In an experiment to understand colon carcinogenesis, all animals were exposed to a carcinogen while half the animals were also exposed to radiation. Spatially, we measured the existence of aberrant crypt foci (ACF), namely morphologically changed colonic crypts that are known to be precursors of colon cancer development. The biological question of interest is whether the locations of these ACFs are spatially correlated: if so, this indicates that damage to the colon due to carcinogens and radiation is localized. Statistically, the data take the form of binary outcomes (corresponding to the existence of an ACF) on a regular grid. We develop score??type methods based upon the Matern and conditionally autoregression (CAR) correlation models to test for the spatial correlation in such data, while allowing for nonstationarity. Because of a technical peculiarity of the score??type test, we also develop robust versions of the method. The methods are compared to a generalization of Moran??s test for continuous outcomes, and are shown via simulation to have the potential for increased power. When applied to our data, the methods indicate the existence of spatial correlation, and hence indicate localization of damage. Assuming that there are correlations in the locations of the ACF, the questions are how great are these correlations, and whether the correlation structures di?er when an animal is exposed to radiation. To understand the extent of the correlation, we cast the problem as a spatial binary regression, where binary responses arise from an underlying Gaussian latent process. We model these marginal probabilities of ACF semiparametrically, using ?xed-knot penalized regression splines and single-index models. We ?t the models using pairwise pseudolikelihood methods. Assuming that the underlying latent process is strongly mixing, known to be the case for many Gaussian processes, we prove asymptotic normality of the methods. The penalized regression splines have penalty parameters that must converge to zero asymptotically: we derive rates for these parameters that do and do not lead to an asymptotic bias, and we derive the optimal rate of convergence for them. Finally, we apply the methods to the data from our experiment.

Colon cancer is one of the most commonly diagnosed cancers in the US, yet small intestine cancer is a rare event. While there are many similarities between these two tissues, inherent differences such as redox status, may contribute to the variation in cancer occurrence. We examined the difference in reactive oxygen species (ROS) generation, antioxidant enzyme activity and oxidative DNA damage in the small and large intestine of rats under normal conditions and following exposure to exogenous oxidative stress. Basal ROS and antioxidant enzyme activities were greater in the colon than the small intestine, and the balance of ROS to antioxidant enzymes in the colon was more pro-oxidant than in the small intestine. During oxidative stress, ROS and oxidative DNA damage were greater in the colon than the small intestine. Thus the colon responds to oxidative stress less effectively than the small intestine, possibly contributing to increased cancer incidence at this site. We next wanted to understand how diets containing a combination of fish or corn oil and pectin or cellulose may alter the redox environment of the colon. ROS, oxidative DNA damage, antioxidant enzyme activity and apoptosis were measured in colonocytes of rats fed one of four diets containing either corn oil or fish oil and cellulose or pectin. Measurements were madein rats untreated with carcinogen and rats exposed to a chemical carcinogen and radiation. In rats not treated with a carcinogen, fish oil enhanced ROS, and fish oil/pectin suppressed antioxidant enzymes as compared to corn oil/cellulose. Oxidative DNA damage was inversely related to ROS in the fish oil/pectin diet and apoptosis was enhanced relative to other diets. In carcinogen treated and irradiated rats, a similar protective effect was seen with fish oil/pectin as evidenced by a reduction in oxidative DNA damage and enhancement of apoptosis. This suggests that a diet containing fish oil/pectin may protect against colon carcinogenesis by modulation of the redox environment to promote apoptosis and minimize oxidative DNA damage.

