OBJETIVOS: Avaliar características clínico-patológicas com ênfase na presença de variantes histológicas (VH) nos carcinomas uroteliais da bexiga e nas metástases linfonodais (ML). Caracterizar perfis imuno-histoquímicos relacionados aos subtipos moleculares e verificar suas associações clínico-patológicas. MÉTODOS: 183 carcinomas uroteliais de alto grau músculo-invasivos submetidos a cistectomia radical no Instituto do Câncer do Estado de São Paulo, HCFMUSP ou Hospital Alemão Oswaldo Cruz foram caracterizados quanto ao gênero, idade, tamanho, focalidade, configuração neoplásica, necrose, invasões angiolinfática e perineural, VH, carcinoma in situ, infiltrado inflamatório peri e intratumoral, estádio, margem cirúrgica, ML e VH na metástase. Resultados semi-quantitativos da pesquisa imuno-histoquímica (IH) de CK20 e GATA3 (associados ao subtipo luminal) e CK5, SALL4 e Vimentina (associados ao subtipo basal), que foi realizada em micromatrizes teciduais com abundante representação do tumor primário e das ML, tiveram valor de corte de 20%, definindo os casos em positivos e negativos. Casos negativos para CK20 ou GATA3 e positivos para CK5 foram agrupados no subtipo basal; casos positivos para CK20 ou GATA3 e negativos para CK5 agrupados no subtipo luminal e casos duplo positivos ou duplo negativos agrupados no subtipo indeterminado. As associações entre estes subtipos e as características clínico-patológicas foram realizadas através de testes qui-quadrado ou exato de Fisher para as variáveis categóricas. A comparação dos subtipos obtidos no centro do tumor e na ML foi realizada com testes de McNemar-Bowker e concordância pelo coeficiente Kappa. A análise de sobrevida foi realizada pelo método Kaplan-Meier e testes de Breslow. RESULTADOS: VH foram observadas em 116 (63,4%) casos e associadas a invasão linfovascular (p=0,043), VH na metástase (p < 0,001), pior sobrevida global (p=0,043). Havia 14 diferentes VH, a escamosa, mais comum, foi associada a tumores maiores (p=0,003); necrose (p=0,004); VH sarcomatoide (p=0,047), VH na metástase (p=0,003), sem impacto nas sobrevidas. VH micropapilífera, segunda mais observada, foi associada a invasão linfovascular (p=0,002); margem cirúrgica positiva (p=0,005); metástase linfonodal (p < 0,001), VH na metástase (p=0,007) e piores sobrevidas doença específica (p=0,016) e global (p=0,005). VHs foram observadas em 40,7% das metástases linfonodais, com apenas um caso discordante das VH observadas no tumor vesical. Nos dois perfis IH estabelecidos não houve impacto nas sobrevidas e o subtipo basal foi associado a tumores maiores (CK5/CK20 p=0,025; CK5/GATA3 p=0,006) e a variante escamosa (CK5/CK20 e CK5/GATA3 p < 0,001) e o subtipo luminal foi associado a variantes micropapilífera (CK5/CK20 e CK5/GATA3 p < 0,001) e plasmocitoide (CK5/CK20 p=0,003; CK5/GATA3 p=0,011). Foi moderado o grau de concordância do subtipo observado no centro comparado ao observado na ML (CK5/CK20 Kappa=0,57; CK5/GATA3 Kappa=0,48). CONCLUSÕES: A presença de VH nos carcinomas uroteliais da bexiga, além de acarretar heterogeneidade intratumoral, foi associada a características clínico-patológicas de agressividade, com impacto na sobrevida, sobretudo na variante micropapilífera. O perfil IH basal foi associado a tumores maiores com variante escamosa e o perfil IH luminal foi associado às variantes micropapilífera e plasmocitoide. Os perfis IHs não diferiram quanto às sobrevidas e houve moderada concordância com os perfis observados nas ML / OBJETIVES: Evaluate clinicopathological features emphasizing the presence of histological variants (HV) in bladder urothelial carcinomas and their lymph node metastasis (LNM). Characterize immunohistochemical profiles related to molecular subtypes and verify their clinicopathological associations. METHODS: 183 high-grade muscle-invasive urothelial carcinomas undergoing radical cystectomy at Instituto do Câncer do Estado de São Paulo, HCFMUSP or Hospital Alemão Oswaldo Cruz were classified according to gender, age, size, focality, neoplastic configuration, necrosis, lymphovascular and perineural invasion, HV, carcinoma in situ, peritumoral