京都大学 / 新制・課程博士 / 博士(医学) / 甲第24196号 / 医博第4890号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊藤 貴浩, 教授 妹尾 浩, 教授 永井 純正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Ce travail, qui fait partie d’un projet européen, « NANOTHER », est focalisé sur la fonctionnalisation de nanoparticules polymériques et lipidiques fonctionnalisées par des anticorps Herceptine® pour cibler des cellules du cancer du sein HER2+. Deux stratégies de fonctionnalisation ont été étudiées : une a reposé sur l’utilisation de protéines de fusion, l’Anx5-ZZ, composée d’Annexine A5 et deux domaines Z homologues de la protéine A de Staphylococcus aureus qui peuvent se fixer des anticorps d’une manière orientée par leur fragment cristallisable ; l’autre a porté sur le couplage direct d’anticorps modifiés pour exposer des groupes sulfhydryles aux nanoparticules exposant des groupes maléimides.La première partie concerne le développement d’un agent de ciblage simplifié du complexe l’Anx5-ZZ-anticorps, à savoir l’Anx5-scFv (single-chain variable fragment). Puisque la cible n’avait pas été décidée au début de ce travail, deux scFvs ont été utilisé comme système modèle. L’expression de protéines de fusion a été essayée chez Escherichia Coli avec différentes constructions de protéines de fusion, différentes conditions d’expression et différentes souches bactériennes. Toutes les protéines sont soient agrégées soient non surexprimées.La deuxième partie consiste à fonctionnaliser les polymersomes par l’Herceptine® via l’Anx5-ZZ. D’abord, nous avons validé une méthode de modification de la surface de polymersome pour présenter des groupes maléimides. Ensuite, le couplage covalent de l’Anx5(SH)-ZZ aux polymersomes-maléimide a été réalisé et quantifié. Nous avons obtenu maximum 30 Anx5-ZZ par polymersome. Puis, la liaison d’affinité d’anticorps aux polymersomes-Anx5-ZZ a été caractérisée, réalisée et quantifiée. Pour 30 Anx5-ZZ par polymersome, nous avons 60 Herceptine® par polymersome. Cependant, l’efficacité de ciblage de ces systèmes est très faible.La troisième partie consiste à fonctionnaliser les liposomes par l’Herceptine® via couplage direct. Tout d’abord, la modification de l’Herceptine® pour présenter des groupes SH a été caractérisée et contrôlée. Ensuite, le couplage covalent d’Herceptine®-SH aux liposomes-maléimides a été réalisé et quantifié. L’étude de ciblage montre que les liposomes fonctionnalisés par une molécule d’Herceptine® sont capable de cibler les cellules HER2+. / This work, which is part of a European project "NANOTHER", focus on the functionalization of polymeric and lipidic nanoparticles by Herceptin® to target HER2+ cancer cells. Two functionalization strategies were studied: one was based on the use of a fusion protein, Anx5-ZZ, composed of Annexin A5 and two Z domains which are homologous with the protein A of Staphylococcus aureus that can bind antibodies by their crystallizable fragment in a oriented way; the other focused on the direct coupling of modified antibodies exposing sulfhydryl groups to nanoparticles exposing maleimid groups.The first part concerns the development of a targeting agent simplified from the Anx5-ZZ-antibody complex, namely Anx5-scFv (single-chain variable fragment). Since the target had not been decided at the beginning of this work, two scFvs were used as model system. The expression of fusion proteins was tested in Escherichia coli with different fusion protein constructions, different expression conditions and different bacterial strains. All proteins are either aggregated or non-overexpressed.The second part is to functionalize the polymersomes by Herceptin® via Anx5-ZZ. First, we validated a method for modifying the surface of polymersome to expose maleimid groups. Then, the covalent coupling of Anx5(SH)-ZZ to polymersomes-maleimid was performed and quantified. We obtained maximum 30 Anx5-ZZ per polymersome. Then, the affinity binding of antibodies to polymersomes-Anx5-ZZ was characterized, performed and quantified. For 30 Anx5-ZZ per polymersome, we have 60 Herceptin® per polymersome. However, the targeting efficiency of this system is very low.The third part consists in functionalizing the liposomes by Herceptin® via direct coupling. Firstly, the modification of Herceptin® to expose SH groups was characterized and controlled. Then, the covalent coupling of Herceptin®-SH to liposomes exposing maleimid groups was performed and quantified. The targeting study shows that liposomes functionalized with one Herceptin® are able to target HER2+ cells.