Ο καρκίνος του παχέος εντέρου αποτελεί αναμφισβήτητα ένα παγκόσμιο πρόβλημα, όντας η δεύτερη αιτία θανάτου από καρκίνο. Τα γεγονότα που οδηγούν σε καρκίνο του παχέος εντέρου ακολουθούν στις περισσότερες περιπτώσεις συγκεκριμένη αλληλουχία. Έτσι, ξεκινώντας από υπερπλαστικό επιθήλιο, εξελίσσεται σε αδένωμα/δυσπλασία, σε ενδοεπιθηλιακή νεοπλασία και καταλήγει σε καρκίνο. Κατά την εξέλιξη σε καρκίνο σημαντικές αλλαγές λαμβάνουν χώρα στη σύσταση και οργάνωση του εξωκυττάριου χώρου του εντερικού τοιχώματος. Για το λόγο αυτό απαιτείται μελέτη του μεταβολισμού των εξωκυττάριων μακρομοριακών συστατικών, με στόχο την κατανόηση και διασαφήνιση της διηθητικής και μεταστατικής συμπεριφοράς των κακοήθων νεοπλασιών του παχέος εντέρου. Στην παρούσα εργασία κρίθηκε χρήσιμη η μελέτη των ενζύμων μεταβολισμού του υαλουρονικού οξέος (ΗΑ), συστατικό του εξωκυττάριου χώρου που φαίνεται να εμπλέκεται στο μηχανισμό της ανάπτυξης του όγκου, της διείσδυσης των καρκινικών κυττάρων και στη διάδοση των μεταστάσεων. Για τον παραπάνω λόγο μελετήθηκε η δραστικότητα των υαλουρονιδασών (Hyals) με ζυμογράφημα-ΗΑ, σε εκχυλίσματα ιστών και σε ορούς, και των συνθασών του ΗΑ (HAS-1, HAS-2) καθώς και του υποδοχέα του ΗΑ, CD44, με RT-PCR ανάλυση. Τα αποτελέσματα που προκύπτουν από το ζυμογράφημα-ΗΑ σε εκχυλίσματα ιστών συναινούν σε αυξημένη δραστικότητα των Hyals σε καρκινικά σε σύγκριση με τα μακροσκοπικώς φυσιολογικά δείγματα στην πλειονότητα των σταδίων, ενώ και οι δύο δραστικότητες είναι σημαντικά αυξημένες σε σχέση με τα δείγματα υγιών ιστών. Όσον αφορά τα δείγματα ορών, τα επίπεδα των Hyals φαίνεται να μειώνονται αισθητά 7 ημέρες μετεγχειρητικά σε σχέση με την ημέρα πριν την εγχείρηση, ενώ 1, 3 και 6 μήνες μετά εμφανίζεται και πάλι σταδιακή αύξηση των επιπέδων τους. Σε γονιδιακό επίπεδο, τα επίπεδα της HAS-1, HAS-2 και του CD44 εμφανίζονται αυξημένα στα καρκινικά δείγματα έναντι των μακροσκοπικώς φυσιολογικών. / Colon cancer is indisputably a great problem, being the second cause of death by cancer. The facts that lead to colon cancer have certain concatenation. Thereby, starting most of the times as hyperplastic epithelium, it develops to endoepithelium adenoma, and it finally leads to cancer. During this development important changes happen at the constitution and organization of the extracellular matrix of the intestinal tract. For this purpose, study of the metabolism of the extracellular matrix constituents is required, so as to understand the metastatic behaviour of the malignant tumors of colon cancer. The present study focuses on the metabolism enzymes of hyaluronic acid (HA), a constituent of the extracellular matrix that seems to be involved in the tumor growth mechanism, the infiltration of the cancerous cells and metastasis. Particularly, hyaluronidases (Hyals) activity (HA-zymography) and hyaluronan synthases (HAS-1, HAS-2) as well as hyaluronan receptors (CD44) expression (RT-PCR analysis) are studied at this study. The results of the study show increased Hyals levels in cancerous samples compared to the macroscopically normal ones, in all anatomic sites of colon examined, while both activities remain significantly increased compared to healthy samples.. as far as it concerns Hyals levels in sera, they seem to decrease perceptibly 7 days postoperatively, while 1, 3 and 6 months afterwards gradually increased to reach the amount preoperatively. In gene level, HAS-1, HAS-2 and CD44 expression levels were increased in cancerous samples compared to the macroscopically normal ones.

The objectives of our study were to determine the potential of 1H MRS in detecting (1) early colonic inflammation, (2) effects of various fatty acids on normal colon and (3) their effects on IBD. Sprague dawley rat fed with 2% carrageenan was used as a model of IBD. Flaxseed oil served as ω-3, corn oil as ω-6 and beef tallow as saturated fatty acid sources. Control group animals were fed 5% corn oil, whereas, those in high-fat diet groups received an additional 7% of the respective fatty acids. After 2 weeks, 1H MRS and histology were conducted on excised colonic mucosa. Statistical classification strategy (SCS) used for analyzing 1H MRS data achieved an accuracy of 82 % in stage 1, 90-100% in stage 2 and 96-100% in stage 3. This implies that 1H MRS is a sensitive tool to diagnose early IBD and the effects of dietary fat on IBD.

