O câncer de mama é o tipo mais frequente de neoplasia maligna entre as mulheres, com a incidência de mais de um milhão de novos casos no mundo, por ano. O gene TP53 é responsável por regular o destino da célula em resposta a estresses genotóxicos e não genotóxicos. Mutações somáticas neste gene são encontradas em, aproximadamente, 50% dos carcinomas humanos. No câncer de mama, a frequência das mutações no TP53 é em torno de 20 a 50%, sendo a alteração mais encontrada. Estas mutações podem alterar a conformação da proteína, prejudicando sua função de ativadora da transcrição de genes alvo e, pode levar a p53 a apresentar tendência à agregação. Neste trabalho, foi realizado a análise da presença de mutações nos exons 5 a 10 do gene TP53, em biópsias de câncer de mama, de mulheres residentes na cidade do Rio de Janeiro. Após a identificação das amostras com mutação em TP53, algumas foram selecionadas para se verificar o comportamento das diversas mutantes quanto à formação de agregados de p53, em cortes histológicos dos tumores de mama. Foram utilizados os anticorpos A11 e DO1, que reconhecem oligômeros pré-fibrilares e a p53 mutante ou selvagem, respectivamente. Para tanto, foi utilizado o ensaio de co-localização por imunofluorescência, utilizando microscópio confocal para a observação dos resultados. Mutações no gene TP53 foram detectadas em 19% dos casos analisados de câncer de mama sendo 88,2% do tipo &#8213;missense&#8214;. Estas mutações, em tumores do tipo carcinoma ductal infiltrante (CDI), estavam associadas a um estágio mais tardio e agressivo de câncer, representado pelo Grau III de Elston (p< 0,0001). Também foi observada relação positiva dos tumores com mutações e o acúmulo da p53 (p= 0,0184). Além disso, foi observado um padrão diferente das mutantes de p53 quanto à tendência a agregação, sendo as mutantes R273H e P278A as que apresentaram uma maior agregação. Assim, a agregação da p53 mutante observada &#8213;in vivo&#8214; e descrita nesta dissertação, parece depender do tipo de mutação observada nos casos de câncer de mama. / Breast cancer is the most frequent cancer in women, with 1 million of new cases in the world each year. The TP53 gene is responsible for the regulation of the cells fate in response to genotoxic and non-genotoxic stress. Somatic TP53 mutations are found in, approximately, 50% of human cancers. In breast cancer, TP53 mutation is the most frequent genetic alteration, being present in 20 to 50% of cases. These mutations may change the protein conformation, impairing the transcription of target genes, and may lead the mutant p53 to aggregate. In this study, we analyzed the presence of mutations in exons 5-10 of TP53 in breast cancer biopsies of women resident in the metropolitan area of Rio de Janeiro. After the determination of samples with mutation, some of them were selected to investigate the behavior of different mutants in the formation of p53 aggregates in tumors using A11 and DO-1 antibodies, which recognizes pre-fibrillar oligomers and mutant or wild-type p53, respectively. So, we utilized a immunofluorescence co-localization assay using confocal microscope. TP53 mutations were detected in 19% of the breast cancer cases, with 88.2% of missense type. These mutations, in tumors classified as infiltrating ductal carcinoma (CDI), were associated with a later and aggressive stage of cancer, represented by Elstons Grade III (p< 0.0001). A relation was also observed between these mutations and p53 accumulation (p= 0.0184). Furthermore, a different pattern of p53 mutants for the tendency to aggregate was observed and we detected that the mutants R273H and P278A showed a greater aggregation. Thus, the mutant p53 aggregation observed in vivo and described in this study, seems to depend on the type of mutation found in breast cancer cases.