Introdução: o câncer de mama que apresenta amplificação/superexpressão do HER2 apresenta-se com pior prognóstico e seu amplicon se localiza no locus 17q12-q21. O gene WIPF2, relacionado a motilidade celular, localiza-se no mesmo locus e também se encontra presente no amplicon do HER2. Objetivo: avaliar a superexpressão simultânea do HER2 e WIPF2 através de marcação imunohistoquímica. Métodos: foram selecionados 94 casos de carcinoma ductal invasor de mama, sendo possível a obtenção de material em 87. Foi realizada técnica de microarranjo tecidual e as lâminas foram analisadas. Informações clínicas foram obtidas de prontuário médico. Resultados: após microscopia óptica das lâminas de TMA obtidas e comparação com lâminas convencionais arquivadas, validou-se o método, com bom índice de correlação kappa (0,83 para receptores de estrógeno e 0,84 para receptores de progesterona). Houve associação entre a superexpressão do WIPF2 com casos Ki-67 positivos e em pacientes nuligestas. O grupo HER2 apresentou maior porcentagem de casos WIPF2 positivos em relação ao grupo triplo-negativo à microscopia óptica (66,7% vs. 22,7%, respectivamente; p=0,03). Na análise digital, o perfil molecular HER2 apresentou maior expressão do WIPF2 em relação ao perfil luminal A e ao triplo negativo (23,9 ± 9,0% vs. 14,6 ± 9,0% e 14,2 ± 9,0%, respectivamente; p=0,01). Conclusão: O WIPF2 é mais expresso por tumores com o perfil HER2, assim como se associa a tumores com maior proliferação e tumores em pacientes nulíparas. / Introduction: the breast cancer with amplification/overexpression of HER2 shows worse prognosis and its amplicon is located in the 17q12-21 locus. The gene WIPF2, related to cellular mobility, is located in the same locus and is also present in the HER2 amplicon. Objective: to evaluate HER2 and WIPF2 simultaneous overexpression using immunohistochemistry technique. Methods: we selected 94 invasive ductal carcinoma samples and it was possible to evaluate 87. Tissue microarray has been done and slides analyzed. Clinical informations were obtained from clinical files. Results: after optical microscopy of TMA slides and comparison with conventional slides, the method was validated with a high correlation kappa index (0.83 for estrogen receptors and 0.84 for progesterone receprtors). The WIPF2 overexpression was associated with positive Ki-67 tumors and nuliparous women. The HER2 group presented greater percentage of WIPF2 positive cases when compared with triple-negative group using optical microscopy (66.7% vs. 22.7%, respectively, p=0.03). With the digital analysis, the HER2 group presented greater expression of WIPF2 when compared with luminal A and triple-negative groups (23.9 ± 9.0% vs. 14.6 ± 9.0% e 14.2 ± 9.0%, respectively; p=0.01). Conclusion: WIPF2 is more expressed in the HER2 group tumors. It is also related to high proliferation index and nuliparous women´s tumors.

