Protéolyse du facteur von Willebrand et cardiopathies à forces de cisaillement élevées: nouvelles approches diagnostiques et thérapeutiques Dans la première partie de ce travail, nous mettons en évidence l’intérêt d’une immunothérapie spécifique à base d’anticorps monoclonal pour la prévention de la dégradation du facteur von Willebrand (VWF) sous assistance circulatoire mécanique à flux continu. Via un anticorps monoclonal murin ciblant le domaine D4 du VWF et inhibant partiellement l’interaction VWF-ADAMTS13, une inhibition partielle de la dégradation du VWF est observée sur sang total dans un modèle ex-vivo d’assistance circulatoire mécanique.Dans la seconde partie, nous avons étudié l’influence de soudaines variations de l’intensité des forces de cisaillement sur la multimérisation du VWF dans 3 modèles in-vivo: un modèle lapin de sténose de l’aorte ascendante, à l’initiation d’une assistance ventriculaire gauche par une pompe à flux continu chez des patients en insuffisance cardiaque terminale et lors d’un remplacement valvulaire aortique par voie percutané chez des patients avec un rétrécissement aortique sévère. Les variations observées du profil multimérique sont très dynamiques survenant quelques minutes après les modifications des conditions de flux. Notre étude met ainsi en évidence une nouvelle application potentielle du VWF comme biomarqueur d’anomalies de flux dans les cardiopathies à forces de cisaillement élevées. Un monitoring en temps réel du VWF pourrait notamment avoir un intérêt en cardiologie interventionnelle pour les techniques percutanées utilisées pour le traitement du rétrécissement aortique.La dernière partie de ce travail porte sur le développement d’un test ELISA pour le diagnostic des formes acquises ou constitutionnelles de maladie de Willebrand secondaire à une protéolyse excessive du VWF par l’ADAMTS13. Ce test pourrait constituer une alternative intéressante aux actuelles méthodes électrophorétiques pour le diagnostic et la prise en charge de ces pathologies hémorragiques. / In the first part of the thesis, we describe a novel approach based on antibody-based therapy to prevent the acquired von Willebrand factor (VWF) degradation observed in continuous-flow mechanical circulatory assist device therapy. Via a murine monoclonal antibody directed against VWF D4 domain and thus interfering with VWF-ADAMTS13 binding, a partial inhibition of VWF degradation is observed in whole blood using an ex vivo circulatory assist device model. In the second part of the thesis, we investigated the relationship between acute changes in shear stress and variations in VWF multimeric profile in three distincts models in vivo: in a rabbit aortic banding model, in end-stage heart failure patients at initiation of continuous-flow ventricular assist device therapy and in severe aortic stenosis patients undergoing percutaneous aortic valve procedures. Variations in VWF multimeric profile in those settings are highly dynamic occuring within minutes after changes in shear stress status. Our study highlights that VWF could be used as a biomarker of blood flow in high shear cardiovascular disorders. A bedside VWF-monitoring could be of clinical interest in interventional cardiology for percutaneous aortic valve procedures used in severe aortic stenosis.The last part of the thesis focused on the development of an ELISA-based diagnosis of constitutive or acquired VWF disorders associated with an increased ADAMTS13-mediated VWF proteolysis. Such assay might represent an attractive alternative to electrophoresis-based assays in the diagnosis and management of such bleeding disorders.

The incidence of cutaneous malignant melanoma has increased dramatically in Caucasians the last few decades, an increase that is partly explained by altered sun exposure habits. For the individual patient, with a localized disease, the tumor thickness of the excised lesion is the most important prognostic factor. However, there is a need to identify characteristics that can place patients in certain risk groups. In this study, the protein expression of multiple proteins in malignant melanoma tumors was studied, with the aim of identifying potential new candidate biomarkers. Representative samples from melanoma tissues were assembled in a tissue microarray format and protein expression was detected using immunohistochemistry. Multiple cohorts were used and for a subset of proteins the expression was also analyzed in melanocytes in normal skin and in benign nevi. The immunohistochemical staining was evaluated manually and for part of the proteins also with an automated algorithm. The protein expression of STX7 was described for the first time in tumors of the melanocytic lineage. Stronger expression of STX7 and SOX10 was seen in superficial spreading melanomas compared with nodular malignant melanomas. An inverse relationship between STX7 expression and T-stage was seen and between SOX10 expression and T-stage and Ki-67, respectively. In a population-based cohort the expression of MITF was analyzed and found to be associated with prognosis. Twenty-one potential biomarkers were analyzed using bioinformatics tools and a protein signature was identified which had a prognostic value independent of T-stage. The protein driving this signature was RBM3, a protein not previously described in malignant melanoma. Other markers included in the signature were MITF, SOX10 and Ki-67. In conclusion, the protein expression of numerous potential biomarkers was extensively studied and a new prognostic protein panel was identified which can be of value for risk stratification.

