Resumo: O carcinoma de esôfago apresenta um modelo de progressão tumoral a partir da seqüência esofagite, atrofia, displasia, carcinoma in situ e carcinoma invasivo, com algumas alterações genéticas bem estabelecidas nos estágios iniciais e avançados da carcinogênese.Contudo em lesões benignas precursoras como o megaesôfago e esofagite crônica os estudos genéticos são escassos. Portanto, com o objetivo de identificar o envolvimento de algumas proteínas que participam da regulação do ciclo celular e apoptose, no presente estudo foi avaliada a expressão das proteínas p53, p16, Fhit, caspase-3 e do antígeno Ki67, por imuno-histoquímica. Foram utilizados cortes histológicas de mucosa de pacientes chagásicos crônicos sem (CD) e com megaesôfago (CM), este último grupo por apresentar maior risco de desenvolvimento de carcinoma esofágico, e pacientes com esofagite crônica (CE), devido à relação entre o processo inflamatório e carcinogênese. Estas amostras foram comparadas com carcinoma de células escamosas de esôfago (ESCC) e mucosa esofágica histologicamente normal (NM). Também se avaliou a ocorrência de concordâncias utilizando o Teste Kappa, entre os casos com a expressão alterada das proteínas nos diferentes grupos, assim como a ocorrência de associações, entre padrões alterados de expressão das proteínas com sexo, idade, hábitos tabagistas e etilistas. Outro objetivo do estudo foi avaliar o padrão de perdas e ganhos cromossômicos de genes freqüentemente descritos como relacionados com a carcinogênese esofágica, FHIT, TP63, PIK3CA, EGFR, FGFR1, MYC, CDKN2A, YES1, NCOA3, e centrômeros 3, 7 e 9, como controles, por FISH. A avaliação imuno-histoquímica revelou que a proporção de casos positivos para a proteína p53 aumentou progressivamente de acordo com a severidade da lesão, CD (7,7%), CM (26,1%), CE (52,2%) and ESCC (100%)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Esophagus carcinoma presents a tumor progression model from the sequence esophagitis, atrophy, dysplasia, carcinoma in situ and invasive carcinoma, with some well-established genetic changes in early and advanced stages of carcinogenesis. In benign precursor lesions such as megaesophagus and chronic esophagitis genetic studies are scarce. Therefore, to identify the involvement of certain cell cycle and apoptosis regulatory proteins, the present study evaluated the expression of p53, p16, Fhit, caspase-3 and Ki67 antigen by immunohistochemistry. Histological sections of esophageal mucosa were obtained from chronic chagasic patients without (CD) and megaesophagus (CM), the latter group presents higher risk of developing esophageal cancer, and patients with chronic esophagitis (CE), because the relationship between the inflammatory process and carcinogenesis. These samples were compared with squamous cell carcinoma of the esophagus (ESCC) and histologically normal esophageal mucosa (NM). It also assessed the occurrence of agreement using the Kappa test, among the cases with altered expression of proteins in different groups as well as the occurrence of associations, and altered patterns of protein expression with sex, age, smoking and alcohol habits. Another aim of the study was to evaluate the pattern of chromosomal gains and losses of genes frequently described as related to esophageal carcinogenesis, FHIT, TP63, PIK3CA, EGFR, FGFR1, MYC, CDKN2A, YES1, NCOA3 and centromere 3, 7 and 9, as controls for FISH. The immunohistochemical evaluation showed that the proportion of cases positive for p53 protein increased progressively according to the severity of the injury, CD (7.7%), CM (26.1%), CE (52.2%) and ESCC (100%). However, the proteins p16 and Fhit showed no statistically significant differences between groups, but also in CE was observed a greater number... (Complete abstract click electronic access below) / Orientador: Ana Elizabete Silva / Coorientador: Marileila Varella-Garcia / Banca: Juliana Karina Ruiz Heinrich / Banca: Agnes Cristina Fett Conte / Banca: Silvia Regina Rogatto / Banca: Paula Rahal / Doutor

