Submitted by ANDRÉ LUIS GIACOMETTI CONCEIÇÃO null (andre4487@gmail.com) on 2016-03-08T12:40:30Z No. of bitstreams: 1 Arquivo_Completo_-_Tese_Doutorado_-_André_Luis_Giacometti_Conceição.pdf: 1296182 bytes, checksum: 29c1b4fbebefc1b96e79210f433f4d2f (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-09T16:44:10Z (GMT) No. of bitstreams: 1 conceicao_alg_dr_sjrp.pdf: 1296182 bytes, checksum: 29c1b4fbebefc1b96e79210f433f4d2f (MD5) / Made available in DSpace on 2016-03-09T16:44:10Z (GMT). No. of bitstreams: 1 conceicao_alg_dr_sjrp.pdf: 1296182 bytes, checksum: 29c1b4fbebefc1b96e79210f433f4d2f (MD5) Previous issue date: 2016-02-16 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O carcinoma renal de células claras (ccRCC) é o mais comum dos subtipos histológicos de carcinoma renal. Este carcinoma é histologicamente caracterizado pela presença de células com citoplasma claro e abundante. O processo inicial de metástase pode ser atribuída à transição epitélio mesênquima (EMT). Neste estudo, buscou-se identificar genes diferencialmente expressos em ccRCC, construindo assim um perfil molecular para este tumor. Nós selecionamos genes descritos na literatura que apresentam relação com EMT, diferenciação e proliferação celular. Analisou-se por PCR quantitativo e imuno-histoquímica a expressão dos genes e suas proteínas, respectivamente, e os possíveis mecanismos epigenético que regulam a sua expressão em amostras de ccRCC e linhagem celular. Os genes OCLN e GAS1 foram encontrados com baixa expressão em ccRCC, e nós sugerimos que o miR-122 e miR- 34a podem regular sua expressão, respectivamente, neste tipo de câncer. Além disso, mostramos, por qPCR e imuno-histoquímica, a alta expressão de SLC2A1 foi significantemente alta em ccRCC. O conjunto de genes identificados neste estudo possibilita a compreensão das bases moleculares e de desenvolvimento do ccRCC. / Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of kidney cancer. This carcinoma is histologically characterized by the presence of clear and abundant cytoplasm. The initial process of ccRCC metastatic tumor formation can be attributed to epithelial- mesenchymal transition (EMT). In this study, we sought to identify genes differentially expressed in ccRCC and build a molecular profile of this cancer. We selected genes described in the literature to be related to EMT, cellular differentiation and proliferation. We analyzed the gene and protein expression by quantitative PCR and immunohistochemistry, respectively, and examined possible epigenetic mechanisms that regulate their expression in ccRCC samples and cell lines. OCLN and GAS1 genes were under-expressed in ccRCC, and we report that miR-122 and miR- 34a, respectively, may regulate their expression in this cancer. Furthermore, we showed by quantitative PCR (qPCR) and immunohistochemistry that SLC2A1 was significantly over-expressed in ccRCC. The set of genes identified in this study furthers our understanding of the molecular basis and development of ccRCC. / FAPESP: 2012/08853-0

Abstract In the kidney, Wnt is involved in ureteric bud branching and nephrogenesis. Wnt mutation may lead to specific developmental dysfunctions and diseases. As part of this thesis, I show that Wnt11 is expressed in the renal tubules, except for the ureteric epitheliums, and I examine the function of Wnt11 in renal tubule organization using the new C57Bl6 Wnt11-/- mouse model. Convoluted and dilated tubules were observed in the Wnt11 mutated kidneys that may cause glomerular cysts and kidney dysfunction. More specifically, a lack of Wnt11 in the kidney reduced Six2, Hoxd1, and Hox10 expression, which may have contributed to the anomalies in the kidney tubular system. Embryogenesis and carcinogenesis share molecular characteristics. Gene expression changes take place during development