University of Macau / Institute of Chinese Medical Sciences

University of Macau / Institute of Chinese Medical Sciences

The impact of the increasing incidence of thyroid cancer presents an interesting case study in public health policy and resource allocation. During the last three decades, thyroid cancer cases have increased by more than 400%. As an illness that affects the lives of hundreds of thousands each year, the human and economic costs will be magnified in the next decade. It is estimated that approximately 13-67% of people will have thyroid nodules during their life of which approximately 5% will be malignant. The standard treatment, a thyroidectomy frequently followed by radioactive 131 iodine treatment, accordingly would seem to be a likely future event for an increasing percentage of the population. Despite the magnitude of the increase, there has been no increase in age-adjusted mortality rates. This raises the question whether treatment is effective or warranted for many of these patients. Although there is almost no reliable data on its economic impact, its prevalence makes it likely that it is becoming one of the more expensive diseases in our health care system. Despite the pressing issue of its growth, thyroid cancer is one of the least studied and least funded cancers in the United States.

This thesis reports new gold nanoparticle-based methods to treat chemotherapy-resistant and metastatic tumors that frequently evade conventional cancer therapies. Gold nanoparticles represent an innovative generation of diagnostic and treatment agents due to the ease with which they can be tuned to scatter or absorb a chosen wavelength of light. One area of intensive investigation in recent years is gold nanoparticle photothermal therapy (PTT), in which gold nanoparticles are used to heat and destroy cancer. This work demonstrates the utility of gold nanoparticle PTT against two categories of cancer that are currently a clinical challenge: trastuzumab-resistant breast cancer and metastatic cancer. In addition, this thesis presents a new method of gold nanoparticle delivery using T cells that increases gold nanoparticle tumor accumulation efficiency, a current challenge in the field of PTT. I ablated trastuzumab-resistant breast cancer in vitro for the first time using anti-HER2 labeled silica-gold nanoshells, demonstrating the potential utility of PTT against chemotherapy-resistant cancers. I next established for the first time the use of T cells as gold nanoparticle vehicles in vivo. When incubated with gold nanoparticles in culture, T cells can internalize up to 15000 nanoparticles per cell with no detrimental effects to T cell viability or function (e.g. migration and cytokine secretion). These AuNP-T cells can be systemically administered to tumor-bearing mice and deliver gold nanoparticles four times more efficiently than by injecting free nanoparticles. In addition, the biodistribution of AuNP-T cells correlates with the normal biodistribution of T cell carrier, suggesting the gold nanoparticle biodistribution can be modulated through the choice of nanoparticle vehicle. Finally, I apply gold nanoparticle PTT as an adjuvant treatment for T cell adoptive transfer immunotherapy (Hyperthermia-Enhanced Immunotherapy or HIT) of distant tumors in a melanoma mouse model. The results presented in this thesis expand the potential of gold nanoparticle PTT from only chemotherapy-sensitive or localized cancers to chemotherapy-resistant non-localized cancers that currently defy conventional therapies.

Growing interest in biomedical applications of nonthermal plasmas inspires the development of new plasmas sources. Dielectric barrier (DBD) and corona discharges produced in ambient air or in noble gas flow are typically applied. Direct production of plasma in liquids has a great potential for sterilization of liquid substances and extracorporeal blood treatment. The physical mechanisms of discharge formation in liquid medium are not fully understood.The first part of this thesis deals with the initiation and development of the nanosecond discharge in liquid dielectrics (deionized water, ethanol and n-pentane). Time-resolved shadowgraph visualization, optical emission spectroscopy and electrical diagnostics are applied to investigate the discharge formation on point anode.We have shown that depending on the applied voltage amplitude three different scenario can occur in the polar dielectric, namely, cavitation of a bubble, discharge development in the gaseous cavity (bush-like mode) and initiation of the filamentary discharge (tree-like mode) propagating in bulk liquid. Formation of the bush-like and the tree-like discharges is governed by distinct physical mechanisms, resulting in strongly different plasma parameters.In the second part of this work we address the question of how cold atmospheric plasma interacts with living cells in-vitro and in-vivo, and what is the mechanism of plasma induced cell death. Flowcytometry based cell viability assay with two markers AnnexinV (AV) and Propidium iodide (PI), demonstrates a dose dependent induction of the apoptosis for human T lymphocyte (Jurkat) and epithelial (HMEC) cells treated with DBD plasma. In nude mice model, induction of apoptosis and necrosis in dose dependant manner is observed by electron microscopy in thin epidermis sections. Histological analysis shows significant lesions appeared in epidermis, dermis, hypodermis and muscle as a function of treatment duration. Production of hydrogen peroxide in culture medium (PBS) exposed to DBD plasma is measured using selective fluorescent probe (Amplex® Red). Cell viability of human thyroid epithelial (HTori-3) and melanoma (1205Lu) cells demonstrates nonmonotonous dependence on H2O2 concentration. The major role of plasma produced hydrogen peroxide and DBD electric field is suggested.

