Das Kolorektale Karzinom (KRK) ist eines der häufigsten malignen Erkrankungen, an der in Deutschland jährlich 26000 Menschen versterben. Auf der Suche nach einem neuen Biomarker für dieses Malignom wurde in dieser Arbeit L1-CAM, ein neuronales Zell-Adhäsionsmolekül, untersucht. Es ist, exprimiert an der Zelloberfläche, assoziiert mit einem signifikant schlechteren Outcome bedingt durch eine raschere lokale Tumorausbreitung und Metastasierung. Es zeigte sich anhand der Untersuchung von 62 Tumorpräparate und 39 präoperativ gewonnenen Seren, dass L1-CAM sowohl immunhistologisch nachgewiesen auf der Tumoroberfläche als auch mittels ELISA bestimmt im Serum der Patienten nachweisbar ist. Patienten mit L1-CAM positiven Tumoren waren im Mittel deutlich jünger als Patienten ohne L1-CAM Expression (60 vs. 69 Jahre). Zudem zeigte sich, dass Patienten mit schwach L1-CAM positiven Tumoren im Mittel einen signifikant höheren BMI aufwiesen (Kruskal Wallis Test p=0,0354). Die L1-CAM Expression hatte in unserem Patientengut keinen signifikanten Einfluss auf die Tumorausbreitung, wenngleich wir eine häufigere Metastasierung in die Leber (44%) bei L1-CAM positiven Tumoren gegenüber Patienten ohne L1-CAM Expression im Tumor (29%) beobachteten. Gleiches gilt für die Infiltration der Perineuralscheiden durch Tumorzellen. Bei der Untersuchung der L1-CAM Serumkonzentrationen zeigte sich im Mittel kein signifikanter Unterschied zu einer gesunden Vergleichsgruppe, sodass L1-CAM als Serum-Tumormarker ungeeignet ist.:Bibliographische Beschreibung 2 Abkürzungsverzeichnis 3 1. Einführung 5 2. Grundlagen 7 3. Material und Methoden 12 3.1. Patientengut 12 3.2. Immunhistochemische Färbung des Primärtumors von L1-CAM und Beurteilung der Expression 13 3.3. Bestimmung der Serumkonzentrationen von L1-CAM und CEA 16 3.3.1. Bestimmung der Serum-Konzentration von L1-CAM mittels ELISA 16 3.3.2. Bestimmung der Serum-Konzentration von CEA mittels ELISA 16 3.4. Statistik 17 4. Ergebnisse 18 4.1. L1- CAM Immunhistochemie des Primärtumors 18 4.1.1. L1-CAM Expression in Bezug auf Alter und Geschlecht sowie BMI 18 4.1.2. L1-CAM Expression entsprechend der Ausdehnung des Primärtumors 20 4.1.3. L1-CAM Expression und Lymphknoten- sowie Fernmetastasierung 22 4.1.3.1 Lymphknotenmetastasierung 22 4.1.3.2. Fernmetastasierung 23 4.1.4. L1-CAM Expression entsprechend der UICC-Klassifikation des Tumors 24 4.1.5. L1-CAM Expression entsprechend der Tumordifferenzierung 25 4.1.6. Tumorlokalisation und L1-CAM Expression 27 4.2. L1-CAM im Serum 28 4.2.1. L1-CAM Konzentration im Serum der Patienten 28 4.2.2 L1-CAM im Serum einer gesunden Vergleichsgruppe 29 4.2.3. L1-CAM Serumkonzentration bezogen auf Alter und Geschlecht sowie BMI 30 4.2.4. L1-CAM Serumkonzentration bezogen auf Lymphknoten- und Lebermetastasierung 30 4.2.4.1. L1-CAM Serumkonzentration und Lymphknotenmetastasierung 30 4.2.4.2. L1-CAM Serumkonzentration und Lebermetastasierung 31 4.2.5. L1-CAM im Serum bezogen auf die Tumortherapie 33 4.3. L1-CAM histologisch und im Serum 33 5. Diskussion 35 6. Thesen 39 7. Zusammenfassung 40 8. Literaturverzeichnis 43 9. Anlagen 49

Colorectal carcinoma (CRC) ranks high in mortality and morbidity in most developed countries. Following theses focus on specific aspects of colorectal carcinoma pathogenesis including the issue of screening. The goal of the first study was assessment of expression of epithelial markers of colorectal carcinogenesis p53, COX-2, bcl-2. The study included patients with active ulcerative colitis (UCA), ulcerative colitis in remission (UCR), primary sclerosing cholangitis with ulcerative colitis (PSC-UC) (PSC), patients after liver transplantation for PSC (OLT) and a control group (N). We found significantly increased expression of tumour suppressor gene p53 in non-dysplastic mucosae in PSC-UC compared with UCA, UCR, OLT, and N, which may indicate higher neoplastic potential of PSC. Statistically significant correlation was found between PSC incidence and p53 expression. Surprisingly, OLT showed no p53 expression in non-dysplastic mucosa compared with PSC-UC. This indicates that PSC may contribute to increased expression of p53 and p53-induced colorectal carcinogenesis. Furthermore, a correlation between expression of p53 and COX-2 together with the increased expression of bcl-2 in UCA compared to N can support the role of inflammation in colorectal carcinogenesis. The goal of the second study was...

