Os marcadores prognósticos em mastologia têm sido utilizados como apoio diagnóstico para prever o comportamento dos neoplasmas mamários (prognóstico) e determinar a provável resposta ao tratamento pré ou pós-cirúrgico. Estudos têm sido feitos sobre o prognóstico dos tumores mamários caninos (TMCs) que apresentam semelhanças e diferenças com tumores mamários humanos. Além disso, esses tumores exibem, com alta freqüência, proliferação de células mioepiteliais que podem sofrer metaplasia, acompanhada de alterações moleculares. O presente estudo teve o objetivo de verificar a expressão imuno-histoquímica e a associação de diferentes marcadores utilizados como prognósticos nos tumores de mama humana (RE, RP, c-erbB-2 e Ki-67) e marcadores mioepiteliais (p63, CK5 e vimentina) nos TMCs. O primeiro artigo analisa a expressão desses marcadores em 35 tumores encontrados em onze fêmeas caninas nas quais foram identificados tumores malignos múltiplos nas glândulas mamárias. Cada tipo histológico analisado em fêmeas portadoras de tumores múltiplos expressou marcadores prognósticos e mioepiteliais peculiares à sua histogênese, porém houve associação dessa expressão apenas em alguns tipos celulares presentes nos TMCs. Os tumores com componente epitelial carcinomatoso não apresentaram diferenças significativas, no entanto, nos tumores com componente complexo e misto, ocorreu associação entre a expressão da p63, CK5 e vimentina. No conjunto de marcadores estudados, a p63 e a CK5 mostram-se promissoras na elucidação da transformação das células mioepiteliais concomitante à invasão tumoral e com relação à expressão da vimentina que se mostrou bem evidenciada durante a transformação da célula mioepitelial proliferada a célula participante do mesênquima do neoplasma invasor em mamas de caninos, ao menos nos aspectos de expressão molecular e morfológica. O segundo artigo analisa os marcadores mioepiteliais em 82 casos de TMCs malignos. Este estudo comprovou a freqüência e a associação da expressão desses marcadores em determinados tipos histológicos tumorais e celulares, permitindo a identificação das células mioepiteliais em transformação na maior parte dos TMCs malignos, notadamente, os que apresentam componente mesenquimal metaplásico. Mais estudos devem ser feitos na tentativa de verificar a significância da expressão encontrada no comportamento biológico desses tumores. / Prognostic markers in mastology have been used as diagnostic support, to predict the behavior of mammary neoplasias (prognosis) and to determine their possible response to treatment before or after surgery. Studies have been conducted on the prognosis of canine mammary gland tumors (MGTs), which show similarities to and differences from human breast tumors. In addition, these tumors often show proliferation of myoepithelial cells, which may undergo metaplasia, accompanied by molecular alterations. The aim of the present study was to check the immunohistochemical expression and the association between different markers used as prognostic factors in human breast tumors (ER, RP, c-erbB-2 and Ki-67) and myoepithelial markers (p63, CK5 and vimentin) in MGTs. The first article analyzes the expression of these markers in 35 tumors in 11 female dogs, where multiple tumors were identified in the mammary glands. Each histological type analyzed in the female dogs with multiple tumors expressed prognostic and myoepithelial markers that were peculiar to their histogenesis, but the association of this expression was observed only in some cell types of MGTs. Tumors with a carcinomatous epithelial component did not have significant differences, but tumors with complex and mixed components showed association between the expressions of p63, CK5 and vimentin. Of the group of investigated markers, p63 and CK5 proved to be promising tools in elucidating the transformation of myoepithelial cells concomitantly to tumor invasion and in terms of vimentin expression, which was quite pronounced in this transformation from proliferating myoepithelial cells into cells that participate in the mesenchyma of the invasive neoplasia in canine mammary glands, at least with regard to the aspects of molecular and morphological expression. The second article analyzes myoepithelial markers in 82 cases of malignant MGTs. This study corroborated the frequency and association of the expression of these markers in certain histological tumor and cell types, allowing for the identification of myoepithelial cells in transformation in most malignant MGTs, chiefly those with a metaplastic mesenchymal component. Further studies are necessary in order to assess the importance of expression found in the biological behavior of these tumors.

