A natureza heterogênea da Leucemia Mielóide Aguda (LMA) tornou-se um desafio para o sucesso da quimioterapia convencional com o agente Citarabina (Ara-C), especialmente em leucemias com prognóstico desfavorável, como aquelas portadoras do rearranjo MLL. Visto que as células de LMA-MLL são consideradas sensíveis ao Ara-C quando comparadas às leucemias que não apresentam o rearranjo, mas a recaída à doença é frequente, a presente tese propôs estudar a relação entre características biológicas relacionadas às bases da resistêmcia ao Ara-C em LMA-MLL. A abordagem proposta foi a seleção de subpopulações de linhagens celulares portadoras do rearranjo MLL submetidas ao tratamento em longo prazo com Ara-C, comparando-as com as linhagens não expostas à droga. As células foram caracterizadas quanto: 1) ao potencial proliferativo na presença ou ausência de Ara-C; 2) a distribuição das células no ciclo celular; 3) a distribuição de marcadores clássicos de superfície de células-tronco hematopoiéticas, CD34 e CD38; e 4) o perfil de expressão global dos RNAs transcritos. O tratamento em longo prazo selecionou células mais resistentes ao Ara-C que as células parentais. Além disso, quanto ao ciclo celular, as células selecionadas com Ara-C apresentaram apoptose reduzida (fase sub-G1), acúmulo na fase de síntese (fase S) e aumento da capacidade proliferativa após reexposição à droga (fase G2-M). Quanto à análise de marcadores de células-tronco hematopoiéticas, observou-se que após o tratamento em longo com Ara-C, uma das linhagens celulares apresentou distribuição bimodal do marcador CD38. Quando separadas por sorting em citometria de fluxo, observou-se que as subpopulações com níveis distintos de expressão de CD38, denominadas MV-4-11 CD38High e MV-4-11 CD38Low apresentaram resposta distinta ao tratamento com Ara-C. Quando avaliadas quanto ao perfil global de expressão gênica, constatou-se que MV-4-11 CD38High eram mais semelhantes às células parentais, e que MV-4-11 CD38Low formavam um grupo isolado, distinto das outras duas populações celulares. A análise de ontologia gênica (GO) evidenciou que entre as categorias mais representativas de processos biológicos estavam atividades associadas à capacidade proliferativa, ao desenvolvimento e a resposta a estímulos. As análises de agrupamentos hierárquicos mostraram que: 1) o cluster de genes do desenvolvimento HOXA estava mais expresso nas células MV-4-11 CD38Low do que em MV-4-11 CD38High, que apresentaram expressão mais elevada do cluster HOXB; 2) o gene HOX mais diferencialmente expresso foi HOXA13, associado na literatura com prognóstico desfavorável em outros tipos de câncer; 3) dos genes associados a resposta a estímulos, o único relacionado à via de metabolização do Ara-C diferencialmente expresso entre as linhagens foi NME1; 4) aqueles que participam das vias de reparo de pareamento incorreto, reparo por excisão de bases e por excisão de nucleotídeos encontraram-se mais expressos nas células MV-4-11 CD38High que em MV-4-11 CD38Low. Além disso, diversas quinases dependentes de ciclinas (CDKs) também estiveram diferencialmente expressas entre MV-4-11 CD38High e MV-4-11 CD38Low. Sugere-se por fim, que o modelo in vitro proposto neste estudo para simular a situação de resistência ao Ara-C em subpopulações de LMA-MLL, demonstrou que os mecanismos de resposta à Citarabina nesta doença, vão além de alterações na detoxificação e metabolização da droga, e parecem mais associados a vantagens proliferativas e do desenvolvimento das células leucêmicas. Estas vias devem ser exploradas como alvos potenciais na terapia combinada ao Ara-C. / The heterogeneity of Acute Myeloid Leukemia (AML) became a challenge for the success of the conventional chemotherapy agent Cytarabine (Ara-C), especially in leukemias with poor prognosis, as those harboring MLL rearrangement. Since AML-MLL cells are considered sensitive to Ara-C when compared with leukemias that do not carry the rearrangement, but relapse is frequent, the present dissertation proposed to study the relationship between biological characteristics related to the basis of chemoresistance to Ara-C in AML-MLL. We proposed an approach based on the selection of subpopulations of cell lines bearing MLL rearrangement submitted to the long-term treatment with Ara-C, comparing them with the cell lines that were not previously exposed to the drug. The cells were characterized according to: 1) the proliferative potential in the presence and absence of Ara-C; 2) the distribution of the cells in the cell cycle; 3) distribution of hematopoietic stem cell classic surface markers, CD34 and CD38; and, 4) global expression profile of transcribed RNAs. The long-term treatment selected cells that are more resistant to Ara-C than the cells that were not previously treated (parental