[Truncated abstract] In recent years a better understanding of the biology of PPAR , a nuclear transcription factor, has emerged, leading to a resurgence in targeting PPAR for chemotherapy. The family of synthetic PPAR agonists, the thiazolidinediones (TZDs), and non-steroidal anti-inflammatory drugs (NSAIDs) have been implicated in the inhibition of cell proliferation, apoptosis and cell cycle arrest of androgen-sensitive (LNCaP) and androgen-independent (PC-3 and DU145) prostate cancer cells generating much interest in their use for potential curative cancer therapies. In light of the potential use of TZDs and NSAIDs in prostate cancer prevention and their ability to induce inhibitory effects in vitro and in vivo, the first aim of this project was to undertake a comprehensive study of the effects of ciglitazone (TZD) and indomethacin (NSAID) on the androgen-independent prostate cancer cell line DU145, using standardised concentrations and time-points to compare the effects of TZDs and NSAIDs on cell proliferation, cell cycle and apoptosis. Treating the cells with either 10 µM ciglitazone or 10 µM indomethacin resulted in a time-dependent decrease in DU145 cell proliferation. The anti-proliferative effects were found to be in-part attributed to the slowing of cell progression through the G1/S-phase checkpoint of the cell cycle, and in the case of ciglitazone, apoptosis also played a role in its anti-proliferative effects in this cell line. Interestingly, although indomethacin failed to induce apoptosis, its antiproliferative effects were more potent than ciglitazone. The second aim of this project was to further investigate the underlying mechanisms responsible for the anti-proliferative effects of ciglitazone and indomethacin by evaluating their ability to modulate PPAR mRNA and protein expression, and to induce PPAR transcriptional activity. ... In addition, ligandinduced regulation of secreted frizzled related protein 4 (sFRP4) expression, a Wnt/ - catenin antagonists, was investigated. It was demonstrated that both ciglitazone and indomethacin attenuated Wnt/ -catenin signalling via the down-regulation of total - catenin levels within the cells, inhibition or slowing of the translocation of cytoplasmic -catenin into the nucleus and inhibition of cyclin–D1 expression An inverse relationship between PPAR and -catenin protein levels was also detected, suggesting that PPAR may directly bind to -catenin itself. sFRP4 expression was transiently upregulated by ciglitazone and indomethacin-treatment, suggesting that the antiproliferative effects of the ligands may be mediated in part through regulation of sFRP4 mRNA and protein levels. In summary, the anti-proliferative effects of ciglitazone and indomethacin on the androgen-independent prostate cancer cell line, DU145, described in this thesis are progressive steps in characterising the role of PPAR in prostate cancer cell proliferation. The identification of indomethacin as a more potent PPAR agonist than ciglitazone represents a novel target for the development of preventative strategies for advanced disease, and the relationship between PPAR and the Wnt/ -catenin signalling pathway provide an insight into the mechanisms involved in the anti-proliferative effects of ciglitazone and indomethacin. Further studies into this relationship would advance help identify novel preventative and curative therapeutic strategies for advanced prostate cancer.

