O carcinoma epidermóide por se tratar de uma doença genética, apresenta dificuldades em relação ao seu tratamento. As vias de sinalização celular por controlarem os mecanismos responsáveis pela proliferação e sobrevivência da célula, são de extrema importância nos estudos da biologia do câncer e oncogênese. Aberrações cromossômicas que afetam a estrutura e a expressão de genes e proteínas que regulam componentes das vias de sinalização são diretamente correlacionadas com o desenvolvimento e progressão tumoral. Vários genes e proteínas vêm sendo avaliados na busca de um alvo terapêutico quimioterápico, algo pouco estudado em carcinomas epidermóides bucais. Este trabalho teve como objetivo analisar a influência do quimioterápico 17-AAG e do fator de crescimento epitelial (EGF) nos níveis das proteínas NFkB, Ciclina D1 e Cdk4 nas linhagens de carcinoma epidermóide de cabeça e pescoço (HN6 e HN31) e no queratinócito imortalizado (HaCat). Este trabalho destinou-se também a estudar uma possível inter-relação entre as proteínas Metalotioneína e NFkB e suas interações com as proteínas Ciclina D1 e Cdk4 nas linhagens celulares HN6 , HN31 e (HaCat, para uma maior compreensão de seus efeitos nas vias de sinalização celular e conseqüente progressão do câncer). Para análise a respeito da localização e os níveis das proteínas MT, NFkB, Ciclina D1 e Cdk4 foram utilizados ensaios de imunofluorescência e western blot, respectivamente.Os resultados apontaram um melhor perfil apoptótico da linhagem HN31 frente ao tratamento com 17-AAG, apresentando diminuição significante dos níveis de NFkB e Ciclina D1, além de exibir importante decréscimo nos níveis de Cdk4. A proteína MT parece não sofrer ação do NFkB. A indução de proliferação celular realizada por EGF exerceu um aumento dos níveis das proteínas NFkB e Ciclina D1, sugerindo um papel importante das vias de sinalização estimuladas por EGF (Akt, NFkB e Ciclina D1) na progressão tumoral dessas linhagens.Por fim, a ocorrência de estímulo nos níveis da proteína MT por parte do EGF, sugeriram um importante papel do EGF e da MT na resistência a apoptose nas linhagens estudadas. / Squamous cell carcinomas as a genetic diseases, presents certain difficulties in relation to their treatment. The process of cell signaling for overseeing the mechanisms responsible for cellular proliferation and survival are very important in studies of the biology of cancer and development. Chromosomal alterations affecting the structure and expression of genes and proteins that regulate the process of signaling components are directly correlated with the development and tumor progression. Several genes and proteins are being evaluated in the search for a biological marker that could help in the understanding of cancer as well as in its prognosis, and mainly in search of therapeutic target chemotherapy, something little studied in oral squamous cell carcinoma. This study aimed to examine the influence of chemotherapy 17-AAG and the epithelial growth factor (EGF) in the levels of proteins NFkB, Cyclin D1 and Cdk4 in strains of squamous cell carcinoma of the head and neck (HN6 and HN31) and immortalized in keratinocytes(HaCat). This work is also intended to explore a possible inter-relationship between the Metallothionein and NFkB proteins and their interactions with the proteins Cyclin D1 and Cdk4 in cell lines HN6, HN31 and (HaCat, to a greater understanding of its effects on pathways of cellular signaling and consequent progression of cancer. For analysis regarding the location and levels of the protein MT, NFkB, Cyclin D1 and Cdk4 were used tests of immunofluorescence and western blot. Results showed a better apoptotic profile of HN31 treated with 17-AAG, showing decrease levels of NFkB and Cyclin D1, with a important decrease in the levels of Cdk4. The metallothionin protein does not appear to suffer action of NFkB. The induction of cell proliferation conducted by EGF had increased levels of NFkB and Cyclin D1 proteins, suggesting an important role in the process of signaling stimulated by EGF (Akt, NFkB and Ciclina D1) in tumor progression of oral squamous cell carcinoma. The occurrence to stimulate the levels of metallothionein protein by the EGF, suggest an important role of EGF and MT in resistance to apoptosis in the studied cell lines.

