<p>Targeted radiotherapy (TRT) of cancer is a promising approach that enables selective treatment of tumour cells, while sparing normal tissue. The humanized monoclonal antibody A33 (huA33) is a potential targeting agent for TRT of colorectal cancer, since its antigen is expressed in more than 95 % of all colorectal carcinomas. The aim of this thesis was to evaluate the therapeutic potential of the two huA33-based TRT-conjugates, ¹⁷⁷Lu-huA33, and ²¹¹At-huA33.</p><p>The conjugates ¹⁷⁷Lu-huA33, and ²¹¹At-huA33, bound specifically to colorectal cancer cells, both <i>in vitro</i> and <i>in vivo</i>. A dose dependent cytotoxic effect of ²¹¹At-huA33 was also demonstrated <i>in vitro</i>. From a therapeutic perspective, both conjugates had a favourable biodistribution in tumour-bearing nude mice, with high tumour uptake and a low uptake in normal organs (with the exception of an expected thyroid uptake of ²¹¹At). After injection of ²¹¹At-huA33, the blood absorbed a slightly higher dose than the tumour, but for ¹⁷⁷Lu-huA33, the tumour received a 12 times higher dose than blood. Two days after intravenous injection of ¹⁷⁷Lu-huA33 in tumour-bearing mice, the tumours could be clearly visualised by gamma camera imaging, with very low interference from normal tissue radioactivity. In an experimental therapy study, also performed in tumour-bearing mice, there was an excellent therapeutic effect of ¹⁷⁷Lu-huA33. About 50 % of the treated animals were tumour free 140 days after injection of ¹⁷⁷Lu-huA33, while none of the non-radioactive controls survived beyond 20 days after injection of treatment substances.</p><p>In conclusion, this thesis demonstrates that the therapeutic conjugates ¹⁷⁷Lu-huA33, and ²¹¹At-huA33, are promising targeting agents that might help improve therapy of colorectal cancer.</p>

Optical coherence tomography (OCT) is a minimally-invasive imaging modality that generates high resolution cross-sectional images of tissue. The present study employed a 2 mm diameter endoscopic spectral domain OCT system in the in vivo evaluation of the drugs α-Difluoromethylornithine and Sulindac as chemopreventive and chemotherapeutic agents in a mouse model of sporadic colorectal cancer. 30 mm lateral images of each colon at eight different rotations were obtained at five different time points. Visual analysis of the images was performed to determine the number and size of discrete adenomas, with gross photos and histology serving as gold standard confirmation of the final imaging time point. When applied for chemoprevention, DFMO and Sulindac both significantly reduced the incidence of adenoma, appearing to interact additively in the prevention of tumorigenesis. For chemotherapy, however, only Sulindac had a significant effect on the number of adenoma and neither DFMO nor Sulindac significantly affected tumor growth.

Background: Cancer and diabetes are the second and twelfth leading global causes of death, respectively. Cancer incidence is increased in diabetics compared to non-diabetics. Common pathobiological pathways are shared by the two diseases: hyperglycaemia, hyperinsulinaemia, chronic inflammation and altered concentrations of endogenous hormones. These pathways can all directly or indirectly be linked to chronic hyperglycaemia. Lifestyle factors also affect cancer, diabetes and hyperglycaemia. Hypothesis: Chronic hyperglycaemia is the common biological pathway linking cancer, diabetes and lifestyle factors. Chronic hyperglycaemia can be assessed by monitoring glycated haemoglobin (HbA1c) levels. Aim: The first aim is to investigate whether the link between diabetes and increased cancer risk can be explained by increasing HbA1c levels. Secondly, glycaemic and overall models of lifestyle factors should be developed and compared to determine the relative influence of lifestyle factors on blood glucose level and, subsequently, cancer risk. This could clarify whether improved glycaemic control via lifestyle factors is sufficient to significantly reduce cancer risk. Method: Dose-response meta-analyses on cancer risk and HbA1c levels were performed and the results communicated via a research article. Statistical glycaemic and overall models were developed from published studies on colorectal cancer (CRC), lifestyle factors and HbA1c, via meta-analysis. Log-linear and restricted cubic spline models were considered for studies relating CRC risk to lifestyle factors or HbA1c. Linear models were considered for studies relating HbA1c to lifestyle factors. Only statistically significant models were compared. Results: Increased cancer risk with increasing HbA1c levels was present for a number of cancers, with some cancer types also showing increased risk in the pre-diabetic and normal HbA1c ranges. Comparison of the glycaemic and overall models revealed that HbA1c significantly affected cancer risk and was significantly affected by lifestyle factors. However, the overall effects of lifestyle factors were much stronger than their glycaemic effects (between 9% and 25% difference in risk between overall effects and glycaemic effects at the exposure levels analysed). Glycaemic and overall models for cigarette smoking and chronic stress revealed increased cancer risk with increasing exposure, but decreased cancer risk for increased dietary fibre intake. The glycaemic model for alcohol consumption displayed decreased cancer risk, while the overall model revealed increased cancer risk, emphasising the strong effect of carcinogenic substances in alcohol. Conclusions: Risk for a number of cancers increased with HbA1c levels in diabetic and non-diabetic persons. Cancer prevention by improved blood glucose control seems plausible. The overall effects of lifestyle factors on cancer risk are much stronger than their glycaemic effects. Lifestyle factors alone do not provide enough reduction in blood glucose levels. Other therapeutic strategies for reducing blood glucose levels, such as pharmacotherapeutics or fasting, should be investigated. The possible harmful effects of reducing blood glucose levels, such as neuroglycopaenia, should be considered before implementation of therapeutic strategies. Although there seems to be a strong association between HbA1c and cancer risk, this does not imply causality. The possibility of residual confounding cannot be ignored, even though the most adjusted estimates were used to develop the models, where possible. / MIng (Electrical and Electronic Engineering), North-West University, Potchefstroom Campus, 2014