to meet the demands of the tissue formation, but ectopic expression of embryonic genes by deletion, SNPs, or epigenetic modification in adult may lead to cancer. The research carried out as part of this thesis identified genes that were differentially expressed in both induced metanephric mesenchymes (MM) and human ccRCC. Gene silencing of Bnip3, Gsn, Lgals3, Pax8, Cav1, Egfr, and Itgb2 mediated by siRNA inhibited the migration, viability and invasion capacity of Renca cells (RCC). Furthermore, by using the novel 3D in vitro MM-Renca co-culture setup, the result revealed that downregulation of Bnip3, Cav1 or Gsn in Renca cells partly rescued the RCC-mediated inhibition epithelial tubules formation during nephrogenesis. Altogether, the data demonstrates that renal ontogenesis control genes play a role both in normal kidney development and in kidney cancer. The 3D RCC-MM chimera organoids developed as part of the research may also serve as a novel model for kidney cancer study. / Tiivistelmä Wnt-viestit ohjaavat munuaisen kehityksen yhteydessä sekä virtsanjohtimen että munuaiskeräsen kasvua. Virhe Wnt-proteiinia tuottavassa geenissä johtaa puolestaan vakavaan kehityshäiriöön ja syöpään, jos geeni aktivoituu aikuisvaiheessa. Tässä väitöskirjassa osoitetaan, että Wnt11-geeni osallistuu alkion munuaisen epiteeliputkiston kehityksen säätelyyn. Wnt11-signaalin tehtävää tutkittiin munuaisen putkiston rakenteen synnyssä poistogeenisen C57Bl6-hiirimallin avulla. Wnt11-puutos häiritsi virtsan kokoojatiehyiden rakenteiden kehitystä. Tämä on mahdollinen syy siihen, että Wnt11-poistogeenisen hiiren munuaiseen kehittyy hiusverisuonikerästen laajentumia. Munuaisen toiminta on myös heikentynyt verrokkiin verrattuna. Munuaisen epiteeliputkien kehitykseen osallistuvien geenien Six1, Hoxd1 ja Hox10 aktiivisuus oli niin ikään heikentynyt Wnt11-signaloinnin puutoksen vuoksi. Nämä seikat voivat olla puutoksen aiheuttamien kudosrakenteellisten muutosten taustalla. Solun kasvusäätely on keskeinen tekijä sekä alkion että syövän kehityksessä. Prosessien taustalla ovat myös samankaltaiset molekyylit. Wnt-solusignaalit esimerkiksi säätelevät normaalin kehityksen aikana solujen itsesäätelyä, solujen jakautumista, solujen vaeltamista ja solujen invaasiota kudoksiin ja osallistuvat syövän syntyyn niiden viestinnän häiriintyessä. Kehitystä säätelevien geenien tuotteet ohjaavat solujen jakautumista, mikä on edellytys kudosrakenteen synnylle. Jos nämä geenit syystä tai toisesta aktivoituvat uudelleen aikuisvaiheen aikana, se voi johtaa syöpäkasvaimen syntyyn. Tässä työssä verrattiin keskenään munuaisen elinkehitykseen ja ihmisen syövän kasvuun osallistuvia geenejä. siRNA-välitteinen hiljennys geeneille Bnip3, Gsn, Lgals3, Pax8, Cav1, Egfr ja Itgb2 inhiboi Renca-solujen migraatiota, elinkykyä ja invaasiota. Lisäksi tulokset paljastivat, että käytettäessä uutta 3D in vitro MM Renca -kasvatusmenetelmää Bnip3-, Cav1- tai Gsn-geenien hiljennys Renca-soluissa osittain pelastaa RCC-välitteisen inhibition epiteeliputkissa nefrogeneesin aikana. Kaiken kaikkiaan työssä seulottiin uusin tavoin sekä ihmisen munuaissyöpään liittyviä geenejä että kehitettiin lisäksi uusia niin kutsuttuja kokeellisia funktionaalisia organoidimenetelmiä. Työn tulokset tarjoavat uuden strategian, jolla geenien osuutta munuaissyöpään voidaan tutkia seikkaperäisesti yhdessä 3D-kasvatusmenetelmien kanssa

