Melflufen (melphalan flufenamide, chemical name L-melphalanyl-p-L-fluorophenylalanine ethyl ester hydrochloride, previously called J1) is a derivative of the classical alkylating agent melphalan. Melflufen is potentiated by hydrolytic cleavage by aminopeptidase N (APN), leading to high intracellular concentrations of alkylating moieties and subsequent cell death. Increased APN expression is associated with the malignant phenotype of several human cancers, including acute myeloid leukemia, lymphoma and ovarian cancer, and plays a functional role in tumor angiogenesis. Therefore investigations of melflufen activity in these malignancies as well as detailed studies of inhibition of angiogenesis are interesting. The aim of this project was to investigate the cytotoxic and antiangiogenic effect, in vitro and in vivo, of melflufen, compared to melphalan and other cytotoxic drugs used in the clinic. We showed that melflufen was more effective than its parental drug melphalan in lymphoma, AML and ovarian cancer in cell lines as well as in primary patient samples. An improved in vitro therapeutic index was demonstrated by an increased cytotoxic activity in the patient samples compared to normal peripheral blood mononuclear cells (PBMCs). Furthermore, melflufen in combination with cytarabine was synergistic in an AML cell line in a sequence-dependent manor. Melflufen was shown effective in several animal models using lymphoma, AML and ovarian cell xenografts (single drug or in combination), including an intraperitoneal ovarian xenograft. Finally, we demonstrated that melflufen had antiangiogenic properties in several different models.

Purpose: Combretastatin A4 phosphate (CA4P) and its structural analog, combretastatin A1 phosphate (CA1P), are soluble prodrugs capable of interacting with tubulin and causing rapid vascular shutdown within tumors. CA4P has completed Phase I clinical trials, but recent preclinical studies have shown that CA1P displays a greater antitumor effect than the combretastatin A4 (CA4) analog at equal doses. The aim of this study, therefore, is to compare pharmacokinetics and metabolism of the two compounds to determine whether pharmacokinetics plays a role in their differential activity. Experimental Design: NMRI mice bearing MAC29 tumors received injection with either CA4P or CA1P at a therapeutic dose of 150 mg·kg-1, and profiles of both compounds and their metabolites analyzed by a sensitive and specific liquid chromatography/mass spectroscopy method. Results: The metabolic profile of both compounds is complex, with up to 14 metabolites being detected for combretastatin A1 (CA1) in the plasma. Many of these metabolites have been identified by liquid chromatography/mass spectroscopy. Initial studies, however, focused on the active components CA4 and CA1, where plasma and tumor areas under the curve were 18.4 and 60.1 µg·h·ml-1 for CA4, and 10.4 and 13.1 µg·h·ml-1 for CA1, respectively. In vitro metabolic comparisons of the two compounds strongly suggest that CA1 is metabolized to a more reactive species than the CA4. Conclusions: Although in vitro studies suggest that variable rates of tumor-specific prodrug dephosphorylation may explain these differences in pharmacokinetics profiles, the improved antitumor activity and altered pharmacokinetic profile of CA1 may be due to the formation of a more reactive metabolite.

