Much interest has recently accumulated of the role of adult stem cells in both normal tissue homeostasis and carcinogenesis. Whereas normal and cancerous mammary epithelial stem cells have been identified and isolated from bulk primary tissue, little remains known about their regulation in vivo. Here we describe the molecular profile of mammary epithelial stem cells cultured in vitro and that of their tumourigenic counterparts, breast cancer stem cells. Our studies of gene transcription reveal potential mechanisms that may cooperate in the regulation of normal and cancer stem cells in vitro, and may also reflect their in vivo behaviour. These data bear consequences for the design of novel breast cancer therapeutics, as cancer stem cells are thought to resist conventional treatments and persist thereafter, causing disease relapse and seeding metastases. To address this issue we have devised a functional genomics approach to screen for novel biomarkers and therapeutic targets of breast cancer modeled in vitro; this culture system is centered on bona fide stem cells and may therefore offer improved relevance to human disease when compared with breast cancer cell lines. / Thesis / Master of Science (MS)

Using a tailored dose distribution for personalized radiotherapy with the help of positron emission tomography (PET) might give an edge for successful tumour elimination. One of the main determinants for tumour radioresistance in several solid tumours has been investigated as hypoxia, including head and neck cancer (HNC). Using novel methods of converting radiotracer uptake into partial oxygen pressure distribution in the form of partial pressure maps, it is possible to delineate the hypoxic region of a target to further escalate the treatment dose there, aiming at an increase in tumour control. However, the registration between functional and structural images may have an impact on the effectiveness of dose escalation, and choosing the correct registration method could be imperative. In this master’s thesis, the impact of choosing rigid or deformable image registration between planning-CT and PET/CT images on the characterization of the hypoxic compartment, as well as on the treatment evaluation in terms of tumour control and normal tissue complication, was assessed. This was achieved by, using hypoxic patients of a cohort of 22 HNC patients, creating a separate plan for each registration method, for each patient, and comparing them quantitatively. The results showed that both methods would yield distinctly different dose distributions when planned using the same objectives and constraints in terms of dose level and shape. Furthermore, they both give a distribution of similar quality. However, using rigid registration together with the deformed PET did not render lower results overall in tumour control. Thus, no advantage could be seen in choosing deformable registration over rigid registration when aiming at tumour control.

Yes / The chemokine receptor CCR7 is expressed on lymphocytes and dendritic cells and is responsible for trafficking of these cells in and out of secondary lymphoid organs. It has recently been shown that CCR7 expression is elevated in a number of cancers, including head and neck cancers, and that its expression correlates to lymph node (LN) metastasis. However, little is known about the factors that can induce CCR7 expression in head and neck cancers. We compared the protein expression and functional responses of CCR7 under normoxia and hypoxia in head and neck cancer cell lines OSC-19, FaDu, SCC-4, A-253 and Detroit-562 cultured as monolayers, spheroids, and grown in vivo as xenografts in balb/c mice. In addition, we analysed the correlation between hypoxia marker HIF-1α and CCR7 expression in a tissue microarray comprising 80 clinical samples with various stages and grades of malignant tumour and normal tissue. Under hypoxia, the expression of CCR7 is elevated in both in vitro and in vivo models. Furthermore, in malignant tissue, a correlation is observed between hypoxia marker HIF-1α and CCR7 across all clinical stages. This correlation is also strong in early histological grade of tumours. Hypoxia plays a role in the regulation of the expression of CCR7 and it may contribute to the development of a metastatic phenotype in head and neck cancers through this axis.