Colorectal carcinoma (CRC) is one of the most prevalent malignancies in the Czech Republic. In general, there are two molecular pathways leading to CRC: one is characterized by chromosomal instability, the other by the deficiency in DNA mismatch repair (MMR) genes. MutL homologue 1 (MLH1) gene, a member of the MMR gene-family, represents a key component of the MMR system, responsible for recognition of nucleotide mismatches occurring during DNA replication, and for the recruitment of repair proteins to correct the replication errors. According to literature, somatic mutations in MMR genes, and MLH1 in particular, hallmark sporadic, MMR deficient, CRC cases. We aimed at analyzing somatic events in MLH1 gene and the determination of microsatellite instability (MSI) status in 99 DNA samples from 96 patients with sporadic CRC. Mutations were screened by high resolution melting (HRM) curve analysis. Positive cases in each run were subsequently verified by automated sequencing. Mainly gene variants were found in MLH1 gene: We discovered two new variants, one in exon 2 at position c. 204 C>G, p. Ile68Met (98 C/C, 1C/G) and the other in exon 11 at position c. 973 C>T, p. Arg325Trp (98 C/C, 1 C/T). Only the latter variant c. 973 C>T was identified as somatic mutation. All other variants found in MLH1 gene...

Au sein d’une tumeur des régions hypoxiques se forment ce qui conduit à l’activation du facteur de transcription HIF1. HIF1, composé des deux protéines HIF1a et HIF1b, permet l’adaptation des cellules à des faibles concentrations d’oxygène en activant la transcription de gène cible. Un de ces gènes est celui codant pour la lysyl oxydase (LOX). Cette enzyme structure la matrice extracellulaire et est impliquée dans la tumorigénèse. Pour comprendre les liens entre LOX et HIF1a, nous avons modulé leurs expressions dans des lignées humaines de carcinome du côlon. En condition hypoxique, HIF1a contrôle l’expression de LOX et réciproquement, LOX régule la synthèse protéique d’HIF1a via l’activation de la voie de signalisation PI3K/AKT. Nous avons donc mis en évidence l’existence d’une boucle de régulation positive entre LOX et HIF1 en conditions hypoxique. Sachant que ces deux protéines sont des acteurs majeurs de la progression tumorale, nous avons cherché à comprendre le rôle de cette régulation mutuelle dans ce processus. Nos résultats démontrent que l’activité enzymatique de LOX promeut la croissance tumorale in vitro et in vivo et que son action est potentialisée par la présence de son partenaire HIF1a. De plus, LOX et HIF1a agissent en synergie afin d’augmenter la potentiel métastatiques des cellules tumorale de côlon in vitro. Ainsi, ce travail de thèse a permis de mettre en évidence l’existence d’une boucle de régulation entre HIF1a et LOX qui est critique dans la progression tumorale et semble également être impliquée dans le processus métastatiques / The microenvironment of solid tumors is exposed to hypoxic conditions which lead to the activation of Hypoxia‐Inducible Factor 1 (HIF1). HIF1, composed by a heterodimer of HIF1a and HIF1b protein, is a key transcription factor involved in cellular adaptation to changes in oxygen level, inducing the expression of several transcriptional targets such as Lysyl Oxidase (LOX). LOX is an amine oxidase that catalyzes crosslinking of fibrillar collagens and elastin in the extracellular matrix. Furthermore, LOX is implied in tumor progression. To clarify, the link between LOX and HIF1a, their expression were modulated in human colorectal carcinoma cell lines. We pointed out that besides HIF1‐dependant regulation of LOX, LOX can also act on the HIF1 pathway under hypoxic conditions. Indeed, LOX enzymatic activity upregulates HIF1a protein synthesis, and this action is mediated by the PI3K/AKT pathway. Thus, these results emphasize the existence of a regulation loop between HIF‐1a and LOX, which represent two main actors of tumoral progression. Thus, we wanted to determine the implication of this amplification loop in tumor progression. Our results show that LOX enzymatic activity increase tumor growth in vitro and in vivo, and this role is partially dependant of its partner HIF1a. Furthermore, we established that that LOX and HIF1a act in synergy to foster metastatic potential in colorectal carcinoma cell lines. Taken together, our results demonstrate a regulation loop between LOX and HIF1a with is critical for tumor progression and metastasis formation

