Acute lymphoblastic leukaemia (ALL) is the most common cause from death of disease in children. Whilst cure rates over the last 30 years have drastically improved, the children that do go on and relapse have a very poor prognosis. Additionally, the ones that do survive can have significant long term side effects from existing treatments. Understanding the molecular mechanisms of the relationship between leukaemia and its microenvironment is essential for the identification of novel targets for treatment and/or the manipulation of existing treatments. The role that vascular endothelial growth factor (VEGF), an integral component of both neovascularisation and normal haematopoiesis, plays in the progression and invasiveness of solid tumours is well established. However, its function in haematological malignancies has been a more recent and thus less considered observation. Human leukaemia cells secrete VEGF, which may act in a paracrine manner with the bone marrow microenvironment to promote the survival and proliferation of leukaemia cells. In addition to VEGF being produced by leukaemias, it also increases vascularity in the bone marrow and lymph nodes of patients. Our previous work has established a panel of 10 childhood acute lymphoblastic leukaemia xenografts from patient biopsies in NOD/SCID mice. Several of these secrete VEGF, and express the FMS-like tyrosine kinase-3 (FLT-3). FLT 3, a receptor tyrosine kinase (RTK), and its ligand, play an essential role in regulating normal haematopoiesis. This thesis builds on the previous work by examining the relationship between VEGF and FLT 3, two widely, yet independently studied molecules in leukaemia, with the aberrant expression of either having adverse outcomes for patients. The results show that the high expression and activation of FLT 3, significantly increases the secretion VEGF. To assess whether VEGF secretion is triggered by FLT-3 signalling, we measured VEGF in the absence and presence of a class III receptor tyrosine kinase (RTK) inhibitor (SU11657), humanised anti-FLT 3 blocking antibodies as well as decreasing the receptors with siRNA. All of these manipulations were able to decrease the secretion of VEGF in leukaemia cells. To further investigate this relationship, we examined the phosphorylation status of FLT-3 and the downstream signalling pathway. Our results indicate that FLT 3 signalling may be an important factor in the induction of VEGF secretion in a sub-type of leukaemia cells and in turn, VEGF secretion can be attenuated by an FLT-3 specific inhibitor. Two separate microarray studies were also used to assess simultaneous gene expressions between the leukaemia and bone marrow microenvironment, and to examine the effects of FL on ALL xenograft cells. The results of the microarray studies confirm the previously observed results regarding the manipulation of the microenvironment by the leukaemic cells. Inhibition of the FLT-3/VEGF pathway may disrupt paracrine signalling between leukaemia cells and the bone marrow microenvironment, and future studies into how this disruption may influence leukaemia cell responses to conventional chemotherapy are warranted.

O radiofármaco FLT-18F é um análogo do nucleosídeo timidina e um promissor marcador da proliferação tumoral para imagens em PET. A síntese deste radiofármaco não é simples e, muitas vezes, apresenta baixos rendimentos. Este radiofármaco já vem sendo estudado há alguns anos, porém, não há produção, nem estudos clínicos, no Brasil. O estudo do processo produtivo e a sua adequação às diretrizes de Boas Práticas de Fabricação (ANVISA) são de extrema importância. Este trabalho teve como objetivo estudar a síntese deste radiofármaco, avaliar os métodos de controle de qualidade que serão utilizados na rotina de produção futura, realizar estudos de citotoxicidade, estudos de biodistribuição e imagens PET em animais, contribuindo para o desenvolvimento e elaboração do protocolo de validação de processo e estabelecimento das metodologias analíticas a serem utilizadas durante a rotina de produção. Inicialmente, foi estudada a síntese e produção do produto FLT-18F, com a avaliação de três temperaturas diferentes de marcação, a m de vericar o comportamento do rendimento radioquímico e a estabilidade do produto nal. Os estudos de metodologia analítica compreenderam as análises de identicação radionuclídica, determinação dos pers cromatográcos, pureza radioquímica, solventes residuais e pH. Estudos in vitro do FLT- 18F de internalização e citotoxicidade também foram feitos. Nos estudos in vivo, avaliou-se a farmacocinética, biodistribuição em animais sadios e em animais com modelos tumorais, além de imagens PET/CT de animais com melanoma. O produto nal apresentou alta pureza radioquímica e mostrou-se estável por até 10 horas após a síntese, porém obteve-se um rendimento radioquímico relativamente baixo, conforme descrito na literatura. As metodologias analíticas testadas