Hepatocellular carcinoma (HCC) is the second most common cause of cancerrelated mortality worldwide. AKT pathway has been found activated in 50% of HCC cases, making it promising target. Therefore we assess efficacy of the allosteric AKT inhibitor or the combination of Sorafenib with AKT inhibitor compared to untreated control and to standard treatment, Sorafenib, in vitro and in vivo. AKT inhibitor blocked phosphorylation of AKT in vitro and strongly inhibited cell growth with significantly higher potency than Sorafenib. Similarly, apoptosis and cell migration were strongly reduced by AKT inhibitor in vitro. To mimic human advanced HCC, we used diethylnitrosamine-induced cirrhotic rat model with fully developed HCC. MRI analyses showed that AKT inhibitor significantly reduced overall tumor size. Furthermore, number of tumors was decreased by AKT inhibitor, which was associated with increased apoptosis and decreased proliferation. Tumor contrast enhancement was significantly decreased in the AKT inhibitor group. Moreover, on tumor tissue sections, we observed a vascular normalization and a significant decrease in fibrosis in surrounding liver of animals treated with AKT inhibitor. Finally, pAKT/AKT levels in AKT inhibitor treated tumors were reduced, followed by down regulation of actors of AKT downstream signalling pathway: pmTOR, pPRAS40, pPLCγ1 and pS6K1. In conclusion, we demonstrated that AKT inhibitor blocks AKT phosphorylation in vitro and in vivo. In HCC-rat model, AKT inhibitor was well tolerated, showed anti-fibrotic effect and had stronger antitumor effect than Sorafenib. Our results confirm the importance of targeting AKT in HCC. / Hepatocellular carcinoma (HCC) is the second most common cause of cancerrelated mortality worldwide. AKT pathway has been found activated in 50% of HCC cases, making it promising target. Therefore we assess efficacy of the allosteric AKT inhibitor or the combination of Sorafenib with AKT inhibitor compared to untreated control and to standard treatment, Sorafenib, in vitro and in vivo. AKT inhibitor blocked phosphorylation of AKT in vitro and strongly inhibited cell growth with significantly higher potency than Sorafenib. Similarly, apoptosis and cell migration were strongly reduced by AKT inhibitor in vitro. To mimic human advanced HCC, we used diethylnitrosamine-induced cirrhotic rat model with fully developed HCC. MRI analyses showed that AKT inhibitor significantly reduced overall tumor size. Furthermore, number of tumors was decreased by AKT inhibitor, which was associated with increased apoptosis and decreased proliferation. Tumor contrast enhancement was significantly decreased in the AKT inhibitor group. Moreover, on tumor tissue sections, we observed a vascular normalization and a significant decrease in fibrosis in surrounding liver of animals treated with AKT inhibitor. Finally, pAKT/AKT levels in AKT inhibitor treated tumors were reduced, followed by down regulation of actors of AKT downstream signalling pathway: pmTOR, pPRAS40, pPLCγ1 and pS6K1. In conclusion, we demonstrated that AKT inhibitor blocks AKT phosphorylation in vitro and in vivo. In HCC-rat model, AKT inhibitor was well tolerated, showed anti-fibrotic effect and had stronger antitumor effect than Sorafenib. Our results confirm the importance of targeting AKT in HCC.

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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.

La résistance aux anti-aromatases (AAs) constitue un obstacle thérapeutique majeur dans le traitement des cancers du sein RE+. Les objectifs de ce travail étaient : (i) de caractériser les événements moléculaires associés à la résistance acquise aux AAs ; (ii) d’identifier de manière globale de nouveaux profils de miRNAs spécifiquement associés à la résistance aux AAs. Notre étude a mis en évidence le rôle central de la voie Akt/mTOR dans la résistance acquise et de novo aux AAs dans des modèles cellulaires, mais également dans des échantillons de patientes ayant récidivé sous anastrozole. La combinaison d’un AA avec le MK-2206, inhibiteur d’Akt ou avec la rapamycine, inhibiteur de mTOR, augmente la sensibilité à l’AA dans les cellules contrôles et est suffisante pour surmonter la résistance et restaurer la sensibilité à l'hormonothérapie dans les cellules résistantes. Notre travail propose également un modèle de résistance acquise aux AAs basé sur la sélection de cellules « cancer-initiating-like » dotées de propriétés d'auto-renouvellement, d’une résistance intrinsèque aux AAs et d’une sensibilité au MK-2206. Notre étude à grande échelle des miRNAs a identifié la voie Akt/mTOR comme une des cibles privilégiées de ces miRNAs. Nous avons identifié et validé trois miRNAs dérégulés capables de moduler le statut d’activation de la voie Akt/mTOR, qui représentent des cibles potentielles. En conclusion, notre projet a mis en évidence de nouvelles voies de signalisations ciblées par ces miRNAs et de nouveaux évènements moléculaires, qui représentent des candidats potentiels dans la résistance aux AAs / Resistance to aromatase inhibitors (AIs) remains a major drawback in the treatment of ER+ breast cancers. Our objectives were (i) to characterize molecular events associated with acquired AI resistance (ii) to capture a global view of the miRNA expression profiles associated with AI resistance. Our results showed the major role of the Akt/mTOR pathway in both de novo and acquired resistance to AI in cellular models and also in breast tumors of patients who relapsed under anastrozole. Combining AI with the Akt inhibitor MK-2206 or with the mTOR inhibitor rapamycin increased sensitivity to this AI in the control cells and was sufficient to overcome resistance and restore sensitivity to endocrine therapy in the resistant cells. Our findings propose a model of AI-acquired resistance based on the selection of cancer-initiating-like cells possessing self-renewing properties, intrinsic resistance to AI and sensitivity to MK-2206. Our large-scale study identified the Akt/mTOR pathway as one of the main targets of the deregulated miRNAs. We identified and validated three miRNAs able to modulate the Akt/mTOR activation status, suggesting these miRNAs as potential targets. To conclude, our project identified new miRNA-targeted signaling pathways and new molecular events, representing strong candidates in the mediation of AI resistance