京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22344号 / 医博第4585号 / 新制||医||1042(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 藤渕 航, 教授 渡邊 直樹, 教授 玉木 敬二 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20271号 / 医博第4230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 木村 剛, 教授 富樫 かおり, 教授 高橋 淳 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20662号 / 医博第4272号 / 新制||医||1024(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 武藤 学, 教授 松田 道行, 教授 原田 浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24494号 / 医博第4936号 / 新制||医||1063(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 村川 泰裕, 教授 小杉 眞司, 教授 松田 文彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Epithelial ovarian cancer (EOC) is the most lethal gynecologic cancer and urgently requires new therapies. Oncolytic viruses (OV) are a strong contender. OVs interact with immune components of the TME, which can be altered due to specific genetic mutations. The present study evaluates the impact of specific tumour mutations on the response to carboplatin, the current standard of care, and VSV∆M51, a promising OV candidate. After a study of genetically diverse models, constitutive KRas activation enhanced VSV∆M51 replication in-vitro and sensitivity in syngeneic in-vivo models. VSV∆M51 prolonged survival in syngeneic tumour- bearing mice with KRas, Trp53 and Pten mutations, including one tumour model that did not respond to carboplatin. Response to VSV∆M51 in-vivo was associated with activation of CD4+ and CD8+ T lymphocytes in the peritoneal TME. In summary, VSV∆M51-based immunotherapy has shown promise in diverse murine models of EOC bearing clinically relevant mutations.

Studies of prophylactic salpingectomy specimens from BRCA1/2 mutation carriers, at risk for tubal and ovarian high-grade serous carcinoma (SerCa), have consistently revealed occult carcinomas and putative histological cancer precursors in the distal fallopian tube epithelium (FTE), supporting the FTE as the source of SerCa. In this thesis I molecularly characterized and compared non-malignant FTE from mutation carriers (FTEb) and control patients (FTEn) to identify alterations that may predispose to malignant transformation. Gene expression profiling of laser capture microdissected FTEn, FTEb and SerCa indicated that SerCa have similar molecular profiles whether of presumed ovarian or tubal origin, supporting the notion they share a common cell of origin within the FTE. Furthermore, FTEb samples obtained during the post-ovulatory luteal phase showed gene expression profiles closely resembling SerCa samples, suggesting that the luteal phase milieu may contribute to serous carcinogenesis. An initial hypothesis was that FTEb may respond differently to luteal progesterone compared to FTEn, via differential expression of progesterone receptor (PR) isoforms. However, similar relative isoform expression in FTEn and FTEb samples suggested that a luteal phase-associated factor other than progesterone directs gene expression changes in FTEb. The possibility that FTEb respond differently to ovulation-associated inflammatory cytokines that are locally elevated during the luteal phase was next investigated. Importantly, FTEb specimens previously found to cluster with SerCa based on their global gene expression profiles showed evidence of increased nuclear factor-κB (NFκB)-dependent (pro-inflammatory) signalling and diminished glucocorticoid receptor (GR)-dependent (anti-inflammatory) signalling. Furthermore, I demonstrate that disabled homolog 2 (DAB2), an adaptor molecule decreased in SerCa and FTE luteal samples, enhances both GR-mediated transactivation and suppression of NFκB signalling, implicating DAB2 as a crucial determinant of inflammatory signalling and ovarian cancer risk. Altogether, this thesis identifies gene expression changes in FTE from BRCA mutation carriers during the post-ovulatory luteal phase that parallel those detected in SerCa. The data support a proposed novel testable model for predisposing events contributing to SerCa that centres on an altered ability to quickly resolve the pro-inflammatory environment created by the ovulatory event.