and intratumoral inflammatory infiltrate, stage, surgical margin, LNM and HV in metastasis. Semi-quantitative results of the immuhistochemical (IHC) studies for CK20 and GATA3 (associated with the luminal subtype) and CK5, SALL4 and Vimentin (associated with basal subtype), which were performed in tissue microarrays with abundant representation of the primary tumor and LNM, had a cutoff value of 20%, dividing cases into positive and negative. Negative cases for CK20 or GATA3 and positive for CK5 were grouped into the basal subtype; positive cases for CK20 or GATA3 and negative for CK5 were grouped into luminal subtype and double positive or double negative cases were grouped into the undetermined subtype. The associations between these subtypes and clinicopathological features were performed using chi-square or Fisher´s exact tests for the categorical variables. Comparison of the subtype obtained at the center of the tumor and LNM was performed using McNemar-Bowker test and agreement with Kappa coefficient. Survival analysis was performed using Kaplan-Meier method and Breslow tests. RESULTS: HV were observed in 116 (63.4%) cases and associated with lymphovascular invasion (p=0.043); HV in metastasis (p < 0.001), worse overall survival (p=0.043). There were 14 different HV, and squamous variant, the most common, was associated with larger tumors (p=0.003); necrosis (p=0.004), sarcomatoid variant (p=0,047), HV in metastasis (p=0.003), with no impact on survival. Micropapillary variant, the second most observed, was associated with lymphovascular invasion (p=0.002); positive surgical margin (p=0.005); LNM (p < 0.001); HV in metastasis (p=0.007) and worse disease-specific (p=0.016) an overall survival (p=0.005). HV were observed in 40.7% of the LNM, and only one case was discordant with HV observed in the bladder tumor. In both IHC profiles there was no impact on survival, and the basal subtype was associated with larger tumors (CK5/CK20 p=0.025; CK5/GATA3 p=0.006) and squamous variant (CK5/CK20 and CK5/GATA3 p < 0.001). Luminal subtype was associated with micropapillary variant (CK5/CK20 and CK5/GATA3 p < 0.001) and plasmacytoid variant (CK5/CK20 p=0.003; CK5/GATA3 p=0.011). There was moderate agreement between the subtype observed in the tumor center compared to that observed in LNM (CK5/CK20 Kappa=0.57; CK5/GATA3 Kappa=0.48). CONCLUSIONS: The presence of HV in bladder urothelial carcinomas, in addition to cause intratumoral heterogeneity, was associated with clinical and pathological characteristics of aggressiveness, with impact on survival, especially in the micropapillary variant. The basal IHC profile was associated with larger tumors and squamous variant, and the luminal IHC profile was associated with micropapillary and plasmacytoid variants. The IHC profiles did not differ on the survival rates and there was moderate agreement compared to the subtypes observed in LNM

Introdução: O câncer de próstata (CaP) é o tumor sólido mais diagnosticado no homem atualmente, e a sexta ocorrência mais frequente de casos novos de neoplasia maligna no mundo, sendo a segunda causa de óbito por câncer. O câncer de bexiga (CaB) é a segunda neoplasia maligna mais comum e a segunda em causa de óbito entre os tumores genito-urinários. Mundialmente o CaB é responsável por aproximadamente 386.000 novos casos e 150.000 óbitos por ano. O conhecimento das alterações em processos celulares envolvidos na sua carcinogênese nos permite melhor compreensão da patogênese dessas neoplasias, subsidiando, assim, mais efetivamente, o planejamento de estratégias de prevenção, diagnóstico e tratamento. Micro RNA (miRNA) são pequenas sequências não codificantes de RNA que possuem grande papel no controle da expressão dos genes, inibindo a tradução da proteína ou promovendo a degradação do RNA mensageiro (RNAm). Os miRNA estão envolvidos em vários processos celulares fisiológicos e patológicos, incluindo o câncer, onde podem atuar como oncogenes (oncomiR) ou como supressores de tumor (tsmiR). Previamente demonstramos que níveis elevados de miR-100 estão relacionados a recidiva bioquímica pós-prostatectomia