Der Tumorsupressor APC ist in der Mehrzahl aller Fälle kolorektaler Karzinome bereits in der initialen Phase der Karzinogenese mutiert. Diese Mutationen führen zu einer aberranten Aktivierung des Wnt-Signalweges sowie zu weiteren die Karzinogenese vorrantreibenden Aktivitäten, beispielsweise einem veränderten Migrationsverhalten. Dieser Dissertation zu Grunde liegt die Idee, dass durch die Trunkierung des APC-Proteins aber auch Abhängigkeiten von Genaktivitäten entstehen, die zuvor entbehrlich waren. Solche synthetisch letalen Gene sollten in einem high-content shRNA-Screen gefunden werden. Für die Durchführung des Screens wurde ein von der SW480 Kolonkarzinomzelllinie abgeleitetes, isogenes Zellsystem generiert, welches durch Induktion mit Doxyzyklin das vollständige APC-Allel (FL-APC) exprimiert. Infolge dieser Expression zeigen die Zellen einen weniger malignen Phänotyp. Dies spiegelt sich darin wider, dass die Zellen durch FL-APC Expression in ihrer Wnt-Signalwegsaktivität eingeschränkt werden. Doxyzyklininduzierte Zellen sind schlechter in der Lage ohne Adhäsion zu proliferieren als nicht induzierte Zellen. Andererseits ist ihre Fähigkeit einem FKS-gradienten entlang zu migrieren verbessert. Der shRNA-Screen wurde mit der Decipher shRNA-Bibliothek durchgeführt. Diese enthält 27.500 verschiedene shRNAs mit Interferenzaktivität gegen 5.000 mRNAs, die potentiell pharmakologisch inhibierbare Proteine kodieren. Die besten zwei Kandidaten für eine synthetisch letale Interaktion mit trunkiertem APC, BCL2L1 und EIF2B5 wurden im Verlauf einer Masterarbeit bzw. direkt in dieser Disseration validiert. EIF2B5 zeigte in vitro nach Depletion durch unterschiedliche shRNAs einen di erentiellen Proliferationse ekt bei FL-APC induzierten im Vergleich zu kontrollbehandelten Zellen. Dieser di erentielle E ekt konnte in einem weiteren Modellsystem, SW480 Zellen mit konstitutiver FL-APC Expression, ebenfalls validiert werden. Durch Expression einer shRNA mit Aktivität gegen EIF2B5 werden in beiden Zellsystem die unfolded protein response (UPR) Gene DDIT3 und splXBP1 aktiviert. Interessanterweise werden durch die Expression von FL-APC diese Gene reprimiert. Im Promotor der EIF2B5-mRNA be ndet sich eine Bindestelle für MYC. Es ist denkbar, dass durch die Expression von FL-APC eine globale Veränderung der Genexpression vorgenommen wird, die einerseits eine Repression von EIF2B5 nach sich zieht aber andererseits eine hierdurch ausgelöste ER-Stress Antwort verhindert. Eine Inhibition von EIF2B5 ohne diese Adaption andererseits führt nach diesem Model zu einer UPR-aktivierten Apoptose. In einem zweiten Projekt wurde das überraschende Verhalten von Kolonkarzinomzellen untersucht, die nach Zugabe von BEZ235, einem dualen PI3K/mTOR Inhibitor, trotz gegenteiliger Erwartungen MYC-Proteinmengen erhöhen. Eine Repression wurde erwar- tet, weil die Inhibition von PI3K einerseits zu einer proteasomalen Destabiliserung und andererseits die mTOR Inhibition zu einer verringerten Synthese von MYC führen sollte. Während bereits gezeigt werden konnte, dass durch einen FOXO-vermittelten Mechanismus MAPK-abhängig die MYC-Expression verstärkt wird, wurde in dieser Dissertation die erwartete Translationsinhibition untersucht. BEZ235 inhibiert zwar CAP-abhängige Translation, das MYC Protein wird jedoch aufgrund einer IRES-vermittelten Translation weiterhin exprimiert. Silvestrol, ein Inhibitor der Helikase eIF4A andererseits interveniert mit CAP- und IRES-abhängiger Translation und kann die MYC-Proteinkonzentrationen verringern. Wir konnten zudem feststellen, dass die Applikation von Silvestrol auch in vivo möglich und wirksam ist und zudem tolleriert wird. Dies gibt Anlass zur Ho nung, dass eine Intervention der Translation auch im Menschen eine valide Strategie zur Behandlung MYC-getriebener Tumore sein könnte. / The tumorsupressor APC is mutated in initiating colorectal cancers. These mutations