[Truncated abstract] Ovarian cancer is currently the leading cause of death from gynaecological malignancies in women from developed countries. Serous ovarian cancer is the most prevalent type of all ovarian cancers, with the majority diagnosed in an advanced stage where treatment efficacy is reduced and patient survival is poor. Because of this fact, the development of improved detection and treatment strategies are necessary, with much research focussing on the complex molecular pathways involved in ovarian tumour growth as one potential avenue for intervention. Apoptosis, or programmed cell death, is one such area of investigation because currently successful cancer treatments induce apoptosis in tumour cells. Molecular analysis of apoptosis in both normal tissue and tumours has established a positive relationship between increased expression of secreted frizzled-related protein 4 (SFRP4) and apoptosis, however to date, very little research has focussed on the role of this gene in the ovary . . . An examination of SFRP4 and β-catenin expression in 163 primary serous ovarian carcinomas revealed high SFRP4 expression was associated with low β-catenin expression and conversely, low SFRP4 was associated with high β-catenin expression in the majority of the ovarian tumours analysed, reinforcing the inverse relationship observed in the ovarian cell lines. A positive trend was observed between cancer stage and the expression level of these proteins, with increased SFRP4 expression and reduced β-catenin expression as cancer stage increased. Additionally, patient survival revealed a trend towards increased survival among ovarian cancer patients who had tumours expressing low levels of SFRP4. Taken together, the novel findings of this study indicate that the increased expression of SFRP4 observed in a large proportion of serous ovarian cancers is a cellular response to down-regulate the level of β-catenin, and thus an attempt to maintain cellular homeostasis by counteracting the excessive proliferating signals present in these tumour cells.

[Truncated abstract] Previous studies in the field of tumour immunology had identified regulatory T (Treg) cells as important suppressors of the anti-tumour immune response as the presence of Treg cells in the peripheral blood of cancer patients was correlated with worse disease outcomes. Other studies had identified Treg cells to be active at sites of immune regulation such as the gut of colitis patients. It was therefore hypothesised that Treg cells would be present and active within tumours to suppress the cellular antitumour immune response. ... This treatment targeting multiple pathways of Treg cell mediated immuno-suppression and resulted in tumour regression in 50% of treated animals. Finally, the anti-tumour immune response is complex and a potentially synergistic multi-modality treatment designed to inactivate intra-tumoural Treg cells but to also induce apoptosis in tumour cells themselves was investigated. Alpha-tocopheryl succinate (α-TOS), an analogue of vitamin E, had previously been shown to induce apoptosis in human MM xenografts implanted into immuno-deficient (nude) mice. Administration of α-TOS was therefore examined as a potentially synergistic treatment to be coupled with Treg cell inactivation. At the previously published doses used to treat immuno-deficient mice, α-TOS was found to be toxic to the immuno-competent mice used in this study. A marked depleting effect on total T cells was seen in the treated animals. The results of this thesis demonstrated the high potential for an adjunct immunotherapy of MM. They did however also highlight the importance of future studies into anticancer therapies to be conducted using clinically relevant tumour models and clinically relevant treatment regimes. The need to consider synergistic multi-modal therapies was also emphasised.