Studies of prophylactic salpingectomy specimens from BRCA1/2 mutation carriers, at risk for tubal and ovarian high-grade serous carcinoma (SerCa), have consistently revealed occult carcinomas and putative histological cancer precursors in the distal fallopian tube epithelium (FTE), supporting the FTE as the source of SerCa. In this thesis I molecularly characterized and compared non-malignant FTE from mutation carriers (FTEb) and control patients (FTEn) to identify alterations that may predispose to malignant transformation. Gene expression profiling of laser capture microdissected FTEn, FTEb and SerCa indicated that SerCa have similar molecular profiles whether of presumed ovarian or tubal origin, supporting the notion they share a common cell of origin within the FTE. Furthermore, FTEb samples obtained during the post-ovulatory luteal phase showed gene expression profiles closely resembling SerCa samples, suggesting that the luteal phase milieu may contribute to serous carcinogenesis. An initial hypothesis was that FTEb may respond differently to luteal progesterone compared to FTEn, via differential expression of progesterone receptor (PR) isoforms. However, similar relative isoform expression in FTEn and FTEb samples suggested that a luteal phase-associated factor other than progesterone directs gene expression changes in FTEb. The possibility that FTEb respond differently to ovulation-associated inflammatory cytokines that are locally elevated during the luteal phase was next investigated. Importantly, FTEb specimens previously found to cluster with SerCa based on their global gene expression profiles showed evidence of increased nuclear factor-κB (NFκB)-dependent (pro-inflammatory) signalling and diminished glucocorticoid receptor (GR)-dependent (anti-inflammatory) signalling. Furthermore, I demonstrate that disabled homolog 2 (DAB2), an adaptor molecule decreased in SerCa and FTE luteal samples, enhances both GR-mediated transactivation and suppression of NFκB signalling, implicating DAB2 as a crucial determinant of inflammatory signalling and ovarian cancer risk. Altogether, this thesis identifies gene expression changes in FTE from BRCA mutation carriers during the post-ovulatory luteal phase that parallel those detected in SerCa. The data support a proposed novel testable model for predisposing events contributing to SerCa that centres on an altered ability to quickly resolve the pro-inflammatory environment created by the ovulatory event.

Assessment of the efficacy of photodynamic therapy in patients with chronic central serous chorioretinopathy The presented postgraduate thesis deals with the issue of macular edema based on central serous chorioretinopathy (CSC) and the current possibilities of therapeutic solution of this disease. Although in most cases central serous chorioretinopathy does not belong to frequent and vision-threatening diseases, it can, especially its chronic form, lead to impaired vision. The aim of the theoretical part of this work is to characterize this chorioretinal disease and describe the basic principles of treatment. The work also describes the pathogenesis of CSC, the examination methods, the up-to-date accepted CSC classification and the therapeutic modalities of the treatment of the disease. The clinical part of this work is a prospective study of 52 patients (54 eyes), aged 30- 75, with chronic form of central serous chorioretinopathy treated at the Eye Clinic of the 1st Faculty of Medicine of Charles University and Military University Hospital Prague in the years 2012 to 2018. The aim of this prospective study is to evaluate the anatomical and functional results of the treatment of 54 eyes with chronic form of central serous chorioretinopathy using photodynamic therapy in a reduced (half) dosing...

The tumour microenvironment comprises the non-cancerous cells present in the tumour mass (fibroblasts, endothelial, and immune cells), as well as signalling molecules and extracellular matrix. Tumour growth, invasion, metastasis, and response to therapy are influenced by the tumour microenvironment. Therefore, characterising the cellular and molecular components of the tumour microenvironment, and understanding how they influence tumour progression, represent a crucial aim for the success of cancer therapies. High-grade serous ovarian cancer provides an excellent opportunity to systematically study the tumour microenvironment due to its clinical presentation of advanced disseminated disease and debulking surgery being standard of care. This thesis first presents a case report of a long-term survivor (>10 years) of metastatic high-grade serous ovarian cancer who exhibited concomitant regression/progression