Introduction: Worldwide, Gastric Cancer (GC) is the fourth cancer in incidence and the second most common cause of cancer death. Because it is asymptomatic in the early stages, it is often diagnosed in advanced stages. HER2 gene expression has been identified in about 20% of GC. Its expression is associated with a worse prognosis for GC patients. Objectives: To study HER2 immunoexpression in specimens of gastric adenocarcinoma and its association with histological classification and anatomical location. Patients and methods: We conduct a cross-sectional study, where we analyzed HER2 immunoexpression in 48 specimens of gastric adenocarcinoma. We use avidin-biotin method with primary antibody peroxidase C-erb B2, clone EP1045Y (Biocare Medical, USA). Results: We found seven positive cases. HER2 was expressed in 5 intestinal type and 2 in the intestinal component of mixed type. There was no expression of HER2 in diffuse type. HER2 expression was associated with the intestinal component of gastric adenocarcinoma (p = 0.003). Regarding the anatomical site, 1 in 6 (16.6%) proximal cases was positive for HER2, and 6 in 42 (14.28%) distal were positive for HER2. We did not find an association between HER2 expression and the anatomical site of GC. Conclusion: HER2 immunoexpression was found in 14.6% of the sample and it showed significant association with Lauren's intestinal subtype. / Introdução: O Câncer Gástrico (CG) ocupa o quarto lugar em incidência no mundo, sendo a segunda causa de óbito por neoplasia maligna. Por ser assintomático nas fases iniciais, na maioria das vezes, é diagnosticado em fases avançadas. A expressão do gene HER2 tem sido identificada em cerca de 20% dos CG, e sua hiper-expressão está associada a um pior prognóstico nestes pacientes. Objetivo: Investigar a expressão imunoistoquímica do HER2 em espécimes de adenocarcinoma gástrico, e sua relação com a classificação histológica e localização anatômica. Pacientes e métodos: Estudo transversal, retrospectivo, onde foi analisada a expressão imunoistoquímica para o HER2, em uma amostra de 48 espécimes de CG, através da técnica de imunoistoquímica, pelo método avidina-biotina-peroxidase, utilizando anticorpo primário C-erb B2, clone EP1045Y (Biocare Medical, USA). Resultados: Foram encontrados 7 casos com expressão positiva de HER2; destes, 5 eram casos de adenocarcinoma do tipo intestinal e 2 eram casos do tipo misto, porém, nestes, a expressão ocorreu no componente intestinal, o que determinou uma associação significante da expressão de HER2 com o componente intestinal do adenocarcinoma gástrico (p=0,003). Quanto ao sítio anatômico, dos 6 casos proximais, somente 1 (16,6%) foi positivo para o HER2, e nos 42 casos distais 6 (14,28%) foram positivos para o HER2. Não foi demonstrada associação da expressão de HER2 com o sítio anatômico das lesões. Conclusão: A expressão de HER2 ocorreu em 14,6% da amostra, associada significativamente ao subtipo intestinal de Lauren.

Introdução: o câncer de mama que apresenta amplificação/superexpressão do HER2 apresenta-se com pior prognóstico e seu amplicon se localiza no locus 17q12-q21. O gene WIPF2, relacionado a motilidade celular, localiza-se no mesmo locus e também se encontra presente no amplicon do HER2. Objetivo: avaliar a superexpressão simultânea do HER2 e WIPF2 através de marcação imunohistoquímica. Métodos: foram selecionados 94 casos de carcinoma ductal invasor de mama, sendo possível a obtenção de material em 87. Foi realizada técnica de microarranjo tecidual e as lâminas foram analisadas. Informações clínicas foram obtidas de prontuário médico. Resultados: após microscopia óptica das lâminas de TMA obtidas e comparação com lâminas convencionais arquivadas, validou-se o método, com bom índice de correlação kappa (0,83 para receptores de estrógeno e 0,84 para receptores de progesterona). Houve associação entre a superexpressão do WIPF2 com casos Ki-67 positivos e em pacientes nuligestas. O grupo HER2 apresentou maior porcentagem de casos WIPF2 positivos em relação ao grupo triplo-negativo à microscopia óptica (66,7% vs. 22,7%, respectivamente; p=0,03). Na análise digital, o perfil molecular HER2 apresentou maior expressão do WIPF2 em relação ao perfil