Der Coxsackie- und Adenovirus Rezeptor (CAR) ist als Bestandteil von Tight Junctions (TJ) an interzellulären Adhäsionsprozessen beteiligt und scheint eine wichtige Rolle in der Karzinogenese zu spielen. Diese ist jedoch insbesondere bei Entstehung von Darmkrebs weitgehend unklar. Ziel der Arbeit war es daher, die funktionelle Bedeutung, mögliche Interaktionspartner sowie die Expressionsregulation von CAR im kolorektalen Karzinom zu analysieren. In den Zelllinien CaCo2, Colo205, DLD1, HCT116, HT29, SW480 und T84 konnte die Expression von CAR (mRNA und Protein) nachgewiesen werden. Nach stabiler CAR-Überexpression durch Transfektion von CARcDNA in DLD1, HCT116 und SW480 wurde das Zellwachstum gehemmt und eine Abnahme von Migration und Invasion induziert. Eine stabile CAR-Inhibition nach Transfektion von CARsiRNA führte in diesen Zelllinien zum Anstieg der Proliferation sowie zu verstärkter Migrations- und Invasionsaktivität, die in DLD1 mit morphologischen Änderungen einhergingen. Eine Genexpressionsanalyse der Zelllinie DLD1 mit CAR-Inhibition identifizierte α-Catenin als das am stärksten regulierte Gen. Obwohl keine direkte Interaktion beider Proteine detektiert werden konnte, führte eine stabile Re-Expression von α-Catenin in DLD1 mit stabiler CAR-Inhibition zu einer deutlichen Reduktion von Proliferation, Migration und Invasion sowie zu einem Rückgang der zellmorphologischen Änderungen. Um den Einfluss von Differenzierung auf die Regulation der CAR-Expression zu untersuchen, erfolgte eine Behandlung aller Zelllinien mit Natriumbutyrat. Dies führte in fünf der sieben Zelllinien zu einer Aktivierung des CAR-Promotors sowie zu einer gesteigerten Expression und Immunoreaktivität von CAR an der Zelloberfläche. Die Zelllinie CaCo2 zeigte nach spontaner Differenzierung durch 21-tägiges Wachstum post Konfluenz ebenfalls eine verstärkte CAR-mRNA-Expression sowie eine erhöhte CAR-Präsenz an der Zelloberfläche. Die gewonnenen Daten konnten die funktionelle Bedeutung von CAR für die Kolonkarzinogenese sowie den Einfluss von α-Catenin auf diese Funktion deutlich machen. Es wurde gezeigt, dass die Expressionsregulation sowie die subzelluläre Verteilung von CAR durch den zellulären Differenzierungsstatus beeinflusst werden kann. / The Coxsackie and Adenovirus Receptor (CAR) is a transmembrane compound of the tight junctions in polarized epithelial cells mediating cellular adhesion. CAR was suggested to play a functional role in the development of epithelial malignomas but detailed knowledge is still lacking, especially for the colorectal carcinoma. Therefore, the functional impact and regulation of CAR expression in human colorectal carcinoma cell models were investigated. CAR protein and mRNA was detectable in the cell lines CaCo2, Colo205, DLD1, HCT116, HT29, SW480 and T84. Stable CAR over expression by transfection of CARcDNA in DLD1, HCT116 and SW480 led to reduced proliferation in vitro and in vivo. Also reduced migration and invasion were observed. Stable CAR inhibition by transfection of CARsiRNA in the same cell lines resulted in increased migration and invasion. In DLD1 morphological changes were found after CAR inhibition. Differential gene expression was detected in DLD1 cells with stable CAR inhibition revealing an 18-fold decrease in α-Catenin gene expression. Loss of α-Catenin was obtained on protein level, too. Although no direct interaction between CAR and α-Catenin could be proven ectopic re-expression of α-Catenin in DLD1 with CAR inhibition reversed the determined functional