of the metastatic lesions (5 samples). We found that progressing metastases were characterized by immune cell exclusion, whereas regressing metastases were infiltrated by CD8+ and CD4+ T cells. Through a T cell - neoepitope challenge assay we demonstrated that pre- dicted neoepitopes were recognised by the CD8+ T cells obtained from blood drawn from the patient, suggesting that regressing tumours were subjected to immune attack. Immune excluded tumours presented a higher expression of immunosuppressive Wnt signalling, while infiltrated tumours showed a higher expression of the T cell chemoattractant CXCL9 and evidence of immunoediting. These findings suggest that multiple distinct tumour immune microenvironments can co-exist within a single individual and may explain in part the hetero- geneous fates of metastatic lesions often observed in the clinic post-therapy. Second, this thesis explores the prevalence of intra-patient tumour microenvironment het- erogeneity in high-grade serous ovarian cancer at diagnosis (38 samples from 8 patients), as well as the effect of chemotherapy on the tumour microenvironment (80 paired samples from 40 patients). Whole transcriptome analysis and image-based quantification of T cells from treatment-naive tumours revealed highly prevalent variability in immune signalling and distinct immune microenvironments co-existing within the same individuals at diagnosis. ConsensusTME, a method that generates consensus immune and stromal cell gene signatures by intersecting state-of-the-art deconvolution methods that predict immune cell populations using bulk RNA data was developed. ConsensusTME improved accuracy and sensitivity of T cell and leukocyte deconvolutions in ovarian cancer samples. As previously observed in the case report, Wnt signalling expression positively correlated with immune cell exclusion. To evaluate the effect of chemotherapy on the tumour microenvironment, we compared site-matched and site-unmatched tumours before and after neoadjuvant chemotherapy. Site- matched samples showed increased cytotoxic immune activation and oligoclonal expansion of T cells after chemotherapy, unlike site-unmatched samples where heterogeneity could not be accounted for. In addition, low levels of immune activation pre-chemotherapy were found to be correlated with immune activation upon chemotherapy treatment. These results cor- roborate that the tumour-immune interface in advanced high-grade serous ovarian cancer is intrinsically heterogeneous, and that chemotherapy induces an immunogenic effect mediated by cytotoxic cells. Finally, the different deconvolution methods were benchmarked along with ConsensusTME in a pan-cancer setting by comparing deconvolution scores to DNA-based purity scores, leukocyte methylation data, and tumour infiltrating lymphocyte counts from image analysis. In so far as it has been benchmarked, unlike the other methods, ConsensusTME performs consistently among the top three methods across cancer-related benchmarks. Additionally, ConsensusTME provides a dynamic and evolvable framework that can integrate newer de- convolution tools and benchmark their performance against itself, thus generating an ever updated version. Overall, this thesis presents a systematic characterisation of the tumour microenvironment of high grade serous ovarian cancer in treatment-naive and chemotherapy treated samples, and puts forward the development of an integrative computational method for the systematic analysis of the tumour microenvironment of different tumour types using bulk RNA data.

Ο καρκίνος εκ του επιθηλίου επιφανείας των ωοθηκών είναι η 5η πιο κοινή αιτία θανάτου σε γυναίκες στο Δυτικό κόσμο και είναι υπεύθυνος για τους περισσότερους θανάτους από ότι όλες οι γυναικολογικές κακοήθειες μαζί. Τόσο ο μηχανισμός του νεοπλαστικού μετασχηματισμού όσο και τα μοριακά μονοπάτια που οδηγούν στο ωοθηκικό επιθηλιακό καρκίνωμα δεν έχουν εξακριβωθεί πλήρως. Ένα πρόσφατα αναγνωρισμένο γονίδιο, η μετατχερίνη (MTDH), γνωστή και ως AEG-1 ή LYRIC ενοχοποιείται ως πιθανός σημαντικός διαμεσολαβητής κατά την καρκινογένεση, την μετάσταση και την αντίσταση στις χημειοθεραπείες. Ωστόσο, η κλινική σημασία και ο βιολογικός ρόλος της μετατχερίνης (MTDH), στο επιθηλιακό καρκίνωμα των ωοθηκών δεν έχουν γίνει αποσαφηνισθεί πλήρως. Η υπερέκφραση της MTDH/AEG-1 μπορεί να ενεργοποιήσει πολλά σηματοδοτικά μονοπάτια, όπως για παράδειγμα το NF-κΒ σηματοδοτικό μονοπάτι σε διάφορους καρκινικούς τύπους. Ο NF-κΒ έχει πρόσφατα συσχετισθεί με την ανάπτυξη και την εξέλιξη των όγκων και επιπλέον τα διμερή του NF-κΒ ενισχύουν την έκφραση ποικίλων γονιδίων που αφορούν την κυτταρική αύξηση, τη διαφοροποίηση, τις φλεγμονώδεις αντιδράσεις και τη