radical enquanto no carcinoma urotelial de bexiga de baixo grau ocorre subexpressão desse miRNA. Objetivo: O estudo pretende analisar o papel do miR-100 na regulação de seus supostos genes alvo SMARCA5, THAP2, BAZ2A, mTOR e FGFR3 em linhagens de CaB e CaP e sua relação com a proliferação, apoptose e ploidia de DNA Material e Métodos: As linhagens de CaB (RT4 e T24) e CaP (DU145 e PC3) foram transfectadas com pré-miR-100, antimiR-100 e seus respectivos controles negativos utilizando lipossomas. Após a transfecção o nível de expressão de RNAm e proteína dos genes alvos foi analisado pelas técnicas da cadeia da polimerase quantitativa em tempo real (qRT-PCR) e western blotting respectivamente. A proliferação celular, apoptose e instabilidade cromossômica foram analisadas por citometria de fluxo. Resultados: A transfecção de pré-miR 100, reduziu de modo significativo a expressão de RNAm dos genes mTOR(p=0,006), SMARCA5 (p=0,007) e BAZ2A (p=0,03) na linhagem RT4, mTOR (p=0,02) e SMARCA5 (p=0,01) na linhagem T24, mTOR (p=0,025), THAP2 (p=0,04), SMARCA5 (p=0,001) e BAZ2A (p=0,005) na linhagem DU145 e mTOR (p=0,01) na linhagem PC3. Quanto a expressão proteica houve diminuição global da expressão de todas as proteínas varável de 22,5% a 69% nas quatro linhagens estudadas. Na linhagem T24 miR-100 promoveu um aumento na proliferação e o antimiR-100 induziu a apoptose demonstrando o papel oncogênico desse miR no câncer de bexiga de alto grau. Na linhagem PC3, do mesmo modo, a exposição ao antimiR-100 promoveu um aumento de células em apoptose. Conclusões: Demonstramos que miR-100 controla a expressão gênica e proteica de seus genes alvos nas linhagens de CaP e CaB. Os genes mTOR e FGFR3 são proto-oncogenes envolvidos com o desenvolvimento e progressão de neoplasias, enquanto os genes BAZ2A, SMARCA5 e THAP2 estão relacionados a regulação da transcrição, estabilidade genômica e indução da apoptose. Desse modo podemos admitir que miR-100 tem um papel contraditório no câncer, podendo se comportar como um oncomiR ou como um tsmiR, o que o classificaria como um miRNA \"contexto dependente\". Demonstramos porém que miR-100 tem um papel oncogênico na linhagem T24 de carcinoma urotelial de alto grau de bexiga promovendo um aumento na proliferação e inibição da apoptose. Na linhagem PC3 também o papel oncogênico de miR-100 pode estar relacionado a inibição da apoptose. Dada a variação de ação dos miRNA nos diversos tecidos e estágios tumorais, a determinação do seu papel nos diversos tumores é fundamental pois existe a possibilidade de utiliza-los como marcadores diagnóstico, prognóstico e como alvos para terapias moleculares / Introduction: Prostate cancer (PC) is the most commonly diagnosed solid tumor in men today, and the sixth most frequent occurrence of new cases of malignancy in the world, being the second cause of death by cancer in men. Bladder cancer (BC) is the second most common malignancy and the second cause of death among genitourinary tumors. Globally BC is responsible for approximately 386.000 new cases and 150.000 deaths per year. The knowledge of cellular processes involved in carcinogenesis allows us to better understand the etiology and pathogenesis of these neoplasms, supporting thus more effectively, planning strategies for prevention and treatment. Micro RNAs (miRNA) are small non-coding RNA sequences that have a large role in the control of gene expression by inhibiting protein translation or promoting the degradation of messenger RNA (RNAm). The miRNA are currently involved in various physiological and pathological cellular processes, including cancer where they can act as oncogenes (oncomiR) or tumor suppressors (tsmiR). Previously we demonstrated that high levels of miR-100 are associated with biochemical recurrence after radical prostatectomy while in low-grade bladder urothelial carcinoma it is persistently underexpressed. Objective: The study aims to examine the role of miR-100 in the regulation of its supposed target genes SMARCA5, THAP2, BAZ2A, mTOR and FGFR3 in BC and PC cell lines and its relationship with proliferation, apoptosis and chromosomal instability. Material