Os marcadores prognósticos em mastologia têm sido utilizados como apoio diagnóstico para prever o comportamento dos neoplasmas mamários (prognóstico) e determinar a provável resposta ao tratamento pré ou pós-cirúrgico. Estudos têm sido feitos sobre o prognóstico dos tumores mamários caninos (TMCs) que apresentam semelhanças e diferenças com tumores mamários humanos. Além disso, esses tumores exibem, com alta freqüência, proliferação de células mioepiteliais que podem sofrer metaplasia, acompanhada de alterações moleculares. O presente estudo teve o objetivo de verificar a expressão imuno-histoquímica e a associação de diferentes marcadores utilizados como prognósticos nos tumores de mama humana (RE, RP, c-erbB-2 e Ki-67) e marcadores mioepiteliais (p63, CK5 e vimentina) nos TMCs. O primeiro artigo analisa a expressão desses marcadores em 35 tumores encontrados em onze fêmeas caninas nas quais foram identificados tumores malignos múltiplos nas glândulas mamárias. Cada tipo histológico analisado em fêmeas portadoras de tumores múltiplos expressou marcadores prognósticos e mioepiteliais peculiares à sua histogênese, porém houve associação dessa expressão apenas em alguns tipos celulares presentes nos TMCs. Os tumores com componente epitelial carcinomatoso não apresentaram diferenças significativas, no entanto, nos tumores com componente complexo e misto, ocorreu associação entre a expressão da p63, CK5 e vimentina. No conjunto de marcadores estudados, a p63 e a CK5 mostram-se promissoras na elucidação da transformação das células mioepiteliais concomitante à invasão tumoral e com relação à expressão da vimentina que se mostrou bem evidenciada durante a transformação da célula mioepitelial proliferada a célula participante do mesênquima do neoplasma invasor em mamas de caninos, ao menos nos aspectos de expressão molecular e morfológica. O segundo artigo analisa os marcadores mioepiteliais em 82 casos de TMCs malignos. Este estudo comprovou a freqüência e a associação da expressão desses marcadores em determinados tipos histológicos tumorais e celulares, permitindo a identificação das células mioepiteliais em transformação na maior parte dos TMCs malignos, notadamente, os que apresentam componente mesenquimal metaplásico. Mais estudos devem ser feitos na tentativa de verificar a significância da expressão encontrada no comportamento biológico desses tumores. / Prognostic markers in mastology have been used as diagnostic support, to predict the behavior of mammary neoplasias (prognosis) and to determine their possible response to treatment before or after surgery. Studies have been conducted on the prognosis of canine mammary gland tumors (MGTs), which show similarities to and differences from human breast tumors. In addition, these tumors often show proliferation of myoepithelial cells, which may undergo metaplasia, accompanied by molecular alterations. The aim of the present study was to check the immunohistochemical expression and the association between different markers used as prognostic factors in human breast tumors (ER, RP, c-erbB-2 and Ki-67) and myoepithelial markers (p63, CK5 and vimentin) in MGTs. The first article analyzes the expression of these markers in 35 tumors in 11 female dogs, where multiple tumors were identified in the mammary glands. Each histological type analyzed in the female dogs with multiple tumors expressed prognostic and myoepithelial markers that were peculiar to their histogenesis, but the association of this expression was observed only in some cell types of MGTs. Tumors with a carcinomatous epithelial component did not have significant differences, but tumors with complex and mixed components showed association between the expressions of p63, CK5 and vimentin. Of the group of investigated markers, p63 and CK5 proved to be promising tools in elucidating the transformation of myoepithelial cells concomitantly to tumor invasion and in terms of vimentin expression, which was quite pronounced in this transformation from proliferating myoepithelial cells into cells that participate in the mesenchyma of the invasive neoplasia in canine mammary glands, at least with regard to the aspects of molecular and morphological expression. The second article analyzes myoepithelial markers in 82 cases of malignant MGTs. This study corroborated the frequency and association of the expression of these markers in certain histological tumor and cell types, allowing for the identification of myoepithelial cells in transformation in most malignant MGTs, chiefly those with a metaplastic mesenchymal component. Further studies are necessary in order to assess the importance of expression found in the biological behavior of these tumors.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

