Abnormalities of lipid metabolism are considered risk factors for cardiovascular, metabolic, nephrologic diseases amd some malignancies, as well. Nowadays, a lot of effort is devoted to study new risk factors and surrogate markers of conditions mentioned above to improve their prognosis and decrease mortality. The aim of this thesis was to provide a comprehensive survey of lipid metabolism, characteristics of different lipid compounds in health and diseases and of possibilities of utilization of selected lipid parameters in the diagnostics of pathological conditions listed above. Selected lioid parameters were observed in several studies, focused on specific pathological conditions. Besides conventional lipid analytes, the composition of fatty acids in plasma lipid pools was studied in healthy controls, and in the patients suffering from metabolic syndrome, chronic pancreatitis, and pancreatic cancer, as well. Markers of an oxidative stress (oxidatively modified LDL particles and conjugated dienes in precipitated LDL) were assessed in healthy controls, patients with metabolic syndrome, chronic pancreatitis, pancreatic cancer, and in the patients with different concentrations of plasma apoB-48, too. LDL particles subfraction were investigated in healthy controls, in the patients with different...

Le cancer du pancréas est la quatrième cause de décès par cancer au Canada. Avec des mutations activatrices de KRas présentes dans près de 90% des lésions bénignes et tumeurs, ce cancer arbore une activation de la voie MAPK très tôt dans son développement. Or, peu de littérature existe sur les étapes clés de la progression et sur le rôle précis de cette signalisation dans le passage des lésions bénignes (PanIN) au stade avancé (PDAC). Depuis plusieurs années, notre laboratoire s’intéresse aux kinases ERK1/2, actives en aval de Ras, des acteurs centraux du programme de sénescence cellulaire, soit un programme antitumoral intrinsèque aux cellules. L’hypothèse centrale des présents travaux est donc que les mutations de KRas acquises dès le stade PanIN induisent une sénescence qui agit comme barrière à la progression tumorale, et que l’atténuation du signal de ERK est impliquée dans le contournement de ce mécanisme. La première partie de cette thèse montrera donc les avancées que nous avons faites sur la caractérisation de la progression entre le stade bénin et le stade avancé, de laquelle l’acquisition d’un caractère souche, la transition épithélio-mésenchymateuse et le développement d’une dépendance mitochondriale semblent être des déterminants. Ensuite, nous présenterons nos découvertes sur le rôle des kinases ERK1/2, de la sénescence cellulaire et du stress nucléolaire dans une nouvelle approche visant à restaurer un mécanisme de suppression tumorale inspiré des lésions bénignes et impliquant une altération de la biogenèse ribosomique. Finalement, pour bonifier cette nouvelle stratégie, nous présenterons les résultats d’un criblage CRISPR-Cas9 génome-entier nous ayant permis d’identifier les composantes d’une stratégie « one-two punch » basée sur l’induction de sénescence dans les cellules PDAC combinée à l’inhibition de la Glutathion peroxydase 4 (GPX4), de façon à promouvoir une sénolyse efficace dans ce contexte. Dans leur ensemble, les travaux présentés dans cette thèse montrent un avancement significatif dans la compréhension de la biologie des cancers pancréatiques en identifiant à la fois des vulnérabilités intrinsèques et inductibles afin de générer de nouvelles idées thérapeutiques pour ce cancer hautement fatal. / Pancreatic cancer is the fourth leading cause of death by cancer in Canada. With frequent activating mutations in KRas in up to 90% of benign lesions and tumors, this cancer possesses an early activation of the MAPK pathway. However, key events of its progression from the PanIN stage to the PDAC stage and the precise role of MAPK signaling in it are still poorly understood. For many years, our laboratory has taken interest in the ERK1/2 signaling pathway, activated downstream of oncogenic Ras and a key mediator of cellular senescence. Cellular senescence is considered an intrinsic antitumor mechanism due to its ability to stably halt the cell cycle. The central hypothesis of this work is then that KRas mutations that are acquired at the PanIN stage induce cellular senescence which acts as a barrier against tumor development. Still, this powerful mechanism can be circumvented as cells tend to attenuate the ERK1/2 signaling to promote progression and acquisition of more aggressive features. Thus, the first part of this thesis will present our most recent advances in characterizing the progression events between PanIN and PDAC stages, during which stem cell features acquisition, epithelial-mesenchymal transition and mitochondrial dependency seem to occur. Next, we will present our discoveries regarding the implication of ERK1/2 kinases, cellular senescence and nucleolar stress in a new approach to restore a tumor suppression mechanism inspired by the PanIN stage and based on ribosome biogenesis alteration. Finally, to potentiate this strategy, we will show the results of a genome-wide CRISPR-Cas9 screen that identified the components of a “one-two punch” approach to induce cellular senescence in PDAC cells and to efficiently eliminate them by GPX4 inhibitors-mediated senolysis. Globally, the work presented in this thesis show significant progress in the field of pancreatic cancer, identifying previously unknown vulnerabilities of those cancer cells and paving the way for the development of new therapeutic combinations.