O carcinoma de células renais (CCR) é o tumor mais agressivo que afeta o rim de pessoas adultas. O CCR é uma doença heterogênea, com diferentes alterações moleculares e variados patrões histológicos e clínicos que apresentam evolução diferente. Atualmente apenas variáveis anatomopatológicas clássicas são utilizadas para determinar o prognóstico dos pacientes. Utilizando uma plataforma de microarranjos de DNA, nosso grupo identificou em um trabalho anterior um conjunto de genes que se encontram diferencialmente expressos em tumores de rim. Neste estudo, nove candidatos foram selecionados para avaliação como marcadores de prognóstico no CCR. Foi confirmada a alteração na expressão dos genes ARNTL, ACTN4 e EPAS1 (p < 0,05) em amostras tumorais de CCR através de PCR em tempo real. Adicionalmente, foi observada a alteração da expressão dos genes ARNTL, EPAS1 e CASP7 em linhagens celulares imortalizadas derivadas de tumores renais, recapitulando por tanto, as alterações observadas nos tumores obtidos de pacientes. Posteriormente investigamos o padrão de expressão proteica destes candidatos por imunohistoquímica utilizando microarranjos de tecidos. Foi detectada a diminuição significativa (p < 0,05) da expressão das proteínas ACTN4, ARNTL, CASP7 e EPAS1 em tumores de pacientes com CCR relativamente ao tecido renal não tumoral. Além disso, foi possível determinar valores de imunomarcação capazes de estratificar pacientes com CCR em diferentes grupos de risco quanto à sobrevida câncer-específica, que adicionalmente apresentaram associação significativa com parâmetros anatomopatológicos utilizados na clínica. As imunomarcações de ACTN4, ARNTL, e EPAS1 se mostraram parâmetros independentes de prognóstico de sobrevida dos pacientes. A imunomarcação de CASP7 foi capaz de identificar subgrupos de pacientes com pior prognóstico dentro de um conjunto de pacientes de baixo risco em função do estadio clinico, além de identificar pacientes com menor risco de morte pelo câncer entre aqueles apresentaram recorrência em até 5 após a cirurgia. O conjunto de resultados obtidos aponta para um novo conjunto de biomarcadores moleculares com potencial relevância para auxiliar no prognóstico de pacientes com carcinoma de células renais. / The renal cell carcinoma (RCC) is the most aggressive tumor that affects the kidney in adult people. The RCC is a heterogeneous disease, with many different molecular alterations and varied histological and clinical patterns with different outcome. Currently, only classic anatomopathological variables are used to determine patients\' prognosis. Using a DNA microarray platform, our group identified in a previous work a set of genes differentially expressed in renal tumors. In this study, nine candidates were selected for evaluation as prognostic biomarkers in RCC. Alteration of the gene expression in RCC tumor samples was confirmed for ARNTL, ACTN4 and EPAS1 (p < 0.05) by real time PCR. Additionally, gene expression changes of ARNTL, EPAS1 and CASP7 were also observed in immortalized cell lines derived from renal tumors, recapitulating the expression changes detected in the patients\' tumors. Next, we used tissue microarrays to investigate the protein expression of the selected candidates by immunohistochemistry. Expression of the proteins ACTN4, ARNTL, CASP7 and EPAS1 was detected as significantly downregulated (p < 0.05) in patients´ tumors relative to non-tumor renal tissue. Furthermore, immunostaining patterns of the selected candidates were able to stratify patients with RCC in different risk groups according to cancer-specific survival, which also showed significant associations with anatomopathological parameters used in the clinics. ACTN4, ARNTL and EPAS1 immunostaining resulted as independent prognostic parameters of patient survival. CASP7 immunostaining was able to identify subgroups of patients with worse prognosis in a set of low risk patients as determined by their clinical stage, and also identified patients with lower risk of death from cancer amongst patients that relapsed within 5 years after surgery. Overall, these results point to a new set of molecular biomarkers with potential relevance to help in the prognosis of patients with renal cell carcinoma.

No description available.