luminal A e ao triplo negativo (23,9 ± 9,0% vs. 14,6 ± 9,0% e 14,2 ± 9,0%, respectivamente; p=0,01). Conclusão: O WIPF2 é mais expresso por tumores com o perfil HER2, assim como se associa a tumores com maior proliferação e tumores em pacientes nulíparas. / Introduction: the breast cancer with amplification/overexpression of HER2 shows worse prognosis and its amplicon is located in the 17q12-21 locus. The gene WIPF2, related to cellular mobility, is located in the same locus and is also present in the HER2 amplicon. Objective: to evaluate HER2 and WIPF2 simultaneous overexpression using immunohistochemistry technique. Methods: we selected 94 invasive ductal carcinoma samples and it was possible to evaluate 87. Tissue microarray has been done and slides analyzed. Clinical informations were obtained from clinical files. Results: after optical microscopy of TMA slides and comparison with conventional slides, the method was validated with a high correlation kappa index (0.83 for estrogen receptors and 0.84 for progesterone receprtors). The WIPF2 overexpression was associated with positive Ki-67 tumors and nuliparous women. The HER2 group presented greater percentage of WIPF2 positive cases when compared with triple-negative group using optical microscopy (66.7% vs. 22.7%, respectively, p=0.03). With the digital analysis, the HER2 group presented greater expression of WIPF2 when compared with luminal A and triple-negative groups (23.9 ± 9.0% vs. 14.6 ± 9.0% e 14.2 ± 9.0%, respectively; p=0.01). Conclusion: WIPF2 is more expressed in the HER2 group tumors. It is also related to high proliferation index and nuliparous women´s tumors.

Made available in DSpace on 2014-08-20T13:33:01Z (GMT). No. of bitstreams: 1 tese_flavia_aleixo_vasconcellos.pdf: 1086060 bytes, checksum: 69a51e8723d756b44009a0d489d3f4d5 (MD5) Previous issue date: 2011-12-01 / Malignant neoplasms such as breast cancer deserve attention for its high prevalence and great demand of financial resources, representing a major problem of public health all over the world. In Brazil, mortality rates from breast cancer remain high, most likely because the disease is diagnosed in advanced stages. Tumor markers can be useful in diagnosis, staging and in the evaluations of therapeutic responsiveness and disease prognostic. The overexpression of the oncogene Human Epidermal growth factor receptor 2 (HER2), a prognostic tumor marker in breast cancer, is observed in 20-30% of breast cancers in humans and canines. In this context, this study reports the development of new murine monoclonal antibodies from a recombinant protein corresponding to the extracellular portion of the HER2 receptor for use in immunohistochemistry (IHC) and in the development of other immunoassays. These antibodies were produced, characterized and tested subsequently in histological sections of human and canine breast tumors. Among five hybridomas produced, two demonstrated potential for use in immunohistochemistry of these two tumors. / As neoplasias malignas, como o câncer de mama, atraem a atenção em todo o mundo por sua alta prevalência e grande demanda de recursos financeiros, e por representarem um grande ônus social. No Brasil, as taxas de mortalidade por câncer de mama continuam elevadas, muito provavelmente porque a doença ainda é diagnosticada em estágios avançados. Marcadores tumorais podem ser úteis no diagnóstico, no estadiamento e nas avaliações da resposta terapêutica e do prognóstico da doença. A superexpressão do oncogene Human Epidermal growth factor Receptor 2 (HER2), um marcador de prognóstico em câncer de mama, é evidenciada em 20-30% dos tumores mamários em humanos e caninos. Nesse contexto, o presente trabalho relata o desenvolvimento de novos anticorpos monoclonais murinos apartir de uma proteína recombinante correspondente à porção extracelular do receptor HER2 para uso em técnica de imunohistoquímica (IHQ) e desenvolvimento de outros ensaios imunodiagnósticos. Estes anticorpos monoclonais foram produzidos, caracterizados e posteriormente testados em cortes histológicos de tumores mamários humano e canino. Entre cinco hibridomas produzidos, dois deles demonstraram potencial para uso na técnica de imunohistoquímica nestes tumores.