and morphological effects of a CAR knock down. Then, the impact of differentiation on regulation of CAR expression was investigated. Sodium butyrate treatment induced differentiation in all cell lines (determined by alkaline phosphatase activity), which was paralleled by an increase of CAR immunoreactivity at the plasma membrane in all cell lines but CaCo2. However, CAR protein and mRNA expression, as well as CAR gene promoter activity increased in 5 cell lines only, whereas in SW480 and CaCo2 a down regulation was observed. Spontaneous differentiation of CaCo2 after a growth period of 21 days post confluence resulted in up regulation of CAR mRNA expression as well as increased CAR presence at the plasma membrane. The data suggest that CAR plays a crucial role in the carcinogenesis of colorectal carcinoma which could be influenced by α-Catenin interaction. Differentiation determines the regulation of CAR expression and the subcellular distribution of CAR in colon cancer cells.

Οι μέχρι τώρα ενδείξεις από τη βιβλιογραφία εισηγούνται ένα πιθανό προστατευτικό ρόλο των οιστρογόνων στην καρκινογένεση στο παχύ έντερο. Η έκφραση των οιστρογονικών υποδοχέων στο φυσιολογικό βλεννογόνο του παχέος εντέρου, στα αδενώματα και τα καρκινώματα και οι αλληλεπιδράσεις τους με διάφορους συμπαράγοντες θα πρέπει να μελετηθούν υπό το πρίσμα των πολύπλοκων μοριακών δικτύων μεταξύ επιθηλιακών κυττάρων και μυοϊνοβλαστών του στρώματος, αλλά και της θεωρίας των βλαστικών κυττάρων που φαίνεται να ενέχονται στην καρκινογένεση. Η έκφραση των ERα, ERβ1, ΑΙΒ-1, TIF-2, PELP1, NCoR και ALDH1 μελετήθηκε ανοσοϊστοχημικά σε 107 καρκινώματα παχέος εντέρου, σε 77 δείγματα φυσιολογικού βλεννογόνου και σε 29 αδενώματα του ίδιου οργάνου. Εκτιμήθηκαν τόσο τα επιθηλιακά κύτταρα όσο και οι μυοϊνοβλάστες. Για την ακριβέστερη εκτίμηση των μυοϊνοβλαστών, συνεχόμενες ιστολογικές τομές υποβλήθηκαν σε ανοσοϊστοχημικό έλεγχο με χρήση των anti-αSMA και CD34 αντισωμάτων. Τα αποτελέσματά μας έδειξαν ότι η έκφραση των ERβ1, ΑΙΒ-1, ΤΙF-2 και PELP1 ήταν πιο συχνή σε μυοϊνοβλάστες του στρώματος των καρκινωμάτων σε σχέση με τα αδενώματα και το φυσιολογικό βλεννογόνο. Επίσης, στους μυοϊνοβλάστες των καρκινωμάτων, ο NCoR εντοπιζόταν αποκλειστικά στο κυτταρόπλασμα των κυττάρων. Αντίθετα, δεν υπήρχε διαφορά στο ποσοστό έκφρασης των δεικτών αυτών στα επιθηλιακά κύτταρα μεταξύ του φυσιολογικού βλεννογόνου, των αδενωμάτων και των καρκινωμάτων. Ωστόσο, η κυτταροπλασματική εντόπιση του ERβ1 ήταν συχνότερη στα επιθηλιακά κύτταρα των καρκινωμάτων σε σχέση με το φυσιολογικό βλεννογόνο και τα αδενώματα. Επίσης, ο NCoR εκφραζόταν πιο συχνά στο κυτταρόπλασμα και σπανιότερα στον πυρήνα των κακοήθων επιθηλιακών κυττάρων σε σχέση με τα φυσιολογικά επιθηλιακά κύτταρα. Η κυτταροπλασματική έκφραση του NCoR στα επιθηλιακά κύτταρα σχετιζόταν με μεγαλύτερη ελεύθερη νόσου και συνολική επιβίωση και αποτελούσε ανεξάρτητο προγνωστικό δείκτη της ελεύθερης νόσου επιβίωσης. Τα αποτελέσματά μας υποδεικνύουν ένα πιθανό ρόλο της ενεργοποίησης του μονοπατιού των οιστρογονικών υποδοχέων στους μυοϊνοβλάστες του στρώματος, στην ανάπτυξη των καρκινωμάτων του παχέος εντέρου. Επίσης, η κυτταροπλασματική μετατόπιση, από τον πυρήνα, του NCoR στα επιθηλιακά κύτταρα, πιθανότατα επηρεάζει διάφορα μοριακά δίκτυα στον πυρήνα των κυττάρων, επιφέροντας ταυτόχρονα ογκοπροαγωγές δράσεις στα επιθηλιακά κύτταρα του βλεννογόνου και ογκοκατασταλτικές επιδράσεις στα αναπτυσσόμενα νεοπλάσματα. Δεδομένου ότι, η πυρηνική έκφραση του NCoR έχει προταθεί ως δείκτης των stem κυττάρων, τα ελάχιστα κύτταρα, στα οποία παρατηρήθηκε πυρηνική έκφραση στον καρκίνο παχέος εντέρου, πιθανότατα, αντιστοιχούν σε καρκινικά stem κύτταρα. Η ALDH1 αποτελεί, επίσης, δείκτη φυσιολογικών και καρκινικών stem κυττάρων σε διάφορα όργανα. Στη μελέτη μας η ALDH1 εκφράστηκε έντονα σε κύτταρα του φυσιολογικού βλεννογόνου, τα οποία βρίσκονταν στη βάση των κρυπτών και πιθανότατα αντιπροσωπεύουν τα stem/προγονικά κύτταρα του εντερικού επιθηλίου. Κατά αντιστοιχία, η έκφραση της ALDH1 