The objectives of our study were to determine the potential of 1H MRS in detecting (1) early colonic inflammation, (2) effects of various fatty acids on normal colon and (3) their effects on IBD. Sprague dawley rat fed with 2% carrageenan was used as a model of IBD. Flaxseed oil served as ω-3, corn oil as ω-6 and beef tallow as saturated fatty acid sources. Control group animals were fed 5% corn oil, whereas, those in high-fat diet groups received an additional 7% of the respective fatty acids. After 2 weeks, 1H MRS and histology were conducted on excised colonic mucosa. Statistical classification strategy (SCS) used for analyzing 1H MRS data achieved an accuracy of 82 % in stage 1, 90-100% in stage 2 and 96-100% in stage 3. This implies that 1H MRS is a sensitive tool to diagnose early IBD and the effects of dietary fat on IBD.

Colorectal cancer (CRC) remains a significant burden in contemporary society due to an aging population, unhealthy dietary choices and an increasingly sedentary lifestyle. While the underlying defects for many hereditary forms of CRC have been determined, many genetic and epigenetic changes promoting common sporadic CRCs have yet to be identified. The Mutated in Colorectal Cancer (MCC) gene, identified in 1991, was initially thought to be responsible for the hereditary form of CRC, familial adenomatous polyposis, before the discovery of the susceptibility gene Adenomatous Polyposis Coli (APC), which then became the focus of intense research. Recent data, however, suggests that MCC may also be important in the development of CRC. I have investigated the mechanism of MCC gene silencing, the putative structure, and multiple functions of MCC. MCC was frequently silenced by promoter hypermethylation in CRC cell lines and primary tumours. MCC methylation showed strong molecular and clinicopathological associations with hallmarks of the serrated neoplasia pathway. Furthermore, MCC methylation was more frequent in serrated precursor lesions compared with adenomas, thus occurring early during carcinogenesis. MCC is highly conserved in complex multicellular organisms. Re-introduction of MCC in CRC cell lines resulted in partial G1 to S phase, and G2/M phase cell cycle blocks, potentially by upregulating cell cycle inhibitor gene transcription and interfering with the process of mitotic checkpoints and division, respectively. Changes in MCC levels also modulated NF?B pathway signalling, the pathway required for maintaining cell viability and proliferation in colonic epithelial cells. In particular, MCC overexpression suppressed both TNF? and LPS-induced NF?B activation, decreasing both the magnitude and rate of cellular responses. Overexpression also resulted in downregulation of proteins involved in canonical NF?B pathway signalling, while increasing the transcription of non-canonical NF?B genes. Therefore, MCC may direct activation of this pathway to a specific subset of NF?B-regulated genes. These data provide a molecular basis for the role of MCC as a tumour suppressor gene in CRC. MCC may have multiple functions, regulating cell cycle progression and modulating NF?B pathway signalling, either through direct involvement in pathway signalling cascades, or by providing a scaffold on which signalling events can occur.

Les intégrines sont des cibles thérapeutiques pertinentes en oncologie. Dans cette thèse, nous avons exploré le rôle de l’intégrine α5β1 dans les gliomes et les tumeurs du colon. Nous nous sommes particulièrement focalisés sur la voie intégrine-protéine p53 et son implication dans la résistance aux thérapies. Dans les gliomes, l’intégrine α5β1 est surexprimée dans les glioblastomes et participe à un mauvais pronostic de survie des patients. Nous avons démontré que l’intégrine confère une résistance à la chimiothérapie par le Temozolomide en régulant négativement l’activité de la protéine suppresseur de tumeurs p53. L’activation directe de p53 par un agent non-génotoxique, la Nutlin-3a, entraine une inhibition de l’expression de l’intégrine suggérant ainsi une réaction croisée négative entre intégrine α5β1 et p53. L’association de la Nutlin-3a avec un antagoniste de l’intégrine α5β1 entraine une mort des cellules par apoptose. Nous avons confirmé l’existence d’une réaction croisée négative entre intégrine α5β1 et protéine p53 dans les tumeurs du colon où l’intégrine représente également une cible thérapeutique. / Integrins seem to be attractive anti-cancer targets. In this work we investigated the role of integrin α5β1 in glioma brain tumors and colon cancer. We were particularly interested in the role of integrin α5β1/p53 pathway in resistance to therapy. We first focused on gliomas and found that α5β1 integrin was overexpressed in aggressive malignant glioma tumors. Moreover, we showed that α5β1 integrin upregulation was associated with a shorter patient survival. We also demonstrated that α5β1 integrin expression in glioblastomas participates to the resistance to the chemotherapeutic agent Temozolomide, through a negative regulation of the tumor suppressor p53. A direct p53-activation by the non-genotoxic agent Nutlin-3a down-regulated α5 integrin subunit and thus sensitized glioblastoma cells to Nutlin-3a. Furthermore, we demonstrated that the inhibition of α5β1 integrin with a concomitant p53-activation enhanced the effects of p53-based therapy. We also confirmed the existence of a negative cross-talk between α5β1 integrin and p53 in colon cancer.

