En Europe, le nombre de cancers est en constante augmentation et explique l’augmentation des traitements. Les bases de ces traitements sont la chimiothérapie et la radiothérapie, seules ou en association. Les chimiothérapies sont effectuées à l’aide de médicaments anticancéreux qui ont des propriétés toxiques pour les cellules. Après administration des traitements aux patients, les médicaments sont excrétés et se concentrent dans les effluents hospitaliers et les réseaux d’égouts. Bien que beaucoup de ces composés soient éliminés dans les stations d’épuration, certains sont difficilement biodégradables et sont directement rejetées dans le milieu naturel où ils représentent un risque toxique pour la flore, la faune et l’Homme. Bien que les concentrations soient faibles (ng/L - μg/L), très peu de données sont disponibles sur leurs impacts écotoxicologiques. Leur présence dans l’environnement est d’autant plus préoccupante que les produits de métabolisation sont souvent plus toxiques que la substance d’origine. L’objectif de la thèse a été d’évaluer le risque (éco)toxicologique induit par de faibles doses de médicaments rejetés seuls ou en mélanges dans les effluents hospitaliers, urbains et dans l’environnement. De par leur utilisation courante dans les traitements anticancéreux, trois molécules ont été sélectionnées pour notre étude : la ciprofloxacine (antibiotique), le tamoxifène (perturbateur endocrinien), et le cyclophosphamide (anticancéreux). Des gammes de concentrations représentatives des effluents hospitaliers, station d’épuration et de l’environnement ont été testées à l’aide de bioessais appliqués à des organismes aquatiques (V. fischeri, P. subcapitata, L. minor) et de biomarqueurs appliqués à une levure (S. cerevisiae) et des cellules humaines hépatiques et mammaires. La viabilité cellulaire (test MTS) et la génotoxicité (cassures à l’ADN et adduit à l’ADN) ont été comparés aux tests standardisés Microtox ®, Algaltoxkit F™, ainsi que d’inhibition de croissance de Lemna minor. Le potentiel perturbateur endocrinien a été évalué en parallèle à l’aide du test YES/YAS. Cette batterie de tests a ensuite été appliquée a des effluents bruts (hospitaliers, station d’épuration) pour en évaluer le potentiel (géno)toxique. Des échantillons à proximité de l’hôpital de Gérone (Espagne) ont été prélevés en sortie de l’hôpital, en entrée et en sortie de station d’épuration, pendant trois mois consécutifs. Plusieurs effets de toxicité ont été observés sur les modèles d’étude, comme notamment l’apparition de phénomènes d’hormèses sur la viabilité des cellules hépatiques exposée au tamoxifène et à la ciprofloxacine, seuls ou en mélange. Le même schéma est observé pour les mélanges avec le test Microtox®. D’autre part, l’exposition respective des cellules hépatiques et mammaires aux médicaments n’entraîne pas de cassures de l’ADN et entraine l’apparition d’adduits seulement avec le tamoxifène, alors qu’on note une augmentation dose-dépendant des cassures et des adduits à l’ADN après exposition aux mélanges. De même, une réponse positive est observée avec le test Algaltox F™. Concernant les effluents, les effets dépendent à la fois du type d’organisme et du temps d’exposition. Les tests Microtox®, Algaltox F™ et le post-marquage des adduits à l’ADN sont apparus être les pertinents pour l’analyse. Les interactions observées entre les composés mettent en avant la nécessité d’évaluer les effets des contaminants à petites doses en mélanges, à plusieurs temps d’exposition et avec différents tests. L’application d’une telle batterie de tests à des échantillons environnementaux permet de qualifier les effluents et de suivre l’efficacité de moyens d’épuration. A terme, son application pourrait permettre de mieux appréhender les risques (éco)toxiques associés aux rejets de médicaments dans l’environnement et pouvant être à l’origine de cancer secondaire chez l’Homme. / In Europe, cancers rate is constantly raising, which explain the increase in treatments. They are usually chemotherapy and radiotherapy, alone or combine. Chemotherapy is done with anticancer drugs with toxic characteristics on cells. After administer the treatments to the patients, some of the drugs are excreted in significant proportion and released in hospital and communal effluents. Even though a lot of the compounds are either removed by adsorption or bio-degradation in waste water treatment plant (WWTP), some of their are not are directly released in the environment and represent a toxic risk for aquatic organisms and the Human health. Despite low concentrations (ng/L-μg/L), few data are available about the ecotoxicological impact. The importance of chemical compounds pollutants, especially anticancer drugs, are a real concern because the metabolites of the chemicals are even more toxic than the original substance. The