lead to an aberrant actiavation of the wnt-signaling pahtway and to further carcinogenic activities such as altered migration behaviour. The idea that novel dependencies upon previously expendable genes are generated through APC-mutations form the basis of this disseration. These so called synthetic lethal Genes were searched for harnessing a high content shRNA screen. We generated an isogenic cell system which was deviated from the colorectal cancer cell line SW480. These cells naturally express truncated APC. The generated system expresses a full-lenght allele upon doxycycline exposure. SW480 cells which are induced partially revert their malignancy. Ancorage independend growth is compromised and migration along a gradient of fetal calf serum is improved. The Decipher shRNA library was used for screening. It consists of 27.500 di erent shRNAs intefering with the activity of 5.000 genes which are potantially drugable. The two best candidates scoring as hits in the screen were EIF2B5 and BCL2L1. BCL2L1 was validated in a cooperating masterthesis and EIF2B5 could be validated in the course of this diseration. Following EIF2B5 depletion using di erent shRNA constructs, we were able to see di erential behaviour in pTRE-APC cells as well as in a second model system in which FL-APC was expressed constitutively. Interestingly an activation of the ER-Stress genes DDIT3 and splXBP1 can be seen after EIF2B5 depletion. These genes are repressed, when FL-APC ist expressed. The EIF2B5 promotor has a MYC-binding site and we speculate, that FL-APC expression induces a genetic program which represses EIF2B5 on the one hand, however prohibits the ER-Stress reaction which follows this trigger. Inhibtion of EIF2B5 without this global adaption in genexpression on the other side initiates UPR-mediated apoptosis. In a second project, the suprising behaviour of colon carcinoma cell lines, which upregulate MYC upon BEZ235 exposure was examined. The dual inhibitor was thought to downregulate MYC through its PI3K and mTOR inhibitory acitivites which were thought to destabilise and MYC and prohibit it's expression, respectively. Whereas former work could demonstrate a FOXO-mediated, MAPK-dependend positive MYC-gene expression clue the aim of this thesis was to analyse the expecte protein tranlational inhibition. Indeed, BEZ235 inhibits CAP-dependend translation, however the MYC protein is still translated through IRES-dependend translation. The eIF4A-inhibitor Silvestrol intervenes with both CAP- and IRES-dependend translation and can therefore reduce MYC protein levels

The ω-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA), in the free fatty acid (FFA) form, has been demonstrated,to reduce adenoma number and size in patients with familial adenomatous polyposis. However, the mechanistic basis of the antineoplastic activity of EPA in the colorectum remains unclear. We tested the hypothesis that EPAFFA negatively modulates synthesis of and signaling by prostaglandin (PG) E2 in human colorectal cancer (CRC) cells.,EPA-FFA induced apoptosis of cyclooxygenase (COX)-2-positive human HCA-7 CRC cells in vitro. EPA-FFA in cell,culture medium was incorporated rapidly into phospholipid membranes of HCA-7 human CRC cells and acted as,a substrate for COX-2, leading to reduced synthesis of PGE2 and generation of PGE3. Alone, PGE3 bound and activated,the PGE2 EP4 receptor but with reduced affinity and efficacy compared with its "natural" ligand PGE2. However,,in the presence of PGE2, PGE3 acted as an antagonist of EP4 receptor-dependent 3',5' cyclic adenosine,monophosphate induction in naturally EP4 receptor-positive LoVo human CRC cells and of resistance to apoptosis,in HT-29-EP4 human CRC cells overexpressing the EP4 receptor. We conclude that EPA-FFA drives a COX-2dependent "PGE2-to-PGE3 switch" in human CRC cells and that PGE3 acts as a partial agonist at the PGE2 EP4 receptor.