INTRODUÇÃO: Os múltiplos passos da carcinogênese do câncer de cólon envolvem a existência de subpopulações de células tronco tumorais (CSC), responsáveis pela transformação, crescimento e proliferação das células tumorais. As proteínas CD44 e CD166 são marcadores de CSC associados a sinalização celular, adesão, migração, metástase e resposta linfocitária. Alguns fatores podem modular a expressão CSC como a mutação KRAS. OBJETIVO: correlacionar a expressão dos marcadores CD44 e CD166 em carcinoma de cólon metastático e status do oncogene KRAS (selvagem/mutado) com as características clínico-patológicas e desfecho do paciente ao final do seguimento. MATERIAL E MÉTODOS: Foram coletadas 58 amostras de tecido tumoral de pacientes com neoplasia de cólon metastático, tratados com CapeOx no Serviço de Oncologia Clínica do HCFMRPUSP de 2003 a 2012. Foram coletadas informações do prontuário sobre status do gene KRAS, características clínico-patológicas e desfecho clínico, sendo também realizada imunohistoquímica para marcação CD44 e CD166 através da técnica de TMA. Utilizado software SPSS 17 para análise estatística e considerado valor de p<0,050 para significância dos dados. RESULTADOS: A expressão de CD44 e CD166 foi positiva em 41,4% e 43%, respectivamente, e o status KRAS mutado em 48,3%. No subgrupo kAs selvagem e nos idosos (>65 anos), houve associação entre CD44 e CD166, p=0,042 e p=0,001, respectivamente. Pacientes CD166 negativo tiveram 3 vezes mais chances de progressão de doença (p=0,02) do que CD166 positivo. Pacientes Kras mutado e CD166 negativo tiveram 8 vezes risco de progressão (p<0,01). Pacientes CD44 positivo tiveram 4 e 5 vezes mais chances de evoluir com metástases hepática e pulmonar (p<0,01) em relação aos CD44 negativo. Pacientes com a combinação KRAS mutado e CD44 positivo tiveram 7 vezes mais chance de evoluir com metástase pulmonar (p=0,02) em relação a pacientes KRAS selvagem e CD44 negativo. DISCUSSÃO: Na amostra estudada observamos a influência das expressões dos marcadores de CSC e suas combinações com o status de mutação do gene KRAS, de modo que pacientes com CD166 negativo no tumor primário apresentam um desfecho de maior recorrência e o CD44 positivo favorece a evolução para metástases pulmonar e hepática. A mutação do gene KRAS atua modulando a via do EGF influenciando o comportamento biologico do tumor e os desfechos (recidiva e metastases) diretamente relacionados com a expressão dos marcadores de CSC no cancer de colon metastatico. CONCLUSÃO: Este estudo demonstrou interação entre a expressão imuno-histoquímica dos marcadores CSC de cólon (CD166 e CD44) e o status KRAS, podendo carcterizar subgrupos de pacientes com maiores chances de evolução desfavorável e assim propor um modelo de tratamento e seguimento mais individualizado. / BACKGROUND: Colon cancer carcinogenesis has been recently correlated with specific cancer stem cell (CSC) subpopulations which are associated with transformation, growth and spread process of tumor cells. CD44 and CD166 are CSC markers correlated with cell signalization, adhesion, migration, metastasis, and lymphocyte response. Some factors as KRAS mutation could modulate CSC. OBJECTIVE: Analyze CD44 and CD166 expressions in metastatic colon carcinoma and its correlation with KRAS status, clinicopathological features, disease recurrence and patient survival. MATERIAL AND METHODS: Tissues were obtained from 58 patients with confirmed metastatic colon cancer, treated with CapeOx at FMRP-USP from 2003 to 2012. Clinical and outcomes informations and KRAS gene status were obtained from medical records. KRAS status was analyzed with RT-PCR. CD44 and CD166 were analyzed with TMA immunohistochemistry. Statistical analyses were performed using SPSS 17.0. A p-value <0,050 was considered to be statistically significant. RESULTS: CD44 and CD166 expressions were positive in 41,4% and 43%, respectively, and KRAS status was mutate in 48,3%. Wild-type KRAS in elderly patients had statistical association between CD44 and CD166, p=0,042 and p=0,001, respectively. Patients with CD166 negative had 3 fold increase in progression disease (p<0,01). Patients with CD44 positive had 4 and 5 fold increase in liver and lung metastasis (p<0,01), respectively. Patients with combined mutated KRAS and CD44 positive had 7 fold increase in lung metastasis (p=0,02) compared with wildtype KRAS and CD44 negative. DISCUSSION: In this study, the influence of markers expression of colon CSC (CD44 and CD166) and its combinations with status KRAS were proven. Patients with CD166 negative in primary colon tumor are more likely to present higher recurrence and, CD44 positive have a higher chance to develop lung and liver metastasis. KRAS mutation contributed, associated with studied CSC expressions, to cancer biological behavior and agressivness. CONCLUSIONS: This study demonstrated interaction between imunohistochemical expression of colonic CSC markers (CD166 and CD44) and KRAS gene status. Subgroups of patients with worse outcomes could be identified and this biological information contributed to personalized treatments and follow ups that should be proposed for these patients.