Background: In the management of metastatic colorectal cancer (mCRC), KRAS, NRAS and BRAF mutational status individualizes therapeutic options and identify a cohort of patients (pts) with an aggressive clinical course. We hypothesized that relapsed and refractory mCRC pts develop unique mutational signatures that may guide therapy, predict for a response and highlight key signaling pathways important for clinical decision making. Methods: Relapsed and refractory mCRC pts (N=32) were molecularly profiled utilizing commercially available next generation sequencing (NGS) platforms. Web-based bioinformatics tools (Reactome/Enrichr) were utilized to elucidate mutational profile linked pathways-networks that have the potential to guide therapy. Results: Pts had progressed on fluoropyrimidines, oxaliplatin, irinotecan, bevacizumab, cetuximab and/or panitumumab. Most common histology was adenocarcinoma (colon N=29; rectal N=3). Of the mutations TP53 was the most common, followed by APC, KRAS, PIK3CA, BRAF, SMAD4, SPTA1, FAT1, PDGFRA, ATM, ROS1, ALK, CDKN2A, FBXW7, TGFBR2, NOTCH1 and HER3. Pts had on average had >= 5 unique mutations. The most frequent activated signaling pathways were: HER2, fibroblast growth factor receptor (FGFR), p38 through BRAF-MEK cascade via RIT and RIN, ARMS-mediated activation of MAPK cascade, and VEGFR2. Conclusions: Dominant driver oncogene mutations do not always equate to oncogenic dependence, hence understanding pathogenic ` interactome(s)' in individual pts is key to both clinically relevant targets and in choosing the next best therapy. Mutational signatures derived from corresponding ` pathway-networks' represent a meaningful tool to (I) evaluate functional investigation in the laboratory; (II) predict response to drug therapy; and (III) guide rational drug combinations in relapsed and refractory mCRC pts.

SOX9 est un facteur de transcription à domaine HMG. Il est impliqué dans de multiples processus biologiques au cours du développement et de la vie adulte. En particulier, SOX9 joue un rôle important dans l'homéostasie de l'épithélium intestinal. Nous avons montré que SOX9, cible positive de la voie de signalisation oncogénique Wnt/(beta)-caténine, réprime l'expression de PKC(alpha). Cette répression implique un nouveau mécanisme d'action qui ne nécessite ni la fixation du domaine HMG à l'ADN ni le domaine de transactivation de SOX9. Nous avons également identifié MiniSOX9, un nouveau variant d'épissage de SOX9, résultant de la rétention du second intron. MiniSOX9 est fortement exprimé dans les tumeurs coliques. Il agit en tant que dominant négatif de SOX9, inhibiteur de l'expression du suppresseur de tumeurs PKC(alpha) et activateur de la voie de signalisation oncogénique Wnt/(beta)-caténine. Nos données suggèrent ainsi un rôle primordial de MiniSOX9 dans la tumorigenèse intestinale. Enfin, notre étude protéomique des partenaires de SOX9 et de MiniSOX9 permet d'ouvrir de nouvelles perspectives quant aux rôles de ces deux protéines dans l'homéostasie et la tumorigenèse intestinale / SOX9 is an HMG transcription factor involved in numerous biological processes during development and adult life. It plays an important role especially in the intestinal epithelium homeostasis. In the present study, we demonstrate that SOX9, a positive target of the oncogenic signaling pathway Wnt/(beta)-catenin, represses PKC(alpha) expression. This repression involves a new mechanism of action requiring neither HMG domain binding to DNA nor the transactivation domain of SOX9. We also report the discovery of MiniSOX9, a new SOX9 splice variant, resulting from the second intron retention. MiniSOX9 is highly expressed in colon tumors. It acts as a SOX9 dominant negative, as a repressor of the expression of the tumor suppressor PKC(alpha), and as an activator of the oncogenic signaling pathway Wnt/(beta)-catenin. Our data suggest a crucial role of MiniSOX9 in intestinal tumorigenesis. Finally, a proteomic analysis allowed us to identify potential new SOX9 and MiniSOX9 partners which will be useful to decipher the roles of these two proteins in intestinal homeostasis and tumorigenesis