Due to the costly and technically challenging nature of genetic testing, methods have been developed to target more specifically those who are at increased risk of carrying the Hereditary Non-Polyposis Colorectal Cancer (HNPCC) mutation. HNPCC is an inherited colorectal cancer syndrome. Testing of tumour material (which has previously been removed during surgery) for features of HNPCC has been found to be an effective and economic method of identifying those at higher risk of having a mutation. Only those at higher risk of having a mutation will undergo genetic testing. This practice of “tumour testing” has become widespread. / There is currently no clarity about requirements for consent prior to testing of stored tumour tissue. The person giving consent to tumour testing does not always have an appointment with a genetics service prior to giving consent. This can be contrasted to genetic testing on blood samples where laws and guidelines state that informed consent is required prior to genetic testing and that comprehensive genetic counselling and support should be provided as part of this process. Protocols for genetic testing have been developed as a result of extensive research around the impact and implications of genetic testing. / Consumer opinion and participation through research is an important aspect of health policy and guideline development. Accordingly the purpose of this study was to contribute to such development by gaining insight into the experiences, understandings, decision making processes and opinions of those who had given consent to have their own or their relatives tumour tested. Seventeen people who had given consent for tumour testing either for themselves, or on behalf of a deceased relative were recruited through a Familial Cancer Centre and in-depth interviews conducted. The interviews were transcribed and analysed using thematic analysis. / Some participants had no memory of consenting to tumour testing. Others remembered basic concepts. Negative implications of testing were unknown or viewed as unimportant. Participants did not understand the difference between tumour testing and germline testing. Despite lack of memory or understanding participants did not want additional or more detailed pre-test information although they did want more follow-up and support after receipt of results. The decision to consent to testing was made as soon as participants were informed of the availability of tumour testing - the major reason being to provide information for the family that would aid in cancer prevention. Participants were more concerned with accessibility to testing than pre test information and counselling. / Findings in this study indicated participants made decisions heuristically rather than systematically and this as well as participants’ opinions and other decision-making research has implications for the traditional view of informed consent around genetic related decisions. This in turn has implications for policy and guidelines in the area. Implications for current practise as a result of findings from this study include ensuring participants understand negative implications of testing and follow up and support of those with negative as well as positive results to tumour testing.

Les mutacions germinals d'elevada penetrància del gen APC que originen una proteïna truncada són les responsables de la majoria de casos de poliposi, mentre que les variants missense, que canvien un aminoàcid de la proteïna, es detecten en una minoria dels casos. S'han identificat diverses variants missense en el gen APC, però el seu potencial patogènic és encara motiu de controvèrsia, el què limita la utilitat de la seva detecció en el consell genètic. L'estudi de la presència de les variants en la població control i en les diferents poblacions de càncer colorectal (CCR) esporàdic i hereditari, juntament amb la realització d'anàlisis funcionals, podrien ajudar a conèixer l'impacte de les variants del gen APC en el desenvolupament del CCR. El nostre objectiu és determinar el significat funcional de les variants identificades en el gen APC en pacients afectes de poliposi adenomatosa familiar en relació al risc de desenvolupar CCR tant esporàdic com hereditari.L'anàlisi molecular de la regió codificant del gen APC realitzat en 138 famílies amb poliposi adenomatosa familiar clàssica (n= 98) i poliposi adenomatosa familiar atenuada (n= 40) ha permès la identificació de deu variants missense del gen APC: G101E, K957N, N1026S, L1129S, I1307K, E1317Q, D1822V, A2274V, G2502S i P2681L. En