στα καρκινικά κύτταρα σχετιζόταν με παρουσία μεταστάσεων και χειρότερη ελεύθερη νόσου επιβίωση. Το εύρημα αυτό, πιθανόν, να αποτελεί ένα δείκτη των καρκινικών stem/προγονικών κυττάρων. Αντίθετα, η έκφραση ALDH1 στους μυοϊνοβλάστες των καρκινωμάτων σχετιζόταν με ευνοϊκούς προγνωστικούς παράγοντες και μεγαλύτερο ελεύθερο νόσου διάστημα. Επίσης, περιστατικά με χαμηλή έκφραση ALDH1 στους μυοϊνοβλάστες και υψηλή έκφραση στα επιθηλιακά κύτταρα σχετιζόταν με μικρότερο διάστημα ελεύθερη νόσου επιβίωσης, αλλά και συνολικής επιβίωσης. Τα ευρήματα αυτά υποδεικνύουν το σημαντικό ρόλο των πολύπλοκων αλληλεπιδράσεων επιθηλίου-στρώματος κατά την καρκινογένεση στο παχύ έντερο και επισημαίνουν τα πολύπλοκα μοριακά δίκτυα που ρυθμίζουν τη λειτουργία των κυττάρων. Η συστημική προσέγγιση των επιθηλιακών κυττάρων και της παθολογίας τους προϋποθέτει τη μελέτη των μορίων τους μέσα σε πολύπλοκα δίκτυα που επηρεάζουν τη δράση τους με μη γραμμικό τρόπο και περιλαμβάνει αμφίδρομες αλληλεπιδράσεις από τα περιβάλλοντα κύτταρα. / Background. The stochastic model of carcinogenesis is recently challenged by the stem cell model. The later suggests that cancer develops from uncontrolled proliferation and aberrant differentiation of adult stem cells or progenitor cells that acquire stem cell-like properties. Microenvironment regulates function and differentiation of normal epithelial cells creating a protective niche for stem cells. Additionally, microenvironment plays a critical role in induction and progression of carcinomas. Both mutations in adult stem cells and changes in signals emanating from the stem cell niche contribute to the initiation of carcinomas. Recent findings suggest a protective role of estrogens in colorectal carcinogenesis. However, estrogens exert various actions on cells depending on the molecular microenvironment and their cross-talk with intracellular cascades and coregulators of transcription. Additionally, estrogens modulate the function of stromal cells and might influence carcinogenesis by indirect actions. Elucidation of the molecular networks implicated in estrogen signaling is very important in view of the potential use of selective estrogen receptor modulators in chemoprevention and targeted anticancer therapy. Materials and methods. An immunohistochemical study was designed to analyze the estrogen receptors α and β and the various co-regulators of transcription expression of along with that of a proposed functional stem cell marker, ALDH1, in normal colonic mucosa, adenomas and colorectal carcinomas. One hundred seven cases of colorectal carcinoma were retrieved from the Pathology files of the University Hospital of Patras, Greece. None of the patients had received preoperative chemotherapy or radiotherapy. All female patients were at the postmenopausal age. Follow-up was available for all patients. Paired normal mucosa and adenoma specimens were evaluated in 77 and 29 cases, respectively, in an effort to examine the whole spectrum of the multistage progression of colorectal carcinogenesis. Primary antibodies against ERα, ERβ1, AIB-1, TIF-2, PELP1, NCoR and ALDH1 and the Envision polymer-based detection system were employed. Epithelial cells and stromal myofibroblasts were separately assessed. α-SMA and CD34 staining of serial histologic sections was valuable for the recognition of the myofibroblastic nature of the cells. Results. ERα expression was extremely rare and was noted in <1% of the epithelial cells in two cases of colorectal carcinoma. ERβ1, TIF-2, and NCoR were expressed in the nuclei and cytoplasm of epithelial cells and myofibroblasts. AIB-1 and PELP-1 were expressed in the nuclei of epithelial cells and myofibroblasts. PELP-1 displayed a dot-like pattern of staining in the nuclei of cells that is possibly attributed to the presence of focally increased concentration of PELP1 in multiprotein co-regulator complexes within the nuclei of cells. Statistical analysis revealed that nuclear and cytoplasmic expression of ERβ1 and