Made available in DSpace on 2014-06-11T19:32:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T19:42:42Z : No. of bitstreams: 1 bellini_mf_dr_sjrp.pdf: 4712849 bytes, checksum: eaed69017a355062338fd2f384e1c381 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O carcinoma de esôfago apresenta um modelo de progressão tumoral a partir da seqüência esofagite, atrofia, displasia, carcinoma in situ e carcinoma invasivo, com algumas alterações genéticas bem estabelecidas nos estágios iniciais e avançados da carcinogênese.Contudo em lesões benignas precursoras como o megaesôfago e esofagite crônica os estudos genéticos são escassos. Portanto, com o objetivo de identificar o envolvimento de algumas proteínas que participam da regulação do ciclo celular e apoptose, no presente estudo foi avaliada a expressão das proteínas p53, p16, Fhit, caspase-3 e do antígeno Ki67, por imuno-histoquímica. Foram utilizados cortes histológicas de mucosa de pacientes chagásicos crônicos sem (CD) e com megaesôfago (CM), este último grupo por apresentar maior risco de desenvolvimento de carcinoma esofágico, e pacientes com esofagite crônica (CE), devido à relação entre o processo inflamatório e carcinogênese. Estas amostras foram comparadas com carcinoma de células escamosas de esôfago (ESCC) e mucosa esofágica histologicamente normal (NM). Também se avaliou a ocorrência de concordâncias utilizando o Teste Kappa, entre os casos com a expressão alterada das proteínas nos diferentes grupos, assim como a ocorrência de associações, entre padrões alterados de expressão das proteínas com sexo, idade, hábitos tabagistas e etilistas. Outro objetivo do estudo foi avaliar o padrão de perdas e ganhos cromossômicos de genes freqüentemente descritos como relacionados com a carcinogênese esofágica, FHIT, TP63, PIK3CA, EGFR, FGFR1, MYC, CDKN2A, YES1, NCOA3, e centrômeros 3, 7 e 9, como controles, por FISH. A avaliação imuno-histoquímica revelou que a proporção de casos positivos para a proteína p53 aumentou progressivamente de acordo com a severidade da lesão, CD (7,7%), CM (26,1%), CE (52,2%) and ESCC (100%)... / Esophagus carcinoma presents a tumor progression model from the sequence esophagitis, atrophy, dysplasia, carcinoma in situ and invasive carcinoma, with some well-established genetic changes in early and advanced stages of carcinogenesis. In benign precursor lesions such as megaesophagus and chronic esophagitis genetic studies are scarce. Therefore, to identify the involvement of certain cell cycle and apoptosis regulatory proteins, the present study evaluated the expression of p53, p16, Fhit, caspase-3 and Ki67 antigen by immunohistochemistry. Histological sections of esophageal mucosa were obtained from chronic chagasic patients without (CD) and megaesophagus (CM), the latter group presents higher risk of developing esophageal cancer, and patients with chronic esophagitis (CE), because the relationship between the inflammatory process and carcinogenesis. These samples were compared with squamous cell carcinoma of the esophagus (ESCC) and histologically normal esophageal mucosa (NM). It also assessed the occurrence of agreement using the Kappa test, among the cases with altered expression of proteins in different groups as well as the occurrence of associations, and altered patterns of protein expression with sex, age, smoking and alcohol habits. Another aim of the study was to evaluate the pattern of chromosomal gains and losses of genes frequently described as related to esophageal carcinogenesis, FHIT, TP63, PIK3CA, EGFR, FGFR1, MYC, CDKN2A, YES1, NCOA3 and centromere 3, 7 and 9, as controls for FISH. The immunohistochemical evaluation showed that the proportion of cases positive for p53 protein increased progressively according to the severity of the injury, CD (7.7%), CM (26.1%), CE (52.2%) and ESCC (100%). However, the proteins p16 and Fhit showed no statistically significant differences between groups, but also in CE was observed a greater number... (Complete abstract click electronic access below)