L’ilot génomique pks de Escherichia coli et d’autres Enterobacteriaceae code des synthases depolycétides et de peptides non ribosomaux qui permettent l’assemblage d’un composé hybride polycétidepeptidenon ribosomal putative. Ce composé nommé colibactine induit des cassures double-brin de l’ADN descellules eucaryotes.La machinerie enzymatique codée par l’ilot pks comporte une protéine essentielle ClbP, atypique dansce type d’ilot. Nous avons montré que ClbP possède une partie N-terminale catalytique et périplasmique, et unepartie C-terminale associée à la membrane cytoplasmique. La structure cristalline de ClbP et des expériences demutagenèse ont révélé un site actif à sérine et des caractéristiques structurales originales, qui sont compatiblesavec une activité peptidase, confirmée par des analyses biochimiques. Dix homologues de ClbP ont été identifiésin silico dans des ilots génomiques de synthases de peptides non ribosomaux d’espèces bactériennes proches etéloignées. Tous les homologues testés ont présenté une promiscuité fonctionnelle avec ClbP. ClbP est donc leprototype d’une nouvelle sous-famille de peptidases, qui sont probablement impliquées dans la maturation decomposés peptidiques non ribosomaux.Par ailleurs, nous avons réalisé deux études épidémiologiques sur la prévalence de l’ilot pks dansl’espèce E. coli dans deux contextes physiopathologiques, l’urosepsis et les cancers coliques et rectaux. L’ilotpks était significativement associé aux souches issues d’urosepsis comparé à des souches commensales, et auxsouches issues de biopsies de tumeurs coliques comparé à des souches commensales ou issues de biopsies detumeurs rectales, de diverticuloses et de lésions iléales de maladie de Crohn. / The pks genomic island of Escherichia coli and other Enterobacteriaceae encodes polyketide andnonribosomal peptide synthases that build a putative hybrid PK-NRP compound. This compound designatedColibactin induces DNA double-strand breaks in eukaryotic cells.The pks-encoded enzymatic machinery comprises an essential protein ClbP, atypical for this type ofgenomic islands. We report that ClbP harbors a catalytic and periplasmic N-terminal part, and a C-terminal partassociated to the cytoplasmic membrane. ClbP crystal structure and mutagenesis experiments revealed a serineactivesite and original structural features, which are compatible with peptidase activity confirmed bybiochemical assays. Ten ClbP homologs were identified in silico in NRPS-encoding genomic islands of closeand distant-related bacterial species. All tested ClbP homologs showed functional promiscuity with ClbP. ClbPis therefore a prototype of a new subfamily of peptidases, which are probably involved for the maturation ofNRP compounds.Furthermore, we undertook two epidemiological studies on the prevalence of pks island in E. coli in twopathophysiology contexts; urosepsis and colorectal cancers. The pks island was significantly associated withurosepsis strains compared to commensal strains, and strains isolated from biopsies of colon tumors comparedwith commensal strains or strains isolated from biopsies of rectal tumors, diverticulosis and ileal lesions ofCrohn disease.