Tumour immunity is a balance between immune mediators that promote tumor progression versus mediators that promote tumor rejection. Infiltrating lymphocytes in human colorectal cancer tissues are independent prognostic factors for a better survival and a high number of cytotoxic CD8+ T-cells have been associated with a better prognosis in terms of a longer and disease free survival for the patient. In our syngeneic rat model we induce colon carcinoma subperitoneally by injecting a colon cancer cell line BN7005, a cell line expressing the epitope (Lewis Y) for the BR96 antibody. Tumours are dissected out and treated with different fixatives and then either frozen, snap-frozen or embedded in paraffin followed by sectioning. Immunohistochemistry using monoclonal antibodies against the tumour infiltrating leukocytes was performed on the tissue. The results were seen as an infiltration of different leukocytes in the tumours.

Positionnée en aval des voies PI3K/AKT et RAS/MAPK, la protéine kinase mTOR joue un rôle déterminant dans le développement et la progression tumorale des cancers colorectaux où elle est fortement surexprimée. Par ailleurs, les cancers colorectaux comme toutes les tumeurs solides, ont un microenvironnement hypoxique. L’adaptation des cellules tumorales à l’hypoxie est notamment régulée par la voie PI3K/AKT/mTOR ainsi que par les facteurs de transcription HIFs dont l’expression protéique et l’activité transcriptionnelle est en partie régulée par mTOR. Dans cette étude, nous avons montré que l’inhibition verticale et complète de l’axe PI3K/AKT/mTOR/HIF-1α par l’utilisation combinée d’irinotecan à faible dose et d’inhibiteurs catalytiques de mTOR inhibe significativement la prolifération cellulaire de lignées coliques humaines, la croissance tumorale et le développement de métastases de xénogreffes de tumeurs coliques dérivées de patients.En parallèle, une étude de cohorte de tumeurs coliques humaines de stade III par Tissue Micro Array montre que les facteurs HIFs sont fortement exprimés dans l’épithélium et le stroma de cancers du côlon de stade III, qu’une faible expression nucléaire de HIF-1α dans les cellules épithéliales confère une mauvaise survie aux patients et qu’elle a une valeur prédictive de moins bonne réponse au traitement 5-FU. / Downstream of the PI3K/AKT and RAS/MAPK pathways, mTOR protein kinase plays a decisive role in the development and tumor progression of colorectal cancers. Furthermore, the microenvironment of colorectal cancers is hypoxic. The adaptation of the tumor cells to hypoxia is regulated by the PI3K/AKT /mTOR pathway as well as by the HIFs transcription factors whose protein expression and transcriptional activity is partially regulated by mTOR. In this study, we showed that the vertical and complete inhibition of the PI3K / AKT / mTOR /HIF-1α axis by the combined use of low-dose irinotecan and mTOR catalytic inhibitors significantly inhibits human colon cancer cell proliferation, as well as the growth and metastatic development of xenografted human colon tumors. In parallel, a Tissue Micro Array study on a cohort of stage III human colic tumors shows that the HIFs are strongly expressed in the epithelium and stroma of the tumors and a low nuclear expression of HIF-1α in epithelial cells provides with poor survival to patients and has a predictive value of worse response to 5-FU treatment.