el nostre estudi s'han caracteritzat amb diferent profunditat set d'aquestes deu variants: G101E, N1026S, L1129S, D1822V, A2274V, G2502S i P2681L. La variant APC G101E, identificada en una família de poliposi clàssica, no s'associa a la malaltia ni sembla tenir cap funció modificadora del fenotip de poliposi. L'efecte biològic de les variants APC A2274V i APC P2681L, identificades en dues famílies de poliposi, és encara desconegut. La variant APC G2502S és un polimorfisme que no sembla tenir rellevància clínica. La variant APC L1129S, identificada en dues famílies de poliposi, no altera la interacció de la proteïna APC 4x15 amb la beta-catenina. La variant APC D1822V és un polimorfisme que incrementa el risc de desenvolupar CCR en pacients amb història prèvia d'adenomes i no s'associa amb la història familiar de CCR. La variant APC N1026S, que està present de forma exclusiva en una família de poliposi adenomatosa familiar atenuada, disminueix la unió d'APC amb beta-catenina i activa moderadament la transcripció mitjançada pel complex beta-catenina/Tcf-4. Aquests resultats indiquen que la variant APC N1026S és patogènica i és la mutació responsable del desenvolupament de la poliposi atenuada a la família on es va identificar.La caracterització funcional de les variants del gen APC és de gran importància per conèixer la seva contribució en el desenvolupament de la poliposi i facilitar l'assessorament genètic. / Truncating germline mutations in the APC gene are responsible for the majority of Familial Adenomatous Polyposis (FAP) cases, while in a minority of cases missense mutations, leading to single amino acid changes, are detected. Germline missense variants in the APC gene have been reported although their contribution to FAP is controversial, limiting their use in genetic counseling. The aim of this thesis is to determine the functional relevance of the variants identified in the APC gene in FAP patients in order to establish its pathogenicity.The molecular analysis of the APC gene was performed in 138 classical (n= 98) and attenuated (n= 40) FAP families and allowed the identification of ten missense variants. In this thesis, seven out of these ten APC variants have been characterised: G101E, N1026S, L1129S, D1822V, A2274V, G2502S and P2681L. The APC G101E variant, identified in a classical FAP family, is not associated with the disease. The biological effect of APC A2274V and APC P2681L variants, identified in two FAP families, remains unknown. The APC G2502S variant is a polymorphism without clinical relevance. The APC L1129S variant, identified in two FAP families, does not modify the interaction of the APC 4x15 protein with beta-catenin. The APC D1822V variant is a polymorphism associated with an increased risk of adenoma transformation and does not associate with family history of colorectal cancer. The APC N1026S variant, identified for the first time in an attenuated FAP family, diminishes beta-catenin binding to APC and moderately activates beta-catenin/Tcf-4-mediated transcription. These findings strongly support a pathogenic role of the APC N1026S variant in the AFAP phenotype.In summary, functional characterization of APC variants is crucial to elucidate their contribution to FAP and improve genetic counseling.

Thesis (Ph.D.). / Written for the Dept. of Biomedical Engineering. Title from title page of PDF (viewed 2009/06/11). Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 96-113).

Hereditary non-polyposis colon cancer syndrome (HNPCC) is associated with an increased risk of developing several types of cancer and is the most common cause of hereditary ovarian cancer after BRCA1 and BRCA2 mutations. HNPCC results from a germline mutation in one of the DNA mismatch repair (MMR) genes: MLH1, MSH2, PMS1, PMS2, MSH6, MSH3 and MLH3. While there has been extensive investigation of MMR deficiency in colorectal cancer, MMR in ovarian cancer is relatively under-investigated. The goal of this project was to study MMR deficiency in ovarian cancer at both the clinical and molecular level. The first aim was to examine the frequency of MMR loss in a large patient cohort and investigate the clinical consequences of MMR deficiency. The second aim was to describe the molecular characteristics of MMR deficiency in ovarian cancer cell lines and establish an in vitro cell line model of MMR deficiency in ovarian cancer. The third aim was to identify synthetic lethal strategies for the treatment of ovarian cancer to maximise cytotoxicity in a MMR-deficient background. In order to characterise