Durant l’exécution de l’apoptose, plus de 2 000 protéines sont protéolysées par les caspases, une famille de protéases à cystéine. Le clivage de plusieurs d’entre elles a pour effet d’interrompre les processus régulant le trafic intracellulaire. Durant mes études, je me suis intéressée à deux substrats potentiels des caspases, soit les sorting nexins SNX1 et SNX2. Leur clivage en N-terminal avait auparavant été identifié par protéomie dans des extraits cellulaires apoptotiques, respectivement aux sites LFAD91[flèche vers le bas]A et VSLD84[flèche vers le bas]S. Conjointement avec le complexe rétromère, SNX1 et SNX2 jouent un rôle essentiel dans le transport rétrograde de cargos, tel le récepteur lysosomal CI-MPR, des endosomes vers le TGN, évitant ainsi leur dégradation aux lysosomes. Notamment, l’association entre SNX1 et SNX2 et le complexe rétromère, via la sous-unité Vps35, requerrait leur domaine N-terminal, or, celui-ci est clivé durant l’apoptose. Dans le but de déterminer l’impact de la protéolyse de SNX1 et SNX2 sur la fonction du complexe rétromère et le transport rétrograde, nous avons étudié leur clivage par les caspases. Nos résultats indiquent qu’in vitro, les caspases initiatrices 8, 9 et 10 protéolysent SNX1 et SNX2 tandis que seule la caspase-6 exécutrice clive SNX2. Plusieurs fragments de SNX1 sont générés par le clivage à 16 sites, dont le site LFAD91[flèche vers le bas]A en N-terminal ainsi que plusieurs suivant un résidu glutamate. Durant l’apoptose, SNX2 est entre autres clivée par la caspase-6, et ce au site VSLD84[flèche vers le bas]S en N-terminal. Nous avons par la suite étudié l’effet de la protéolyse de SNX1 et SNX2 sur la fonction du complexe rétromère. Nos résultats démontrent que SNX2 tronquée, imitant le clivage au site VSLD84[flèche vers le bas]S, n’interagit plus avec Vps35, la sous-unité centrale du complexe rétromère. De plus, la déplétion de SNX1 et SNX2, récapitulant potentiellement leur protéolyse, a pour effet de délocaliser Vps26, une autre sous-unité du complexe rétromère. Par ailleurs, nous avons évalué l’effet de la protéolyse de SNX2 sur la régulation du récepteur Met, lequel serait régulé entre autres par SNX1 et SNX2. La déplétion de SNX2 induit une augmentation de la phosphorylation du récepteur Met et de ERK1/2 suivant sa stimulation. De plus, l’ARNm de SNX1 et SNX2 sont tous deux réduits dans les tissus de tumeurs de patients atteints du cancer colorectal (CCR) et une diminution des niveaux de SNX2 corrèle avec une hausse de mortalité chez ces patients. Pour conclure, notre étude démontre un effet direct de la protéolyse de SNX2 sur le complexe rétromère durant l’apoptose et suggère un lien entre SNX2 et la pathogenèse du CCR. / Abstract: During the execution of apoptosis, more than 2,000 proteins are proteolysed by caspases, a family of cysteine proteases. The cleavage of several of them results in the interruption of intracellular trafficking processes. During my studies, I investigated two potential caspases substrates, namely the sorting nexin SNX1 and SNX2. Their cleavage at their N-terminus has previously been identified in apoptotic cell lysates by proteomics, respectively at LFAD91[down arrow]A and VSLD84[down arrow]S sites. Together with the retromer complex, SNX1 and SNX2 play an essential role in the retrograde transport of cargos, such as the lysosomal receptor CI-MPR, from endosomes to TGN, thus avoiding their degradation by lysosomes. In particular, the association between SNX1 and SNX2 and the retromer complex, via the Vps35 subunit, seems to require their N-terminal domain, which is thought to be cleaved during apoptosis. To determine the impact of SNX1 and SNX2 proteolysis on the function of the retromer complex and retrograde transport, we have first studied their cleavage by caspases. Our results indicate that in vitro, initiator caspases 8, 9, and 10 proteolyze SNX1 and SNX2 while only executioner caspase-6 cleaves SNX2. Several fragments of SNX1 are generated by the cleavage of up to 16 sites, including at the N-terminus LFAD91[down arrow]A site and following glutamate residues. During apoptosis, SNX2 is directly cleaved by caspase-6 at the site VSLD84[down arrow]S in its N-terminus. We next investigated the effect of SNX1 and SNX2 proteolysis on the function of retromer complex. Our results demonstrate that truncated SNX2, mimicking cleavage at the VSLD84[down arrow]S site, no longer interacts with Vps35, the central subunit of retromer complex. Furthermore, depletion of SNX1 and SNX2, potentially recapitulating their proteolysis, redistributes Vps26, another retromer subunit. In addition, we evaluated the effect of SNX2 proteolysis on the regulation of Met receptor, which has been shown to be regulated by SNX1 and SNX2. SNX2 depletion induces an increase in Met and ERK1/2 phosphorylation after stimulation. In addition, both SNX1 and SNX2 mRNAs are reduced in tumor tissues of colorectal cancer patients and decreased expression levels of SNX2 correlates with increased mortality. In conclusion, our study demonstrates a direct effect of SNX2 proteolysis on retromer complex association during apoptosis and suggests a link between SNX2 and the pathogenesis of colorectal cancer.