Background: Prostate Cancer (PC) is a common and highly variable disease. Using current diagnostic methods, the prostate specific antigen (PSA) blood test and histological grading of prostate tissue needle biopsies, it is often difficult to evaluate whether the patient has a PC that requires active treatment or not. The absolute majority of all 10,000 cases of PCs diagnosed annually in Sweden have tumours graded as Gleason score (GS) 6-7 and a PSA value in blood below 10. Many of these are harmless and can be left without active treatment and hence spared problematic post-therapy side-effects, others are highly malignant and require early diagnosis and treatment. Better prognostic markers are needed and the aim of this study was to evaluate prognostic markers and to test if these markers could identify patients with indolent tumours. Methods: We have studied tumour material from 419 men consecutively diagnosed with PC at transurethral resection (1975-1990). The majority of these patients (295) had no metastasis at diagnosis and was not given any curative treatment and only hormonal treatment upon symptoms from metastatic progression. Standard histological sections and tissue microarrays (TMA) from these tumours and surrounding normal prostate tissue were stained and evaluated for cell proliferation (Ki67), blood vessels (endoglin and von Willebrand factor, vWf) and the extracellular matrix component hyaluronan (HA). An orthotopic rat PC model was used to explore hyaluronan staining, hyaluronic acid synthase (HAS)-1 mRNA levels and the effect of local HA treatment on tumour growth. Results: Tumour cell proliferation (Ki67) and the density of intra-tumoural endoglin stained blood vessels were independent prognostic markers (i.e. they added prognostic information to the conventional prognostic markers; clinical stage and GS). None of the GS 6 patients with low staining for both Ki67 and endoglin died of PC within 15 years of follow-up. High HA staining in the tumour epithelium and stroma was a negative prognostic marker of cancer specific survival but they were not independent of GS. High HA staining and high vascular density in the stroma of the surrounding morphologically normal prostate were prognostic for short cancer specific survival. Implantation of tumour cells in the normal rat prostate resulted in an increase in HA and HAS-1 mRNA levels in the prostate tissue surrounding prostate tumours. Concurrently intra-prostatic injection of HA also stimulated tumour growth. Conclusions: By evaluating both tumour cell proliferation (Ki67) and vascular density, it is possible to identify patients with very low risk of cancer specific death in the absence of active treatment. Prostate tumours influence the surrounding non-malignant prostate tissue, for example they cause an increased angiogenesis and synthesis of hyaluronan. Such responses can possibly be used to diagnose PC and to evaluate PC aggressiveness.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

ABSTRACT The morphological premalignant changes in prostate epithelium such as high grade prostatic intraepithelial neoplasia (HGPIN) precede invasive prostate cancer (PC) by several decades. The overall aim of this project was to identify patterns of gene expression in HGPIN and early PC which increase our understanding of the early biology of PC and identify genes and pathways that correlate with an aggressive phenotype. A comprehensive tissue cohort of premalignant prostate lesions was collected in a tissue microarray (TMA) platform that was utilised for high-throughput validation of target genes. Using this unique resource, the expression of the tumour suppressor gene PTEN was assessed using immunohistochemistry in an initial candidate gene approach based on mouse models implicating PTEN in carcinogenesis. No significant difference in expression of PTEN was detected in premalignant and benign epithelium. A transcript profiling approach was undertaken by integrating laser capture microdissection, linear RNA amplification and oligonucleotide microarrays to perform a screen of matched patient samples of normal, HGPIN and PC cells. The expression patterns of two genes encoding secreted proteins, neuropeptide Y (NPY) and macrophage inhibitory cytokine (MIC-1) were validated using immunohistochemistry on TMAs representing the progression model of early PC. Increased expression of these proteins in PC was confirmed to occur early in the disease process and altered expression of NPY and MIC-1 was associated with worse clinical outcome. Further analysis of global gene expression patterns using a structured network knowledge base identified a notable aberration in the expression of extracellular matrix and extracellular matrix associated proteins in HGPIN and provided novel evidence for the role of this class of molecules in the development of PC. In summary, contrary to current dogma based on work in animal models, altered PTEN expression is unlikely to represent an important event in the development of malignancy in the human prostate. In contrast, the expression patterns and prognostic value of NPY and MIC-1 in HGPIN support their further evaluation as biomarkers for the development and progression of PC. The aberrant expression of genes and networks of genes detected in HGPIN will assist in further identification of biological pathways which may be targeted in therapeutic strategies against the development and progression of PC.

