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As of 2010, cancer remains the leading cause of death in Canada, and second in the United States of America. This is despite decades of research into development of chemotherapeutics and diagnostics. A number of major challenges have prevented new discoveries from translating into a reduction in mortality rates. One challenge is the poor efficiency with which anti-cancer agents (diagnostic contrast agents and therapeutics) reach deregulated cells in the body. Therefore, development of new methods and technologies for improving efficiency of delivery has been a focus of research. Nanoparticles are leading candidates for improving the efficiency of delivery because they can act as payload vehicles for anti-cancer agents, because it is possible to mediate their interaction with biological systems and thus their pharmaockinetics, and because they can exploit inherent vulnerabilities of tumours. This thesis describes the results from a series of research projects designed to progress our understanding of how nanoparticles behave in vivo, and how their design can be optimized to improve tumour targeting.

A subgroup of non-small cell lung cancer (NSCLC) cases harbour mutations in classical oncogenes, which can affect therapy response and prognosis. By therapeutically targeting the corresponding proteins with inhibitory drugs, the clinical outcome for these lung cancer patients may be improved. One of these oncogenes is the phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) which encodes the catalytic subunit of the phosphatidylinositol 3 kinase (PI3K). PIK3CA is a central regulator in the PI3K/Akt/mTOR pathway, which controls cell growth and apoptosis. Mutations in the PIK3CA gene are considered to up-regulate the kinase activity in tumour cells and through that dysregulate fundamental cellular processes. PI3K inhibitors are currently tested in clinical trials and present a promising therapy option in lung cancer patients. In this study, a pyrosequencing assay for detection of PIK3CA mutations in tumours from patients with NSCLC was established. The three "hot-spot" codons 542, 545 and 1047 of the PIK3CA gene were analysed. The sensitivity of this assay was determined to the presence of 5 % of mutant alleles. In agreement with previous reports, three of the 60 lung cancer cases revealed PIK3CA mutations (5 %). All mutations occurred in exon 9 codon 542 or 545. In line with previous reports, two of the three samples harboured concurrent mutation in the EGFR or KRAS gene. The established pyrosequencing analysis for PI3KCA mutations provides a reliable and cost-effective assay for clinical diagnostics. The determination of the PI3KCA mutation status may help to distinguish patients for treatment targeting the PI3K pathway.

The concept of bioreductive prodrug chemotherapy is introduced in chapter 1. Tumour cell hypoxia is a significant factor in limiting tumour growth control with conventional radiotherapy and some chemotherapeutic agents. Following therapy these cells can repopulate and cause a relapse of the cancer. On the other hand, hypoxia is unique to tumours, and is therefore potentially exploitable. Bioreductive prodrugs are compounds in which a oxygen inhibited redox-based bioactivation step triggers a reaction leading to a lethal intermediate. The concept of bioreductive DNA alkylators and DNA topoisomerase 11 inhibitors is discussed. The synthesis of model thiazolylindole compounds based on the natural product BE \0988 are discussed in chapter 2. Two strategies were employed for the construction of the thiazolylindoles: the Hantzsch reaction; and nucleophilic substitution on 2-bromothiazole by an indolyl anion. The synthesis of thiazolylindolequinone compounds are discussed in chapter 3. The quinone C(5) position of the thiazolylindolequinone analogues was elaborated to provide a series of cyclic and acyclic C(5)-amino derivatives. Synthetic strategies towards the synthesis of indole-2-carboxylates are discussed in chapter 4. The Moody-Rees and Cadogan-Sundberg reactions were employed to provide a synthesis of the useful highly substituted indole [154]. The Brederek imidazole reaction (i.e., the reaction of a amidine and a-halo ketone) is discussed in chapter 5. Application of the Brederek reaction was employed towards the construction of the bisindole imidazole natural compounds, the nortopsentins. The biological properties of the compounds of the compounds synthesised are discussed in chapter 6. The compounds were tested for DNA topoisomerase 11 inhibitory activity and cytotoxicity under a hypoxic environment.