mostraram-se adequadas para o uso no controle de qualidade do FLT-18F. Nos estudos in vitro o FLT-18F apresentou uma signicativa porcentagem de ligação às células tumorais e a molécula não radiomarcada não foi considerada tóxica para estas células estudadas. A biodistribuição e as imagens apresentaram resultados compatíveis com o esperado. As contribuições para a validação de processo foram satisfatórias e auxiliarão na validação futura do processo produtivo do radiofármaco em estudo. / Radiopharmaceutical 18F-FLT is a thymidine nucleoside analogue and a promising tumor proliferation marker for PET images. The synthesis of this radiopharmaceutical is not simple, and often has low yields. This radiopharmaceutical has already been studied for some years; however, there is no production, nor are there clinical studies in Brazil. The study of the production process and its compliance with the guidelines of Good Manufacturing Practices (ANVISA) are of extreme importance. This study aimed to investigate the synthesis of this radiopharmaceutical, evaluate methods of quality control that will be used in future production routines, perform cytotoxicity studies, biodistribution studies and PET imaging in animals, thereby contributing to the development and elaboration of the process validation protocol and to the establishment of analytical methods to be used during production routines. Initially, we studied the synthesis and production of 18F-FLT, with the evaluation of three dierent temperatures of radiolabeling to check the behavior of the radiochemical yield and stability of the nal product. Studies of analytical methodology comprised the analysis of radionuclide identication, determination of chromatographic proles, radiochemical purity, residual solvents, and pH. In vitro studies of internalization and cytotoxicity were also carried out. In in vivo studies, we evaluated the pharmacokinetics, biodistribution in healthy animals and in animals with tumor models, in addition to PET/CT images in animals with melanomas. The nal product had high radiochemical purity and was stable for up to 10 hours after the synthesis, but got a relatively low radiochemical yield, as described in the literature. The tested analytical methods proved suitable for use in the quality control of 18F-FLT. In in vitro studies, 18F-FLT showed a signicant percentage of binding to tumor cells, and the nonradiolabeled molecule was not considered toxic for these studied cells. The biodistribution and images showed results that were consistent with expectations. Contributions to the validation process were satisfactory, and will assist in the future validation of the production process of the radiotracer under study.

O radiofármaco FLT-18F é um análogo do nucleosídeo timidina e um promissor marcador da proliferação tumoral para imagens em PET. A síntese deste radiofármaco não é simples e, muitas vezes, apresenta baixos rendimentos. Este radiofármaco já vem sendo estudado há alguns anos, porém, não há produção, nem estudos clínicos, no Brasil. O estudo do processo produtivo e a sua adequação às diretrizes de Boas Práticas de Fabricação (ANVISA) são de extrema importância. Este trabalho teve como objetivo estudar a síntese deste radiofármaco, avaliar os métodos de controle de qualidade que serão utilizados na rotina de produção futura, realizar estudos de citotoxicidade, estudos de biodistribuição e imagens PET em animais, contribuindo para o desenvolvimento e elaboração do protocolo de validação de processo e estabelecimento das metodologias analíticas a serem utilizadas durante a rotina de produção. Inicialmente, foi estudada a síntese e produção do produto FLT-18F, com a avaliação de três temperaturas diferentes de marcação, a m de vericar o comportamento do rendimento radioquímico e a estabilidade do produto nal. Os estudos de metodologia analítica compreenderam as análises de identicação radionuclídica, determinação dos pers cromatográcos, pureza radioquímica, solventes residuais e pH. Estudos in vitro do FLT- 18F de internalização e citotoxicidade também foram feitos. Nos estudos in vivo, avaliou-se a farmacocinética, biodistribuição em animais sadios e em animais com modelos tumorais, além de imagens PET/CT de animais com melanoma. O produto nal apresentou alta pureza radioquímica e mostrou-se estável por até 10 horas após a síntese, porém obteve-se um rendimento radioquímico relativamente baixo, conforme descrito na literatura. As metodologias analíticas testadas mostraram-se adequadas para o uso no controle de qualidade do FLT-18F. Nos estudos in vitro o FLT-18F apresentou uma signicativa porcentagem de ligação às células tumorais e a molécula não radiomarcada não foi considerada tóxica para estas células estudadas. A biodistribuição e as imagens apresentaram resultados compatíveis com o esperado. As contribuições para a validação de processo foram satisfatórias e auxiliarão na validação futura do processo