TIF-2 and nuclear expression of AIB-1 and PELP1 in myofibroblasts increased from normal mucosa through adenoma to carcinomas. NCoR was expressed in the cytoplasm of carcinoma-associated fibroblasts but not in myofibroblasts of normal mucosa. Thus, various components of estrogen signaling namely ERβ1 (both genomic and non-genomic actions-associated localization) and co-regulators of transcription, are enhanced in cancer associated myofibroblasts, whereas co-repressor NCoR is expressed in the cytoplasm of the cells implying that ER signaling is enhanced in myofibroblasts of carcinomas. In contrast, nuclear expression of ERβ1, AIB-1, TIF-2, and PELP-1 in epithelial cells was not different among normal mucosa, adenomas and carcinomas. Cytoplasmic expression of ERβ1 was higher in colorectal carcinomas, implying activation of non-genomic actions of ERβ in colorectal carcinogenesis. A translocation of NCoR from the nucleus to the cytoplasm was noted in colorectal carcinomas, since nuclear expression was more common in normal mucosa and cytoplasmic expression was noted in the majority of carcinomas. Cytoplasmic expression of NCoR in epithelial cells was associated with favorable prognosis. These findings might suggest that derepression of NCoR repressed transcription is an important feature of colorectal carcinogenesis and correlates with patients’ prognosis. ALDH1 expression was noted in the nuclei and the cytoplasm of myofibroblasts and epithelial cells. Expression in myofibroblasts was more often noted in carcinomas compared to normal mucosa and was associated with absence of metastasis and favorable prognosis. Epithelial cells of normal mucosa expressed high levels of ALDH1 expression. A distinct pattern of ALDH1 expression along the crypt axis was noted. Nuclear expression was more common and cytoplasmic expression was intensified at the base of the crypts (compartment where epithelial stem cells reside) compared to superficial epithelium. Carcinomas displayed heterogenous expression of ALDH1 in epithelial cells. Increased cytoplasmic expression was associated with the presence of metastasis and poor prognosis. Thus, ALDH1 expression had distinct impacts on metastatic potential of carcinomas and patients’ prognosis, accordingly to the cell where it is expressed. Additionally, patients with increased expression in epithelial cells and decreased expression in myofibroblasts had worse prognosis compared to patients displaying all other combinations of ALDH1 expression in epithelial cells and myofibroblasts. Our findings imply a possible role of ALDH1 as a stem/progenitor cell marker in normal mucosa. The association of ALDH1 expression in malignant cells with metastatic potential and worse prognosis implies that it might represent a marker of carcinomas with increased stem/progenitor cell content. The favorable prognostic role of ALDH1 expression in myofibroblasts might be associated with its role in local retinoic acid production. Retinoic acid has various tumor suppressive roles in colorectal carcinomas and can potentially be used in chemopreventive or chemotherapeutic strategies especially in patients with low local production levels. Thus, a comprehensive analysis of molecular networks both in any single cell and among the different cells of colorectal carcinomas and non neoplastic mucosa are mandatory in order to elucidate the role of estrogen signaling in colorectal carcinogenesis in view of development of targeted clinical applications. Conclusions 1.ERβ is the predominant estrogen receptor in colonic tissue. 2.ERβ1 dependent signaling is enhanced in cancer-associated myofibroblasts. 3.PELP1 is associated with genomic actions in both epithelial cells and myofibroblats. 4.In epithelial cells, loss of NCoR nuclear expression correlates with colorectal carcinogenesis possibly through derepression of transcription mediated by various transcription factors. 5.ALDH1 emerges as a marker of normal and cancer stem cells of colorectal carcinomas.