O câncer de mama é o tipo mais frequente de neoplasia maligna entre as mulheres, com a incidência de mais de um milhão de novos casos no mundo, por ano. O gene TP53 é responsável por regular o destino da célula em resposta a estresses genotóxicos e não genotóxicos. Mutações somáticas neste gene são encontradas em, aproximadamente, 50% dos carcinomas humanos. No câncer de mama, a frequência das mutações no TP53 é em torno de 20 a 50%, sendo a alteração mais encontrada. Estas mutações podem alterar a conformação da proteína, prejudicando sua função de ativadora da transcrição de genes alvo e, pode levar a p53 a apresentar tendência à agregação. Neste trabalho, foi realizado a análise da presença de mutações nos exons 5 a 10 do gene TP53, em biópsias de câncer de mama, de mulheres residentes na cidade do Rio de Janeiro. Após a identificação das amostras com mutação em TP53, algumas foram selecionadas para se verificar o comportamento das diversas mutantes quanto à formação de agregados de p53, em cortes histológicos dos tumores de mama. Foram utilizados os anticorpos A11 e DO1, que reconhecem oligômeros pré-fibrilares e a p53 mutante ou selvagem, respectivamente. Para tanto, foi utilizado o ensaio de co-localização por imunofluorescência, utilizando microscópio confocal para a observação dos resultados. Mutações no gene TP53 foram detectadas em 19% dos casos analisados de câncer de mama sendo 88,2% do tipo &#8213;missense&#8214;. Estas mutações, em tumores do tipo carcinoma ductal infiltrante (CDI), estavam associadas a um estágio mais tardio e agressivo de câncer, representado pelo Grau III de Elston (p< 0,0001). Também foi observada relação positiva dos tumores com mutações e o acúmulo da p53 (p= 0,0184). Além disso, foi observado um padrão diferente das mutantes de p53 quanto à tendência a agregação, sendo as mutantes R273H e P278A as que apresentaram uma maior agregação. Assim, a agregação da p53 mutante observada &#8213;in vivo&#8214; e descrita nesta dissertação, parece depender do tipo de mutação observada nos casos de câncer de mama. / Breast cancer is the most frequent cancer in women, with 1 million of new cases in the world each year. The TP53 gene is responsible for the regulation of the cells fate in response to genotoxic and non-genotoxic stress. Somatic TP53 mutations are found in, approximately, 50% of human cancers. In breast cancer, TP53 mutation is the most frequent genetic alteration, being present in 20 to 50% of cases. These mutations may change the protein conformation, impairing the transcription of target genes, and may lead the mutant p53 to aggregate. In this study, we analyzed the presence of mutations in exons 5-10 of TP53 in breast cancer biopsies of women resident in the metropolitan area of Rio de Janeiro. After the determination of samples with mutation, some of them were selected to investigate the behavior of different mutants in the formation of p53 aggregates in tumors using A11 and DO-1 antibodies, which recognizes pre-fibrillar oligomers and mutant or wild-type p53, respectively. So, we utilized a immunofluorescence co-localization assay using confocal microscope. TP53 mutations were detected in 19% of the breast cancer cases, with 88.2% of missense type. These mutations, in tumors classified as infiltrating ductal carcinoma (CDI), were associated with a later and aggressive stage of cancer, represented by Elstons Grade III (p< 0.0001). A relation was also observed between these mutations and p53 accumulation (p= 0.0184). Furthermore, a different pattern of p53 mutants for the tendency to aggregate was observed and we detected that the mutants R273H and P278A showed a greater aggregation. Thus, the mutant p53 aggregation observed in vivo and described in this study, seems to depend on the type of mutation found in breast cancer cases.

Abstract The prognosis of patients with head and neck squamous cell carcinoma has improved only little during the last decades. Clinical markers for the biological aggressiveness of the cancer are few. The most reliable prognostic indicator is the stage of the disease. Research of the significance of the TP53 tumor suppressor gene as a predictive marker for prognosis and response to treatment in head and neck cancer has given discrepant results. One reason is probably the attempt to use p53 immunohistochemistry as a surrogate for TP53 mutations. However, in immunohistochemistry the protein is analyzed and thus the result does not usually correlate with TP53 mutations. The marker for prognosis of the response to treatment has to be reliable, and the analytical method needs to be both sensitive and specific. In addition to a sensitive method for TP53 mutation analysis the localization and quality of the mutations have to be analyzed to reveal the significance of the mutation on the function of the p53 protein. In this study, TP53 mutations were analyzed, using a sensitive PCR-SSCP method, in the tumors of patients with head and neck squamous cell carcinoma. The quality and localization of mutations were analyzed by sequencing. The frequency of the TP53 mutations and the effect on the function of the p53 protein were studied using IARC TP53 mutation database and literature. Correlation of TP53 mutations with chemical exposure