produtivo do radiofármaco em estudo. / Radiopharmaceutical 18F-FLT is a thymidine nucleoside analogue and a promising tumor proliferation marker for PET images. The synthesis of this radiopharmaceutical is not simple, and often has low yields. This radiopharmaceutical has already been studied for some years; however, there is no production, nor are there clinical studies in Brazil. The study of the production process and its compliance with the guidelines of Good Manufacturing Practices (ANVISA) are of extreme importance. This study aimed to investigate the synthesis of this radiopharmaceutical, evaluate methods of quality control that will be used in future production routines, perform cytotoxicity studies, biodistribution studies and PET imaging in animals, thereby contributing to the development and elaboration of the process validation protocol and to the establishment of analytical methods to be used during production routines. Initially, we studied the synthesis and production of 18F-FLT, with the evaluation of three dierent temperatures of radiolabeling to check the behavior of the radiochemical yield and stability of the nal product. Studies of analytical methodology comprised the analysis of radionuclide identication, determination of chromatographic proles, radiochemical purity, residual solvents, and pH. In vitro studies of internalization and cytotoxicity were also carried out. In in vivo studies, we evaluated the pharmacokinetics, biodistribution in healthy animals and in animals with tumor models, in addition to PET/CT images in animals with melanomas. The nal product had high radiochemical purity and was stable for up to 10 hours after the synthesis, but got a relatively low radiochemical yield, as described in the literature. The tested analytical methods proved suitable for use in the quality control of 18F-FLT. In in vitro studies, 18F-FLT showed a signicant percentage of binding to tumor cells, and the nonradiolabeled molecule was not considered toxic for these studied cells. The biodistribution and images showed results that were consistent with expectations. Contributions to the validation process were satisfactory, and will assist in the future validation of the production process of the radiotracer under study.

Improved radiotherapy (RT) outcomes may be facilitated through monitoring of physiological processes implicated in radio-resistance such as proliferation. To this end, we studied 16 patients with non-small cell lung cancer with dynamic 3'-deoxy-3'-fluorothymidine (FLT) PET-CT before and after a week of radical RT. In absence of changes in primary tumour volume manually delineated on CT, RT induced a significant, moderately variable decrease in maximum and mean standard uptake values (SUVmax and SUVmean) of the order of 25%. Metastatic nodes showed a larger relative decrease in uptake approximating 40% associated with volumetric regression and only partially accountable by partial volume effect. Implementation of different segmentation approaches including manual delineation by a second operator and PET-based semi-automatic algorithms [two fixed thresholds, 2/3-cluster Fuzzy C-means (FCM-2, FCM-3) and 2/3-cluster fuzzy locally adaptive Bayesian algorithm (FLAB-2, FLAB-3)] yielded substantially different volumes and SUVs but consistent SUV responses. Reproducibility comparison favoured manual delineation, while thresholding delivered poor volumetric robustness and no apparent SUV reproducibility advantage over SUVmax or SUVpeak. FCM-2/FLAB-2 demonstrated intermediate reproducibility. In contrast to anatomical volumes, metabolic volumes exhibited significant increases with treatment, which for FLAB-2 correlated with changes of intratumoural uptake heterogeneity quantified by the coefficient of variation. Normal tissue analysis revealed an anterior-posterior gradient of lung uptake and an association of baseline marrow SUV with type/timing of neo-adjuvant chemotherapy. RT induced a dramatic (≈-76%), sharply demarcated marrow SUV decline in response to a minimum of 5Gy and a small (≈-20%), consistent decline in normal lung SUV. Kinetic analysis revealed a significant increase in the tumour delivery constant K1 (+32%) and a decrease in Ki/K1, larger (-36%) and more variable than the Ki (-26%) and SUV responses. Furthermore, despite baseline independence, we found a strong negative correlation between Ki/K1 and K1 at the response level. Kinetic analysis of the most uptake-avid tumour cluster extracted with FCM-3 yielded similar results with attenuated changes in delivery and retention. Overall, we found that RT induces early measurable changes in lung tumour FLT uptake. Spatial analysis indicated a variable dissociation of anatomical and metabolic volumes, while temporal analysis showed a variable antagonistic effect on delivery and phosphorylation, indicating that SUV analysis may misrepresent the magnitude and variability of RT anti-proliferative effect.