cells). Besides, according to cell cycle, the cells selected by Ara-C treatment present decreased apoptosis (sub-G1 phase), accumulation in the synthesis phase (S-phase) and increase in the proliferative capability after re-exposition to the drug (G2-M phase). Regarding the hematopoietic stem cell markers, we observed that after Ara-C long-term treatment, one of the cell lines exhibited a bimodal distribution of the CD38 marker. When sorted by flow cytometry, we observed that both subpopulations with distinct levels of CD38 expression, called MV-4-11 CD38High and MV-4-11 CD38Low also showed distinct response to Ara-C. When evaluated regarding to their global gene expression profiles, we verified that MV-4-11 CD38High were more closely related to the parental cells, and MV-4-11 CD38Low made up an isolated group, distinct of the other cell populations. Gene ontology (GO) analysis revealed that among the most representative categories of biological processes, activities associated with proliferative capability, development and response to stimuli were included. The hierarchical clustering analysis showed that: 1) the cluster HOXA of genes of development was more expressed in the MV-4-11 CD38Low than in the MV-4-11 CD38High cells, that presented increased expression of HOXB cluster; 2) the most differentially expressed HOX gene was HOXA13, which according to the literature is associated with poor prognosis in other types of cancer; 3) among the genes associated with response to stimuli, the only one related to Ara-C-metabolizing pathway that was differentially expressed between the cell lines was NME1; 4) those genes that take part in the mismatch repair, base excision repair and nucleotide excision repair pathways were more expressed in the MV-4-11 CD38High than in the MV-4-11 CD38Low cells. Additionally, several cyclin-dependent kinases (CDKs) were also differentially expressed between MV-4-11 CD38High and MV-4-11 CD38Low. Finally, we suggest that the in vitro model proposed in this study to mimic the situation of chemoresistance to Ara-C in subpopulations of AML-MLL, showed that the mechanisms of Ara-C response in this disease, go beyond changes in drug detoxification and metabolization, and seem more associated to proliferative and development advantages of the leukemic cells. These pathways should be explored as potential targets to Ara-C combination therapies.

A natureza heterogênea da Leucemia Mielóide Aguda (LMA) tornou-se um desafio para o sucesso da quimioterapia convencional com o agente Citarabina (Ara-C), especialmente em leucemias com prognóstico desfavorável, como aquelas portadoras do rearranjo MLL. Visto que as células de LMA-MLL são consideradas sensíveis ao Ara-C quando comparadas às leucemias que não apresentam o rearranjo, mas a recaída à doença é frequente, a presente tese propôs estudar a relação entre características biológicas relacionadas às bases da resistêmcia ao Ara-C em LMA-MLL. A abordagem proposta foi a seleção de subpopulações de linhagens celulares portadoras do rearranjo MLL submetidas ao tratamento em longo prazo com Ara-C, comparando-as com as linhagens não expostas à droga. As células foram caracterizadas quanto: 1) ao potencial proliferativo na presença ou ausência de Ara-C; 2) a distribuição das células no ciclo celular; 3) a distribuição de marcadores clássicos de superfície de células-tronco hematopoiéticas, CD34 e CD38; e 4) o perfil de expressão global dos RNAs transcritos. O tratamento em longo prazo selecionou células mais resistentes ao Ara-C que as células parentais. Além disso, quanto ao ciclo celular, as células selecionadas com Ara-C apresentaram apoptose reduzida (fase sub-G1), acúmulo na fase de síntese (fase S) e aumento da capacidade proliferativa após reexposição à droga (fase G2-M). Quanto à análise de marcadores de células-tronco hematopoiéticas, observou-se que após o tratamento em longo com Ara-C, uma das linhagens celulares apresentou distribuição bimodal do marcador CD38. Quando separadas por sorting em citometria de fluxo, observou-se que as subpopulações com níveis distintos de expressão de CD38, denominadas MV-4-11 CD38High e MV-4-11 CD38Low apresentaram resposta distinta ao tratamento com Ara-C. Quando avaliadas quanto ao perfil global de expressão gênica, constatou-se que MV-4-11 CD38High eram mais semelhantes às células parentais, e que MV-4-11 CD38Low formavam um grupo isolado, distinto das outras duas populações celulares. A análise de ontologia gênica (GO) evidenciou que entre as categorias mais representativas de processos biológicos estavam atividades associadas à capacidade proliferativa, ao desenvolvimento e a resposta a estímulos. As análises de agrupamentos hierárquicos mostraram que: 1) o cluster de genes do desenvolvimento HOXA estava mais expresso nas