ONC201 is a novel compound that upregulates endogenous TNF-Related Apoptosis-Inducing Ligand (TRAIL), in tumor and normal cells, restoring autocrine and paracrine anti-tumor activity within tumor cells, and upregulates the DR5 gene by activating the integrated stress response, inducing eIF2-alpha-dependent ATF4 and CHOP [1-3]. ONC201 also demonstrates potent anti-tumor effects on colorectal cancers [4, 5]. ONC201 presented a promising oral bioavailability, wide distribution throughout the body, and ability to cross the blood-brain barrier. Further, the unique ability of its TRAIL-and-DR5-based signaling to induce apoptosis in cancer cells and not normal cells adds to its appeal as an anti-cancer therapeutic and prompted clinical development [1-4, 6]. ONC201 has successfully completed an FDA advanced Phase I/II clinical trial in advanced aggressive refractory solid tumors. Results indicated that ONC201 is well-tolerated and recommended a phase II dose of 625 mg orally every 3 weeks. Several Phase I/II clinical trials are enrolling in multiple solid tumors and hematological malignancies [7, 8]. Chapter two of this study provides evidence that ONC201 dose intensification demonstrates an increased pharmacodynamic effect and an increasing anti-tumor efficacy in vivo while having a safe toxicity profile upon weekly dosing. This data influenced the Phase II clinical trials, which have now been adjusted to include weekly dosing. Given the potential anti-metastatic effects of TRAIL signaling and the role of TRAIL in the immune surveillance of cancer, we hypothesized that ONC201 would suppress metastatic tumor development and engage the immune system in its anti-cancer activity. We also establish that ONC201 provides an important anti-metastatic effect in CRC that should be pursued in both pre-clinical and clinical studies. Tail vein and surgical CRC models demonstrate that ONC201 inhibits the number and size of metastases. Evidence has shown that TRAIL can also inhibit cancer metastasis by possibly inducing cell death or TRAIL-sensitization in the primary tumor when cells undergo extravasation upon detachment from the primary tumor [9-11]. While we show that TRAIL plays a role in ONC201’s ability to inhibit migration/invasion in vitro, further investigation of the role of TRAIL in vivo is necessary. Our data indicates that ONC201 promotes a pro-immune response in CRC subcutaneous tumors with increased NK cells that play a role in ONC201’s efficacy in syngeneic models. Since activated natural killer cells express TRAIL, we established that ON201 can activate and induce TRAIL expression in NK cells [12, 13]. As we did not find any immune infiltrates in the metastases, we suggest that the effect of the micro-environment or in more clinically-relevant models with stromal environments should be pursued. Chapter 3 of this of thesis demonstrates the characterization of ONC201’s core structure and development of ONC201 analogues including their mechanistic differences and potential in vivo efficacy and safety. We have demonstrates the importance of the angular structure of ONC201 to ONC201’s anti-tumor efficacy [14]. The novel pharmacophore has now been called as imipridone and is essential for its anti-tumor activity, as the linear isomer had no anti-tumor effect. We leveraged this unique pharmacophore to synthesize ONC201 analogues with distinct therapeutic properties; namely, targeting ONC201-resistant tumor types or possessing distinct signaling properties. Imipridone R2 analogues have a lower IC50 and are more promising than their lead compound in certain tumor types. ONC212, a halide R2 analogue, demonstrates superior efficacy in vivo in melanoma xenografts, a large therapeutic window; but does have a rapid PK. Oncoceutics is currently developing ONC212 for a first-in human Phase I clinical trial. The fourth chapter of this study demonstrates the potential of a combinational therapy with ONC201 in colorectal cancer with bevacuzimab. Clinical trials in CRC and other tumor types have demonstrated that therapeutics targeting the vascular endothelial growth factor (VEGF) pathway, such as bevacizumab, are effective in combination with certain chemotherapeutic agents. ONC201 in combination with bevacuzimab led to superior results with almost no tumor growth. This result was re-capitulated in syngeneic models. Given that bevacuzimab is approved for metastatic CRC, we suggest that ONC201 in combination with bevacuzimab should be introduced into a combinatorial Phase II clinical trial. This thesis focuses on the importance of dose-intensification of ONC201 on its pre-clinical efficacy; establish an anti-metastatic effect; demonstrate an immune increase in subcutaneous models; and elucidate the role of the core angular structure in efficacy with the development novel ONC201 analogues. The importance of pre-clinical studies, ONC201’s analogues including the successful development of ONC212, and potentially advantageous combinational therapies with anti-angiogenics is explained in the chapters throughout. / Cancer Biology & Genetics

No / Purpose: Combretastatin A4 phosphate (CA4P) and its structural analog, combretastatin A1 phosphate (CA1P), are soluble prodrugs capable of interacting with tubulin and causing rapid vascular shutdown within tumors. CA4P has completed Phase I clinical trials, but recent preclinical studies have shown that CA1P displays a greater antitumor effect than the combretastatin A4 (CA4) analog at equal doses. The aim of this study, therefore, is to compare pharmacokinetics and metabolism of the two compounds to determine whether pharmacokinetics plays a role in their differential activity. Experimental Design: NMRI mice bearing MAC29 tumors received injection with either CA4P or CA1P at a therapeutic dose of 150 mg/kg-1 , and profiles of both compounds and their metabolites analyzed by a sensitive and specific liquid chromatography/mass spectroscopy method. Results: The metabolic profile of both compounds is complex, with up to 14 metabolites being detected for combretastatin A1 (CA1) in the plasma. Many of these metabolites have been identified by liquid chromatography/mass spectroscopy. Initial studies, however, focused on the active components CA4 and CA1, where plasma and tumor areas under the curve were 18.4 and 60.1 microgram/h/ml-1 for CA4, and 10.4 and 13.1 microgram/h/ml-1 for CA1, respectively. In vitro metabolic comparisons of the two compounds strongly suggest that CA1 is metabolized to a more reactive species than the CA4. Conclusions: Although in vitro studies suggest that variable rates of tumor-specific prodrug dephosphorylation may explain these differences in pharmacokinetics profiles, the improved antitumor activity and altered pharmacokinetic profile of CA1 may be due to the formation of a more reactive metabolite.