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Made available in DSpace on 2016-07-18T17:53:17Z (GMT). No. of bitstreams: 1 Francislaine.pdf: 394781 bytes, checksum: a0d56232957fee86543512d568bcec4c (MD5) Previous issue date: 2015-12-18 / Tea is an extremely popular drink, being the second most commonly consumed in the world. People ingest teas on average two to three times a day, the majority being derived from the Camellia sinensis plant. The beneficial health effects of the consumption of tea from this plant are well known, such as the prevention of cancer, cardiovascular disease and osteoporosis. Despite this, little is known about the action of white tea on reproduction. It is important to evaluate the possible consequences of consumption on luteal and endometrial development since the main catechin, epigallocatechin gallate (EGCG), present in the tea influences the gene expression of VEGF in tumors and this is an important angiogenic factor in the reproductive organs. This study aimed to verify the effects of prolonged intake of white tea on the relative abundance of VEGF mRNA and its receptors, as well as in cell proliferation in the endometrium of superovulated rats. For this purpose, the rats were divided into two groups, control group (n = 30), which received water, and white tea intake group (n = 30). The ovaries and uteri were collected from 10 animals in each group at the end of every month, for three consecutive months, stored in Trizol in a freezer at -80 ° C and the relative abundance of VEGF mRNA, Flt-1 and KDR were subsequently evaluated. In addition, the uteri were histologically analyzed using the silver staining method to detect cell proliferation. The data were evaluated for the assumption of normality (Shapiro-Wilk) and statistical comparisons were performed using the unpaired t test between groups at different collection moments (p <0.05). The relative abundance of VEGF mRNA and its receptors was changed by the tea consumption and there were a lower number of nucleolar organizer regions in endometrial cells. It was concluded that prolonged consumption of white tea interferes the expression of the VEGF system genes in the corpus luteum and decreases cell proliferation in the endometrium of Wistar rats. / O chá é uma das bebidas mais populares e a segunda mais consumida no mundo. A população ingere chás em média, de duas a três vezes ao dia, sendo em sua maioria oriundos da planta Camellia sinensis. São bem conhecidos os efeitos benéficos para a saúde do consumo dos chás provenientes dessa planta, como a prevenção de câncer, de doença cardiovascular e da osteoporose. Apesar disso, pouco se sabe sobre a ação do chá branco na reprodução, sendo importante avaliar as possíveis consequências do seu consumo no desenvolvimento luteal e endometrial. Visto que a principal catequina, a epigalocatequina galato (EGCG) presente neste chá influencia a expressão gênica do Vegf em tumores e este é um importante fator angiogênico dos órgãos reprodutivos, este estudo teve como objetivo verificar o efeito da ingestão do chá branco sobre a abundância relativa do mRNA do Vegf e dos seus receptores,sobre a proliferação celular do endométrio de ratas superovuladas. Para tanto, as ratas foram distribuídas em dois grupos, grupo controle (n=30) que recebeu água e grupo com ingestão de chá branco (n=30). Os ovários e os úteros foram coletados ao final de cada mês de ingestão de chá branco ou água de 10 animais de cada grupo, durante três meses consecutivos, sendo os ovários armazenados em trizol no freezer a -80ºC e posteriormente a abundância relativa de mRNA do Vegf, do Flt-1 e do Kdr foram avaliadas. Além disso, os úteros foram analisados histologicamente pelo método de coloração de prata para detecção de proliferação celular. Os dados foram avaliados quanto ao pressuposto de normalidade (Shapiro-Wilk) e as comparações estatísticas foram realizadas por meio dos testes t não pareado entre os grupos nos diferentes momentos de colheitas (p<0,05). A abundância relativa de mRNA do Vegf e dos seus receptores foi alterada pelo consumo de chá e houve um menor número de regiões organizadoras de nucléolo nas células do endométrio. Conclui-se que a ingestão prolongada de chá branco altera a expressão dos genes do sistema Vegf no corpo lúteo e diminui a proliferação celular do endométrio de ratas Wistar.