This study evaluated comparative genomic hybridisation (CGH) as a tool to detect candidate regions of the genome associated with chemoresistance. Using a variation on conventional CGH, DNA from three cell lines that were resistant to thymidylate synthase (TS) inhibitors (tomudex [TDX] or 5-fluorouracil [5-FU]) and their sensitive parent cells were evaluated. In MCF-7 and H630, cells that were resistant to TDX, a specific TS inhibitor with no other known cytotoxic potential, only a single region of change (18p gain) was apparent. The third cell line H630R10, which was resistant to 5-FU, had changes in several genomic regions following the acquisition of resistance, including 18p. Gain in the chromosomal region containing the TS gene (18pll.32) was detected by CGH in all three resistant cell lines. However, additional novel regions of interest were identified in the cells that were resistant to 5-FU, a cytotoxic agent known to have several other modes of cytotoxicity besides TS inhibition. These results suggested that CGH is of potential use in the detection of regions of the genome involved in chemoresistance. Having shown the potential of CGH as a tool for assessing chemoresistance at the genomic level, steps toward clinical application of this technique were evaluated. A prerequisite for study in archival pathology samples was successful DNA extraction and universal amplification of tumour DNA from paraffin-embedded tumour sections for CGH analysis. Degenerate oligonucleotide primed - polymerase chain reaction (DOP-PCR) was performed on minute quantities (50ngs) of fresh cell line DNA (H630R10) and tumour DNA (osteosarcoma), as well as paraffin-embedded DNA from the same case. The results of these DOP-PCR CGH reactions were compared with conventional CGH using l|0.g quantities of fresh DNA from both H630R10 cell line and osteosarcoma. The CGH profiles of the conventional CGH and DOP-PCR CGH did not show a high level of concordance, only 55% of the gains and 83.3% of losses detected by conventional CGH were detected by DOP-PCR CGH The use of universal amplification by DOP-PCR in paraffin-embedded sections was not taken forward into clinical evaluation. A study of colorectal cancer (CRC) was initiated which involved the microdissection of 29 Dukes' C CRC tumours from fresh frozen material for CGH analysis. This conventional CGH analysis of CRC tumours involved assessing each tumour twice by reversal of fluorochromes. Only genomic regions that were detected as changed in both forward and reverse profiles were accepted. This approach detected several regions of genome as changed across the 29 tumours. In all, 108 gains (a mean number of 3.7 aberrations per tumour, range 1-12) and 85 losses (a mean number of 2.9 aberrations per tumour, range 0-11) were detected in the 29 tumours. CGH analyses identified certain chromosomal regions as more likely to be changed than others. The most frequent aberrations detected across the 29 tumours was a loss of chromosomal arm 18q, seen in 31% of the tumours assessed. Gain was also common at some sites throughout the genome, for example, gain of chromosomal arms, 13q and 20q was seen in 27.6% of cases. Mann-Whitney U tests investigating the association between specific chromosomal aberrations such as gain of 20q or loss of 18q and known markers of CRC tumourigenesis (p53, p27, p21, Rb, cyclin Dl, PCNA, P-catenin, e-cadherin, c-erbB-2, bcl2, EGFR and c-erbB-2) assessed by immunohistochemistry (IHC) in 29 tumours found no association. Testing of the total number of genomic aberrations detected (loss + gain = genetic grade) rather than the frequency of aberration at specific chromosomal loci also found no association with the CRC tumour markers. Finally, the association between the chromosomal aberrations detected by CGH was investigated in relation to patient survival. This thesis has demonstrated the value of a global approach to the study of chemoresistance and tumourigenesis through the application of powerful technology such as CGH.

Prostate cancer is the second most commonly diagnosed cancer in men worldwide. Because prognosis can vary depending on tumour stage, precise diagnosis is vital. Circulating tumour cells (CTC) detach from primary and secondary tumour sites into the bloodstream. Changes in three-dimensional (3D) nuclear organization are associated with different types of cancer and were examined in this study in CTCs of high-risk prostate cancer patients. CTCs were isolated from 3mL of patient blood samples of 20 high-risk prostate cancer patients before treatment; after neoadjuvant androgen deprivation therapy (ADT) but before radiotherapy (RT); and after completing RT. Telomere-specific fluorescence in situ hybridization was performed on filters containing cells, 3D images of 30 CTCs per filter were analysed. Changes in telomere organization were observed post ADT and RT; patients fell into three groups depending on the change in CTC telomeric profiles in response to ADT. These groups displayed responses characteristic to each group upon delivery of RT. 3D nuclear telomere profiles in CTCs post-ADT may indicate both ADT response and predict RT response in high-risk prostate cancer. / October 2016

