No description available.

Tumour associated macrophages (TAMs) have been associated with prognosis in a wide variety of tumours with most studies showing a high number of macrophages equating with poor prognosis. This is postulated to be due to TAMs providing support to the tumour through a wide variety of mechanisms including suppression of the immune response, promotion of angiogenesis and provision of growth supporting signals. Previous work within the group has characterised some of the mechanisms by which Burkitt lymphoma cells attract macrophages to the tumour and some of the mechanisms by which these macrophages support tumour cell growth. This thesis extends some of the work carried out in Burkitt lymphoma to Diffuse Large B cell lymphoma (DLBCL) and examines TAMs in this tumour type. Diffuse Large B cell lymphoma is the commonest high grade lymphoma in the Western world. Like Burkitt lymphoma it is characterised by diffuse sheets of lymphoid blasts. In contrast to Burkitt lymphoma, it represents a less well-defined entity that encompasses tumours with variable morphology, genetic abnormalities and outcome. Rates of proliferation and apoptosis vary between individual tumours, and unlike Burkitt lymphoma not all cases are characterised by a prominent macrophage infiltrate. Previous work within the group has shown a relationship in Burkitt lymphoma between apoptosis, macrophage infiltration and proliferation suggesting that apoptosis recruits macrophages to provide support to the tumour cells. This relationship was studied here in a large cohort of patients with DLBCL and the same relationship shown to exist in this tumour also. Following this observation, a bioinformatic approach was taken to define a gene expression signature of the TAM in DLBCL in situ in an unbiased way. Using large publicly available human tumour gene expression datasets, a graph clustering approach using the tool Biolayout Express 3D was used to explore the transcriptome of DLCBL and other human tumours. Signatures of immune cells and stromal cells, functional pathways and tumour specific signatures were defined from individual tumour type transcriptomes by study of clusters of co-expressed genes. Further work used a novel graph clustering approach based on mean Pearson correlations to define a ‘core’ transcriptome signature shared across many unrelated tumour types and in which elements of the tumour stroma were prominent. To validate the TAM signature derived from the DLBCL dataset, protein expression of selected elements of the signature were analysed at the protein level by immunohistochemistry in an unrelated cohort of DLBCL. Selected markers from the DLBCL TAM signature were then assessed for relationship to outcome in a cohort of patients treated with CHOP chemotherapy. Of the proteins studied, a significant difference in outcome was demonstrated only for leukocyte associated immunoglobulin receptor 1 (LAIR1) expression by TAMs, where low intensity staining for LAIR1 in TAMs was associated with better overall survival. LAIR1 is a collagen-binding inhibitory receptor expressed only in cells of haemopoetic lineage whose role is little studied in macrophages. The final results chapter presents some preliminary data from co-culture experiments in which the expression of LAIR-1 on the ‘macrophage-like’ cell line THP-1 is studied in various polarisation states and the ability of these cells to support or constrain tumour cell growth studied in the presence or absence of collagen.

Pancreatic ductal adenocarcinoma is a highly desmoplastic tumour, and non-malignant stromal cells contribute to progression and treatment resistance. Inflammatory cells in particular are known drivers of carcinogenesis, and macrophages are one of the most abundant inflammatory leucocytes. Therefore, exploring how macrophages drive tumour progression in pancreatic cancer would not only aid in understanding disease biology but could also offer insight to novel treatment strategies. Results presented in this thesis show macrophages secrete factors that drive epithelial-to-mesenchymal transition, promote invasion and lead to expression of checkpoint inhibitors. To determine what factors were driving this phenotype, the serine protease inhibitor SerpinB3 was initially explored, as it was highly upregulated in cancer cells cultured with conditioned media from macrophages. However, SerpinB3 gene overexpression and knockdown did not confirm a direct role for this gene in mediating migration and invasion. Further investigation revealed macrophages were secreting the cytokine oncostatin M, which was driving a metastatic phenotype through activation of the STAT3 pathway. Expression of oncostatin M receptor was upregulated in cancer cells following culture with macrophage conditioned media and conferred a worse prognosis in patient samples. STAT3 pathway activation by oncostatin M led to increased invasion in vitro, particularly of the highly tumourigenic cancer stem cell population, and increased metastasis in vivo. Moreover, oncostatin M mediated expression of the immune 'checkpoint' inhibitors on the surface of pancreatic cancer cells. Using antibody and small molecule inhibitors, reversion of these signalling pathway effects were seen and preliminary data from in vivo assays showed decreased metastasis formation with cytokine receptor antibody inhibition. Overall, the findings in this thesis contribute to emerging knowledge of how tumour associated macrophages drive tumour progression in pancreatic adenocarcinoma. Not only do they promote invasion and metastatic potential through oncostatin M secretion, but also potentiate inherent biological properties of cancer stem cells and assist in immune tolerance. In addition, results provide preliminary data to support a rationale for clinical targeting of macrophage-derived oncostatin M in pancreatic cancer.