The full text will be available at the end of the embargo period: 3rd April 2025 / The author's name as given on this thesis is Francis MPRAH BARNIEH. His publications use the name format Francis M. Barnieh.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Os mÃtodos tradicionais de tratamento do cÃncer, como a quimioterapia e a radioterapia, embora sejam eficazes em vÃrios tipos de tumores, encontram freqÃentemente populaÃÃes de cÃlulas neoplÃsicas resistentes, alÃm de apresentarem uma baixa margem de seguranÃa para os pacientes. A utilizaÃÃo da hipertermia associada à quimioterapia e/ou radioterapia jà se encontra fartamente relatada como vantajosa na literatura especializada, principalmente em pacientes portadores de cÃncer em estÃdio avanÃado, submetidos previamente aos mÃtodos clÃssicos de tratamento. A aplicaÃÃo de calor nos tecidos atravÃs de ultrassom contÃnuo torna mais Ãgil Ãste procedimento e com eficÃcia comprovada. O uso dos antiangiogÃnicos tambÃm vem sendo relatado como eficaz na literatura especializada e atualmente, a lista destas substÃncias vem aumentando consideravelmente. O estudo da aÃÃo da hipertermia associada a alguns agentes antiangiogÃnicos tem sido sugerida uma vez que os vasos tumorais ao encontrarem-se dilatados, nÃo promoverÃo a diminuiÃÃo da temperatura no tecido tumoral e, consequentemente, os efeitos desta associaÃÃo serÃo mais intensos do que no tecido normal devendo contribuir para a morte celular. Objetiva-se neste trabalho, avaliar o efeito antitumoral e antiangiogÃnico da hipertermia induzida por US isolada e combinada com etoricoxibe e pegaptanibe,no carcinossarcoma de Walker 256 implantado na tela subcutÃnea do dorso de ratos por meio de utilizaÃÃo do modelo experimental de hipertermoterapia por US assim como o estudo dos efeitos da hipertermia por US isolada e em combinaÃÃo com etoricoxibe e pegaptanibe,na angiogÃnese tumoral.O mÃtodo utilizado para o estudo teve inÃcio com o implante de cÃlulas de tumor de Walker 256 no dorso de ratos Wistar machos. Os animais foram tratados com hipertermia aplicada atravÃs de aparelho de ultrassom, mantida a nÃvel de 45o C durante cinco minutos no terceiro dia apÃs a inoculaÃÃo e tambÃm tratados com etoricoxibe e pegaptanibe por via oral e intraperitoneal respectivamente a partir do dia da inoculaÃÃo. Cada grupo de animais foi submetido a medidas do crescimento tumoral durante o perÃodo de 30 dias, assim como tambÃm à avaliaÃÃo da microdensidade vascular atravÃs de estudo mesoscÃpico fotogrÃfico, validado pelo estudo microscÃpico. A aplicaÃÃo do calor atravÃs de aparelho de ultrasom demonstrou eficiÃncia e agilidade A hipertermia, o etoricoxibe e o pegaptanibe, apresentaram capacidade antiangiogÃnica, expressada tanto pela curva de sobrevida, como pela avaliaÃÃo da microdensidade vascular. Particularmente, a hipertermia isoladamente apresentou um efeito antiangiogÃnico significativo tanto na curva de crescimento tumoral como na diminuiÃÃo da densidade microvascular. A associaÃÃo da hipertermia com o pegaptanibe, demonstrou uma eficiÃncia na diminuiÃÃo da densidade microvascular significativamente maior do que os demais grupos. O modelo de aplicaÃÃo de hipertermia gerada por um aparelho de ultrassom na modalidade contÃnua foi satisfatÃria, demonstrando ter sido efetiva tanto na diminuiÃÃo do crescimento tumoral, como na diminuiÃÃo da densidade microvascular. / The traditional methods of cancer treatment, like the chemotherapy and radiotherapy, even though they are effective in many types of tumours, they find frequently resistant neoplasic cellsâ population, beyond presenting a low security margin to the patients. The hyperthermia use associated to the chemotherapy and radiotherapy are plenty mentioned as profitable in the specialist literature, especially in patients with cancer in advanced stage, submitted previously to the classic methods of the treatment. The tissuesâ heat insertion through the continuous ultrasound becomes the procedure faster and with proved efficacy. The antiangiogenic use also is being related like effective in the specialist literature and, at this moment, the substancesâ list has grown vastly. The study of the hyperthermia action associated to antiangiogenic agents has been suggested, once the tumour vessels are dilated, would not promote the temperature reduction in the tumour vessels and, therefore, the effects of this association would be more intense than in the normal tissue, what might contribute to the death cell. The study objective is to evaluate the antitumor and antiangiogenic effect of the hyperthermia induced by isolated ultrasound and combined with etoricoxibe and pegaptanibe in the 256 Walker carcinossarcoma implanted in the subcutaneous back screen of mouse by using the hyperthermia experimental model by ultrasound, like the hyperthermia effects study by isolated ultrasound and linked with etoricoxibe and pegaptanibe, in the tumour angiogenesis. The method used describes the insertion of 256 Walker Tumour cells in the back of male Wistar mouse. The animals were treated with hyperthermia applied through the ultrasound equipment, kept to a 45 C level during five minutes in the third day after the inoculation and also treated with etoricoxibe and pegaptanibe by oral and intraperitoneal respectively since the inoculation day. Each animal group was submitted to a tumour growth measurement during a period of 30 days, as well as also a vascular microdensity evaluation through a photographic mesoscopic study, validated by the microscopic study. The heat application through the ultrasound equipment demonstrated efficiency and agility. The hyperthermia, the etoricoxibe and the pegaptanibe showed antiangiogenic capacity, expressed by the over life curve, and also by the vascular microdensity evaluation. Particularly, the isolated hyperthermia showed a significative antiangiogenic effect in the tumour growth curve and also in the decreasing of the micro vascular density. The association between the hyperthermia and the pegaptanibe demonstrated a greater efficiency in the reducing of the micro vascular density than the other groups. The hyperthermia application model generated by the ultrasound equipment in the continuous modality was satisfactory, demonstrating by being effective as much in the reducing of the tumour growth as in the decreasing of the micro vascular density.