As the title reveals, the thesis deals with primary and secondary prevention of colorectal carcinoma among people over 50 years of age. Colorectal carcinoma, i.e. tumour disease of the colon or rectum, is a serious disease with increasing incidence. The Czech Republic has one of the highest incidence rates of this disease and is at the forefront of global statistics. Every year, about 8000 people are diagnosed with colorectal carcinoma in our country and about 4000 patients die of this disease every year. Almost four people out of ten have vicarious experience with colorectal carcinoma, claiming that someone in their immediate vicinity has developed this disease. Early detection of the disease is thus of crucial importance. Prevention and diagnostics play a major role because tumours detected at an early stage can be treated well. It is reported that lifestyle, the right regimen, plenty of physical activity, wholesome food with an appropriate proportion of fibre and vitamins have a 60 to 80 % impact on the development of carcinoma. The disease poses a threat mainly to people over fifty years of age and people with genetic predispositions. The thesis is divided into a theoretical and practical part. The theoretical part consists of several chapters. First of all, I will be dealing with the basic anatomy and physiology of the colon and rectum. Then I will be dealing with the colorectal carcinoma itself, its development, symptoms, incidence or epidemiological aspects of the disease in the Czech Republic. I will be dealing with the risk factors of colorectal carcinoma that include age, lifestyle, as well as hereditary predispositions. A large part of the thesis is dedicated to colorectal carcinoma prevention. I will be focusing on primary and secondary prevention, including the faecal occult blood test and colonoscopy. Finally, I will touch on diagnostics and treatment of colorectal carcinoma. The practical part makes use of the research data obtained through a quantitative interrogation method, a questionnaire. The questionnaire was anonymous and included 32 questions. The first group of the questions was focused on basic information about the respondents. The rest of the questions concerned respondents´ awareness of colorectal carcinoma, its risk factors and potential prevention. I explored the respondents´ attitudes to lifestyle, their concern for tumour diseases in general, as well as whether they regularly see their physician. A substantial part of the questionnaire was devoted to questions regarding the occult blood test and colorectal screening. The questionnaire was intended for people over 50 years of age. The purpose of the thesis was to map awareness of the risk factors of colorectal carcinoma, look into awareness of the options of secondary prevention of colorectal carcinoma and whether people attend regular screenings. I examined the importance of giving media publicity to the disease and thus related interest in this issue. I wished to know whether there is a gender difference in the interest in undergoing colorectal screening. Four hypotheses were established in the research. Hypothesis 1: People over the age of 50 are informed about the risk factors of colorectal carcinoma. This hypothesis was confirmed. Hypothesis 2: People over the age of 50 know the options of secondary prevention of colorectal carcinoma. This hypothesis was only partially confirmed. Hypothesis 3: The number of colorectal screenings undergone by women over the age of 50 is statistically more significant than that of man over 50 years of age. This hypothesis was not confirmed for the occult blood test. However, men underwent colonoscopy more often. Hypothesis 4: The interest in undergoing colorectal screening increases with the level of education attained. The actual proportion of those who underwent an occult blood test or colonoscopy does not differ depending on education, and therefore hypothesis number 4 was not confirmed.