Dans les cancers du poumon, une des altérations les plus souvent observées est la perte ou l’atténuation de l’expression du gène FHIT (Fragile Histidine Triad). Nous avons précédemment montré que FHIT est un suppresseur d’invasion tumorale. En effet, FHIT contrôle l’invasion des cellules tumorales bronchiques en régulant négativement l'expression de gènes associés à la transition épithélio-mésenchymateuse (TEM), en particulier la vimentine et la MMP-9 via l’inhibition d’une voie orchestrée par l’EGFR. Un intérêt particulier a donc été porté aux relations entre FHIT et un autre membre de la famille de l’EGFR : HER2. Nous avons non seulement mis en évidence, in vivo et in vitro, une corrélation inverse entre les taux de FHIT et l’activité du récepteur HER2 dans les CBNPC mais également montré que FHIT est capable de réguler l’activité du récepteur HER2 dans les cellules tumorales pulmonaires et ce grâce à sa dimérisation avec HER3. De plus, l’utilisation de deux inhibiteurs spécifiques d’HER2, le Trastuzumab et l’Irbinitinib, nous a permis de mettre en évidence, que l’activation du récepteur HER2 lors de l’inhibition de FHIT, participe à l’acquisition par les cellules tumorales bronchiques de caractéristiques invasives via la régulation de certaines cibles de la TEM, telles la vimentine, la MMP-14 ou encore le facteur de transcription TWIST-1. Ces résultats montrent que FHIT régule l’activité d’HER2 dans les cellules tumorales pulmonaires et que les inhibiteurs d’HER2 sont capables de limiter l’invasion induite par l’inhibition de FHIT. Cette étude laisse envisager de nouvelles perspectives thérapeutiques pour le cancer du poumon. / The lack or decrease of FHIT (fragile histidine triad) expression is a common event in lung cancer. We recently showed that FHIT acts as a suppressor of tumor invasion. Indeed, FHIT controls the invasive phenotype of lung tumor cells by regulating the expression of genes associated with epithelial-mesenchymal transition (EMT) such as vimentin or MMP-9 through an EGFR signaling pathway. Accordingly, we focused on the relationships between FHIT and another member of this tyrosine kinase receptor family: HER2. First, we observed in vivo and in vitro a negative correlation between FHIT expression and the activated form of HER2 in lung tumor cells. Moreover, FHIT controls HER2 activation through its dimerization with HER3. The use of HER2 specific inhibitors, Trastuzumab and Irbinitinib, allowed to demonstrate that the in vitro invasion induced by FHIT inhibition is HER2-dependent. Furthermore, FHIT controls the HER2-dependent invasion by regulating genes associated with EMT such as vimentin, MMP-14 or TWIST-1. In conclusion, we showed that FHIT regulates HER2 activity in lung tumor cells and that HER2 inhibitors reduce invasion induced by FHIT inhibition. This study would allow for the identification of new therapeutic leads for lung cancer.