the clinical consequences of MMR deficiency, a large patient cohort was studied with regard to MMR status. Three tissue microarrays consisting of 581 ovarian tumours were constructed, and expression of the four most frequently lost MMR proteins: MLH1, MSH2, PMS2 and MSH6 were detected by immunohistochemistry. Afterwards, MMR status and histology subtypes were analysed in combination with the associated clinical data. The overall incidence of MMR deficiency (loss of any MMR protein) was 15.7%, with PMS2 being the most frequently lost protein (9.7%). In addition, MMR deficiency tended to appear in a grouped fashion: MLH1 with PMS2; MSH2 with MSH6. Patients with non-serous subtypes of ovarian cancer, clear cell or mucinous especially, had higher incidence of MMR deficiency compared to patients with serous ovarian cancer. Overall MMR deficient patients were more likely to be diagnosed at early stages compared with MMR proficient patients, and this is probably due to the association between MMR deficiency and non-serous histology. However, platinum-based treatment for patients with MMR deficiency gives no advantage over those without MMR deficiency. Therefore better treatments for this subgroup of patients may be needed. The features of MMR deficiency in ovarian cancer were also characterized at the molecular level. After quantifying mRNA and protein expression of MMR genes in 19 ovarian cell lines, three cell lines (SKOV3, TOV21G and IGROV1) were found to have a defect in MLH1 expression at both the mRNA and protein level. Interestingly, the three cell lines also carried a defect in PMS2 expression at the protein level but not at the mRNA level, which is consistent with our clinical data demonstrating that MLH1 protein and PMS2 protein are paired in loss. In addition, across the 19 cell lines, MLH1 and PMS2 showed positive correlation at both the mRNA level (R=0.53, p=0.02) and protein level (R=0.72, p=0.0006). In order to study co-expression of MLH1 and PMS2, a plasmid encoding the cDNA for MLH1 was transfected into the three MLH1 deficient cell lines; and conversely siRNA targeting MLH1 was transfected into the MMR proficient cell line A2780 and expression of MLH1 protein and PMS2 protein was quantified. The results showed that re-introduction of MLH1 into MLH1 deficient cells resulted in increased expression of PMS2 protein, while knocking down MLH1 in MMR proficient cells leads to decreased PMS2 protein expression. This indicates that MLH1 may play a crucial role in regulating PMS2 protein expression. As the three MLH1 and PMS2 protein deficient cell lines all express PMS2 mRNA, the regulation of PMS2 expression by MLH1 is likely to be at the translational or post-translational level. However, the expression of PMS2 protein was not increased in the absence of MLH1, even when the proteasomal and lysosomal protein degradation pathways were blocked (as seen with SKOV3 cells), suggesting decreased PMS2 protein expression is not due to rapid degradation in the absence of MLH1. Therefore MLH1 may play a role in regulating the synthesis of PMS2 protein at the translational level, rather than preventing the degradation of PMS2. Thus, to investigate the mechanism by which PMS2 protein levels are regulated by MLH1, future work should focus on translational regulation of PMS2. In order to identify synthetic lethal strategies to target MMR deficiency in ovarian cancer, an isogenic cell line model of MMR deficiency was established by stable transfection of a plasmid for MLH1 and its corresponding empty vector into SKOV3 cells. The MLH1+ cell line SAC-1 and MLH1- cell line SN-5 were selected for drug screening based on their phenotype and growth rate. The AlamarBlue assay, with z’ above 0.5, was chosen for drug screening and a kinase inhibitor library containing 362 drugs of known target was screened. Two drugs with similar structures that targeted PLK1 showed greater growth inhibition of SN-5 compared with SAC-1. When the two cell lines were treated with another PLK1 inhibitor, BI2536, with different structure, a 2-fold difference in growth inhibition between SAC-1 and SN-5 was also observed, suggesting PLK1 is a potential synthetic lethal target for MLH1 deficiency in ovarian cancer. Together these data demonstrate that clinically, MMR deficiency is associated with non-serous subtypes of ovarian cancer and specific MMR proteins are paired in loss. While current standard therapy offers no selective benefit to ovarian cancer patients with MMR deficiency, inhibiting PLK1 activity may confer selective benefit.