Possibilities of Portal Vein Reconstruction during Surgical Treatment of Pancreatic Cancer - Experiment on a Large Animal Introduction: Pancreatic cancer is a fatal malignancy that is known as one of the leading causes of cancer mortality worldwide. The only potentially curative treatment is radical surgical resection. Because of the lack of early symptoms, the diagnosis is usually made in advanced stages of the disease. In the majority of patients, the tumor is already locally advanced or it has distant metastases at the time of diagnosis. Pancreatic cancer tends to infiltrate the portal vein (PV) or the superior mesenteric vein (SMV). Nowadays, resection of infiltrated parts of PV/SMV is recommended in specialized centers. There are several established techniques of PV/SMV reconstruction. The use of allogeneic venous grafts seems to be a method with minimal risk of adverse effects but there is only limited experience with these grafts. The optimal anatomical origin of allogeneic venous grafts for PV/SMV reconstruction remains unknown. Aims: The aim of this experiment was to compare two types of allogeneic venous grafts used for PV reconstruction in a large animal model of pancreatico- duodenectomy. These grafts were harvested from the systemic venous system (inferior caval vein grafts - IVC grafts) and...

Pancreatic stellate cells (PSCs) constitute important cells of the pancreatic microenvironment and their close interaction with cancer cells is important in pancreatic cancer. It is currently not known whether PSCs accumulate genetic alterations that contribute to tumor biology. Our aim was to analyze genetic alterations in cancer associated PSCs. PSC DNA was matched to DNA isolated from pancreatic cancer patients’ blood (n = 5) and analyzed by Next-Generation Sequencing (NGS). Bioinformatic analysis was performed using the GATK software and pathogenicity prediction scores. Sanger sequencing was carried out to verify specific genetic alterations in a larger panel of PSCs (n = 50). NGS and GATK analysis identified on average 26 single nucleotide variants in PSC DNA as compared to the matched blood DNA that could be visualized with the Integrative Genomics Viewer. The absence of PDAC driver mutations (KRAS, p53, p16/INK4a, SMAD4) confirmed that PSC isolations were not contaminated with cancer cells. After filtering the variants, using different pathogenicity scores, ten genes were identified (SERPINB2, CNTNAP4, DENND4B, DPP4, FGFBP2, MIGA2, POLE, SNRNP40, TOP2B, and ZDHHC18) in single samples and confirmed by Sanger sequencing. As a proof of concept, functional analysis using control and SERPINB2 knock-out fibroblasts revealed functional effects on growth, migration, and collagen contraction. In conclusion, PSC DNA exhibit a substantial amount of single nucleotide variants that might have functional effects potentially contributing to tumor aggressiveness.

To optimize neoadjuvant radiochemotherapy of pancreatic ductal adenocarcinoma (PDAC), the value of new irradiation modalities such as proton therapy needs to be investigated in relevant preclinical models. We studied individual treatment responses to RCT using patient-derived PDAC organoids (PDO). Four PDO lines were treated with gemcitabine, 5-fluorouracile (5FU), photon and proton irradiation and combined RCT. Therapy response was subsequently measured via viability assays. In addition, treatment-naive PDOs were characterized via whole exome sequencing and tumorigenicity was investigated in NMRI Foxn1nu/nu mice. We found a mutational pattern containing common mutations associated with PDAC within the PDOs. Although we could unravel potential complications of the viability assay for PDOs in radiobiology, distinct synergistic effects of gemcitabine and 5FU with proton irradiation were observed in two PDO lines that may lead to further mechanistical studies. We could demonstrate that PDOs are a powerful tool for translational proton radiation research.