The Ph.D. thesis is a collection of eleven commented articles on the topic of molecular-genetic profiling of urogenital tract tumors published in impact factor journals. In the introduction the origin and development of classification units is described including a brief overview of recent genetic profiles of selected types of renal carcinomas. Reviewed are major signaling pathways exploited in targeted therapy as well as the function of the corresponding drugs. Directions in which the research of new biomarkers is aimed are mentioned and the introduction ends with a short list of molecular genetic methods used in classification of renal carcinomas. In the results section are summarized the most important morphological, immunohistochemical, and molecular genetic findings of the studied sets of renal carcinomas. The data are compared with the present characteristics of known entities and hypotheses of possible new entities or relations between them are inferred. In the conclusions the suitability and limitations of the used molecular genetic methods are discussed in the context of the difficulties of the material analyzed and the designs of the studies.

Das NZK ist nach dem Prostata- und Harnblasenkarzinom der dritthäufigste urologische Tumor. Die Prognoseaussichten hängen beim NZK vom Metastasenstatus der Patienten ab. Die Heilungschancen für das lokal begrenzte NZK sind im Vergleich zum metastasierten NZK deutlich besser. Durch den Einsatz von TKI und mTOR-Inhibitoren wurde die Therapie des metastasierten NZK revolutioniert und das Überleben von Patienten signifikant verbessert. Nichtsdestotrotz profitiert ein Teil dieser Patienten aufgrund von Resistenzmechanismen nicht von solch einer anti-VEGF-Therapie. Bisher gibt es keine geeigneten Biomarker, die das Ansprechen auf eine solche Therapie vorhersagen könnten. Daher bestand das primäre Ziel dieser Arbeit darin, molekulare Marker für die Abschätzung der Prognose beim lokal begrenzten und metastasierten NZK sowie die Vorherage für das Ansprechen auf eine Sunitinib-Therapie beim metastasierten NZK zu identifizieren. Für das Prognosemodell am lokal begrenzten NZK konnten auf mRNA-Ebene signifikante Assoziationen der Marker HIF-2α, VEGFR3 und sVEGFR1 mit dem PFS, TSS und OS der Patienten identifiziert werden. Da bisher nur klinische Parameter für Prognosemodelle des lokal begrenzten NZK genutzt werden, könnten die hier untersuchten molekularen Marker nach einer unabhängigen Validierung zur Vorhersage der Prognose herangezogen werden. Patienten mit einem metastasierten NZK wiesen VHL-Mutationen (50%) und -Kopienzahlverluste (60 %) auf, die jedoch nicht mit dem Ansprechen auf Sunitinib assoziiert waren und nur geringfügige Auswirkungen auf die Proteinlevel von VHL und dessen Targetgene HIF-1α, CA9 und VEGFA zeigten. Bei den Untersuchungen zur VHL-Promotormethylierung wurde im tumorfreien Gewebe eine hohe Grundmethylierung festgestellt. Aufgrund der geringen Patientenzahl und der weitgehend unbekannten komplexen Methylierungsstruktur des VHL-Promotors konnten keine Assoziationen mit der Prognose und dem Ansprechen der metastasierten NZK-Patienten auf Sunitinib bestimmt werden. Für die Proteinlevel potenzieller prädiktiver Marker wie CA9, HIF-1α, VEGFR1 und -2, pVEGFR1, pPDGFRα und -β, CD31, pAkt sowie Ki67 wurden signifikante Assoziationen mit dem Ansprechen auf die Sunitinib-Behandlung beobachtet. Die CA9-Membranfärbung und das Ansprechen nach 9 Monaten wurden in der multivariaten Analyse als unabhängige prognostische Marker für das OS bei Patienten mit metastasiertem NZK identifiziert. In anderen Arbeiten wurde CA9 bereits mehrfach als potenzieller Biomarker beschrieben und könnte daher eine Anwendung in der Prognosevorhersage und Patienten-Selektion für eine Target-Therapie