In severe cases of ulcerative colitis (UC) unresponsive to current treatment options, patients require a complete proctocolectomy, or surgical removal of the colon. Ileal pouch anal anastomosis (IPAA) has become the preferred surgical technique for patients who require surgery, as this method restores rectal function. This procedure is also used to treat colorectal cancers such as adenocarcinoma and familial adenomatous polyposis (FAP). The surgery involves an abdominal colectomy with the construction of an ileal pouch created from folded tissue recovered from the ileal portion of the small intestine. Up to 50% of patients who require IPAA surgery experience an episode of pouchitis, a non-specific inflammation of the constructed ileal pouch with unknown etiology. Several hypotheses have been proposed regarding the pathogenesis of pouchitis. Current theories include bacterial overgrowth due to fecal stasis, microbial imbalance (dysbiosis), immune alteration, genetic susceptibility, metaplasia, ischemic complications of surgery, a recurrence of UC, or even a novel form of inflammatory bowel disease. The efficacy of antibiotics and probiotics in treating pouchitis and maintaining remission underscores the importance of gut microbiota in the development of this condition. In the study, we aimed to characterize the intestinal bacterial communities that inhabit IPAA pouches of both UC and FAP patients, in an effort to investigate the hypothesis that bacterial dysbiosis is involved in the pathogenesis of pouchitis. Mucosal biopsy and stool samples were analyzed from patients with UC and pouchitis (UCP), healthy UC controls (HUC) and healthy pouches with a background of FAP (FAP). Samples were examined through analysis of terminal restriction fragment length polymorphisms (TRF) and DNA sequencing. The data presented here demonstrate that a microbial imbalance exists in pouchitis, as bacterial communities in pouchitis differ significantly from healthy UC pouches and pouches constructed for FAP. Both methods identified potential groups of organisms that may play a role in the development of pouchitis, including decreases in protective Lactobacillus and Bacteroides and increases in mucin-degrading Clostridium and Akkermansia. A better understanding of the factors driving the pathogenesis of pouchitis will not only benefit patients with this disease, but also lead to a better understanding of the complex relationship that exists between the human host and the diverse community of organisms that inhabit the gastrointestinal tract.

Contexte : Le pronostic de la fonction olfactive après chirurgie de la fente olfactive (FO) dans la polypose nasosinusienne (PNS) n'est pas connu. Objectifs : 1) Préciser la localisation des polypes dans les différents sous-compartiments de l'ethmoïde ; 2) Déterminer la corrélation entre l'auto-évaluation de l'odorat et les résultats de Sniffin'Sticks test ainsi qu'entre l'auto-évaluation de l'odorat et de l'obstruction nasale chez les patients porteurs d'une PNS avec ou sans hamartome épithélial respiratoire adénomatoïde des fentes olfactives (HERA - FO); 3) Évaluer la fonction olfactive avant et 6 semaines après chirurgie de la PNS comportant une chirurgie de la FO et rechercher les facteurs pronostiques de la récupération de l'olfaction après chirurgie. Échantillons : Ce travail repose sur des études observationnelles rétrospectives et prospectives chez les patients atteints de PNS opérés par voie endoscopique selon la procédure de nasalisation de Septembre 2009 à Novembre 2010 dans le service ORL du CHU de Nancy. Résultats : 1) Dans la PNS, les polypes se développaient dans tous les compartiments ethmoïdaux (au niveau du méat moyen dans 98%, de la fente olfactive postérieure dans 75%, du méat supérieur dans 61%, du cornet moyen dans 50% et de la FO antérieure dans 40% des cas); 2) Il existait une forte corrélation entre l'auto-évaluation et la mesure de l'olfaction avant la chirurgie (r =-0,66 ; p<0,0001) et après la chirurgie (r =-0,67 a 6 semaines r = -0.66 a 7 mois, p<0,0001). La corrélation était plus faible avant chirurgie (r =-0,35; p=0,01) qu'après chirurgie chez les patients hypo-anosmiques (r =-0,74 ; p<0,0001 a 6 semaines et r =-0,73 ; p=0,0002 a 7 mois). Les auto-évaluations de l'obstruction nasale et des troubles de l'odorat n'étaient pas corrélées lorsque les deux symptômes étaient dissocies ; 3) Il existait une relation étroite entre la présence de l'HERA dans les FO et l'ancienneté de la PNS (p= 0,0009), l'asthme (p = 