Im Vergleich zu anderen Krebsentitäten, konnten Patienten mit PDAC bisher kaum von Therapieerfolgen der Präzisionsmedizin profitieren. Um diese Problematik zu adressieren, habe ich eine umfassende molekularbiologische Studie durchgeführt, um prädiktive Biomarker zu identifizieren und die Risikostratifizierung der Patienten zu verfeinern. Mittels gen-spezifischer Sequenzierung und gezielter RNA-Expressionsanalyse wurden 293 R0-resezierte Patienten aus einer multizentrischen Phase-III-Studie untersucht. Ziel der klinischen Studie war der Vergleich von adjuvanter Chemotherapie mit Gemcitabin entweder mit oder ohne Zusatz von Erlotinib. Für meine Arbeit wurden die Patientenproben unter Verwendung einer nicht-negativen Matrixfaktorisierung (NMF) basierend auf ihren Einzelnukleotidvarianten (SNV) und ihren Kopienzahlveränderungen (CNA) gruppiert und auf klinische und molekularbiologische Unterschiede untersucht. Um die biologischen Hintergründe der identifizierten genetischen Besonderheiten zu verstehen, wurden anschließend Zelllinien genetisch modifiziert und in vitro modelliert. Es wurden 1086 SNVs und 4157 CNAs identifiziert. Dabei wiesen 99% aller Patienten mindestens eine genetische Veränderung auf, mit durchschnittlich 18 Aberrationen pro Patient. In Übereinstimmung mit früheren Berichten waren KRAS, TP53, CDKN2A und SMAD4 die am häufigsten betroffenen Gene. Alterationen in diesen Genen konnten in 63-93 % der Fälle nachgewiesen werden. Basierend darauf konnte ich fünf Patientengruppen identifizieren die sich in ihren biologischen Charakteristika unterscheiden und Angriffspunkte für gezielte Therapien bieten. Mittels NMF wurden zudem SMAD4alt MAPK9low als prognostische Biomarker für Erlotinib identifiziert. Anschließende in vitro Experimente zeigten, dass dies nicht auf eine Erhöhung der Erlotinib-Zelltoxizität zurückzuführen ist. Zuletzt definiere ich einen prognostischen Score der genutzt werden kann um das Überleben von R0-resizierten PDAC Patienten abzuschätzen. / In contrast to other cancer entities, PDAC patients have not benefited from recent improvements in precision medicine. To address this gap, I embarked on a comprehensive molecular study to identify predictive biomarkers and refine risk stratification. I performed targeted sequencing and targeted RNA expression analysis of 293 R0-resected patients from a multicenter phase III trial comparing adjuvant chemotherapy of gemcitabine with or without erlotinib. Patients were clustered using non-negative matrix factorization (NMF) based on their single nucleotide variant (SNV) and copy number alteration (CNA) statuses. Overall (OS) and disease-free survival (DFS) were analysed with the multivariate cox hazard and log rank tests. Finally, using a method based on CRISPR/Cas, findings from the patient cohort where modeled in vitro to assess their biological backgrounds. A total of 1,086 SNVs and 4,157 CNAs were found with at least one genetic alteration in 99% of all patients, and an average of 18 aberrations per patient. In line with previous reports, KRAS, TP53, CDKN2A, and SMAD4 were the most frequently affected genes, detected in 63–93 % of cases. In this thesis, I identified five biologically distinct patient subgroups with different actionable lesions that may serve for refined PDAC classification and tailored treatment approaches. NMF based clustering and subsequent differential expression analysis revealed SMAD4alt (SNV and/or CAN in SMAD4) MAPK9low (MAPK9 expression below median) as prognostic erlotinib biomarker. Modeling of SMAD4alt MAPK9low status in vitro showed that the effect is not based on increased erlotinib toxicity. Finally, I proposed a genetic risk score for prognostic evaluation of newly diagnosed R0-resected PDAC patients.

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