[Truncated abstract] Hepatocellular carcinoma (HCC) is the major malignancy complicating chronic liver disease. New therapies for the prevention of HCC are required due to the limited success and high tumour recurrence rates of existing treatments. Emerging evidence suggests that HCC arise from the transformation of adult liver progenitor cells (LPCs), which have the capacity to differentiate into hepatocytes and biliary cells during liver regeneration. LPC activation precedes neoplasia in experimental hepatocarcinogenesis. LPCs share antigenic epitopes with HCCs, including α-fetoprotein (AFP) and M2- pyruvate kinase (M2PK). In animal models of hepatocarcinogenesis, attenuation of the LPC response reduces the incidence of HCC following prolonged liver injury via a tumour necrosis factor (TNF) dependent mechanism. As TNF is a pro-inflammatory cytokine, these data suggest that anti-inflammatory agents may be effective in inhibiting LPC activation and hepatocarcinogenesis. Cyclo-oxygenase-2 (COX-2) is an inducible enzyme that mediates the production of many prostaglandins during inflammation and carcinogenesis. Recent investigations show that the administration of selective COX-2 inhibitors (SC2Is) may reduce the incidence of a variety of tumours including breast, colon and skin. The broad aim of this thesis was to conduct a series of detailed studies on the effects of a SC2I on LPC activation and the hepatic pathologies associated with hepatocarcinogenesis in order to test the hypothesis that S2CIs may be a beneficial therapy that can reduce liver injury and pre-neoplastic changes in the choline-deficient, ethionine supplemented (CDE) murine model of hepatocarcinogenesis. Administration of a SC2I (SC-236) significantly inhibited a variety of hepatic cell populations that expand during the first month of the CDE mouse model of hepatocarcinogenesis (a choline deficient, ethionine supplemented diet). Numbers of M2PK-positive LPCs (which are more hepatocytic in morphology and are also COX-2 positive) and inflammatory cells were all significantly reduced by SC-236. In contrast, numbers of A6-positive LPCs (which are more biliary cell-like in morphology and do not express COX-2) were unchanged. ... In summary, these data suggest that COX-2 inhibitors such as SC-236 inhibit LPC activation and a variety of pre-neoplastic liver pathologies as a result of COX-2 dependent and independent mechanisms that may be mediated through inhibition of Akt phosphorylation and induction of apoptosis. Moreover, SC2Is may be useful as preventative treatment strategies for HCC in patients with chronic liver disease.

Esta pesquisa apresenta e compara medidas de doses pediátricas periféricas em radioterapia, em regiões de tireóide, coração, mama, abdome, medial de ovários e testículos. Tais doses foram obtidas com TLDs de LiF:Mg,Ti (TLD-100) em pó, posicionados em três objetos simuladores humanóides com tamanhos de crianças de dois, cinco e dez anos, feitos de polietileno de alta densidade e completamente preenchidos com água. Foi empregado um acelerador linear Varian Clinac 600CD para irradiar a cabeça dos três objetos simuladores, com feixes de Raios X produzidos com potencial de 6 MV, com três diferentes planejamentos craniais: (a) IMRT sliding window com o colimador multifolhas rotacionado em 0º, (b) IMRT sliding window com o colimador multifolhas rotacionado em 90º e (c) planejamento conformal (3D). As doses aplicadas foram de 300 cGy e 600 cGy com cinco campos coplanares para todos os planejamentos. Como resultado deste trabalho observa-se que as doses obtidas para todas as irradiações são muito baixas, quando comparadas aos valores de doses determinísticas para as regiões de maior interesse em proteção radiológica e que IMRT 90º proporciona maior blindagem para a radiação de fuga que se direcionaria para o corpo do paciente, oferecendo vantagens quando comparado com os planejamentos conformal e IMRT 0º. / This research presents and compares peripheral pediatric doses measurements in radiation therapy, for of thyroid, heart, breast, abdomen, ovaries and testicles regions, obtained with TLD LiF: Mg, Ti (TLD-100) powder, placed on three humanoid phantoms with sizes of children as two, five and ten years old, made of high density polyethylene and completely filled with water. It at linear accelerator Varian Clinac 600CD was employed to irradiate the heads of the three phantoms, with X-rays beams generated by a potential of 6 MV, with three different skull plannings: (a) IMRT sliding window with multileaf collimator rotated 0°, (b) IMRT sliding window with the multileaf collimator rotated 90° and (c) conformal planning (3D). The doses applied were 300 cGy and 600 cGy with five coplanar fields for all cares planning. The results show that the doses obtained for the all irradiations are very low compared to deterministic dose values deterministic for the regions of greater interest in radiological protection and that IMRT 90º provides more shielding for leakage radiation which would be directed to patient's body, offering advantages when compared to conformal planning and IMRT 0º.