finden. Polymorphismen in Angiogenese-assoziierten Genen gelten ebenfalls als potenzielle Marker für das Ansprechen auf eine Therapie mit Sunitinib. Die Überlebensanalysen deckten signifikante Assoziationen zwischen dem VEGFA-SNP -2578 und dem PFS und für die SNPs VEGFR1 B sowie VEGFR2 +1191 mit dem OS auf. Das kombinierte Auftreten der Varianten-Allele der VEGFA-SNPs -2578, -1154 und +405 wirkte sich ebenfalls signifikant auf ein verlängertes OS der mit Sunitinib behandelten Patienten aus. Bei eindeutiger Bestätigung dieser Ergebnisse in prospektiven Studien könnten einfache SNP-Analysen an Blutproben die Therapieentscheidung und das Überleben der NZK-Patienten maßgeblich beeinflussen. Die künstlich erzeugte Sunitinib-Resistenz in den NZK-Zelllinien A498, Caki-1 und KTCTL-26 offenbarte nur begrenzt veränderte Proteinniveaus potenzieller Marker wie HIF-1α, Akt und pAkt zwischen den resistenten und sensitiven Zellen. Ein besseres Verständnis der molekularen Grundlagen der Resistenzentwicklung könnte zusammen mit einem wirkungsvollen, prädiktiven Biomarker für das Ansprechen die Therapie beim metastasierten NZK erheblich verbessern. In dieser Arbeit konnten letztlich verschiedenste Biomarker identifiziert und evaluiert sowie deren Bedeutung für die Prognosevorhersage und Prädiktion von Patienten mit metastasiertem NZK unter Sunitinib-Therapie herausgearbeitet werden. Diese Daten stellen damit einen weiteren Grundstein für mögliche prospektive klinische Studien dar, die den therapeutischen Nutzen der Biomarker eindeutiger definieren könnten.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions. Background: Metastasis accounts for 90% of cancer-associated mortality in patients with renal cell carcinoma (RCC). However, the clinical management of RCC metastasis is challenging. Lactate export is known to play an important role in cancer cell migration. This study investigated the role of heat shock protein A12A (HSPA12A) in RCC migration. Methods: HSPA12A expression was examined in 82 pairs of matched RCC tumors and corresponding normal kidney tissues from patients by immunoblotting and immunofluorescence analyses. The proliferation of RCC cells was analyzed using MTT and EdU incorporation assays. The migration of RCC cells was evaluated by wound healing and Transwell migration assays. Extracellular acidification was examined using Seahorse technology. Protein stability was determined following treatment with protein synthesis inhibitor cycloheximide and proteasome inhibitor MG132. Mass spectrometry, immunoprecipitation, and immunoblotting were employed to examine protein-protein interactions. Results: RCC tumors from patients showed downregulation of HSPA12A, which was associated with advanced tumor node metastasis stage. Intriguingly, overexpression of HSPA12A in RCC cells inhibited migration, whereas HSPA12A knockdown had the opposite effect. Lactate export, glycolysis rate, and CD147 protein abundance were also inhibited by HSPA12A overexpression but promoted by HSPA12A knockdown. An interaction of HSPA12A with HRD1 ubiquitin E3 ligase was detected in RCC cells. Further studies demonstrated that CD147 ubiquitination and proteasomal degradation were promoted by HSPA12A overexpression whereas inhibited by HSPA12A knockdown. Notably, the HSPA12A overexpression-induced inhibition of lactate export and migration were abolished by CD147 overexpression. Conclusion: Human RCC shows downregulation of HSPA12A. Overexpression of HSPA12A in RCC cells unstabilizes CD147 through increasing its ubiquitin-proteasome degradation, thereby inhibits lactate export and glycolysis, and ultimately suppresses RCC cell migration. Our results demonstrate that overexpression of HSPA12A might represent a viable strategy for managing RCC metastasis.