ρύθμιση της απόπτωσης. Η παρούσα μελέτη σχεδιάστηκε προκειμένου να διερευνηθεί η έκφραση των πρωτεϊνών MTDH και NF-kB (p65/p50) σε επιθηλιακά ωοθηκικά καρκινώματα (καλοήθεις, οριακής κακοήθειας και διηθητικά καρκινώματα). Για το σκοπό αυτό μελετήθηκαν τμήματα επιθηλιακών νεοπλασμάτων ωοθηκών από 76 ασθενείς (15/46 οριακής κακοήθειας όγκοι, 30/46 διηθητικά αδενοκαρκινώματα και 31/76 κυσταδενώματα), μονιμοποιημένα σε ουδέτερη φορμόλη και εγκλεισμένα σε παραφίνη με τη μέθοδο της ανοσοϊστοχημείας για την έκφραση των πρωτεϊνών MTDH και NF-κB (p50/p65). Επίσης εκτιμήθηκε η σχέση της MTDH/AEG-1 με τον NF-κB και με κλινικοπαθολογοανατομικές παραμέτρους όπως ο βαθμός κακοήθειας του όγκου, το στάδιο, η μέγιστη διάμετρος του όγκου και η ηλικία της ασθενούς. Τα αποτελέσματα της ανοσοϊστοχημείας αναλύθηκαν με τη χρήση του στατιστικού πακέτου SPSS. Ο φυσιολογικός ωοθηκικός ιστός και τα κυσταδενώματα ήταν κυρίως αρνητικά για τις πρωτεΐνες MTDH/AEG-1 και NF-κB (p50, p65). Η έκφραση των MTDH/AEG-1 και NF-kappa B/ p50, πρωτεϊνών ήταν σημαντικά αυξημένες στα αδενοκαρκινώματα σε σχέση με τους οριακής κακοήθειας όγκους. Σε αντίθεση η έκφραση της NF-kappa B/ p65 πρωτεΐνης δεν έδειξε σημαντικές διαφορές μεταξύ των οριακής κακοήθειας όγκων και των αδενοκαρκινωμάτων. Σημαντική στατιστική συσχέτιση παρατηρήθηκε στην έκφραση των πρωτεϊνών MTDH/AEG-1, NF-kappa B/p50 και NF-kappaB/p65 στα αδενοκαρκινώματα. Καμία στατιστική συσχέτιση δεν παρατηρήθηκε στην έκφραση μεταξύ του NF-κB, της MTDH πρωτεΐνης και κλινικοπαθολογοανατομικών παραμέτρων. Συμπερασματικά, τα αποτελέσματα μας υποδεικνύουν ότι η MTDH/AEG-1 ίσως παίζει ένα σημαντικό ρόλο στην παθογένεια του ανθρώπινου ωοθηκικού καρκίνου, πιθανώς μέσω της ενεργοποίησης του σηματοδοτικού μονοπατιού του πυρηνικού μεταγραφικού παράγοντα NF-κB. Επειδή η MTDH συσχετίζεται σημαντικά με την αντίσταση στη χημειοθεραπεία, θα μπορούσε ενδεχομένως να αποτελέσει σημαντικό στόχο για θεραπεία, ενισχύοντας την αποτελεσματικότητα της χημειοθεραπείας στον επιθηλιακό ωοθηκικό καρκίνο. / Epithelial ovarian cancer is the fifth most common cause of cancer death in women in the Western world and the leading cause of death from gynaecological malignancies. Little is known about the mechanism of neoplastic transformation and the molecular events leading to epithelial ovarian cancer are poorly understood. A recently discovered gene, metadherin (MTDH, also known as AEG-1 or LYRIC) has emerged as a potentially crucial mediator of tumor progression, metastasis, and resistance to chemotherapies. The clinical significance and biological role of metadherin (MTDH), in epithelial ovarian carcinoma however, remains unclear. Overexpression of MTDH/AEG-1 can activate several downstream pathways, including the NFκB pathway in various types of cancer cells. Recently, NF-kB has been related to cancer development and progression and NF-kB dimers (p50/p65) could induce the expression of various genes regarding cell growth, differentiation, inflammatory responses and the regulation of apoptosis. This study was designed in order to determine the expression of the MTDH and NF-kB (p65/p50) proteins in epithelial ovarian tumors (benign, borderline and malignant). Formalin-fixed and paraffin embedded tissue blocks from 76 patients with epithelial ovarian neoplasms (15/46 borderline tumors, 30/46 invasive adenocarcinomas and 31/76 cystadenomas) were studied. Expressions of MTDH/AEG-1, NF-κB (p50, p65) were investigated immunohistochemically. The relationship of MTDH/AEG-1 with NF-κB and clinicopathological parameters such as tumor grade, stage, tumor maximal diameter and patient age were evaluated. The results of immunohistochemistry were analyzed with the SPSS statistic analyze protocol. Normal ovarian tissue and benign ovarian cystadenomas were mostly MTDH/AEG-1, NF-κB (p50, p65) negative. The expression of MTDH/AEG-1 and NF-kappaB p50, proteins were significantly higher in adenocarcinoma tissue in comparison with borderline tumors. In contast NF-kappaB p65 expession shows no significant differences between borderline tumors and adenocarcinomas. A statistical significant correlation was observed between MTDH/AEG-1 and NF-kappaB p50, p65 protein expression in adenocarcinomas. No statistical correlation was observed between the NF-Kb and MTDH protein expression and clinicopathological parameters. In conclusion our data indicate that the upregulation of MTDH/AEG-1 may play an important role in the pathogenesis of human ovarian cancer possibly through activation of Nuclear factor-κB signalling pathway. Since MTDH has also a significant correlation with chemoresistance could be an important therapeutic target enhancing chemotherapy efficacy in ovarian epithelial cancer.