and their significance on prognosis and response to radiation treatment was studied. In addition, the significance of cell cycle regulators cyclin D1, p16, p21 as potential markers of biological aggressiveness of tumors was studied. The results of this study showed that the patients carrying in their tumor TP53 mutations in the DNA binding region of the gene had been exposed to chemicals more than patients with no mutation or other types of mutations. These mutations also correlated with biological aggressiveness and prognosis and the response to radiation treatment. It was also shown that a combination of cyclin D1 and p16 analyzed by immunohistochemistry correlated with worse prognosis in head and neck cancer. / Tiivistelmä Pään ja kaulan alueen levyepiteelisyöpää sairastavien potilaiden ennuste ei ole juurikaan parantunut viime vuosikymmeninä. Syövän biologista aggressiivisuutta kuvaavia ennustetekijöitä on vähän, luotettavimpana niistä taudin levinneisyys. Tutkimustulokset TP53-kasvunrajoitegeenin merkityksestä prognostisena ja hoitovastetta kuvaavana, prediktiivisenä merkkiaineena pään ja kaulan alueen syövissä ovat ristiriitaisia. Tämä johtuu muun muassa siitä, että p53-immunohistokemiaa on yritetty käyttää TP53-mutaatioiden analysoimiseen. Immunohistokemiassa analysoidaan proteiinia, eikä tulos siksi yleensä korreloi TP53-mutaatioiden esiintymiseen. Prognostisen tai hoitovastetta ennustavan merkkiaineen tulee mitata haluttua asiaa luotettavasti, ja sen analysoimiseen tulee käyttää herkkää ja spesifistä menetelmää. Herkän mutaatioanalyysimenetelmän lisäksi mutaatioiden paikan ja laadun tarkempi analysoiminen on välttämätöntä, jotta saadaan selville mutaation merkitys p53 proteiinin toiminnalle. Tässä työssä tutkittiin pään ja kaulan alueen levyepiteelisyöpää sairastavien potilaiden kasvaimista TP53- mutaatioiden esiintymistä validoidulla, herkällä PCR-SSCP-menetelmällä. Mutaatioiden laatu ja sijainti geenissä analysoitiin sekvensoimalla. IARC:n TP53-mutaatiotietopankin ja kirjallisuuden tietojen avulla selvitettiin mutaatioiden yleisyys ja niiden vaikutus p53-proteiinin toimintaan. Tutkimuksessa selvitettiin TP53-mutaatioiden korrelaatiota kemialliseen altistumiseen ja niiden merkitystä potilaan ennusteeseen ja sädehoitovasteeseen. Lisäksi tutkittiin solusyklin säätelijöiden sykliini D1-, p16- ja p21-proteiinien merkitystä taudin biologiseen aggressiivisuuteen. Väitöskirjatutkimuksen tulokset osoittivat, että potilaat, joiden kasvaimessa oli TP53-mutaatio DNA-sitoutumisalueella, olivat altistuneet kemikaaleille enemmän kuin potilaat, joiden kasvaimissa oli toisenlaisia mutaatioita tai ei mutaatiota ollenkaan. Tutkimuksessa havaitut mutaatiot liittyivät taudin biologiseen aggressiivisuuteen ja huonoon ennusteeseen sekä heikompaan sädehoitovasteeseen. Lisäksi havaittiin, että sykliini D1- ja p16-proteiinin yhdistelmä immunohistokemiallisesti analysoituna korreloi huonoon ennusteeseen pään ja kaulan syövissä.

The presence of TP53 mutations has been associated with inferior outcome in diffuse large B-cell lymphoma (DLBCL) and chronic lymphocytic leukemia (CLL). In DLBCL, the impact of the TP53 codon 72 polymorphism and MDM2 SNP309 has not been clearly elucidated, whereas MDM2 SNP309 was suggested as a poor-prognostic marker in CLL. In addition, p16INK4a promoter hypermethylation has been implicated as a negative prognostic factor in DLBCL. The aim of this thesis was to further evaluate these molecular markers in well-characterised materials of DLBCL and CLL. In paper I, we investigated the prognostic role of TP53 mutation, codon 72 polymorphism and MDM2 SNP309 in DLBCL (n=102). The presence of TP53 mutations (12.7%) correlated with a poor lymphoma-specific and progression-free survival, and a particularly pronounced effect was observed in the germinal center subtype. Neither the MDM2 SNP309 nor the TP53 codon 72 polymorphism had an impact on age of onset or survival. In paper II, we applied pyrosequencing to measure the level of p16INK4a methylation in DLBCL (n=113). Thirty-seven percent of cases displayed p16INK4a methylation; however, no clear association could be observed between degree of methylation and clinical characteristics or lymphoma-specific survival. In papers III–IV, we investigated the prognostic role of MDM2 SNP309 (n=418) and TP53 mutation (n=268) in CLL. No correlation was observed between any particular MDM2 SNP309 genotype and time to treatment and overall survival. Furthermore, no association was found between the different MDM2 SNP309 genotypes and established CLL prognostic markers. TP53 mutations were detected in 3.7% of CLL patients; where the majority showed a concomitant 17p-deletion and only three carried TP53 mutations without 17p-deletion. We confirmed a significantly shorter overall survival and time to treatment in patients with both TP53 mutation and 17p-deletion. Altogether, our studies could confirm the negative prognostic impact of TP53 mutations in DLBCL, whereas MDM2 SNP309 and TP53 codon 72 polymorphisms appear to lack clinical relevance. We also question the role of p16INKa methylation as a poor-prognostic factor in DLBCL. Finally, the presence of TP53 mutation in CLL appears to be rare at disease onset and instead arise during disease progression.