Avec 42 000 nouveaux cas diagnostiqués en 2012, le cancer colorectal (CCR) représente en France le troisième cancer en termes d’incidence. Les métastases, qui surviennent principalement au niveau du foie et des poumons, en constituent la principale cause de décès. Malgré les progrès récents de la chimiothérapie et des agents ciblés, le taux de survie à 5 ans des patients présentant un CCR métastasé reste faible. Aujourd’hui, la résection chirurgicale est le seul traitement curatif, cependant moins de 20% des patients porteurs de métastases sont opérables. Il existe donc un grand nombre de patients présentant un CCR métastasé pour lequel aucun traitement curatif ne peut être proposé. La formation des métastases à partir d’une tumeur primaire résulte d’une longue série d’étapes séquentielles liées les unes aux autres. L’issue de ce processus dépend à la fois des propriétés intrinsèques des cellules tumorales et de la réponse de l’hôte. Il a récemment été montré que les couples chimiokines/récepteurs interviennent dans le contrôle des différentes étapes de la progression tumorale.Le projet de recherche développé au cours de mon travail de thèse avait pour objectif d’utiliser les chimiokines et leurs récepteurs dans de nouvelles stratégies thérapeutiques pour bloquer et/ou éradiquer les métastases hépatiques et pulmonaires des CCRs. Le travail s’est articulé selon deux axes dans lesquels nous avons montré d’une part que, le blocage du récepteur de chimiokines CXCR7 permet de limiter les métastases pulmonaires de CCRs et d’autre part que, le transfert de gène codant CX3CL1 au niveau du foie entraîne une réponse anti-tumorale efficace dans les métastases hépatiques de CCRs. / With 42 000 newly-diagnosed patients in 2012, the colorectal cancer (CRC) represents the third type of cancer in terms of incidence in France. The leading cause of death from CRC is the development of metastases and these metastases will occur mostly within the liver (50% of the patients) and within the lungs (15%). Despite recent progress, notably in the chemotherapies now used and the targeted agents, the rate of 5-years survival for late stage CRC remains low. Nowadays, the surgical resection is the only curative treatment proposed to patients with metastatic CRC, however less than 20% of them have an operable tumour. There is therefore a high number of patients for whom no cure is currently available. A primary tumour’s dissemination to a second organ is the result of a long process made of numerous cross-linked steps. The final outcome of this process depends on the intrinsic properties of tumour cells as well as the host response. Recently, it has been shown that the chemokine-chemokine receptor pairs (initially described as regulating the leukocyte migration) play crucial roles in the various stages involved in tumour progression. The aim of the research project developed during my PhD was to assess the use of the chemokines and their receptors in new therapeutic strategies to block and/or eradicate the hepatic and pulmonary metastases of CRC. Our work has been organized along two main lines of approach. We have shown that the blockage of the CXCR7 chemokine receptor enables the limitation of the CRC metastases within the lungs and that the CX3CL1 gene transfer into the hepatocytes leads to an efficient anti-tumor response in the CRC metastases within the liver.