células MV-4-11 CD38Low do que em MV-4-11 CD38High, que apresentaram expressão mais elevada do cluster HOXB; 2) o gene HOX mais diferencialmente expresso foi HOXA13, associado na literatura com prognóstico desfavorável em outros tipos de câncer; 3) dos genes associados a resposta a estímulos, o único relacionado à via de metabolização do Ara-C diferencialmente expresso entre as linhagens foi NME1; 4) aqueles que participam das vias de reparo de pareamento incorreto, reparo por excisão de bases e por excisão de nucleotídeos encontraram-se mais expressos nas células MV-4-11 CD38High que em MV-4-11 CD38Low. Além disso, diversas quinases dependentes de ciclinas (CDKs) também estiveram diferencialmente expressas entre MV-4-11 CD38High e MV-4-11 CD38Low. Sugere-se por fim, que o modelo in vitro proposto neste estudo para simular a situação de resistência ao Ara-C em subpopulações de LMA-MLL, demonstrou que os mecanismos de resposta à Citarabina nesta doença, vão além de alterações na detoxificação e metabolização da droga, e parecem mais associados a vantagens proliferativas e do desenvolvimento das células leucêmicas. Estas vias devem ser exploradas como alvos potenciais na terapia combinada ao Ara-C. / The heterogeneity of Acute Myeloid Leukemia (AML) became a challenge for the success of the conventional chemotherapy agent Cytarabine (Ara-C), especially in leukemias with poor prognosis, as those harboring MLL rearrangement. Since AML-MLL cells are considered sensitive to Ara-C when compared with leukemias that do not carry the rearrangement, but relapse is frequent, the present dissertation proposed to study the relationship between biological characteristics related to the basis of chemoresistance to Ara-C in AML-MLL. We proposed an approach based on the selection of subpopulations of cell lines bearing MLL rearrangement submitted to the long-term treatment with Ara-C, comparing them with the cell lines that were not previously exposed to the drug. The cells were characterized according to: 1) the proliferative potential in the presence and absence of Ara-C; 2) the distribution of the cells in the cell cycle; 3) distribution of hematopoietic stem cell classic surface markers, CD34 and CD38; and, 4) global expression profile of transcribed RNAs. The long-term treatment selected cells that are more resistant to Ara-C than the cells that were not previously treated (parental cells). Besides, according to cell cycle, the cells selected by Ara-C treatment present decreased apoptosis (sub-G1 phase), accumulation in the synthesis phase (S-phase) and increase in the proliferative capability after re-exposition to the drug (G2-M phase). Regarding the hematopoietic stem cell markers, we observed that after Ara-C long-term treatment, one of the cell lines exhibited a bimodal distribution of the CD38 marker. When sorted by flow cytometry, we observed that both subpopulations with distinct levels of CD38 expression, called MV-4-11 CD38High and MV-4-11 CD38Low also showed distinct response to Ara-C. When evaluated regarding to their global gene expression profiles, we verified that MV-4-11 CD38High were more closely related to the parental cells, and MV-4-11 CD38Low made up an isolated group, distinct of the other cell populations. Gene ontology (GO) analysis revealed that among the most representative categories of biological processes, activities associated with proliferative capability, development and response to stimuli were included. The hierarchical clustering analysis showed that: 1) the cluster HOXA of genes of development was more expressed in the MV-4-11 CD38Low than in the MV-4-11 CD38High cells, that presented increased expression of HOXB cluster; 2) the most differentially expressed HOX gene was HOXA13, which according to the literature is associated with poor prognosis in other types of cancer; 3) among the genes associated with response to stimuli, the only one related to Ara-C-metabolizing pathway that was differentially expressed between the cell lines was NME1; 4) those genes that take part in the mismatch repair, base excision repair and nucleotide excision repair pathways were more expressed in the MV-4-11 CD38High than in the MV-4-11 CD38Low cells. Additionally, several cyclin-dependent kinases (CDKs) were also differentially expressed between MV-4-11 CD38High and MV-4-11 CD38Low. Finally, we suggest that the in vitro model proposed in this study to mimic the situation of chemoresistance to Ara-C in subpopulations of AML-MLL, showed that the mechanisms of Ara-C response in this disease, go beyond changes in drug detoxification and metabolization, and seem more associated to proliferative and development advantages of the leukemic cells. These pathways should be explored as potential targets to Ara-C combination therapies.