aim of the thesis is to develop a battery based approach to evaluate the risks induct by low doses of drugs released independently or in mixture, in hospital waste water. Because of their common use in anticancer treatment procedures, three molecules have been chosen for our study: ciprofloxacin (antibiotic), tamoxifen (endocrine disruptor), cyclophosphamide (anticancer). Concentrations were range from hospital sewers and WWTP to the environment have been tested with a battery base approach using standardized bioassays applied on aquatic organisms (V fischeri, S. subcapitata, L. minor) and biomarker applied on yeast (S. cerevisia), hepatic and mammary human cell lines. Cell viability (test MTS) and genotoxicity (DNA breaks, DNA adducts) were compared with the standardized bioassays Microtox®, Algaltoxkit F™, and Lemna minor growth inhibition. In parallel, the endocrine disruptor activity was estimated the YES/YAS assay. The battery assay was then applied to evaluate the (geno)toxicity of raw effluents (hospital, wastewater-treatment plant). Samples from the hospital of Girona (Spain) were taken got out of it from the hospital, in entrance and got out of it from water-treatment plant, during three consecutive months. Several toxic effects have been observed during this work on aquatic organisms and both human cell lines. Results show especially hormetic effect on viability of hepatic cell line exposed to ciprofloxacin and tamoxifen alone or in mixture. Same results were observed the Microtox assays after mixtures exposures. On the other hand, the individually hepatic and mammary cell exposure to the drugs doesn’t induce DNA break, and induce DNA adduct only with the tamoxifen. Furthermore, we observe a dose-dependent increasing of the DNA break and adduct if the cells are exposed in mixture. Same results were observed with Algaltox F™. Concerning the effluents, effects depending on the kind of organisms and time exposure. The Microtox ®, Algaltox F ™ and the DNA adducts post-labelling appeared to be the most relevant for the analysis. The interactions observed between drugs pinpoint the necessity to assess the effect of contaminants in low doses mixtures, at many exposure times, and using different tools. The application of this battery with environmental raw samples is in use to rank outflows toxicity and follow the WWTP efficiency, which could lead to a better understanding of the human health risks.

The assessment of teratogenic effects of chemicals is generally performed using in vivo teratogenicity assays e.g., in rats or rabbits. Following the 3R principles, the development of alternative methods is encouraged to reduce the number of animal tests. From this perspective, we have developed an in vitro assay (mDarT) using the zebrafish Danio rerio embryo teratogenicity assay (DarT) combined with an exogenous mammalian metabolic activation system (MAS), able to biotransform proteratogenic compounds. Cyclophosphamide, ethanol, benzo[a]pyrene and thalidomide were used as test materials to assess the efficiency of this assay. Briefly, the zebrafish embryos were co-cultured at 2 hpf (hours post fertilization) with the test material at varying concentrations, mammalian liver microsomes from different species and NADPH for 60 min at 32°C under moderate agitation in Tris buffer. The negative control (test material alone) and the MAS control (MAS alone) were incubated in parallel. For each test group, 20 eggs were used for statistical robustness. Afterwards fish embryos were transferred individually into 24-well plates filled with fish medium for 48 hours at 26°C with a 12 hour-light cycle. Teratogenicity was scored after 24 and 48 hpf using morphological endpoints. The test was considered to be valid if a minimum of 90% of fish eggs developed normally for the two controls (test material alone and MAS alone). For each test material, the experiment was repeated three times with the controls satisfying the validation criteria (≤ 10% impaired embryos). Indeed, no significant teratogenic effects were observed compared to controls in fish embryos exposed to the proteratogens alone (i.e., without metabolic activation) or the MAS alone. In contrast, the four test materials induced significant abnormalities in fish embryos when co-incubated with animal liver microsomes. For cyclophosphamide, ethanol and thalidomide a concentration-response relationship was shown and the qualitative nature of the malformations was similar between fish embryos and humans. Benzo[a]pyrene was demonstrated to be significantly teratogenic in fish embryos in spite of no concentration-response and unspecific teratogenic fingerprints. We conclude that the application of animal liver microsomes will improve and refine the DarT as a predictive and valuable alternative method to screen teratogenic substances.