Elevated levels of circulating asymmetric and symmetric dimethylarginines (ADMA and SDMA) predict and potentially contribute to end organ damage in cardiovascular diseases. Alanine-glyoxylate aminotransferase 2 (AGXT2) regulates systemic levels of ADMA and SDMA, and also of beta-aminoisobutyric acid (BAIB)-a modulator of lipid metabolism. We identified a putative binding site for hepatic nuclear factor 4 α (HNF4α) in AGXT2 promoter sequence. In a luciferase reporter assay we found a 75% decrease in activity of Agxt2 core promoter after disruption of the HNF4α binding site. Direct binding of HNF4α to Agxt2 promoter was confirmed by chromatin immunoprecipitation assay. siRNA-mediated knockdown of Hnf4a led to an almost 50% reduction in Agxt2 mRNA levels in Hepa 1–6 cells. Liver-specific Hnf4a knockout mice exhibited a 90% decrease in liver Agxt2 expression and activity, and elevated plasma levels of ADMA, SDMA and BAIB, compared to wild-type littermates. Thus we identified HNF4α as a major regulator of Agxt2 expression. Considering a strong association between human HNF4A polymorphisms and increased risk of type 2 diabetes our current findings suggest that downregulation of AGXT2 and subsequent impairment in metabolism of dimethylarginines and BAIB caused by HNF4α deficiency might contribute to development of cardiovascular complications in diabetic patients.

Elevated levels of circulating asymmetric and symmetric dimethylarginines (ADMA and SDMA) predict and potentially contribute to end organ damage in cardiovascular diseases. Alanine-glyoxylate aminotransferase 2 (AGXT2) regulates systemic levels of ADMA and SDMA, and also of beta-aminoisobutyric acid (BAIB)-a modulator of lipid metabolism. We identified a putative binding site for hepatic nuclear factor 4 α (HNF4α) in AGXT2 promoter sequence. In a luciferase reporter assay we found a 75% decrease in activity of Agxt2 core promoter after disruption of the HNF4α binding site. Direct binding of HNF4α to Agxt2 promoter was confirmed by chromatin immunoprecipitation assay. siRNA-mediated knockdown of Hnf4a led to an almost 50% reduction in Agxt2 mRNA levels in Hepa 1–6 cells. Liver-specific Hnf4a knockout mice exhibited a 90% decrease in liver Agxt2 expression and activity, and elevated plasma levels of ADMA, SDMA and BAIB, compared to wild-type littermates. Thus we identified HNF4α as a major regulator of Agxt2 expression. Considering a strong association between human HNF4A polymorphisms and increased risk of type 2 diabetes our current findings suggest that downregulation of AGXT2 and subsequent impairment in metabolism of dimethylarginines and BAIB caused by HNF4α deficiency might contribute to development of cardiovascular complications in diabetic patients.