A better understanding of tumour heterogeneity is central for accurate diagnosis, targeted therapy and personalised treatment of glioblastoma patients. This thesis aims to investigate whether pre-operative multi-parametric magnetic resonance imaging (MRI) can provide a useful tool for evaluating inter-tumoural and intra-tumoural heterogeneity of glioblastoma. For this purpose, we explored: 1) the utilities of habitat imaging in combining multi-parametric MRI for identifying invasive sub-regions (I & II); 2) the significance of integrating multi-parametric MRI, and extracting modality inter-dependence for patient stratification (III & IV); 3) the value of advanced physiological MRI and radiomics approach in predicting epigenetic phenotypes (V). The following observations were made: I. Using a joint histogram analysis method, habitats with different diffusivity patterns were identified. A non-enhancing sub-region with decreased isotropic diffusion and increased anisotropic diffusion was associated with progression-free survival (PFS, hazard ratio [HR] = 1.08, P < 0.001) and overall survival (OS, HR = 1.36, P < 0.001) in multivariate models. II. Using a thresholding method, two low perfusion compartments were identified, which displayed hypoxic and pro-inflammatory microenvironment. Higher lactate in the low perfusion compartment with restricted diffusion was associated with a worse survival (PFS: HR = 2.995, P = 0.047; OS: HR = 4.974, P = 0.005). III. Using an unsupervised multi-view feature selection and late integration method, two patient subgroups were identified, which demonstrated distinct OS (P = 0.007) and PFS (P < 0.001). Features selected by this approach showed significantly incremental prognostic value for 12-month OS (P = 0.049) and PFS (P = 0.022) than clinical factors. IV. Using a method of unsupervised clustering via copula transform and discrete feature extraction, three patient subgroups were identified. The subtype demonstrating high inter-dependency of diffusion and perfusion displayed higher lactate than the other two subtypes (P = 0.016 and P = 0.044, respectively). Both subtypes of low and high inter-dependency showed worse PFS compared to the intermediate subtype (P = 0.046 and P = 0.009, respectively). V. Using a radiomics approach, advanced physiological images showed better performance than structural images for predicting O6-methylguanine-DNA methyltransferase (MGMT) methylation status. For predicting 12-month PFS, the model of radiomic features and clinical factors outperformed the model of MGMT methylation and clinical factors (P = 0.010). In summary, pre-operative multi-parametric MRI shows potential for the non-invasive evaluation of glioblastoma heterogeneity, which could provide crucial information for patient care.

During this thesis we tried to design, synthesise and analyse some novel devices for the selective delivery of peptides. These systems are based on the enzyme-activated anticancer prodrugs developed by Prof. Gesson in Poitiers and the peptide rotaxanes developed by Prof. Leigh in Edinburgh. The innovative rotaxanes we constructed are devised to protect and selectively release a peptide in response to an enzyme-specific stimulus for the targeted therapy of cancer. In Chapter 1 we tried to expose the main synthetic strategies aimed at improving the stability and permeation features of biologically active peptides. We examined some prodrug approaches and particularly the tumour-activated prodrugs (TAPs), largely investigated for use in anticancer chemotherapy. TAPs are generally three-part molecules composed of trigger, spacer and effector units. We also presented the original methodology developed by Prof. Leigh, namely the hydrogen bond-directed assembly of peptide rotaxanes, to protect a peptide thread from external environment. Finally we presented our project which consists of a combination of the peptide prodrug and rotaxane approaches. Therefore, based on the knowledge of both research groups we tried in Chapter 2 to develop some model systems in order to study the influence of the rotaxane architecture upon prodrug molecules. The first step towards such rotaxane-based peptide prodrugs relied on the efficient design of a spacer which has to be bulky enough to work as a stopper for the macrocycle. Much of the work presented in this chapter is based on the design and synthesis of such self-immolative units. We then explored the response of our model rotaxanes under the action of the activating enzyme. After this detailed study, in Chapter 3 we applied our concept to the biologically active peptide Met-enkephalin. In this chapter we presented a comparison between a rotaxane prodrug of Met-enkephalin and its non-interlocked derivative. Thus both compounds were successfully synthesised and evaluated to release the free peptide after enzymatic activation. The protective effect of encapsulating the peptide within a rotaxane assembly was also studied in human plasma and with different proteases. Finally, in Chapter 4, we introduced the construction of a rotaxane-based molecular machine programmed to synthesise a short peptide unit from the amino acids carried on its thread. We synthesised with success a one-station model rotaxane to study the catalyst effect of the macrocycle. Unfortunately this model machine proved not to work and current research is still ongoing to achieve such a synthetic device.