The progress of cell therapy can be greatly facilitated by using suitable experimental models. It is essential to verify the clinical usefulness of new healing procedures obtained in studies on laboratory animals by using a large animal model. One of suitable models well acceptable in medical community is undoubtedly the miniature pig, which resembles humans in terms of physiology and body proportions. This PhD thesis presents the summary of our experimental studies relating to possible exploitation of mesenchymal and neural stem cells in the healing of locomotive apparatus and neural tissue disorders in humans or animals. The first part of the thesis briefly describes the current issue of cell therapy and animal models, mesenchymal cells and/or their combination with new types of scaffolds, neurogenesis, neural stem cells and their potential application in therapy of spinal cord injury. The second part is focused on the goals and methodology, the individual publications being listed in the third part. Our experiments with iatrogenic physeal defect in rabbits, which served as a model of the occurrence of valgous deformation in the clinical practice, showed the positive preventive and therapeutical effects of a new type of scaffolds seeded with allogeneic mesenchymal stem cells in animals without...

La recherche dans le domaine de la prise en charge de la douleur, notamment chronique, a un besoind’innovation car les traitements disponibles à l’heure actuelle sont pour la plupart anciens et souventliés à des effets indésirables. Il est maintenant admis que les études précliniques de la douleur ont denombreuses limites : pertinence des modèles, utilisation d’une stimulation douloureuse surajoutée,détermination d’un simple seuil ou délai, prise en compte de la seule composante sensoridiscriminative…De ce fait, certaines molécules efficaces chez l’animal et donc prometteuses, n’ontpas eu les effets escomptés chez l’homme. La base de notre travail de recherche s’attache donc àproposer de nouvelles méthodes d’appréciation de la douleur chronique chez l’animal en prenant encompte ses aspects multidimensionnels. De nombreuses études ont mis en évidence une altération dela qualité de vie chez des patients atteints de douleur chronique. Cette altération se caractérisenotamment par des perturbations émotionnelles et cognitives. Ces paramètres ne sont pas toujours prisen compte chez l’animal dans l’évaluation de traitements antalgiques mais pourrdouleurnt amener denouvelles possibilités et perspectives précliniques. Notre travail a consisté à étudier l’impact de ladouleur sur les comportements spontanés (automatisation du test au formol), la composanteémotionnelle et les capacités cognitives chez le rongeur. Il a été complété par l’exploration du rôle del’amygdale dans les mécanismes impliqués dans ces modifications comportementales.L’amélioration du test au formol a été réalisée dans le but de visualiser au mieux les comportementsspécifiques observés lors d’une douleur aiguë de type inflammatoire. Notre adaptation a permis, chezles mêmes animaux, de pouvoir dissocier l’effet antalgique et l’effet sédatif d’une molécule à l’aided’une méthode automatisée plus rapide et moins subjective.Parallèlement, nous avons apprécié l’impact de la douleur chronique sur la composante émotionnelleet les performances cognitives dans deux modèles de douleur chronique (inflammatoire etneuropathique). Les animaux souffrant de douleur chronique inflammatoire présentent desperturbations plus importantes que les animaux neuropathiques, perturbations pouvant être amélioréespar un traitement pharmacologique. Des études mécanistiques utilisant des micro-injections demorphine au niveau de l’amygdale ont souligné une implication importante du complexe basolatéraldans ces composantes émotionnelles et cognitives de la douleur.Ces nouvelles approches comportementales pourrdouleurnt permettre de mieux caractériser l’impact globalde la douleur chronique chez l’animal et de compléter la batterie de tests couramment utilisés enpréclinique. Ceci pourrait déboucher sur une transposition plus réaliste des résultats obtenus chezl’animal à l’homme, et donc conduire à une meilleure prédictibilité clinique de l’efficacité destraitements. Enfin, la mise en évidence de nouvelles cibles thérapeutiques innovantes implique l’étudedes mécanismes responsables de ces altérations comportementales. / Research in the field of pain management, including chronic pain management, needs innovationbecause available treatments are mostly old and often associated with many side effects. It is now wellrecognized that preclinical studies on pain have many limitations: the relevance of the models, the