Monoclonal antibodies which recognise tumour-associated antigens provide a means of targeting radionuclides selectively to tumour cells. (^99m)Tc and (^64)Cu are potentially useful isotopes for radioimmunoimaging;(^ 90)Y and (^67)Cu may be suitable for radioimmunotherapy. The synthesis of functionalised macrocycles for binding these four radioisotopes to antibodies is described. In each case, a macrocycle has been selected to provide a complex which is kinetically inert, thereby preventing dissociation of the radiolabel in vivo. A novel strategy for conjugating a C-alkylated cyclam derivative (for binding Tc and Cu) to an antibody is described. This method facilitates the selective acylation of an exocyclic primary amino group in the presence of the secondary ring nitrogens. Unfortunately, the labelling of antibody-bound cyclam with (^99m)Tc required conditions (pH 11) which produced extensive binding of the radiolabel to the protein backbone. "Non-specific" (^99m) Tc was subsequently found to dissociate in vivo. Pre-labelling the macrocycle with (^99m)Tc solved the "non-specifics" problem but required a pH which meant that the conjugation step was too slow for sufficient specific activity to be bound. A phenol-pendent derivative of cyclam was found to incorporate (^99m)Tc at a lower pH than cyclam itself. The "non-specific" binding of copper to the protein was minimised using a low pH labelling strategy in conjunction with a chelate wash. Macrocycle antibody conjugates labelled manner provide very promising biodistribution profiles in normal mice. A labelling buffer was selected to enhance the rate of uptake of copper by the macrocycle at low pH. Macrocycle-antibody conjugates containing 13N(_4), which was found to provide faster association kinetics than cyclam, have been prepared and await radiolabelling studies. A derivative of I3N(_4), containing 4 carboxylic acid donor sites, has been functionalised for conjugation to an antibody to act as a (^90)Y binder.

No description available.

Hereditary endometrial cancer (EC) is a Lynch syndrome (LS) related cancer variant and 2-10% of all EC are hereditary. The aim of this study was to develop a method for analysis of microsatellite instability (MSI) as such analysis would assist in identifying potential LS patients with EC at an early state of their disease, before a possible second cancer is developed in another organ. Twenty-six patients with adenocarcinoma in the endometrium, diagnosed at Uppsala University Hospital in Sweden between 1993 and 2012, were included in the study. Seven of these patients were also diagnosed with LS and the rest were sporadic EC. DNA was extracted from the patients’ formalin-fixed and paraffin-embedded tissues. The extracted DNA was subjected to a multiplex PCR with fluorescently labelled primers and then analysed by using capillary electrophoresis. Of the sporadic EC, 26% was MSI-High, which correlates well with published data. Of the LS patients, 83% was MSI-High. The outcome of this project resulted in that MSI analysis is now a validated and established method used in the process of identifying potential LS among patients with EC.

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No description available.

No description available.

Concurrence of adenocarcinoma and large-cell neuroendocrine carcinoma of the stomach is a rare condition. Here, we report a case of gastric collision tumour with large-cell neuroendocrine carcinoma and adenocarcinoma. A 71-year-old Peruvian man presented with nausea, epigastric pain, and weight loss for seven months. An Endoscopic evaluation revealed a huge ulcerative and infiltrative mass in the upper and middle third of the stomach. The patient underwent a D2 total gastrectomy. Microscopically, two separated and attached ulcerative lesions were recognised. The proximal to the cardial lesion showed neuroendocrine morphology and immunoreactivity for synaptophysin, and the other a moderated tubular adenocarcinoma Borrmann type III. Both lesions invaded serosa and lymph nodes metastases were found in 17 of 41 lymph nodes retrieved (one lymph node with neuroendocrine metastatic deposits).