Traumatic brain injury (TBI) induces a robust cellular proliferative response among neural stem/progenitor cells (NS/NPCs) in the dentate gyrus of the hippocampus. This proliferative effect is thought to contribute to the innate cognitive recovery observed following TBI. Inhibition of hippocampal neurogenesis impairs cognitive function. Furthermore, enhancement of injury-induced hippocampal neurogenesis via intraventricular administration of basic fibroblast growth factor (bFGF) improves cognitive function in animals following TBI. In this experiment, we investigated the direct association between injury-induced hippocampal neurogenesis and cognitive recovery utilizing an antimitotic agent, arabinofuranosyl cytidine (Ara-C). In this study, adult rats received a moderate lateral fluid percussion injury (LFPI). Immediately following injury, Ara-C with or without bFGF was infused into the lateral ventricle via an osmotic mini-pump for 7 days. To label dividing cells animals received daily single injections of 5-bromo-2'-deoxyuridine (BrdU) at 2-7 days post-injury. To examine the effect of Ara-C on cell proliferation, a group of animals was sacrificed at 1 week following injury. Brain sections were immunostained for BrdU and cell type specific markers, and the number of BrdU+ cells in the hippocampus was assessed by stereology. To examine the effect of inhibition of injury-induced cell proliferation on cognitive recovery, animals were assessed on Morris water maze tasks (MWM) either at 21 to 25 days or 56-60 days post-injury. We found that post-injury Ara-C treatment significantly reduces injury-induced cell proliferation in the DG and abolishes the innate cognitive recovery on MWM performance at 56-60 days post-injury. Additionally, Ara-C diminishes bFGF enhanced cell proliferation in the DG and cognitive recovery following TBI. These results support the causal relationship between injury-induced hippocampal neurogenesis and cognitive functional recovery. Our studies suggest that the post-TBI neurogenic response is an endogenous repair mechanism that contributes to the restoration of hippocampal function post-injury.

La 1-β-D-arabinofuranosylcytosine (ara-C) demeure l’agent anticancéreux principalement utilisé dans le traitement de la leucémie myéloblastique aiguë (LMA), malgré sa dégradation et son élimination rapide après une administration parentérale. Son encapsulation dans des vecteurs pharmaceutiques, majoritairement des liposomes, a permis de surmonter ces inconvénients. L’objectif général de ce projet de doctorat était de développer deux systèmes à libération prolongée, à base de phospholipides, de cholestérol et de poly(éthylène glycol) (PEG) afin d’encapsuler l’ara-C et ultimement, d’améliorer son efficacité dans le traitement de la LMA. Des Sphérulites® (vésicules multilamellaires d’un type particulier) ont d’abord été étudiées pour leur forte capacité d’encapsulation, due à leur mode de préparation. Par la suite, une formulation liposomale capable, d’une part de cibler spécifiquement les cellules leucémiques et, d’autre part, de promouvoir la libération intracellulaire de l’ara-C grâce à sa sensibilité au pH, a été mise au point. Les deux formulations se devaient d’avoir un faible diamètre, une stabilité en présence de fluides biologiques et des temps de circulation prolongés chez l’animal. Une préparation de Sphérulites®, composée de Phospholipon 90G, de Solutol HS15 et de cholestérol, a permis d’obtenir des vésicules de 300 nm de diamètre. Un dérivé lipidique de PEG a pu être fixé à leur surface, sans modifier la disposition concentrique des lamelles, ni changer leur stabilité. Les Sphérulites® PEGylées ont été chargées d’ara-C et injectées chez le rat par la voie intraveineuse. Elles ont démontré des temps de circulation significativement prolongés comparativement aux Sphérulites® sans PEG. Cependant, l’ara-C s’est retrouvée éliminée de la circulation sanguine très rapidement, révélant une libération précoce du principe actif à partir de ces vésicules. Les liposomes sensibles au pH (~150 nm) ont été obtenus suite à l’insertion d’un copolymère à base de dioctadécyle, de N-isopropylacrylamide (NIPAM) et d’acide méthacrylique. L’anticorps anti-CD33, soit complet soit son fragment Fab’, a été fixé à la surface des liposomes afin de cibler les cellules leucémiques. Les essais in vitro ont démontré la spécificité de la formulation