Cyclophosphamide (CY) was injected intraperitoneally into mice at varying dosage levels 48 hours prior to intravenous inoculation of constant amounts of dialysable leucocytic transfer factor (TF). Bovine TF to coccidioidin and Brucella abortus and porcine TF to Mycobacterium avium were used. Twenty-four hours after TF injections, mice were tested for delayed hypersensitivity by footpad inoculation with specific antigens. The results show that CY slightly enhanced the delayed hypersensitivity response to the specific test antigens in all three systems. This was not true at every CY dose level, however, since there was a correlation between the dosage of CY and the time of peak footpad swelling. Cyclophosphamide at a low level (20 mg/kg body wt) caused the maximal reading at 24 hours after test, whereas the high level dose (200 mg/kg) showed greatest thickening of the footpad at 48 hours. Transfer factor dosage differences appeared to change the response relatively little, if at all. The cyclophosphamide dose response, on the other hand, showed disparities among various antigen systems and at the different observation times. Under these conditions, no consistent, striking effects of CY on transfer could be noted.

Advances in haploidentical bone marrow transplantation (h-BMT) have drastically broadened the treatment options for patients requiring BMT. The possibility of significantly reducing the complications resulting from graft-versus-host disease (GvHD) with the administration of post-transplant cyclophosphamide (PT-CY) has substantially improved the efficacy and applicability of T cell-replete h-BMT. However, higher frequency of disease recurrence remains a major challenge in h-BMT with PT-CY. There is a critical need to identify novel strategies to prevent GvHD while sparing the graft-versus-leukaemia (GvL) effect in h-BMT. To this end, we evaluated the impact of bendamustine (BEN), given post-transplant, on GvHD and GvL using clinically relevant murine h-BMT models. We provide results indicating that post-transplant bendamustine (PT-BEN) alleviates GvHD, significantly improving survival, while preserving engraftment and GvL effects. We further document that PT-BEN can mitigate GvHD even in the absence of Treg. Our results also indicate that PT-BEN is less myelo-suppressive than PT-CY, significantly increasing the number and proportion of CD11b(+)Gr-1(hi) cells, while decreasing lymphoid cells. In vitro we observed that BEN enhances the suppressive function of myeloid-derived suppressor cells (MDSCs) while impairing the proliferation of T-and B-cells. These results advocate for the consideration of PT-BEN as a new therapeutic platform for clinical implementation in h-BMT.

Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a chronic pain disorder characterized by at least six weeks of lower urinary tract symptoms and unpleasant sensations (pain, pressure and discomfort) thought to be related to the urinary bladder and not meeting exclusion criteria. While the etiology is not known, BPS/IC may involve a "vicious circle" of uroepithelial dysfunction, inflammation and peripheral and central sensitization. We propose that the urinary bladder inflammatory insult partly mediates voiding dysfunction and visceral neurogenic pain characteristic of BPS/IC. Several studies from our laboratory have already demonstrated the role(s) of cytokines and their downstream targets in the functional alterations in micturition reflex pathways following chemically (cyclophosphamide, CYP)-induced cystitis. More recently, the pleiotropic protein, TGF-β, has been implicated in the pathogenesis of CYP-induced cystitis. TGF-β is activated locally at the initial site of injury by protease-dependent or protease-independent mechanisms to initiate a proinflammatory milieu. Depending on its contextual cues, TGF-β may then aid in resolving the primary immune response and support tissue repair. Though TGF-β is necessary to maintain normal immunological function, its aberrant expression and activation may have detrimental effects on responding tissues and cell types. A sustained increase in peripheral TGF-β reactivity, such as what may be observed in chronic inflammatory bladder conditions, may influence bladder afferent excitability to amplify nociceptive transmission and CNS input. The subsequent sensitization of peripheral afferent