Made available in DSpace on 2016-12-23T13:56:09Z (GMT). No. of bitstreams: 1 Dissertacao Fernanda Magri de Carvalho PDF.pdf: 4813468 bytes, checksum: f874502e73ece86d6ada6693a89b3fc4 (MD5) Previous issue date: 2009-03-19 / A incidência do carcinoma hepatocelular (CHC) apresenta grandes variações geográficas associadas a diferentes prevalências dos seus fatores etiológicos mais comuns. Embora não se conheça a sua real incidência no Espírito Santo, o CHC é freqüentemente diagnosticado no estado, associado à infecção com os vírus da hepatite B (VHB) e da hepatite C. No entanto, cerca de 40% dos casos não apresentam evidências destes fatores etiológicos. Por essa razão, buscou-se verificar se outro fator aflatoxinas poderia estar envolvido na etiologia do CHC no ES. Nas regiões tropicais, as aflatoxinas são consideradas um importante fator etiológico do CHC, especialmente quando associadas à infecção com o VHB. O objetivo da presente investigação foi estudar a prevalência da mutação específica ser-249 no gene TP53, cuja presença é um indicador indireto de contaminação alimentar com estas micotoxinas e sua relação com a infecção pelo VHB. Foram investigadas 41 amostras de CHC e 74 amostras de cirrose hepática sem CHC, utilizando-se a metodologia de PCR-RFLP e sequenciamento. O DNA do VHB foi pesquisado com iniciadores específicos para seis diferentes regiões do seu genoma. Os iniciadores utilizados foram escolhidos considerando as regiões mais conservadas do genoma viral e englobando os oito genótipos já identificados do VHB. A presença do DNA do VHB foi observada em 46% (19/41) dos casos de carcinoma hepatocelular estudados. A mutação ser-249 TP53 foi observada em 15% (6/41) e 1,5% (1/69) dos casos de CHC e de cirrose hepática sem CHC associado, respectivamente, não havendo correlação estatisticamente significativa com a presença do DNA do VHB. Foram encontradas outras quatro mutações no códon 250 do gene TP53. A prevalência total de 24% (10/41) de mutações ser-249 e mutações no códon 250 nos pacientes com carcinoma hepatocelular possivelmente também associadas à contaminação com aflatoxinas pode indicar a provável exposição alimentar às aflatoxinas no Espírito Santo / The hepatocellular carcinoma (HCC) incidence has large geographic variation, which is associated with the different prevalences of its most common etiological factors. Although its real incidence in the Espirito Santo State is not known, the HCC is frequently diagnosed in ES associated with hepatitis B (HBV) and C virus infections. However, approximately 40% of the cases do not present known etiological factors. Therefore, it was the purpose of this study to verify if another factor - aflatoxins - could be involved in the HCC etiology in ES. In tropical areas, the aflatoxins are considered an important etiological factor of CHC, especially when associated with HBV infection. The aim of this investigation was to study the prevalence of the specific ser-249 mutation in the TP53 gene was studied, that indicates indirect food contamination with aflatoxins and its association with HBV infection. Forty-one HCC samples and seventy-four hepatic cirrhosis samples were investigated, using PCRRFLP methodology and sequencing. The HBV DNA was amplified with specific primers targeting six different regions of its genome. Primers were chosen considering the most conserved regions of the viral genome and encompassing the eight known genotypes of HBV. Presence of HBV DNA was observed in 46% (19/41) of the hepatocellular carcinoma cases studied. The ser-249 TP53 mutation was observed in 15% (6/41) and 1,5% (1/69) of the HCC and cirrhosis cases respectively, not having statistical correlation with the presence of HBV DNA. Other four mutations in TP53 codon 250 were found, yielding a total mutation prevalence of 24% (10/41), considering both ser-249 and codon 250 mutations, possibly also associated with food contamination by aflatoxins, and suggesting an alimentary exposition to aflatoxins in Espirito Sant