Einleitung: Die Dysbalance proangiogener (Placental Growth Factor = PlGF) und antiangiogener Faktoren (soluble fms-like tyrosine kinase 1 = sFlt-1) gilt heute als pathophysiologische Grundlage bei der Entstehung einer Präeklampsie (PE), eines HELLP-Syndroms (Haemolysis, Elevated Liver enzymes, Low Platelets) oder einer intrauterinen Wachstumsretardierung (IUGR). Der sFlt1/PlGF-Quotient, ein sensitiver und robuster diagnostischer Marker, ist bereits Wochen vor der Krankheitsmanifestation erhöht. Ziel dieser Studie war es, die Wertigkeit des sFlt1/PlGFQuotienten als prädiktiven Faktor bei Risikopatientinnen zu untersuchen. Patienten und Methode: In diese prospektive Studie wurden 68 Patientinnen mit einer Einlingsschwangerschaft und mindestens einem Risikofaktor für das Auftreten einer PE, eines HELLP-Syndrom oder einer IUGR im Schwangerschaftsverlauf eingeschlossen. Die Patientinnen wurden je nach Verlauf der Schwangerschaft in eine Gruppe mit Symptomen (Fallgruppe) und eine Gruppe ohne Symptome (Kontrollgruppe) für eine der oben genannten Erkrankungen unterteilt. Der sFlt1/PlGF-Quotient wurde bei der Aufnahme in die Studie und im weiteren Schwangerschaftsverlauf bestimmt. Ergebnisse: Eine PE, ein HELLP-Syndrom oder eine IUGR trat bei 41 % der Risikopatientinnen auf… Der absolute Wert des sFlt-1/PlGF-Quotienten war nur bei der Gruppe mit Symptomen auf ≥ 85 erhöht und zeigte sich in der 25 + 0-31 + 0 SSW (p = 0,005) und ab der 35 + 0 SSW (p = 0,044) als prädiktiver Faktor für eine PE, ein HELLP-Syndrom oder eine IUGR. Ab 7–10 Wochen vor der Entbindung war, in der Fallgruppe stärker als in der Kontrollgruppe, ein Anstieg des sFlt1/PlGFQuotienten zu beobachten. Dieser war 0–2 Wochen vor der Entbindung bei beiden Gruppen (Kontrollgruppe (MW ± SA 66,9 ± 134) vs. Fallgruppe (MW ± SA 393,3 ± 147,4, p = 0,021) am ,stärksten und zeigte sich ebenfalls als prädiktiver Faktor für eine der genannten Schwangerschaftserkrankungen (p = 0,025). Schlussfolgerung: Bei Risikoschwangeren kann der sFlt1/ PlGF-Quotient für die Einschätzung des individuellen Risikos für eine PE, ein HELLP-Syndrom oder eine IUGR im Schwangerschaftsverlauf genutzt werden. Wiederholte Messungen des Quotienten versprechen eine risikoangepasste Betreuung dieser Patientinnen. / Background: A dysbalance of proangiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase 1 (sFlt-1)] proteins is known to cause the symptoms of preeclampsia (PE), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) or intrauterine growth restriction (IUGR). An increased sFlt-1/ PlGF ratio ≥ 85 is considered a reliable diagnostic marker. Altered sFlt1 and PlGF concentrations can be detected several weeks prior to the onset of clinical symptoms. In this study we analysed the role of the sFlt1/PlGF ratio as a predictive marker for preeclampsia in a high-risk patient group. Patients and materials: We prospectively included 68 singleton pregnancies with at least one risk factor for PE, HELLP syndrome or IUGR. During the study the patients were divided into one group with symptoms (patient group) and one group without symptoms (control group) for the above-mentioned diseases. The sFlt1/PlGF ratios were measured on admission and during the course of pregnancy. Results: During pregnancy 41 % of patients developed PE, HELLP syndrome or IUGR. An increase of the absolute value of the sFlt1/PlGF ratio ≥ 85 was only observed in the patient group and was found to be a predictive factor for PE, HELLP syndrome or IUGR at 25 + 0 to 31 + 0 weeks of gestation (p = 0.005) and after 35 + 0 weeks of gestation (p = 0.044). Alterations of the sFlt1/PlGF ratio were observed in all patients but were higher in the patient group from 7–10 weeks prior to delivery and with the highest peak 0–2 weeks prior to delivery. Compared to the control group (mean ± SD 66.9 ± 134) absolute values of sFlt1/PlGF ratio were signifi cantly (p = 0.021) increased 0–2 weeks prior to delivery in the patient group (mean ± SD 393.3 ± 147.4). An increase of the sFlt1/PlGF ratio ≥ 85 0–2 weeks before delivery has shown to be predictive for one of the mentioned diseases (p = 0.025).Conclusions: In high-risk patients the sFlt1/PlGF ratio can be used for an individual risk assessment with regard to PE, HELLP syndrome or IUGR. Serial measurements permit a risk-adapted prenatal care of these patients.