and Methods: The BC (RT4 and T24) and PC cell lines (DU145 and PC3) were transfected with pre-miR-100, antimiR-100 and their respective controls using liposomes. After transfection RNAm and protein levels of its supposed target genes were analyzed by quantitative real time polymerase chain reaction (qRT-PCR) and western blotting. Cell proliferation, apoptosis and DNA ploidy were analyzed by flow cytometry. Results: After transfection of pre-miR 100, there was a significant reduction in the RNAm expression of mTOR (p=0.006), SMARCA5 (p=0.007) and BAZ2A (p=0.03) in RT4, mTOR (p=0.02) and SMARCA5 (p=0.01) in T24, mTOR (p=0.025), THAP2 (p=0.04), SMARCA5 (p=0.001) and BAZ2A (p=0.005) in DU145 and mTOR (p=0.01) in PC3. There was a reduction in the expression of all proteins, variable from 22.5% to 69% in all cell lines. In T24 miR-100 promoted an increase in cell proliferation and antimiR-100 promoted apoptosis characterizing miR-100 as an oncomiR in this cell line representative of a right grade urothelial carcinoma. Also in PC3 antimiR-100 promoted an increase in apoptosis. Conclusions: We have shown that miR-100 controls the expression of gene and protein of its supposed target genes in PC and BC cell lines. mTOR and FGFR3 are proto-oncogenes related to the tumor development and progression, while BAZ2A, SMARCA5 and THAP2 are related to the DNA transcription regulation, chromossomic stability and apoptosis induction. We can conclude that miR-100 has a contradictory role in cancer, behaving as an oncomir or tsmiR depending the type and stage of a specific neoplasia, classifying it as a \"context depending\" miRNA. In T24 cell line however miR-100 acts as an oncomiR increasing cell proliferation and inhibiting apoptosis. In PC3 cell line miR-100 also acts as an oncomiR inhibiting apoptosis. Due to the variation of roles of miRNAs in different tissues and stage of tumors, the characterization of their role in neoplasm is very important because of the possibility to use them as diagnostic or prognostic markers, even as targets for the development of new drugs

Introdução: O câncer de próstata (CaP) é o tumor sólido mais diagnosticado no homem atualmente, e a sexta ocorrência mais frequente de casos novos de neoplasia maligna no mundo, sendo a segunda causa de óbito por câncer. O câncer de bexiga (CaB) é a segunda neoplasia maligna mais comum e a segunda em causa de óbito entre os tumores genito-urinários. Mundialmente o CaB é responsável por aproximadamente 386.000 novos casos e 150.000 óbitos por ano. O conhecimento das alterações em processos celulares envolvidos na sua carcinogênese nos permite melhor compreensão da patogênese dessas neoplasias, subsidiando, assim, mais efetivamente, o planejamento de estratégias de prevenção, diagnóstico e tratamento. Micro RNA (miRNA) são pequenas sequências não codificantes de RNA que possuem grande papel no controle da expressão dos genes, inibindo a tradução da proteína ou promovendo a degradação do RNA mensageiro (RNAm). Os miRNA estão envolvidos em vários processos celulares fisiológicos e patológicos, incluindo o câncer, onde podem atuar como oncogenes (oncomiR) ou como supressores de tumor (tsmiR). Previamente demonstramos que níveis elevados de miR-100 estão relacionados a recidiva bioquímica pós-prostatectomia radical enquanto no carcinoma urotelial de bexiga de baixo grau ocorre subexpressão desse miRNA. Objetivo: O estudo pretende analisar o papel do miR-100 na regulação de seus supostos genes alvo SMARCA5, THAP2, BAZ2A, mTOR e FGFR3 em linhagens de CaB e CaP e sua relação com a proliferação, apoptose e ploidia de DNA Material e Métodos: As linhagens de CaB (RT4 e T24) e CaP (DU145 e PC3) foram transfectadas com pré-miR-100, antimiR-100 e seus respectivos controles negativos utilizando lipossomas. Após a transfecção o nível de expressão de RNAm e proteína dos genes alvos foi analisado pelas técnicas da cadeia da polimerase quantitativa em tempo real (qRT-PCR) e western blotting respectivamente. A proliferação celular, apoptose e instabilidade cromossômica foram analisadas por citometria de fluxo. Resultados: A transfecção