biosondes permettant d’étudier à grande échelle, à l’aide d’une plateforme de vidéo-microscopie automatisée, la capacité de différentes drogues à induire les différents phénomènes clefs de la mort cellulaire immunogène des cellules tumorales (exposition de la CRT, libération d’HMGB1 et d’ATP). Nous avons ainsi pu montrer que la correction pharmaceutique du défaut d’activation d’un stress du réticulum endoplasmique par le cisplatine permettait de restaurer l’immunogénicité de la mort cellulaire induite par cette chimiothérapie. Ces résultats ouvrent la voie à la découverte de nouvelles molécules susceptibles, à elles seules ou en association à d’autres thérapies connues, d’améliorer le pronostic des néoplasies. / The steady improvement of cancer prognosis is the result of progress in cancer prevention, screening, diagnosis and treatment. Despite the recent advent of targeted therapies, conventional chemotherapy often remains the only solution for patients with non-operable cancer or not eligible for these novel therapies.Some conventional chemotherapy (including anthracyclines and oxaliplatin) has the ability to cause tumor cells death with characteristics able to induce an effective antitumor immune response. This specific antitumor immune response would be synergistic with the direct cytotoxic effect of these drugs and contribute to their efficacy. The antitumor immune response induced by chemotherapy depends on several key cellular and molecular mechanisms recently identified. The induction of an endoplasmic reticulum (ER) stress is necessary for the exposure of calreticulin (CRT), an ER-resident chaperone protein, on the surface of dying cells, then acting as a phagocytosis signal for dendritic cells. Release of danger signals into the extracellular medium is also essential. The nuclear protein High Mobility Group Box 1 (HMGB1) is a ligand of the Toll-like receptor 4 (TLR4) on the surface of dendritic cells. TLR4 activation promotes the processing of tumor antigens and their presentation to cytotoxic T lymphocytes. Adenosine-5'-triphosphate (ATP) is also released by tumor cells, leading to the activation of the purinergic receptors P2RX7 expressed on the surface of dendritic cells, activating the NLRP3 inflammasome and causing the release of IL-1β by dendritic cells, while promoting the orientation of the immune response towards a TH1 response and the production of γ-interferon by cytotoxic T lymphocytes.In this work, we aimed to compare the ability of two drugs of a same class of chemotherapy, the platinum derivates oxaliplatin (OXP) and cisplatin (CDDP), to induce immunogenic death of tumor cells. Thanks to in vitro and in vivo experiments (models of tumor vaccination and chemotherapy on established tumors in mice), we showed that OXP, in contrast to CDDP, has the ability to induce immunogenic death of colon cancer cells. This intra-class difference depends on the ability of each drug to cause one of the key phenomena of immunogenic cell death: the induction of the exposure of the CRT to the surface of dying tumor cells. We could also show that the induction of immunogenic death of colon cancer cells by OXP had clinical relevance in humans. Indeed, the existence of a loss-of-function polymorphism of tlr4 affects the prognosis (PFS) of patients treated with OXP-based chemotherapy regimen for a metastatic colorectal cancer. Subsequently, we developed biosensors to study the ability of different drugs to induce key phenomena of cell death immunogen tumor cells (CRT exposure, HMGB1 and ATP release) using high-content screening by an automated video-microscopy platform. We showed that a pharmaceutical correction of the inability of cisplatin to induce an endoplasmic reticulum stress could restore the immunogenicity of cisplatin-induced tumor cell death. These results open the way to the discovery of new molecules that, alone or in combination with other known therapies, could improve the prognosis of cancer.