nociceptors at the level of the DRG or urothelium may promote spinal cord "wind-up" and cascade into visceral hyperalgesia and allodynia. In the first aim of this dissertation we investigated the functional profile of TGF-β isoforms and receptor (TβR) variants in the normal and inflamed (CYP-induced cystitis) urinary bladder with qRT-PCR, ELISA, IHC and in vivo cystometry. Our studies determined (i) the involvement of TGF-β in lower urinary tract neuroplasticity following urinary bladder inflammation, (ii) a functional role for TGF-β signaling in the afferent limb of the micturition reflex and (iii) urinary bladder TβR-1 as a viable target to reduce voiding frequency with cystitis. In the second aim of this dissertation we investigated the sensory components of the urinary bladder that may underlie the pathophysiology of aberrant TGF-β activation with bladder-pelvic nerve electrophysiology and luciferin-luciferase assays for ATP measurement. Our studies determined that TGF-β1 increased bladder afferent nerve excitability by stimulating ATP release from the urothelium via vesicular exocytosis mechanisms with minimal contribution from pannexin-1 channels. Furthermore, blocking aberrant TGF-β signaling in CYP-induced cystitis with TβR-1 inhibition decreased afferent nerve excitability with an equivalent decrease in ATP release. Taken together, these results establish a causal link between an inflammatory mediator, TGF-β, and intrinsic signaling mechanisms of the urothelium that may contribute to the altered sensory processing of bladder filling to facilitate increased voiding frequency. The distinct interactions of multiple mediators underscore the challenges for single target therapies and support the development of combinatory therapeutics for bladder dysfunction. Ultimately, these studies have increased our understanding of functional disorders and visceral pain and have the potential to improve the health of those suffering from inflammation-associated bladder syndromes.

ABSTRACT In humans, advanced malignancies are often targeted with broad-spectrum cytotoxic drugs that engender several detrimental side effects, in addition to their primary usage for eradicating cancerous cells. One of the lesser-researched of these effects, histological distortion of the olfactory system impedes a patient's ability to smell, perceive flavor, and ultimately may interfere with their nutritional intake and recovery from chemotherapy. Recent studies have indicated that cytotoxic drugs can damage gustatory epithelia immediately following administration (Mukherjee & Delay, 2011, 2013). We sought to observe the histological effects that cyclophosphamide (CYP), one of the oldest and most popular alkylating antineoplastic agents, may have on the murine main olfactory epithelium (MOE) and vomeronasal organ (VNO). We utilized two immunohistochemical antibodies to label cells in the olfactory epithelia: anti-Ki67, a marker strictly associated with cell proliferation; and, anti-Keratin 5, a marker for the cytoskeleton of horizontal basal cells. Twenty-eight C57BL/6 mice were administered a single intraperitoneal injection of CYP (75 mg/kg), while 20 control mice were administered saline, all at approximately seven weeks of age. Mice were euthanized at days one, two, six, 14, 30, and 45 post injection; subsequently, they were perfused with 4% paraformaldehyde, decalcified, cryoprotected, cryosectioned, and incubated with anti-Ki67 and anti-Keratin 5 antibodies, sequentially. Quantification results by fluorescent imaging of labeled sections revealed a significant decrease in the number of proliferative cells in the MOE and VNO of CYP-injected mice within the first 10 days post injection, followed by a compensatory period of increased cell proliferation through day 45 post injection, compared to saline-injected mice. Co-localization of horizontal basal cells and proliferative cells in the MOE and VNO of CYP-injected mice was significantly amplified at approximately 14 and 45 days post injection, respectively, compared to saline-injected mice. Our results suggest that administration of CYP can rapidly depress the populations of proliferative cells in the murine MOE and VNO; consequently, horizontal basal cells may afford restoration of the proliferative cell populations in the murine MOE and VNO, 14 to 45 days post injection, respectively.