useof imposed painful stimulations, determination of simple thresholds or delays, taking into account thesensory-discriminative component of pain alone… Indeed, some molecules that are efficient inanimals and that are considered as promising, didn’t have the desired effect in humans. Therefore, thebasis of our research aims to propose new methods to assess chronic pain in animals taking intoaccount its multidimensional aspects. Many studies have shown impaired quality of life in patientssuffering from chronic pain. This alteration is characterized by emotional and cognitive disturbances.These components of pain are not always taken into account in animal when studying analgesictreatments, but could bring new preclinical possibilities and perspectives. Our work consisted instudying the impact of pain on spontaneous behaviours (automated formalin test), emotionalcomponent and cognitive capacities in rodents. This work has been completed by the exploration ofthe role of the amygdala in the mechanisms underlying those behavioural modifications.Improvement of the formalin test was conducted in order to better visualize the specific behaviorsobserved during an acute inflammatory pain. Our adaptation has allowed dissociating the analgesicand sedative effect of a molecule in a same animal, using an automated method which is faster and lesssubjective than the manual method.In the meantime, we assessed the impact of chronic pain on the emotional and cognitive performancesin two models of chronic pain (inflammatory and neuropathic). Animals suffering from chronicinflammatory pain have more important impairments than animal suffering from neuropathic pain,impairments that can be improved with a pharmacological treatment. Mechanistic studies using microinjectionsof morphine in the amygdala have emphasized an important involvement of the basolateralcomplex in these emotional and cognitive components of pain.These new behavioural approaches may help better characterize the overall impact of chronic pain inanimals and complete the battery of tests commonly used in preclinical studies. This could lead to amore realistic transposition of the results obtained from animals to humans, and thus lead to betterpredictability for the clinical efficacy of treatments. Finally, the identification of new targets forinnovative therapies involves the study of mechanisms responsible for these behavioral impairments.

Sanofi Pasteur travaille depuis plus de 20 ans au développement d’un vaccin contre la Dengue, maladie virale pouvant présenter des formes sévères. Ce vaccin, dénommé Dengue CYD est composé de quatre virus recombinants basés sur la souche vaccinale contre la Fièvre Jaune dans laquelle les gènes codant les protéines prM et E ont été remplacés par ceux des différents sérotypes de virus Dengue.Dans les études décrites ici, nous avons démontré la stabilité génétique des souches vaccinales au cours des étapes de production, et nous avons mis au point un système de qRT-PCR pour quantifier le génome viral afin de caractériser les lots et suivre les virémies post-vaccinales.De plus, différentes études précliniques menées chez le macaque ont permis :1) d’évaluer l’immunogénicité du vaccin après immunisation par différentes formulations vaccinales et selon différents schémas visant à réduire les interférences entre les sérotypes. L’administration de vaccins bivalents complémentaires à des sites anatomiques différents ou de façon séquentielle, l’établissement d’une pré-immunité hétérologue, une moindre dose relative du sérotype vaccinal dominant ou l’administration d’un rappel à un an ont ainsi permis de mettre en évidence des pistes d’amélioration du schéma vaccinal.2) d’évaluer la biodistribution et l’excrétion du vaccin afin de confirmer son innocuité.3) de tester la neutralisation d’un panel de souches virales par des sérums des singes vaccinés pour montrer que les anticorps induits par le vaccin peuvent neutraliser des souches Dengue circulantes d’origines géographiques et de génotypes variés.Enfin, l’absence de risque de dissémination du virus dans l’environnement via les tiques, arthropodes vecteurs d’autres Flavivirus, a été confirmée.Ces études ont permis d’apporter des éléments démontrant l’intérêt du vaccin Dengue CYD pour lancer des études cliniques et compléter les dossiers réglementaires visant à l’enregistrement du vaccin Dengvaxia® / Sanofi Pasteur has been working for more than 20 years to develop a vaccine against Dengue, viral disease that can cause life-threatening forms. The CYD Dengue vaccine is a tetravalent recombinant virus based on Yellow fever vaccine strain in which genes encoding prM and E proteins have been replaced by the