de pré-miR 100, reduziu de modo significativo a expressão de RNAm dos genes mTOR(p=0,006), SMARCA5 (p=0,007) e BAZ2A (p=0,03) na linhagem RT4, mTOR (p=0,02) e SMARCA5 (p=0,01) na linhagem T24, mTOR (p=0,025), THAP2 (p=0,04), SMARCA5 (p=0,001) e BAZ2A (p=0,005) na linhagem DU145 e mTOR (p=0,01) na linhagem PC3. Quanto a expressão proteica houve diminuição global da expressão de todas as proteínas varável de 22,5% a 69% nas quatro linhagens estudadas. Na linhagem T24 miR-100 promoveu um aumento na proliferação e o antimiR-100 induziu a apoptose demonstrando o papel oncogênico desse miR no câncer de bexiga de alto grau. Na linhagem PC3, do mesmo modo, a exposição ao antimiR-100 promoveu um aumento de células em apoptose. Conclusões: Demonstramos que miR-100 controla a expressão gênica e proteica de seus genes alvos nas linhagens de CaP e CaB. Os genes mTOR e FGFR3 são proto-oncogenes envolvidos com o desenvolvimento e progressão de neoplasias, enquanto os genes BAZ2A, SMARCA5 e THAP2 estão relacionados a regulação da transcrição, estabilidade genômica e indução da apoptose. Desse modo podemos admitir que miR-100 tem um papel contraditório no câncer, podendo se comportar como um oncomiR ou como um tsmiR, o que o classificaria como um miRNA \"contexto dependente\". Demonstramos porém que miR-100 tem um papel oncogênico na linhagem T24 de carcinoma urotelial de alto grau de bexiga promovendo um aumento na proliferação e inibição da apoptose. Na linhagem PC3 também o papel oncogênico de miR-100 pode estar relacionado a inibição da apoptose. Dada a variação de ação dos miRNA nos diversos tecidos e estágios tumorais, a determinação do seu papel nos diversos tumores é fundamental pois existe a possibilidade de utiliza-los como marcadores diagnóstico, prognóstico e como alvos para terapias moleculares / Introduction: Prostate cancer (PC) is the most commonly diagnosed solid tumor in men today, and the sixth most frequent occurrence of new cases of malignancy in the world, being the second cause of death by cancer in men. Bladder cancer (BC) is the second most common malignancy and the second cause of death among genitourinary tumors. Globally BC is responsible for approximately 386.000 new cases and 150.000 deaths per year. The knowledge of cellular processes involved in carcinogenesis allows us to better understand the etiology and pathogenesis of these neoplasms, supporting thus more effectively, planning strategies for prevention and treatment. Micro RNAs (miRNA) are small non-coding RNA sequences that have a large role in the control of gene expression by inhibiting protein translation or promoting the degradation of messenger RNA (RNAm). The miRNA are currently involved in various physiological and pathological cellular processes, including cancer where they can act as oncogenes (oncomiR) or tumor suppressors (tsmiR). Previously we demonstrated that high levels of miR-100 are associated with biochemical recurrence after radical prostatectomy while in low-grade bladder urothelial carcinoma it is persistently underexpressed. Objective: The study aims to examine the role of miR-100 in the regulation of its supposed target genes SMARCA5, THAP2, BAZ2A, mTOR and FGFR3 in BC and PC cell lines and its relationship with proliferation, apoptosis and chromosomal instability. Material and Methods: The BC (RT4 and T24) and PC cell lines (DU145 and PC3) were transfected with pre-miR-100, antimiR-100 and their respective controls using liposomes. After transfection RNAm and protein levels of its supposed target genes were analyzed by quantitative real time polymerase chain reaction (qRT-PCR) and western blotting. Cell proliferation, apoptosis and DNA ploidy were analyzed by flow cytometry. Results: After transfection of pre-miR 100, there was a significant reduction in the RNAm expression of mTOR (p=0.006), SMARCA5 (p=0.007) and BAZ2A (p=0.03) in RT4, mTOR (p=0.02) and SMARCA5 (p=0.01) in T24, mTOR (p=0.025), THAP2 (p=0.04), SMARCA5 (p=0.001) and BAZ2A (p=0.005) in DU145 and mTOR (p=0.01) in PC3. There was a reduction in the expression of all proteins, variable from 22.5% to 69% in all cell