Ulcerative colitis (UC) and Crohn’s disease (CD) are the two common forms of inflammatory bowel disease (IBD). They share similar clinical and demographic features as well as harbor key differences in tissue damage and prognosis. Previous studies indicated that they contributed to the increased rick to Colorectal cancer (CRC). However, whether UC and CD share inflammatory signatures still remains controversial. In addition, no inflammatory signatures have been reported on CRC. To answer these questions, a comprehensive study has been conducted on collected microarray datasets. Our analysis suggests that although CD and UC share common inflammatory pathways, they also present difference. Especially, CD patients are likely to have type I response, while UC patients are inclined to undergo type II response. Pathway enrichment analysis on CRC uncovered two potential CRC-specific inflammatory pathways.

Colorectal cancer (CRC) remains the second deadliest cancer in the United States, despite steady reduction in mortality rate over the last three decades. Colonoscopy is the gold-standard screening modality with high sensitivity and specificity to mature polyps. However, the miss rate for small (<5 mm) lesions is estimated to be as high as 26%. Because the five-year survival rate for CRC detected at the local stage is 90%, there is a clear need for a screening procedure that is sensitive to these small lesions. Optical coherence tomography (OCT) has become a major biomedical imaging modality since its invention in 1991. As the optical analog to ultrasound, OCT provides information in both lateral and depth dimensions with resolution < 10 µm and an imaging depth of about 1.5 mm in scattering tissue. In this dissertation, I describe my efforts to develop new uses of OCT for improved early detection of adenoma in the azoxymethane mouse model of CRC. In recent years, commercial OCT systems have reached imaging speeds sufficiently high for in vivo volumeric imaging while laterally sampling the tissue at the Nyquist limit. First, I describe the design of a miniature endoscope and the integration of this probe with a commercial OCT system. Then I describe the development of two OCT imaging methods, one structural and one functional, that could be used for future work in diagnostic or therapeutic studies. The structural method produces en face images of the colon surface showing the colonic crypts, the first such demonstration of crypt visualization in the mouse. Changes in the crypt pattern are correlated with adenoma and are one of the earliest morphological changes. The functional method uses a Doppler OCT algorithm and image processing to detect the colon microvasculature. This technique can be used for vessel counting and blood flow measurements. Angiogenesis occurs at the beginning of tumorigenesis, and the tumor-originated arterioles are incapable of regular vasodilation. This Doppler OCT technique could potentially detect tumors at the earliest stages by measuring the change in local blood flow velocity in response to vasodilatory stimuli.

Bakgrund: Att få en cancerdiagnos innebär ofta en kris för den som drabbas. Kolorektalcancer är den tredje vanligast cancersjukdomen i Sverige och den tredje vanligaste dödsorsaken där män och kvinnor drabbas likvärdigt. Eftersom allt fler blir sjuka i cancer ökar också behovet av kunskap och stöd i form av vård och omvårdnad. Syfte: Att beskriva patienters upplevelser av att drabbas och leva med kolorektalcancer. Metod: Metoden som användes var en litteraturöversikt. Resultatet bygger på 10 stycken kvalitativa artiklar som sökts fram i databaserna Cinahl och PubMed. Resultat: Patienterna som drabbades av kolorektalcancer upplevde att känslorna pendlade mellan hopp och förtvivlan. Detta ledde till en känsla av förlorad kontroll över sitt liv. Information hade stor betydelse. Patienterna uttryckte ett behov av stöd från omgivningen i kampen mot sjukdomen. De upplevde också att det fanns olika strategier för hantering som var helt individuella och unika. Konklusion: Patienter som drabbas av kolorektalcancer ställs inför förändringar och starka känslor uppstår. De saknar kontroll över sina liv och är i behov av stöd. För att kunna hantera livet med kolorektalcancer behöver de använda sig av olika strategier. Sjuksköterskan behöver ha kunskap om sjukdomen kolorektalcancer för att kunna möta patienters individuella behov.