corresponding genes from the different Dengue virus serotypes.In the studies described here, we demonstrated the genetic stability of the vaccine strains during the manufacturing steps and we set-up a qRT-PCR system to quantify viral genome in order to characterize batches and to follow post-vaccination viremia.In addition, different pre-clinical studies were conducted in macaques in order:1) To evaluate the vaccine immunogenicity after immunizations according to different schedules and formulations aiming at decreasing interferences between serotypes. Different parameters were shown to improve vaccine immunogenicity, such as administration of complementary bivalent vaccines at separate anatomical sites or sequentially, establishment of a heterologous pre-immunity, adaptation of the formulation by decreasing the dose of the dominant serotype or administration of a 1-year booster.2) To evaluate the biodistribution and shedding of the vaccine to confirm its safety3) To test neutralization by vaccinated-monkey sera of a panel of circulating viral strains to demonstrate that antibodies elicited by the vaccine should neutralize Dengue strains from different geographical origins and genotypesFinally, the absence of risk of dissemination of the virus in the environment via ticks, i.e. arthropods responsible for transmission of other Flaviviruses, was confirmed.These studies brought elements demonstrating the interest of the CYD Dengue vaccine to allow starting clinical trials and filing of technical dossiers supporting Dengvaxia® submission and registration

Le domaine transmembranaire des récepteurs membranaires est aujourd’hui considéré comme essentiel dans l’activation et la régulation des voies de signalisation sous-jacentes. Ceci est tout particulièrement le cas pour neuropiline-1 et -2 (NRP1/2), et ErbB2, trois récepteurs impliqués dans la croissance tumorale. Notre laboratoire a initialement démontré qu’un peptide ciblant le domaine transmembrane du récepteur NRP1, bloque l’oligomérisation de ce récepteur et provoque ainsi l’inhibition de la prolifération/migration des cellules tumorales et l’angiogenèse in vivo. L’objectif principal de ce travail de thèse était d’élargir cette stratégie aux récepteurs membranaires NRP2 et ErbB2, et ce, dans le contexte du cancer du sein. Mes travaux montrent que ces peptides inhibent la pousse tumorale et les métastases associées dans différents modèles de cancer du sein. Les effets anti-tumoraux peuvent s’expliquer par les propriétés anti-angiogéniques et anti-prolifératives des peptides démontrées in vitro et in vivo. J’ai également disséqué le mécanisme d’action du peptide ErbB2 et montré que le peptide inhibiteur de NRP2 induit des effets secondaires rédhibitoires (promotion des métastases osseuses). Dans l’ensemble, mes recherches valident le potentiel thérapeutique de cette stratégie peptidique et renforce l’idée d’un développement clinique de ces composés. D’une terre inconnue à une terre d’espoir, le cœur de la membrane est incontestablement une nouvelle source d’inspiration pour le développement des médicaments de demain. / The role of transmembrane domains (TMD) in membrane receptor activation and regulation is nowadays appearing as a key step of cell signaling. This has been indeed evaluated for neuropilin-1 and -2 (NRP1/2) and ErbB2 receptors, three membrane receptors whose signaling has clearly been implicated in tumorigenesis. Our team had demonstrated that a synthetic peptide blocking the transmembrane domain of NRP1 blocked NRP1-dependent signaling leading to the inhibition of glioma cell proliferation/migration and tumor associated angiogenesis in vivo. The major goal of this thesis project was to extend this novel strategy to NRP2 and ErbB2 in the breast cancer context. Thus, I was able to demonstrate for the first time that the use of peptides, inhibiting the TMD of these receptors, was able to inhibit tumor growth and related metastases in vivo, in three different breast cancer mouse models that I have developed in the laboratory. These results were supported by in vitro experiments demonstrating anti-proliferative and anti-angiogenic properties of these peptides. Besides, I was able to dissect the mechanism of action of the peptide targeting ErbB2 receptor in vitro and in vivo, and I provided data excluding NRP2 as a target because of an unexpected promotion of bone metastasis. Altogether, my data offer convincing evidences to further develop MTP-ErbB2 and MTP-NRP1 peptides as novel therapeutic compounds for patients suffering metastatic cancers. From terra incognita to the exploration of a world of hope, the heart of the membrane is becoming a new promising estate for drug design.