The antineoplastic drug doxorubicin is widely used in the treatment of various types of cancers including breast, colon and lung cancer. However, doxorubicin has adverse effects on the heart and prolonged doxorubicin administration results in cardiomyopathy and congestive heart failure. In the present study we have established that treatment of rat cardiac myoblasts (H9c2 cells) for 24 hours with doxorubicin resulted in concentration and time dependent cell death as determined by proliferation assay. Almost 50-55% cell death was attained at 24 hours treatment of H9c2 cells with 5 μM doxorubicin. We have selected about 50% cell injury as an optimum doxorubicin-induced cell injury because once this threshold is reached, cells became irreversibly injured and are unable to respond to protective treatment. We have observed that another potent antineoplastic drug, cyclophosphamide, had no cardiotoxic effects even with exposure at 35 μM concentrations for a treatment time of up to 72 hours. Pretreatment of H9c2 cells for 24 hours with 100 nM 17β-estradiol protects about 30% cell death against subsequent treatment for 24 hours with 5 μM doxorubicin. Interestingly 500 nM quecertin and 20 μM resveratrol pretreatment provide about 30% and 40% protection, respectively, to the H9c2 cells against subsequent doxorubicin treatment. However, diethylstilbestrol (DES), bisphenol A, and estrone exhibit no protective effects. It is concluded that 17β-estradiol, resveratrol and quercetin considerably protect H9c2 cells against doxorubicin-induced cell death.

Tumor microenvironment is an area, where the local immunosuppressive effects dominate and prevents the immune system to perform its physiological functions. The cells infiltrating the microenvironment have an important function among many cell types since they produce a large quantity of factors suppressing the immune response. In our work, we monitored the immune changes in the microenvironment during tumor growth and chemotherapy. For these purposes, we utilized the methods for analysis of the proportion and phenotype of the distinct populations of immunocytes and for analysis of the total level of expressions of selected genes associated with immunosuppression or with distinct populations of immunocytes. The aim of our work was to discover, using two types of mouse tumors (TRAMP-C2 and TC-1/A9), how 5-azacytidine (5AC), a cytostatic drug with epigenetic activity, affects the proportion of leukocytes infiltrating the tumor microenvironment and, further, whether these changes are accompanied by decreased expression of immunosuppressing genes. In addition, we have also focused on the changes of relative expression of genes encoding markers of lymphoid lines and, on other immunoregulating genes, encoding IL-6, IL-10, IL-12, IL-4 and IFNγ cytokines, in the microenvironment of these tumors....

Hematologic malignancies are among the most often diagnosed forms of cancers. Treatment regimens often utilise various combination of cytostatic drugs and total body irradiation and subsequent transplantation of hematopoietic stem cells. One of the most common combinations includes ionising radiation with the antineoplastic alkylating agent cyclophosphamide. In this study we used congenic Ly5.2 and L5.1 mouse strains that express different isoforms of CD45 antigen to evaluate the effects of various time interval between cyclophosphamide and irradiation treatments on the viability of hematopoietic stem cells and their viability. This was done by competitive repopulation assay. The results revealed that level of engraftment and subsequent reconstitution of hematopoiesis can significantly vary and depend on the time interval between cyclophosphamide and total body irradiation administrations. The results indicate that patients with hematologic malignancies could possibly benefit from the treatment especially if they received transplants after being irradiated five or seven days after cyclophosphamide because at that time point their own stem cells would be least competitive. Key words: bone marrow transplantation, cyclophosphamide, chimerism, hematopoietic stem cells, ionising radiation