Objectif: Environ 30% des patients ayant un cancer du rein métastatique présentent d’emblée des résistances aux agents de thérapie ciblée. Les autres patients développent des résistances thérapeutiques à plus long terme. Une amélioration de la capacité du clinicien à prédire la réponse thérapeutique avant l’initiation du traitement pourrait améliorer le pronostic des patients. Le but de notre projet a été de développer un modèle de xénogreffes dérivées de patients afin d’évaluer la sensibilité des cellules tumorales de chaque patient aux différents agents de thérapie ciblée, avant d’initier un traitement.Méthodes: La membrane chorio-allantoïque de l’embryon de poulet a servi de base à notre modèle. Dans une première phase de notre travail, une xénogreffe de cellules tumorales rénales humaines en suspension a été réalisée afin de vérifier que les caractéristiques histologiques et phénotypiques des tumeurs d’origine étaient conservées dans les xénogreffes réalisées sur notre modèle. Dans une seconde étape, des fragments tissulaires de tumeurs rénales de 5 patients opérés pour néphrectomie cytoréductive dans notre centre hospitalier étaient prélevés et greffés sur notre modèle (>60/patient). Différents agents dethérapie ciblée étaient testés sur les xénogreffes ainsi réalisées.Résultats : Les caractéristiques histo-pathologiques et phénotypiques des tumeurs rénales d’origine étaient conservées après xénogreffes. Il existait une hétérogénéité spatiale intra-tumorale en termes de sensibilité aux différents agents de thérapie ciblée. Il existait également un polymorphisme nucléotidique au sein des différentes régions de chaque tumeur rénale.Conclusion : Ce modèle de xénogreffes rénales dérivées de patients est utile pour l’évaluation de la sensibilité aux agents de thérapie ciblée des cellules tumorales en amont de la prise en charge thérapeutique. Ce modèle permet au clinicien de personnaliser le traitement de chaque patient ayant un cancer du rein métastatique, avant la mise en route d’un traitement systémique. Une évaluation prospective de notre modèle pourrait permettre de mieux appréhender les potentielles retombées cliniques liées à son utilisation. / Objective: Approximately 30% of patients with metastatic renal cancer are resistant to targeted therapy agents. The other patients will eventually develop long-term therapeutic resistances. An improvement in the clinician's ability to predict therapeutic response before treatment initiation could improve patients' prognosis. The aim of our projet was to develop a patient-derived xenograft models to be able to test the sensibility of each patient's renal tumor cells to the different available targeted therapy agent prior to treatment.Methods: The chicken embryo chorioallantoic membrane has been the base of our model. In a first phase of our work, a xenograft of human kidney tumor cells has been carried out in order to verify that the histologic and phenotypic characteristics of the original tumors were preserved in the xenografts performed on our model. As a second step, fragments of the kidney tumor speciments of 5 patients undergoing cytoreductive nephrectomy in our hospital center were grafted on our model (> 60/patient). Different targeted therapy agents were tested on the xenografts we performed.Results: The histopathologic and phenotypic characteristics of the original renal tumors were preserved in our xenografts. There was intra-tumor spatial heterogeneity in terms of sensitivity in different targeted therapy agents. There was also a nucleotide polymorphism within the different regions of each renal tumor.Conclusion: This patient-derived renal xenograft model could be useful prior to treatment for the evaluation of each patients'renal tumor cells to the different available targeted therapy agents. This model could make it possible to personalize the treatment of each metastatic kidney cancer patient, prior to systemic treatment. A prospective evaluation of our model could help assess the potential clinical benefits of its use.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20265号 / 医博第4224号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 柳田 素子, 教授 武田 俊一, 教授 野田 亮 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The Ph.D. thesis is a collection of eleven commented articles on the topic of molecular-genetic profiling of urogenital tract tumors published in impact factor journals. In the introduction the origin and development of classification units is described including a brief overview of recent genetic profiles of selected types of renal carcinomas. Reviewed are major signaling pathways exploited in targeted therapy as well as the function of the corresponding drugs. Directions in which the research of new biomarkers is aimed are mentioned and the introduction ends with a short list of molecular genetic methods used in classification of renal carcinomas. In the results section are summarized the most important morphological, immunohistochemical, and molecular genetic findings of the studied sets of renal carcinomas. The data are compared with the present characteristics of known entities and hypotheses of possible new entities or relations between them are inferred. In the conclusions the suitability and limitations of the used molecular genetic methods are discussed in the context of the difficulties of the material analyzed and the designs of the studies.