Abstract Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers, the 5-year survival rate being less than 5%. At the time of diagnosis, 90% of PDACs extend beyond the pancreas and distant metastases are often present. Due to aggressive growth, local expansion and early appearance of metastasis, primary PDAC tumours are local enough for curative surgical resection in only 10–20% of the cases. Adjuvant chemotherapy is indicated in these curative-treated cases, with slight improvement in survival. PDAC is considered to represent a heterogeneous group of biologically and prognostically different malignancies. Characterization of these subgroups is essential and there is an urgent need for more accurate biomarkers and targeted treatments in PDAC. In the current work, we immunohistochemically investigated the expression levels and prognostic values of oxidative stress markers (8-OHdG, Keap1, Prx I, II, III, V and VI), epigenetic histone modifiers (KDM4A, KDM4B, KDM4D and SIRT1–4), and cell-cycle regulators (p16, Rb, CDK4) and DNA-repair enzymes (FEN1 and MGMT) in the cohort of surgically treated PDAC patients. We found that Keap1 expression was associated with better pancreatic cancer-specific survival. Expression of antioxidative peroxiredoxins I, III, V and VI was also connected with a more favourable tumour characteristics and Prx I and VI showed prognostic value. When considering the biology of PDAC, we noticed that pivotal epigenetic regulation also occurred in exocrine pancreatic tissue adjacent to resection margins. Overexpression of the cell-cycle regulator CDK4 and the DNA-repair enzyme FEN1 in the whole population, and elevated expression level of MGMT in the most high-risk patients were connected with worse prognosis. The results of the study can be utilized in the future when individualized therapies are being designed for PDAC patients. Due to occurrence of the epigenetic regulation also in exocrine pancreatic tissue adjacent to resection margins, it could be evaluated in future for routine diagnostics and treatment optimization. The potential role of MGMT in the development of PDAC chemoresistance should be studied in the future. / Tiivistelmä Haiman duktaalinen adenokarsinooma (PDAC) on yksi aggressiivisimmista syöpäsairauksista. Viiden vuoden elossaoloennuste on vain lähellä 5 prosenttia. Diagnoosihetkellä 90% haiman adenokarsinoomista yltää haiman ulkopuolelle ja usein kasvain on jo lähettänyt etäpesäkkeitä. Kasvutaipumuksen sekä metastasoinnin takia kuratiivinen kirurginen hoito on mahdollista vain 10–20% tapauksista. Liitännäissolunsalpaajahoito on aiheellista näissä kuratiivistavoitteisesti hoidetuissa tapauksissa. Kuitenkin vaikutus kokonaiselossaoloaikaan on melko vähäinen. Uusimman tutkimustiedon valossa PDAC:aa pidetäänkin heterogeenisenä ryhmänä biologisesti ja ennusteellisesti erilaisia tautiryhmiä. Näiden tautiryhmien tunteminen ja tunnistaminen riittävän tarkkojen merkkiaineiden avulla olisi ensiarvoisen tärkeää, jotta hoitoja voitaisiin kohdentaa niistä hyötyville potilaille. Väitöskirjatutkimuksessa selvitimme immunohistokemiallisin menetelmin oksidatiivisen stressin merkkiaineiden (8-OHdG, Keap1, Prx I, II, III, V ja VI), epigeneettisten histonimodifikaattorien (KDM4A, KDM4B, KDM4D ja SIRT1–4) sekä solusyklin säätelijöiden (p16, Rb, CDK4) ja DNA-korjausentsyymien (FEN1 ja MGMT) ilmentymistä ja ennusteellista arvoa kirurgisesti hoidetuilla PDAC-potilailla. Tutkimuksessamme totesimme, että kasvainkudoksen Keap1-ilmentymä yhdistyi parempiennusteiseen taudinkuvaan. Antioksidatiivisten peroksiredoksiinien I, III, V ja VI ilmentyminen yhdistyi niin ikään suotuisampaan kasvaimen fenotyyppiin ja Prx I ja VI osoittivat ennusteellista arvoa. Havaitsimme lisäksi, että PDAC:n biologiaan keskeistesti vaikuttavaa epigeneettistä säätelyä tapahtuu myös malignin haimakudoksen viereisessä eksokriinisessä haimakudoksessa. Solusyklin säätelijä CDK4:n ja DNA-korjausentsyymi FEN1:n voimakas ilmentyminen koko tutkimuspopulaatiossa sekä kohonnut MGMT:n ilmentyminen korkeimman riskin potilailla yhdistyivät huonompaan taudin ennusteeseen. Väitöskirjatyön tutkimustuloksia voidaan tulevaisuudessa hyödyntää, kun tutkitaan yksilöllisiä hoitomuotoja PDAC-potilailla. Koska epigeneettistä säätelyä tapahtuu myös syövän viereisessä eksokriinisessa haimakudoksessa, voidaan tulevaisuudessa tämän kudoksen arviointia mahdollisesti käyttää rutiinisti diagnostiikassa sekä hoidon optimoinnissa. MGMT:n mahdollinen rooli PDAC:n kemoresistenssin kehittymisessä tulisi tulevaisuudessa selvittää.