As neoplasias de cabeça e pescoço constituem um importante problema de saúde pública devido à alta incidência e alguns tipos estão associados a fatores comportamentais como consumo de álcool e tabaco. Apesar desses dados, a doença, especialmente em sua fase inicial, pode ser curada e alguns tipos podem ser prevenidos. Portanto, existe a necessidade de identificar e validar novos biomarcadores em câncer de cabeça e pescoço com aplicação em prognóstico e seleção de terapias mais adequadas. Neste sentido, o objetivo deste trabalho foi validar o perfil de três proteínas, SET, hnRNP K e MARK3 em tumores de cabeça e pescoço, e verificar a potencial aplicação como marcadores de diagnóstico e prognóstico em HNSCC, bem como propor um papel para estas proteínas na tumorigênese. Foram analisadas 22 amostras de tumores de cabeça e pescoço por western blotting (WB) e 96 amostras (91 tumores, 4 biópsias e 1 controle) dispostas em duplicata em lâmina de tissue microarray, obtidas no Brasil e cedidas pelo Grupo GENCAPO, por imunohistoquímica (IHC). Os dados obtidos foram correlacionados com todos os parâmetros clínicos e patológicos e com prognóstico do paciente com HNSCC por um período de 48 meses. Os resultados obtidos por WB e IHC mostraram acúmulo e fragmentação da SET e acúmulo nuclear e citoplasmático da hnRNP K nos tumores comparado a respectiva margem cirúrgica e tecido normal. A hnRNPK mostrou valor prognóstico sendo associada a sobrevida global do paciente. A proteína c-Myc e a sua forma fosforilada foram analisadas nas amostras de tumores e suas respectivas margens cirúrgicas devido a sua relação com SET, PP2A e hnRNP K. Os resultados mostraram acúmulo da c-Myc fosforilada e total nas amostras tumorais, o que coincidiu com aumento de SET e hnRNP K. Com relação à proteína MARK3, observou-se sua redução no tumor e menor sobrevida livre de doença. Foi realizado ensaio de RNA de interferência (RNAi) contra hnRNP K e SET em linhagem de carcinoma oral (HN13). A redução da proteína SET por RNAi levou a redução significativa da hnRNP K, enquanto a hnRNP K gerou menor efeito na proteína SET, sugerindo um efeito regulatório na expressão ou manutenção da hnRNP K pela SET na célula tumoral. A interferência contra a hnRNP K também reduziu a proliferação celular tumoral. Em conclusão, o aumento da proteína SET está associado à desmoplasia em HNSCC e pode ser um potencial marcador específico para essa condição. hnRNP K e MARK3 podem servir como potenciais marcadores em HNSCC e ajudar a identificar um subgrupo de pacientes com pobre prognóstico. A hnRNPK exerce efeito positivo na proliferação da célula tumoral. SET e hnRNP K podem atuar como fatores oncogênicos favorecendo o aumento de c-Myc. / The head and neck cancers constitute a major public health problem due to the high incidence and some types are associated with behavioral factors such as consumption of alcohol and tobacco. Despite these data, the disease, especially in its early stage can be cured and some types can be prevented. Therefore, there is a need to identify and validate new biomarkers in head and neck cancer, with applications in prognosis and selection of therapies most appropriate. Accordingly, the objectives of this study were validation of the profile of three proteins, SET, hnRNP K and MARK3 in tumors of head and neck, and verify the potential application as markers for diagnosis and prognosis in HNSCC, and suggest a role for these proteins in tumorigenesis. We analyzed 22 samples of head and neck tumors by western blotting (WB) and 96 samples (91 tumors, 4 biopsies and 1 control) arranged in duplicate in the tissue microarray slide, obtained in Brazil and assigned by the GENCAPO Group, by immunohistochemistry (IHC). The data were correlated with all clinical and pathological parameters and prognosis of patients with HNSCC for a period of 48 months. The results obtained by WB and IHC showed the SET accumulation and fragmentation and hnRNP K nuclear and cytoplasmic accumulation in tumor compared to the surgical margin and normal tissue. The hnRNPK prognostic value has been associated with overall survival of patients. The c-Myc protein and its phosphorylated form were analyzed