Tumour-associated macrophages (TAM) are a major component of the inflammatory infiltrate that typifies most malignancies. Among them, Burkitt’s lymphoma (BL), a high-grade non Hodgkin lymphoma (NHL) of B-cell origin, represents a characteristic example. Studies from our group have shown that TAM in BL exert pivotal roles that are mainly supportive of tumourigenesis such as maintaining an immunosuppressive microenvironment. In order to unravel the molecular mechanisms underlying TAM functions in BL, solid tumours from a mouse xenograft model of BL have been used to obtain TAM and assess their activation status in vivo. Laser-capture microdissection has been successfully used to procure intact macrophage sections from the tumour site, allowing the production of a pure, in situ gene expression signature of TAM in BL. Tingible-body Mφ from lymph node germinal-centres and resident tissue Mφ from resting lymph nodes of non-tumour bearing mice were chosen for direct comparison with TAM. Whole-genome microarray technology has revealed a distinct TAM gene expression profile, with 454 genes being significantly up-regulated (fc ≥ 2, p<0.05) and 1293 genes being significantly down-regulated (fc ≤ -2, p<0.05) between TAM and either of the two normal Mφ populations. Further bioinformatics analysis of gene functions has highlighted matrix remodeling, phagocytosis, and immune response among the processes most highly enriched in TAM. Importantly, mRNA and tissue expression of selected differentially expressed genes relevant to these processes was validated by real-time qPCR and immunofluorescence labeling respectively. Following the generation of the TAM profile in situ, in vitro experimental approaches were undertaken in order to investigate how specific elements of the BL microenvironment drive the observed TAM signatures. Specifically, the direct role of apoptotic tumour cells, a key component of the BL microenvironment, versus that of viable tumour cells in driving TAM matrix remodelling gene expression was assessed in short-term mouse and human Mφ-NHL cell co-cultures. From the aforementioned cluster, emphasis was given to MMP12 and MMP2 transcripts: mRNA and protein expression of these MMPs was found to be up-regulated in Mφ following viable tumour cell co-cultures and this effect was further enhanced following apoptotic tumour cell co-cultures, implying that apoptotic NHL cells could directly shape TAM matrix remodeling phenotype in BL in vivo. Whereas the mRNA of both MMPs was solely Mφ-derived in this system, MMP12 and MMP2 protein was surprisingly found also to be increased in NHL cells in the apparent absence of increased mRNA. Detailed examination of MMP12 production by NHL cells revealed that it is most likely an apoptosis-dependent process, since apoptotic NHL cells generated through different apoptosis stimuli, as well as apoptotic cell-derived microparticles, showed markedly increased MMP12 protein levels. In conclusion, the data presented in this thesis, provide the first insight into the in vivo activation status of TAM in high-grade NHL, through generation of the TAM gene signature in situ. Upon further in vitro studies, apoptotic NHL cells were shown to directly modulate the matrix remodelling component of the TAM signature as well as to actively produce matrix remodelling mediators themselves, suggesting distinct roles for tumour cell apoptosis within the NHL microenvironment that can profoundly influence the disease outcome.

<p>The optimal way to detect and treat cancer is to target cancer cells exclusively without affecting the surrounding tissue. One promising approach is to use radiolabelled molecules to target receptors that are overexpressed in cancer cells. Since the epidermal growth factor receptor (EGFR) family is overexpressed in many types of cancer, it is an attractive target for both diagnostic and therapeutic applications.</p><p>This thesis can be divided into two parts. In part one (paper I), studies were conducted to modulate radionuclide uptake in tumour cells. The results showed that it was possible to modulate the cellular uptake of ¹²⁵I delivered by trastuzumab (targeting HER2) by adding EGF (targeting EGFR).</p><p>In part two (papers II-V) a high affinity EGFR-targeting affibody molecule (Z_EGFR:955)₂ was selected and analysed both <i>in vitro</i> and <i>in vivo</i>. In papers II, III and V, the results obtained when using (Z_EGFR:955)₂ were compared with those obtained with the two EGFR-binding molecules, EGF and cetuximab. These studies demonstrated that the affibody molecule bound specifically to EGFR (probably to subdomain III) with high affinity (~50 nM in biosensor analysis and ~1 nM in cellular studies) and produced intracellular signalling changes similar to those with cetuximab. In paper IV, <i>in vivo</i> studies were made, demonstrating that [¹¹¹In](Z_EGFR:955)₂ gave a tumour-specific ¹¹¹In uptake of 3.8±1.4% of injected dose per gram tumour tissue, 4 h post-injection. The tumours could be easily visualized with a gamma camera at this time-point. </p><p>The results of these studies indicated that the affibody molecule (Z_EGFR:955)₂ is a possible candidate for radionuclide-based imaging of EGFR-expressing tumours. The biological effects of (Z_EGFR:955)₂ might be of interest for therapy applications.</p>

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