In the only human study to date arginine supplementation stimulated tumour protein synthesis in patients with breast cancer. However, it is not known if these stimulatory effects of arginine are limited to breast cancer, and the mechanisms of its action are not well understood. Moreover it would be important to find out whether the action of arginine is selective for malignant tissues or if it can affect normal, healthy tissues. The first study investigated the effect of arginine supplements for 3 days on nitrogen balance and on the liver synthesis rate of albumin in healthy volunteers. The addition of arginine to the diet produced a remarkable nitrogen retention over the three days. No changes in the albumin synthesis rates were detected between the two dietary periods. No effects were observed on the protein synthesis, RNA content or transcriptional efficiency in a variety of the tissues when adult rats were supplemented with arginine for three days. In vitro studies using a human breast tumour cell line (MCF-7) showed that arginine is an essential nutrient for the proliferation of breast tumour cells. Neither the direct precursor for polyamine synthesis, ornithine, nor the polyamine putrescine could replace arginine for growth. Only citrulline could completely substitute arginine for protein synthesis and growth. The arginine:nitric oxide pathways did not seem involved in the stimulatory effects of arginine. The main reason for the high arginine requirement was found to be the production of the enzyme arginase. The final study investigated the in vivo effects of arginine supplements on human tumours. Arginine supplementation did not affect the tumour protein synthesis rates in patients with head and neck tumours, suggesting that not all human tumours are stimulated by arginine.

Ovarian cancer accounts for more deaths than all other gynaecological cancers taken together. The 5 year survival rate can be as high as 80% for cases diagnosed early, but the asymptomatic nature of the disease means that it is most frequently detected in the later stages. By this time, disease has invariably spread beyond the ovaries and the survival rate drops to around 30%. Treatment of ovarian cancer often fails due to a high rate of chemoresistance and novel methods of treatment and detection are required to increase the survival chances of patients. This study sought to determine whether gene therapy for sporadic ovarian cancer could offer a novel and more successful treatment option for the disease. Mutation or abnormal expression of the p53 gene has already been shown to be the most common genetic even in ovarian cancer, being involved in up to 70% of cases. Wild-type p53 was delivered, using liposomes, into p53 mutant ovarian cancer cell lines and this resulted in a restoration of the wild-type functions of the gene, namely cell cycle arrest and apoptosis. The results from the cell line studies suggested that restoration of the wild-type p53 function limit or reduce tumour progression and increase the sensitivity of the tumour to chemotherapy. A mouse model of human peritoneal ovarian cancer was then constructed and the wild-type p53 gene was administered in liposomes into the peritoneum. The results suggested that p53 gene therapy prevents tumours from growing in the mice, when compared to a control gene. It is now known that p53 gene therapy for humans is being clinically assessed. There are a proportion of tumours that do not harbour an abnormal p53 gene, raising the possibility that other tumour suppressor gene mutations may play a role in the molecular genetic control of growth arrest and apoptosis. P53-dependent, apoptosis-regulating family members bcl-2 and bax were analysed immunohistochemically to determine their involvement in ovarian cancer. Both proteins were significantly associated with malignancy and also with overall length of survival, but not associated with the various prognostic factors such as stage and differentiation of tumour. It is unlikely that these genes will become targets for gene therapy in ovarian cancer. Mutation, deletion and hypermethylation of the p53-independent pi6 gene, alter its function, resulting in loss of G1 cell cycle arrest control. The status of methylation of the pi 6 promoter in ovarian tumours was determined and combined with mutation data, resulting in the conclusion that abnormal pi 6 was not a common event in ovarian cancer and is therefore not a likely candidate for gene therapy. This study has contributed to the evergrowing wealth of knowledge on the molecular genetic events of ovarian cancer, and has shown that gene therapy for sporadic ovarian cancer as a clinical application is feasible.