Vascular endothelial growth factor (VEGF) is a potent angiogenic agent. VEGF activates its biologic responses through two cell-surface receptors, Flt1 and Flk1. In addition to the transmembrane form of Flt1, the Flt1 gene also encodes a secreted, truncated form of the receptor (sFlt1) translated from an mRNA in which a portion of intron 13 is preserved. sFlt1 retains high affinity for VEGF and thereby inhibits its angiogenic activity. Intron 13 contains important cis elements involved in sFlt1 mRNA formation. Here, we test the hypothesis that polymorphisms in the human Flt1 gene, particularly SNPs at sites suspected to contain splicing or cleavage-polyadenylation signals, influence Flt1 pre-mRNA processing and rates of Flt1 and sFlt1 expression. The NCBI SNP database contained 23 SNPs in the region of interest, one each in exons 13 and 14. An independent human SNP screen confirmed several of the reported SNPs. The web-based ESEfinder software predicted that the exon 13/14 SNPs had reduced potential for recruitment of splicing components. To test effects of exonic SNPs on Flt1 pre-mRNA processing, wild type and mutant Flt1 minigene plasmids were transfected into NIH/3T3 cells. Both exonic SNPs were associated with ~40% decreases in Flt1:sFlt1 mRNA ratios determined by real-time PCR. To facilitate exploration of ESEs in regulated RNA splicing, a PERL computer program, "EXONerator" was written to silence predicted ESEs without altering polypeptide sequence. These results support the notion that small changes in exon composition can have significant effects on splicing activity and underscore the utility of software tools for hypothesis generation. / Ph. D.

Angiogenesis is the formation of new blood vessels from existing vasculature. Vascular Endothelial Growth Factor (VEGF), a known angiogenic protein, stimulates endothelial cell proliferation and migration via interactions with its receptors, KDR and Flt-1. A secreted form of Flt-1 (sFlt-1), derived from alternatively-spliced RNA, can inhibit actions of VEGF in vivo. It has been suggested that alterations in sFlt-1 expression could significantly change the angiogenic VEGF activity. This project focuses on characterizing intronic elements that regulate Flt-1 mRNA splicing. A "wild-type" construct (pFIN13), containing the first 13 exons, intron 13 and exons 14-30 of mouse Flt-1, was shown to produce both forms of Flt-1 mRNA after transfection into HEK293 cells. To gauge the strength of the native splicing signals in intron 13 of Flt-1, a series of point mutations were made in the polypyrimidine tract using pFIN13. After transient transfection, the levels of Flt-1 and sFlt-1 protein and mRNA were compared using quantitative PCR, RNA hybridization analysis, and protein immunoblotting. Results from quantitative PCR showed that purine substitutions were associated with 120 to 350 fold decreases in Flt-1 mRNA (normalized against neor), consistent with less efficient splicing. These large decreases in Flt-1 mRNA were accompanied by increases in sFlt-1 mRNA. Modest (20 to 100%) increases in Flt-1 mRNA, reflecting improved splicing, resulted from increasing the uridine complement in the polypyrimidine tract. These results suggest that the wild-type polypyrimidine tract is of intermediate strength and may be a regulatory locus for modulating Flt-1: sFlt-1 ratios. / Master of Science