in tumor and surgical margins samples due to its relationship with SET, PP2A and hnRNP K. The results showed accumulated total and phosphorylated c-Myc in tumor samples, which was coincided with increase in SET and hnRNP K. Regarding the protein MARK3 was observed its reduction in tumor and lower disease-free survival. RNA interference (RNAi) against hnRNP K and SET were performed in oral squamous cell carcinoma line (HN13). SET protein reduction by RNAi led to significant reduction of hnRNP K, and hnRNP K showed a minor effect on SET protein, suggesting a regulatory effect on expression or maintenance of hnRNP K by SET in tumor cells. Interference against hnRNP K also reduced tumor cell proliferation. In conclusion, increased SET protein is associated with desmoplasia in HNSCC and may be a potential specific marker for this condition. hnRNP K and MARK3 can serve as potential markers in HNSCC and help identify a subgroup of patients with poor prognosis. The hnRNPK must act a positive effect on cell proliferation of the tumor. SET and hnRNP K may act as oncogenic factors contributing for c-Myc activity.

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New diagnostic methods and novel therapeutic agents spawn additional and heterogeneous information, leading to an increasingly complex decision-making process for optimal treatment of cancer. A great amount of information is collected in organ-specific multidisciplinary tumor boards (MDTBs). By considering the patient’s tumor properties, molecular pathological test results, and comorbidities, the MDTB has to consent an evidence-based treatment decision. Immunotherapies are increasingly important in today’s cancer treatment, resulting in detailed information that influences the decision-making process. Clinical decision support systems can facilitate a better understanding via processing of multiple datasets of oncological cases and molecular genetic information, potentially fostering transparency and comprehensibility of available information, eventually leading to an optimum treatment decision for the individual patient. We constructed a digital patient model based on Bayesian networks to combine the relevant patient-specific and molecular data with depended probabilities derived from pertinent studies and clinical guidelines to calculate treatment decisions in head and neck squamous cell carcinoma (HNSCC). In a validation analysis, the model can provide guidance within the growing subject of immunotherapy in HNSCC and, based on its ability to calculate reliable probabilities, facilitates estimation of suitable therapy options. We compared actual treatment decisions of 25 patients with the calculated recommendations of our model and found significant concordance (Cohen’s κ = 0.505, p = 0.009) and 84% accuracy.

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Introduction : La thérapie ciblée des cancers des VADS nécessite la mise au point de nouveaux vecteurs spécifiques. Ces vecteurs servent à acheminer des substances thérapeutiques, mais aussi ils peuvent être couplés à des fluorophores afin de les utiliser dans la chirurgie guidée par l'imagerie de fluorescence proche infrarouge.Objectifs : L'objectif de notre travail est de tester de nouveaux vecteurs des cancers des VADS et d'étudier l'apport de l'imagerie de fluorescence proche infrarouge dans la chirurgie des cancers des VADS chez un modèle animal orthotopique que nous mettons au point.Matériel et méthodes : La lignée cellulaire des cancers des VADS CAL33 est caractérisée in vitro et in vivo. De nouveaux vecteurs qui ciblent un ou plusieurs récepteurs des cellules CAL33 comme l'intégrine alpha v beta 3, l'EGFR et la NRP1, sont testés in vitro. Parallèlement, un modèle animal orthotopique des cancers des VADS est développé par implantation de fragments tumoraux des cellules CAL33, au niveau de la cavité buccale de la souris nude. La résection des tumeurs orthotopiques est guidée par l'imagerie de fluorescence proche infrarouge, après injection systémique du peptide RAFT-c[RGD]4 couplé à un fluorophore. Ce peptide cible l'intégrine alpha v beta 3 et est préalablement testé in vivo sur les cellules CAL33.Résultats : Nos résultats préliminaires montrent que certaines molécules bispécifiques présentent une liaison accrue in vitro aux cellules CAL33. Par ailleurs, la chirurgie guidée par l'imagerie de fluorescence proche infrarouge ciblant l'intégrine alpha v beta 3, présente un impact positif sur la survie sans rechute dans notre modèle orthotopique, à travers la détection de reliquats tumoraux qui pourraient passer inaperçus si l'exérèse tumorale avait été réalisée exclusivement d'une façon macroscopique. Elle permet aussi de détecter les adénopathies métastatiques.Conclusion : L'imagerie de fluorescence proche infrarouge améliore la qualité de l'exérèse tumorale dans notre modèle orthotopqiue optimisé des cancers des VADS. Cette étape préclinique est indispensable avant de tester cette technique chez l'être humain. / Introduction: Targeted therapy of head and neck squamous cell carcinoma (HNSCC) requires the development of novel specific vectors that can deliver therapeutic molecules. These vectors could also be coupled to fluorophores to be used in near infrared fluorescence imaging-guided surgery.Objectives: The aim of our work is to test new targeted vectors of HNSCC and to study the role of the near infrared fluorescence imaging-guided surgery in HNSCC resection in a novel orthotopic animal model that we develop.Materials and Methods: The HNSCC cell line CAL33 is characterized in vitro and in vivo. Novel vectors that target one or more receptors of this cell line such as alpha v beta 3 integrin, EGFR and NRP1, are tested in vitro. Meanwhile, an orthotopic animal model of HNSCC is developed by implanting tumor fragments of CAL33 cells, in the oral cavity of nude mice. Surgical resection of orthotopic tumors is guided by the near infrared fluorescence imaging after systemic injection of RAFT-c[RGD]4 peptide coupled with a fluorophore. This peptide targets alpha v beta 3 integrin and is previously tested in vitro.Results: Our preliminary results show that bispecific vectors would present an increased binding to CAL33 cells in vitro. On the other hand, near infrared fluorescence imaging-guided surgery has a positive impact on the recurrence-free survival rate in our orthotopic model, by detecting fluorescent cancer foci that could remain unidentified if resection was performed exclusively under visual guidance. Our results show also that near infrared fluorescence imaging can also help to detect metastatic lymph nodes.Conclusion: Near-infrared fluorescence imaging-guided surgery improves the quality of tumor resection in our optimized orthotopic animal model of HNSCC. This preclinical stage is essential before testing this novel technique in humans.

Background: Leukocytes in peripheral blood (PB) are prognostic biomarkers in head and neck squamous cell carcinoma cancer patients (HNSCC-CPs), but differences between HNSCC-CPs and healthy adults (HAs) are insufficiently described. Methods: 10-color flow cytometry (FCM) was used for in-depth immunophenotyping of PB samples of 963 HAs and 101 therapy-naïve HNSCC-CPs. Absolute (AbsCC) and relative cell counts (RelCC) of leukocyte subsets were determined. A training cohort (TC) of 43 HNSCC-CPs and 43 HAs, propensity score (PS)-matched according to age, sex, alcohol, and smoking, was used to develop a score consecutively approved in a validation cohort (VC). Results: Differences in AbsCC were detected in leukocyte subsets (p < 0.001), but had low power in discriminating HNSCC-CPs and HAs. Consequently, RelCC of nine leukocyte subsets in the TC were used to calculate 36 ratios; receiver operating characteristic (ROC) curves defined optimum cut-off values. Binary classified data were combined in a score based on four ratios: monocytes-to-granulocytes (MGR), classical monocytes-to-monocytes (clMMR), monocytes-to-lymphocytes (MLR), and monocytes-to-T-lymphocytes (MTLR); ≥3 points accurately discriminate HNSCC-CPs and HAs in the PS-matched TC (p = 2.97 × 10−17), the VC (p = 4.404 × 10−178), and both combined (p = 7.74 × 10−199). Conclusions: RelCC of leukocyte subsets in PB of HNSCC-CPs differ significantly from those of HAs. A score based on MGR, clMMR, MLR, and MTLR allows for accurate discrimination.