Background: Malignant cerebral glioma is a rare cancer but has a devastating impact on patients and their families. In Scotland each year, around 450 people are diagnosed with glioma. Prognosis is generally poor and treatment is essentially palliative. There is a growing recognition that non-clinical aspects of care for both patients and their families need to be acknowledged and integrated into health care provision in line with a patient-focused ethos of care. Currently, there is relatively little research exploring the psychosocial issues and needs of this patient group. Aims: To give patients being investigated for malignant cerebral glioma and their families the opportunity to describe their shared experiences of their illness journey and voice their concerns and unmet needs. To examine how these experiences and needs change over time as the patient progresses through the illness journey. To ascertain the extent to which these needs are recognised and supported, taking into accounts professionals’ views and making suggestions for steps forward in improving patients’ psychosocial care. Methods: A total of 80 qualitative prospective longitudinal interviews (30 paired and 50 separate) were conducted with 26 people with a suspected or confirmed diagnosis of malignant cerebral glioma being treated at a regional hospital and 24 primary relative/informal carers. Patients and carers were interviewed at the following five times: leading up to diagnosis; following a formal diagnosis; around the end of initial treatment (radiotherapy); at a designated six-month follow-up stage; and bereavement interviews with carers. One-off interviews were carried out with 66 health professionals (19 case-linked GPs and 47 other health, health-related and social care professionals involved in patients' care). Interviews were recorded and transcribed verbatim and analysed using the constant comparative method from a grounded theory approach assisted by QSR NVivo Version 7. Findings: Distress, anxiety and shock were overwhelming reactions in the period leading up to a diagnosis of glioma, making it difficult for participants to make sense of their experience. Over time, participants employed a range of strategies in order to cope with their diagnosis. Social and emotional support from professionals and friends, family and other patients were vital in many cases but support often felt inadequate. The role of information and the manner in which it was communicated was closely linked to participants’ ability to cope. Information needs were variable but on the whole patients and carers did not feel well informed. Dealing with cognitive and physical symptoms of their illness and side effects of treatment inhibited patients’ ability to resume their everyday activities. The lives of relatives were also affected as they struggled to care for their loved ones. People with a diagnosis of glioma were faced with the possibility of death from an early point in their illness trajectory and awareness of this, coupled with ability to make sense of existential issues, varied across participants. Issues around support, communication, information and palliative care were considered to be important among health professionals involved in the care of people with a diagnosis of glioma but provision fell short. Conclusions: Concerns regarding information, communication and support reported elsewhere in the literature are enduring in glioma patients and their relatives. Reporting of unmet psychosocial and supportive care issues by patients and recognition by professionals of the need to improve these dimensions of care for people affected by glioma emphasises previous recommendations yet to be fully implemented into patient care.

Ischaemia causes irreversible tissue damage in cardiovascular disease. Since regenerative angiogenesis fails to consistently induce sufficient reperfusion to facilitate repair, targeted manipulation of angiogenesis is clinically desirable. The Wilms' tumour suppressor (Wt1) is a transcription factor which regulates numerous genes and cellular processes, including many intrinsic to angiogenesis. We hypothesise that WT1 in the endothelium influences the angiogenic function of endothelial cells. WT1 was identified in endothelial and non-endothelial cells comprising vessel outgrowths generated by cultured aortic rings from WT1-GFP reporter mice. Inducible deletion of WT1 from the endothelium (VE-Wt1 KO) significantly delayed angiogenesis in this assay (p < 0.05 relative to controls). In vivo, WT1 expression was evident in vascular endothelial and perivascular cells of the hindlimb as early as 3 days following femoral artery ligation to induce ischaemia, often in cells expressing epithelial and mesenchymal markers simultaneously. However, VE-Wt1 KO had no effect on hindlimb reperfusion (laser Doppler; days 0-28) or on vessel density (day 28). Similarly, VE-Wt1 KO had no effect on vessel density or expression of angiogenic factors (qRT-PCR) in sponges inserted subcutaneously in mice (20 days). To further understand the role of WT1 in angiogenesis, transcriptomic RNA expression analysis was performed in WT1+ and WT1- cells isolated (FACs) from sponges after implantation in WT1-GFP mice. WT1+ cells exhibited higher expression of genes involved in a number of processes relevant to tissue repair, including angiogenesis (p=3.11x10-8), wound healing (p=3.45x10-7) and epithelial-to-mesenchymal transition (EMT) (p=5.86x10-4). These results shed new light on the role of WT1 in ischaemic angiogenesis. In concurrence with previously published work, we show that deletion of endothelial WT1 can delay angiogenesis however, WT1 is not just instrumental in endothelial cells in this context. WT1 has a broader role in tissue repair in ischaemia, in part through regulation of cell transition (EMT). This work has improved our understanding of the regulatory role of WT1 in angiogenesis and repair, while revealing a number of novel insights into the function of WT1. This highlights WT1 as a potentially beneficial therapeutic target to facilitate regeneration in cardiovascular disease.