lines. In T24 miR-100 promoted an increase in cell proliferation and antimiR-100 promoted apoptosis characterizing miR-100 as an oncomiR in this cell line representative of a right grade urothelial carcinoma. Also in PC3 antimiR-100 promoted an increase in apoptosis. Conclusions: We have shown that miR-100 controls the expression of gene and protein of its supposed target genes in PC and BC cell lines. mTOR and FGFR3 are proto-oncogenes related to the tumor development and progression, while BAZ2A, SMARCA5 and THAP2 are related to the DNA transcription regulation, chromossomic stability and apoptosis induction. We can conclude that miR-100 has a contradictory role in cancer, behaving as an oncomir or tsmiR depending the type and stage of a specific neoplasia, classifying it as a \"context depending\" miRNA. In T24 cell line however miR-100 acts as an oncomiR increasing cell proliferation and inhibiting apoptosis. In PC3 cell line miR-100 also acts as an oncomiR inhibiting apoptosis. Due to the variation of roles of miRNAs in different tissues and stage of tumors, the characterization of their role in neoplasm is very important because of the possibility to use them as diagnostic or prognostic markers, even as targets for the development of new drugs

No / BACKGROUND: Activating mutations of FGFR3 are frequently identified in superficial urothelial carcinoma (UC) and increased expression of FGFR1 and FGFR3 are common in both superficial and invasive UC. METHODS: The effects of inhibition of receptor activity by three small molecule inhibitors (PD173074, TKI-258 and SU5402) were investigated in a panel of bladder tumour cell lines with known FGFR expression levels and FGFR3 mutation status. RESULTS: All inhibitors prevented activation of FGFR3, and inhibited downstream MAPK pathway signalling. Response was related to FGFR3 and/or FGFR1 expression levels. Cell lines with the highest levels of FGFR expression showed the greatest response and little or no effect was measured in normal human urothelial cells or in UC cell lines with activating RAS gene mutations. In sensitive cell lines, the drugs induced cell cycle arrest and/or apoptosis. IC(50) values for PD173074 and TKI-258 were in the nanomolar concentration range compared with micromolar concentrations for SU5402. PD173074 showed the greatest effects in vitro and in vivo significantly delayed the growth of subcutaneous bladder tumour xenografts. CONCLUSION: These results indicate that inhibition of FGFR1 and wild-type or mutant FGFR3 may represent a useful therapeutic approach in patients with both non-muscle invasive and muscle invasive UC.

No / Radiotherapy is a major treatment modality used to treat muscle-invasive bladder cancer, with patient outcomes similar to surgery. However, radioresistance is a significant factor in treatment failure. Cell-free extracts of muscle-invasive bladder tumors are defective in nonhomologous end-joining (NHEJ), and this phenotype may be used clinically by combining radiotherapy with a radiosensitizing drug that targets homologous recombination, thereby sparing normal tissues with intact NHEJ. The response of the homologous recombination protein RAD51 to radiation is inhibited by the small-molecule tyrosine kinase inhibitor imatinib. Stable RT112 bladder cancer Ku knockdown (Ku80KD) cells were generated using short hairpin RNA technology to mimic the invasive tumor phenotype and also RAD51 knockdown (RAD51KD) cells to show imatinib's pathway selectivity. Ku80KD, RAD51KD, nonsilencing vector control, and parental RT112 cells were treated with radiation in combination with either imatinib or lapatinib, which inhibits NHEJ and cell survival assessed by clonogenic assay. Drug doses were chosen at approximately IC40 and IC10 (nontoxic) levels. Imatinib radiosensitized Ku80KD cells to a greater extent than RAD51KD or RT112 cells. In contrast, lapatinib radiosensitized RAD51KD and RT112 cells but not Ku80KD cells. Taken together, our findings suggest a new application for imatinib in concurrent use with radiotherapy to treat muscle-invasive bladder cancer. Cancer Res; 73(5); 1611-20. (c)2012 AACR.