pour différentes cellules leucémiques (CD33+), sa stabilité en présence de protéines plasmatiques et la libération intracellulaire d’un marqueur fluorescent et de l’ara-C. Enfin, des études menées chez la souris saine et immunodéprimée inoculée de cellules HL60 ont montré que la formulation exposant le fragment Fab’ possédait un profil pharmacocinétique et une biodistribution semblables à ceux des liposomes contrôles non-ciblés. L’encapsulation de l’ara-C a permis d’améliorer grandement ses temps de circulation après une administration intraveineuse. Cependant, bien que les immunoliposomes ont permis de prolonger la survie des souris leucémiques comparativement à l’ara-C libre, l’addition du polymère sensible au pH n’a pas permis d’apporter de réel avantage à la formulation lorsque administrée in vivo. Les résultats obtenus dans ce travail de thèse ont, dans un premier temps, mis en évidence que les Sphérulites® pourraient s’avérer utiles dans la vectorisation d’agents anticancéreux si leur capacité à retenir le principe actif in vivo était améliorée. Dans un second temps, les données présentées avec les immunoliposomes suggèrent qu’ils pourraient apporter un bénéfice notable dans le traitement de la LMA. / Despite its rapid degradation and fast elimination in vivo, 1-β-D-arabinofuranosylcytosine (ara-C) is the main anticancer agent used in the treatment of acute myeloid leukemia (AML). The encapsulation of this drug into nanocarriers such as liposomes has been shown to improve its stability, pharmacokinetic profile and, consequently, the treatment efficacy. The purpose of this doctoral work was to develop two nanocarriers employing phospholipids, cholesterol and poly(ethylene glycol) (PEG) to encapsulate ara-C, with the ultimate goal of developing more efficient treatments for AML. The first formulation relied on Spherulites®, which are multilamellar vesicles possessing high entrapment yields due to their fabrication method. In a second part, pH-sensitive immunoliposomes were optimized to target specifically the leukemia cells and promote the release of the loaded ara-C at the desired intracellular site. Both formulations required a small diameter, stability in the presence of biological fluids and long circulation time properties when injected intravenously. An optimized formulation of Spherulites® was developed. It was composed of Phospholipon 90G, Solutol HS15 and cholesterol. The vesicles (300 nm) were able to accommodate PEG-lipid derivatives at their surface without altering their concentric lamellar shape and their in vitro stability. The PEGylated Spherulites® were loaded with ara-C and injected intravenously into rats. The surface-modified vesicles exhibited longer circulation times compared to uncoated Spherulites®. However, most of the loaded-drug was cleared from the systemic circulation very rapidly, reflecting rapid leakage of ara-C from the vesicles. The pH-sensitive immunoliposomes (~150 nm) were obtained by including a terminally-alkylated copolymer made of dioctadecyl, N-isopropylacrylamide (NIPAM) and methacrylic acid in the liposome bilayer. The whole monoclonal antibody anti-CD33 or its Fab’ fragment were grafted on liposomes to target leukemic cells. In vitro assays revealed that this formulation was really specific for the various CD33+ leukemic cell lines, stable in presence of blood proteins, and able to promote the intracellular release of an encapsulated fluorescent probe as well as ara-C. In vivo studies in naïve Balb/c and immunodeprimed (SCID) mice inoculated with HL60 cells confirmed that the anti-CD33 Fab’ targeted formulation possessed pharmacokinetic and biodistribution profiles similar to those of the non-targeted liposomes. The encapsulation of ara-C in this formulation improved substantially its circulation time after intravenous injection. However, although ara-C-loaded immunoliposomes were able to prolong the survival of leukemic mice compared to the free drug, the addition of pH-sensitive polymer did not add any benefit to the formulation. Although these formulations require some optimization, the first part of this work pointed out that Spherulites® could be used to deliver anticancer agents provided that leakage is reduced in vivo. On the other hand, the data obtained with the targeted immunoliposomes suggest that these carriers could be beneficial in the treatment of AML.

No description available.