0,004) et les antécédents de la chirurgie de PNS (p = 0,0006). Les facteurs prédictifs de non-récupération de la fonction olfactive après la chirurgie étaient un bas score TI préopératoire (p = 0,028), l'antécédent de résection des cornets moyens au cours des procédures chirurgicales précédentes (p = 0,0018), et la résection récente des cornets moyens (p = 0,04). L'histologie des polypes (HERA vs Polype éosinophile) et le type de geste sur les FO (biopsies vs exérèse des polypes) n'étaient pas des facteurs prédictifs pour la non-récupération de l'odorat. Conclusion : l'évaluation de l'odorat dans la PNS est complexe et nécessite une combinaison de tests psychophysiques et d'auto-évaluation. La chirurgie de la fente olfactive dans la PNS n'est pas un facteur péjoratif du pronostic olfactif en post-opératoire / Background: The olfactory outcome after surgery of the olfactory clefts (OC) in patients with nasal polyposis (NP) is unknown. Objectifs: 1) to refine the description of the polyps' origin within the different subcompartments of the ethmoidal bone; 2) to investigate correlations, before and after surgery, between the sense of smell self-ratings and measures of olfactory function, and self-ratings of sense of smell and nasal obstruction; 3) to assess the olfactory outcome after surgery of ethmoidal labyrinths and OC for either Eosinophilic Polyps (EP) or Respiratory Epithelial Adenomatoid Hamartoma (REAH) in patients with nasal polyposis (NP). Samples: All patients with NP operated according to the nasalization procedure from September 2009 to November 2010 in our tertiary hospital (CHU de Nancy) were enrolled in these retrospective and prospective studies. Results: 1) Polyps were found in the middle meatus (98%), in the posterior olfactory fossa (75%), in the superior meatus (61%), on the middle turbinate proper (50%) and in the anterior olfactory fossa (40%); 2) Overall, self-ratings and measures of olfactory function correlated strongly preoperatively (r = - 0.66, p < 0.0001) and postoperatively (r = -0.67 at 6 weeks and -0.66 at 7 months, p < 0.0001). This relationship was better in patients with previous surgery. The correlation was weaker before (r = -0.35, p=0.01) than after surgery in hyposmic/anosmic patients (r = -0.74, p < 0.0001 at 6 weeks and r = -0.73, p = 0.0002 at 7 months) and wasn't found in normosmic patients. Self-ratings of nasal patency and smell were not correlated when the two complaints were dissociated; 3) There was a close relationship between the presence of REAH-OC and the duration of NP disease (p=.0009), asthma (p=.004) and previous surgery (p=.0006). Predictors of poor olfactory outcomes after surgery were low TI score before surgery (p = 0.028), history of previous middle turbinate resection (p = 0.0018), and recent middle turbinate resection (p = 0.04). Polyp histology and surgery of the OC were not predictors of poor olfactory outcomes. Conclusion: The evaluation of the sense of smell in patients with NP should be performed in combination of psychophysic tests and self-ratings of the olfactory function. The resection of REAH or EP of the OC in patients with NP does not worsen but instead can improve the postoperative olfaction

Mucosal immune system comprises not only the major compartment of the immune system but also important interface with the outer environment. It is responsible in maintaining an intricate balance with the danger and non-danger stimuli of the outer world by employing specific anatomical features and unique functional mechanisms. Mucosal immune system has been long understudied, perhaps due to the limited accessibility, and its biological importance is thus still underevaluated. However, it has become evident that it is important to study mucosal immune system not only in local mucosal affections but also when uncovering pathogenic mechanisms and novel prevention strategies of organ specific autoimmune diseases such as type 1 diabetes. Thus, the first, more clinically oriented part of this thesis is focused on mucosal immune system of the upper respiratory tract in disease conditions - in nasal polyposis (NP). Because there is a substantial accumulation of eosinophils and neutrophils in the most frequent type of NP, we investigated and described increased expression of chemokine receptors CCR1 and CCR3 in NP versus nasal mucosa. Both innate immune mechanisms as well as homeostasis of epithelial cells may participate in NP. We have documented increased numbers of iNOS-positive and insulin-like growth...