No / We identify cytochrome P450 1A1 (CYP1A1) as a target for tumor-selective drug development in bladder cancer and describe the characterization of ICT2700, designed to be metabolized from a prodrug to a potent cytotoxin selectively by CYP1A1. Elevated CYP1A1 expression was shown in human bladder cancer relative to normal human tissues. RT112 bladder cancer cells, endogenously expressing CYP1A1, were selectively chemosensitive to ICT2700, whereas EJ138 bladder cells that do not express CYP1A1 were significantly less responsive. Introduction of CYP1A1 into EJ138 cells resulted in 75-fold increased chemosensitivity to ICT2700 relative to wild-type EJ138. Negligible chemosensitivity was observed in ICT2700 in EJ138 cells expressing CYP1A2 or with exposure of EJ138 cells to CYP1B1- or CYP3A4-generated metabolites of ICT2700. Chemosensitivity to ICT2700 was also negated in EJ138-CYP1A1 cells by the CYP1 inhibitor alpha-naphthoflavone. Furthermore, ICT2700 did not induce expression of the AhR-regulated CYP1 family, indicating that constitutive CYP1A1 expression is sufficient for activation of ICT2700. Consistent with the selective activity by CYP1A1 was a time and concentration-dependent increase in gamma-H2AX protein expression, indicative of DNA damage, associated with the activation of ICT2700 in RT112 but not EJ138 cells. In mice-bearing CYP1A1-positive and negative isogenic tumors, ICT2700 administration resulted in an antitumor response only in the CYP1A1-expressing tumor model. This antitumor response was associated with detection of the CYP1A1-activated metabolite in tumors but not in the liver. Our findings support the further development of ICT2700 as a tumor-selective treatment for human bladder cancers.

No / Fibroblast growth factor receptors (FGFR) play key roles in proliferation, differentiation, and tumorigenesis. Many urothelial carcinomas contain activating point mutations or increased expression of FGFR3. However, little is known about the role of other FGFRs. We examined FGFR expression in telomerase-immortalized normal human urothelial cells, urothelial carcinoma cell lines, and tumor samples and showed that FGFR1 expression is increased in a high proportion of cell lines and tumors independent of stage and grade. To determine the role of FGFR1 in low-stage bladder cancer, we overexpressed FGFR1 in telomerase-immortalized normal human urothelial cells and examined changes in proliferation and cell survival in response to FGF2. FGFR1 stimulation increased proliferation and reduced apoptosis. To elucidate the mechanistic basis for these alterations, we examined the signaling cascades activated by FGFR1. FRS2alpha and PLCgamma were activated in response to FGF2, leading to activation of the mitogen-activated protein kinase pathway. The level of mitogen-activated protein kinase activation correlated with the level of cyclin D1, MCL1, and phospho-BAD, which also correlated with FGFR-induced proliferation and survival. Knockdown of FGFR1 in urothelial carcinoma cell lines revealed differential FGFR1 dependence. JMSU1 cells were dependent on FGFR1 expression for survival but three other cell lines were not. Two cell lines (JMSU1 and UMUC3) were dependent on FGFR1 for growth in soft agar. Only one of the cell lines tested (UMUC3) was frankly tumorigenic; here, FGFR1 knockdown inhibited tumor growth. Our results indicate that FGFR1 has significant effects on urothelial cell phenotype and may represent a useful therapeutic target in some cases of urothelial carcinoma.

This thesis addresses the three principal questions concerning the development of CT urography for investigating haematuria and each question is the subject of a separate chapter. The questions are: What is the reasoning behind using CT urography? What is the optimum diagnostic strategy using CT urography? What are the problems with using CT urography and how may solutions be provided? Haematuria can signify serious disease such as urinary tract stones, renal cell cancer, upper tract urothelial cancer (UTUC) and bladder cancer (BCa). CT urography is defined as contrast enhanced CT examination of kidneys, ureters and bladder. The technique used here includes unenhanced, nephrographic and excretory-phases for optimized diagnosis of stones, renal masses and urothelial cancer respectively. The reasoning behind using excretory-phase CT urography for investigating haematuria is based on results showing its high diagnostic accuracy for UTUC and BCa. Patients with haematuria are classified as low risk or high risk for UTUC and BCa, by a risk score, determined by the presence/absence of risk factors: age > 50 years, visible or nonvisible haematuria, history of smoking and occupational exposure. The optimum diagnostic strategy for patients at high risk for urothelial cancer, uses CT urography as a replacement test for ultrasonography and intravenous urography and as a triage test for flexible and rigid cystoscopy, resulting in earlier diagnosis and potentially improving prognosis. For patients at low risk, ultrasonography, unenhanced and nephrographic-phase CT urography are proposed as initial imaging tests. Problems with using CT urography include false positive results for UTUC, which are eliminated by retrograde ureteropyelography-guided biopsy, an innovative technique, for histopathological confirmation of diagnosis. Recommendations for the NHS and possible future developments are discussed. CT urography, including excretory-phase imaging, is recommended as the initial diagnostic imaging test before cystoscopy for patients with haematuria at high risk for urothelial cancer.