A ciclofosfamida (CPA) é um agente alquilante da classe das oxazafosforinas amplamente usada no tratamento de múltiplas formas de câncer e de doenças autoimunes em adultos e crianças. A CPA está disponível na clínica como racemato, no entanto, dados pré-clínicos demonstraram diferenças na eficácia e toxicidade dos seus enantiômeros, sendo o enantiômero (S)-(-)-CPA o de maior índice terapêutico. O presente estudo investigou a enantiosseletividade e a influência do CYP2B6, CYP2C9, CYP2C19 e CYP3A na disposição cinética da ciclofosfamida (CPA) em pacientes portadoras de câncer de mama. Foram incluídas na investigação 15 pacientes previamente submetidas ao procedimento de retirada do tumor e tratadas com CPA racêmica (900-1000 mg) e epirrubicina. A atividade in vivo do CYP3A foi avaliada empregando o midazolam como fármaco marcador. As amostras seriadas de sangue foram coletadas até 24 horas após a administração do primeiro ciclo da CPA. Os enantiômeros da CPA foram extraídos do plasma, usando mistura de acetato de etila:clorofórmio (75:25, v/v) e separados na coluna Chiralcel® OD-R com fase móvel constituída por acetonitrila:água (25:75, v/v), contendo 0,2% de ácido fórmico. Os enantiômeros da CPA foram analisados por LC-MS-MS, sendo que os íons protonados e seus respectivos íons-produtos foram monitorados nas transições 261>141 para a CPA e 189>104 para o padrão interno (antipirina). A recuperação foi maior que 95% para ambos os enantiômeros da CPA e o limite de quantificação foi de 2,5 ng/mL de plasma para cada enantiômero. Os coeficientes de variação e os erros relativos obtidos na avaliação da precisão e exatidão intra e inter-ensaios foram menores que 10%. Os parâmetros farmacocinéticos foram calculados empregando o programa WinNonlin e utilizando modelo monocompartimental e cinética de primeira ordem. Os parâmetros farmacocinéticos com razões enantioméricas diferentes da unidade foram avaliados com base no teste de Wilcoxon (P0,05). A disposição cinética da CPA é enantiosseletiva em pacientes com câncer de mama, com acúmulo plasmático do enantiômero (S)-(-)-CPA (AUC 195,00 vs 174,80 g.h/mL) em função do clearance preferencial do enantiômero (R)- (+)-CPA (5,13 vs 5,99 L/h). Os clearances de ambos os enantiômeros da ciclofosfamida não diferem em função dos genótipos CYP2B6, CYP2C9 e CYP2C19 e da atividade in vivo do CYP3A avaliada pelo clearance do midazolam. / Cyclophosphamide (CPA) is an alkylating oxazaphosphorine agent widely used in the treatment of multiple forms of cancer and autoimmunes disesases in adults and children. CPA is used as a racemic mixture, although preclinical data have demonstrated differences in the efficacy and toxicity of its enantiomers, with the (S)-(- )-CPA exhibiting a higher therapeutic index. The present study investigated the enantioselectivity and influence of CYP2B6, CYP2C9, CYP2C19 and CYP3A on the kinetic disposition of cyclophosphamide (CPA) in patients with breast cancer. Fifteen patients previously submitted to removal of the tumor and treated with racemic CPA (900-1000 mg) and epirubicin were included in the study. The in vivo activity of CYP3A was evaluated using midazolam as a marker drug. Serial blood samples were collected up to 24 h after administration of the first cycle of CPA. The CPA enantiomers were extracted from plasma using a mixture of ethyl acetate:chloroform (75:25, v/v) and separated on a Chiralcel® OD-R column, with the mobile phase consisting of acetonitrile:water (25:75, v/v) and 0.2% formic acid. The CPA enantiomers were analyzed by LC-MS-MS, and the protonated ions and their respective ion products were monitored at transitions of 261>141 for CPA and of 189>104 for the internal standard (antipyrine). Recovery was higher than 95% for both CPA enantiomers and the quantification limit was 2.5 ng/mL plasma for each enantiomer. The coefficients of variation and relative errors obtained for the evaluation of the intra- and interassay precision and accuracy were less than 10%. The pharmacokinetic parameters were calculated with the WinNonlin program using a monocompartmental model and first-order kinetics. The pharmacokinetic parameters presenting enantiomer ratios different from one were evaluated using the Wilcoxon test (P0.05). The kinetic disposition of CPA was enantioselective in patients with breast cancer, with plasma accumulation of the (S)-(-)-CPA enantiomer (AUC 195.00 vs 174.80 g.h/mL) due to the preferential clearance of the (R)-(+)-CPA enantiomer (5.13 vs 5.99 L/h). Clearances of both CPA enantiomers did not differ between the CYP2B6, CYP2C9 and CYP2C19 genotypes or as a function of in vivo activity of CYP3A evaluated by the midazolam clearance.