The circadian clock generates circadian rhythms, which participate on regulation of a number of signalling pathways. Disruption of the circadian regulatory mechanism is linked to a development and a progression of certain types of cancer including colorectal tumorigenesis. Progression of tumorigenesis depends on the cell cycle machinery related to cell proliferation and apoptosis. MiRNAs play a role in initiation and progression of tumorigenesis because they interfere in regulatory pathways associated with tumorigenesis. The aim of the thesis was to determinate existence of circadian rhytms in clock controlled genes (Tef, Dbp), miRNAs (miR-1-3p, miR-16-5p, miR-34a-5p, miR-155-5p, miR-192-3p) and genes of the cell cycle machinery (Ccnd1, Ccne1, Ccna1, Ccnb1) and apoptosis (Casp3, Bcl2, Bad). Further, to compare detected circadian rhythms during aging and neoplastic transformation of colon by quantitative RT-PCR. We have observed circadian expression of Tef, Dbp, Ccne1, Ccna1, Ccnb1, Casp3 and Bcl2 in young mice colon, Tef, Dbp, miR-1-3p, Ccne1, Ccna1 in old mice colon and Tef and Dbp in colorectal tumors. In summary, circadian expression of clock controlled genes varied but was maintained in mice colorectal tumors. In aging we demonstrated weakening of circadian rhythms of the genes of the cell...

Colorectal cancer is one of the most common cancer types worldwide. Both genetic and epigenetic alterations play a critical role in its initiation and progression. One of the genes frequently epigenetically silenced or lost in many types of human cancer is tumor suppressor gene Hypermethylated in Cancer 1 (HIC1). It encodes for transcriptional repressor regulating its target genes directly or indirectly. Twelve genes whose expression is repressed by HIC1 have been identified to date. These genes encode for transcription factors, cell cycle and apoptosis regulators or proteins involved in angiogenesis as well as cell migration and invasiveness. Employing mouse embryonic fibroblasts upon Hic1-conditional knockout we have revealed six novel genes potentially repressed by Hic1 including Toll-like receptor 2 (Tlr2). Here we show that Tlr2 is one of the Hic1 target genes and that Hic1 inactivation in the intestine leads to increased Tlr2 production. Moreover, enhanced inflammatory response upon chemical-induced colitis as well as increased tumor formation in ApcMin mice was observed in Hic1-deficient mice. Expression profiling in human fibroblast upon HIC1 knockdown revealed increased expression of another potential target gene, transcription factor E2F7. Our study describes a new relationship between HIC1 and...

Inadequate metabolic conditions in solid tumors lead to the formation of quiescent cancer cells that are suspended in a transient cell cycle arrest. When conditions change, quiescent cancer cells can re-enter the cell cycle and cause recurrence. Drug screening efforts have revealed mitochondrial oxidative phosphorylation as a unique metabolic dependency in quiescent cancer cells. The anthelmintic drug nitazoxanide is an inhibitor of oxidative phosphorylation and preferentially active against quiescent cancer cells in multicellular tumor spheroids.  In this thesis, we employed current and developed new models of quiescent cancer cells and applied live cell imaging for improved preclinical evaluation of cancer drugs in hepatocellular and colorectal carcinoma cell lines. As part of this work, a new assay to measure mitochondrial membrane potential in three-dimensional cell models was developed, an application of the JC-1 assay, and we demonstrated that the preferential activity against quiescent cancer cells of nitazoxanide is shared by two kinase inhibitors: sorafenib and regorafenib. The sensitivity of quiescent cancer cells to nitazoxanide, sorafenib, and regorafenib correlated with the disruption of the mitochondrial membrane potential. Nitazoxanide and sorafenib, in combination, caused an additive decrease in viability, mitochondrial membrane potential, and colony regrowth capacity.  Furthermore, we developed a quiescent hollow fiber assay and implemented an improved analysis using live cell imaging and adenosine triphosphate analysis. Hypoxia and cancer cell quiescence were enriched in hollow fiber macrocapsules over time, and the culture conditions affected nitazoxanide sensitivity. Additionally, we used basement membrane extract gel to support cell growth in hollow fiber macrocapsules and implanted macrocapsules in mice. We observed that the in vivo environment was favorable to cell growth. Through this characterization of the quiescent hollow fiber assay, we were able to outline important paths for future research.