Chronic lymphocytic leukemia (CLL) is a heterogeneous malignancy displaying varying clinical outcome, where molecular markers today can divide patients into prognostic subgroups. Despite the introduction of new agents for treatment, remissions are usually not sustained in CLL and resistance towards treatment can partly be explained by aberrant apoptosis. The aim of this thesis was to find new drugs for CLL patients resistant to conventional therapy and to analyze genes involved in apoptosis within different prognostic subgroups. In paper I-II, the in vitro activity of substances was investigated using the fluorometric microculture cytotoxicity assay (FMCA). When evaluating rapamycin (paper I), an inhibitor of mTOR, in 97 tumor samples from different entities, CLL was found to be one of the most sensitive tumor types. Combination experiments on patient CLL cells indicated that rapamycin acted synergistically with the CLL drugs vincristine and chlorambucil. An investigation of 20 anti-cancer agents in cells from 40 CLL patients (paper II) revealed that prednisolone and rolipram displayed high activity in poor-prognostic patients, in particular IGHV unmutated CLL. Furthermore, when used in combination these agents were found to produce a synergistic effect. In paper III, the anti-apoptotic BCL2 family member BFL1 was evaluated in 37 CLL cases. Levels of BFL1 were higher in fludarabine-resistant patients compared to fludarabine-sensitive patients. In addition, the high expression of BFL1 inversely correlated to fludarabine-induced apoptosis in CLL cells. A single nucleotide polymorphism in the anti-apoptotic BCL2 gene (-938C>A) has been suggested as a novel poor-prognostic marker in CLL. In paper IV, we investigated this BCL2 polymorphism in 268 CLL patients and correlated genotypes to clinical data. However, no association could be confirmed between this polymorphism and clinical outcome or established prognostic markers. In conclusion, this thesis has shown that rapamycin is a potential drug for treatment in CLL. Furthermore, prednisolone and rolipram were identified as interesting candidates for treatment of poor-prognostic patients. Finally, the anti-apoptotic protein BFL1 may contribute to chemoresistance and hence represents a potential therapeutic target in CLL, whereas from our data, the BCL2 -938C>A polymorphism does not appear to have any prognostic significance.

The clinical course of chronic lymphocytic leukemia (CLL) is highly heterogeneous, which has prompted the search for biomarkers that can predict prognosis in this disease. The IGHV gene mutation status and certain genomic aberrations have been identified as reliable prognostic markers of clinical outcome for this disorder. However, the search for more feasible prognostic markers in CLL is still being pursued. Recently, certain single nucleotide polymorphisms (SNPs) in the GNAS1, BCL2 and MDM2 genes and the RNA expression levels of the LPL, ZAP70, TCL1, CLLU1 and MCL1 genes were suggested as novel prognostic markers in CLL. In papers I-III, we performed genotyping analyses of the GNAS1 T393C, BCL2 -938C>A and MDM2 SNP309 polymorphisms in 268-418 CLL patients and related the genotypes with clinical data. Association studies between the polymorphisms and established prognostic markers (i.e. IGHV mutation status, genomic aberrations, CD38 expression) were also performed. Our studies did not find any significant relationship between these SNPs with either clinical outcome or other known prognostic markers in CLL. In paper IV, we measured the RNA expression levels of LPL, ZAP70, TCL1, CLLU1 and MCL1 in 252 CLL cases and correlated these levels with clinical outcome. Here, we verified that high expression of all these RNA-based markers, except MCL1, were associated with an unfavourable prognosis. We also confirmed a close relationship between IGHV mutation status and the RNA-based markers, especially for LPL and CLLU1 expression. Among the RNA-based markers, multivariate analysis revealed LPL expression as the strongest independent prognostic marker for overall survival and time to treatment. Furthermore, the RNA-based markers could add further prognostic information to established markers in subgroups of patients, with LPL expression status giving the most significant results. In summary, data from papers I-III could not verify the GNAS1 T393C, BCL2 -938C>A and MDM2 SNP309 polymorphisms as prognostic markers in CLL. Future SNP markers must hence be confirmed in large, independent cohorts before being proposed as prognostic marker in CLL. In paper IV, we conclude that LPL expression appears to be the strongest among the RNA-based markers for CLL prognostication. Further efforts to standardize LPL quantification are required before it can be applied in the clinical laboratory to predict clinical outcome in this disease.