Amyloid PET imaging with [11C]PIB enabled detection of Aβ for the first time in vivo. However, [11C]PIB is a small molecule that binds only the insoluble Aβ plaque. Rather, the soluble Aβ aggregates are considered the cause of Alzheimer’s disease (AD). As such, a more sensitive and specific PET tracer is needed for tracking longitudinal AD pathology. Soluble Aβ aggregates likely interact with the metabotropic glutamate receptor 5 (mGluR5) to cause neurotoxic effects. However, with [11C]ABP688 PET we were unable to detect aberrant mGluR5 binding in AD mouse models, although we find elevated mGluR5 protein levels with immunoblotting. Antibodies are highly specific large molecules that can bind specifically to soluble Aβ aggregates, thus they can be a good marker for AD pathology. Unfortunately, due to their large size they cannot cross the blood-brain barrier (BBB). However, it is possible to shuttle antibodies into the brain by taking advantage of endogenous transporter systems on the BBB. By creating bispecific antibodies binding both to soluble Aβ aggregates and to the transferrin receptor (BBB target), we successfully transported the antibody into the brain and could visually detect soluble Aβ aggregates with PET. Recombinant expression further improved and optimized antibody design, creating smaller bispecific antibody-based constructs that had better pharmacokinetic properties allowing for earlier PET scanning (1 day instead of 3), and more sensitive signal. Lastly, using TCO-tetrazine click chemistry, we indirectly labeled our antibodies with fluorine-18, and could successfully perform PET already 11 h post-injection with a fluorine-18 labeled antibody.

Urinary bladder cancer is a heterogeneous disease appearing in different forms, e.g. non-muscle invasive and muscle invasive. For all variants, the expression of proteins is interesting to analyze for diagnostic, predictive, prognostic and drug targeting purposes, since it reflects the altered gene expression causing the cancer. Since urothelial cells of the bladder are in direct contact with urine it is likely that this body fluid contains cancer-related proteins. In Paper I, unbiased analysis of proteins in urine from urinary bladder cancer patients and controls, using label-free quantification by mass spectrometry, was applied and four interesting proteins APOE, FGB, LRG and SERPINA1 were selected and further analyzed with western and dot blot. In Paper II, two more proteins, POLR1E and TOP2A, were validated as relevant proteins in bladder cancer urine. In Paper III and IV, the proteins GAL1 and STMN1 were investigated for their prognostic and therapeutic target potential in bladder cancer. In Paper II, III and IV, the expression of seven of the proteins were analyzed on tissue microarrays representing tumour tissue from 360 patients with different tumour stages. For the proteins identified by the urine screening approach, their protein expressions were confirmed in bladder cancer tissue. The expression level in tissue of five of the proteins, APOE, FGB, POLR1E (Paper II), GAL1 (Paper III) and STMN1 (Paper IV), increased with tumour stage, showing diagnostic relevance and three of the proteins, SERPINA1 (Paper II), STMN1 (Paper IV) and GAL1 (Paper III) had prognostic potential in urinary bladder cancer. In addition, GAL1 and STMN1 were demonstrated to be highly expressed in metastatic disease and inhibition of STMN1 reduced cell growth (Paper III and IV), indicating that these proteins are promising drug targets in urinary bladder cancer. In conclusion, the approach of this thesis has generated several candidate protein biomarkers in urine and tissue, validated with independent methods, which have the potential to improve the care for bladder cancer patients.