Breast cancer is a common malignant disease affecting millions of women worldwide. Amplification of HER2 oncogene, a tyrosine kinase receptor, in breast cancer allows application of targeted therapy, but approximately one third of patients develop resistance to treatment. Relocalization of HER2 from the plasma membrane into the mitochondria was found and suggested as one of the potential causes of such resistance. Here we document that the function of mitochondrial HER2 is distinct from that of HER2 in the plasma membrane. Mitochondrial HER2 enhances cancer cell energetic metabolism, proliferation and migration in vitro, and tumour formation in vivo in mice correlating with elevated level of ROS signalling. The kinase activity of mitochondrial HER2 is unaffected, therefore I investigated its role in mitochondrial HER2 function. Moderate, endogenous levels of the kinase activity of mitochondrial HER2 drive pro-tumorigenic properties of breast cancer cells, while constitutive kinase activity sensitizes these cells to cell death and attenuates tumour formation in animal models. On the other hand, impairment of kinase activity due to mutation in the ATP binding site of mitochondrial HER2 supports adherence-independent growth in vitro and tumor growth in vivo. We propose that HER2 function in...

Breast cancer is a common malignant disease affecting millions of women worldwide. Amplification of HER2 oncogene, a tyrosine kinase receptor, in breast cancer allows application of targeted therapy, but approximately one third of patients develop resistance to treatment. Relocalization of HER2 from the plasma membrane into the mitochondria was found and suggested as one of the potential causes of such resistance. Here we document that the function of mitochondrial HER2 is distinct from that of HER2 in the plasma membrane. Mitochondrial HER2 enhances cancer cell energetic metabolism, proliferation and migration in vitro, and tumour formation in vivo in mice correlating with elevated level of ROS signalling. The kinase activity of mitochondrial HER2 is unaffected, therefore I investigated its role in mitochondrial HER2 function. Moderate, endogenous levels of the kinase activity of mitochondrial HER2 drive pro-tumorigenic properties of breast cancer cells, while constitutive kinase activity sensitizes these cells to cell death and attenuates tumour formation in animal models. On the other hand, impairment of kinase activity due to mutation in the ATP binding site of mitochondrial HER2 supports adherence-independent growth in vitro and tumor growth in vivo. We propose that HER2 function in...

In oncology, there is a need to optimize drug treatment for efficient eradication of tumors, minimization of adverse effects (AEs), and prolonging patient survival. Pharmacometric models can be developed to streamline information between drug development phases, describe and quantify response to treatment, and determine dose regimens that balance toxicity and efficacy. In this thesis, data from trastuzumab emtansine (T-DM1) and taxane drug treatment were used to develop pharmacometric models of pharmacokinetics (PK), AEs, anti-tumor response, and survival, supporting drug development. T-DM1 is an antibody-drug conjugate (ADC) for treatment of human epidermal growth factor receptor 2 (HER2)–positive breast cancer. ADCs are a relatively new class of oncologic agents, and contain multiple drug-to-antibody ratio (DAR) moieties in their dose product. The complex distribution of T-DM1 was elucidated through PK models developed using in vitro and in vivo rat and cynomolgus monkey DAR data. Mechanism–based PK/pharmacodynamic (PKPD) models were also developed for T-DM1 that described the AEs thrombocytopenia (TCP) and hepatotoxicity in patients receiving T-DM1. Variable patterns of platelet and transaminase (ALT and AST) response were quantified, including an effect of Asian ethnicity that was related to higher incidences of TCP.  Model simulations, comparing dose intensities (DI) and Grade 3/4 incidences between the approved T-DM1 dose (3.6 mg/kg every three weeks) and weekly regimens, determined that 2.4 mg/kg weekly provided the highest DI. Docetaxel and paclitaxel are taxane treatment options for HER2–negative breast cancer. Tumor response data from these treatments were used to develop a mechanism–based model of tumor quiescence and drug–resistance. Subsequently, a parametric survival analysis found that tumor baseline and the model–predicted time to tumor growth (TTG) were predictors of overall survival (OS). This tumor and OS modeling approach can be applied to other anticancer treatments with similar patterns of drug–resistance. Overall, the pharmacometric models developed within this thesis present new modeling approaches and provide understanding on ADC PK and PKPD (TCP and hepatotoxicity), as well as drug–resistance tumor response. These models can inform simulation strategies and clinical study design, and be applied towards dose finding for anticancer drugs in development, especially ADCs.