Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Martina Sýkorová Supervisor: RNDr. Jakub Hofman, Ph.D. Title of diploma thesis: Study on impact of selected tyrosine kinase inhibitors on multidrug resistance mediated by ABC drug efflux transporters Tyrosine kinases are an important class of enzymes controlling cell proliferation, carcinogenesis, apoptosis and cell differentiation. Deregulation of these enzymes can transform normal cell into a cancerous one. Blocking their function by tyrosine kinase inhibitors (TKi) is considered a promising treatment for various types of cancer. ATP-binding cassette (ABC) transporters form a family of transmembrane proteins that can transport a wide variety of substrates across biological membranes via ATP-dependent drug efflux pumps. They modulate drug pharmacokinetics, but on the other hand, lead to therapy failure due to overexpression in cancer cells. In our previous study, we evaluated inhibition properties of two selected TKi (alectinib, brivanib) in MDCKII cell lines (parent one and those transduced with human ABCB1, ABCC1 and ABCG2). Alectinib significantly inhibited ABCB1, ABCG2 but not ABCC1 transporter. Brivanib showed triple inhibition of all studied transporters. In the present work, we...

A Leucemia Mielóide Crônica (LMC) é uma neoplasia mieloproliferativa resultante da expansão clonal de células mielóides positivas para o cromossomo Philadelphia. A patogênese da LMC está associada à expressão do oncogene BCR-ABL1, que codifica a proteína Bcr-Abl com constitutiva atividade da tirosina quinase, promovendo a mieloproliferação exacerbada e a resistência à apoptose das células leucêmicas. Os pacientes com LMC são tratados principalmente com inibidores de tirosina quinase (TKI), mas a resistência aos inibidores e a refratariedade tem sido relatada em alguns pacientes na fase crônica e na maioria dos pacientes em fases avançadas da doença. Assim sendo, continua a ser de suma importância a elucidação da patogênese da LMC e a busca de novos alvos terapêuticos, como os membros da via de sinalização Hippo e reguladores do ciclo celular, da família Aurora quinase. O presente estudo quantificou o nível de expressão de genes que codificam componentes da via de sinalização Hippo (MST1, MOB1B, MOBKL1B, LATS1, LATS2, YAP e TAZ) e Aurora quinases A e B em: 1) pacientes com LMC em diferentes fases da doença, resistentes ou sensíveis à terapia com mesilato de imatinibe (MI), em indivíduos saudáveis e 2) linhagens celulares HL-60, HL-60.Bcr- Abl tratadas com TKI (imatinibe, dasatinibe e nilotinibe), KCL22 e LAMA84 resistentes e sensíveis ao MI. Os níveis de expressão dos genes alvo foram correlacionados com o índice de prognóstico de Sokal. Os principais resultados revelaram que há alteração nos genes MST1, MOB1B, MOBKL1B, LATS1, LATS2, TAZ, AURKA e AURKB em pacientes com LMC em relação aos controles. Não houve correlação entre o índice de Sokal e a expressão gênica dos genes da via Hippo, MST1, MOB1B, MOBKL1B, LATS1, LATS2 e TAZ, assim como os genes Aurora quinases A e B. Pacientes com LMC em fases avançadas apresentaram maiores valores de expressão dos genes TAZ e AURKB, comparado aos pacientes na fase crônica. Os pacientes resistentes ao TKI apresentaram as expressões dos genes MST1, TAZ e AURKB, significativamente mais elevadas, comparado aos pacientes sensíveis ao MI. Os resultados dos estudos em linhagens celulares indicaram principalmente que a expressão do gene LATS1 pode ser modulada pela atividade de tirosina quinase Bcr-abl e que o oncogene BCR-ABL1 induz a expressão de AURKA, AURKB, LATS1 e TAZ. Em conjunto os dados obtidos revelam que a alteração da expressão dos genes da família Aurora quinase, A e B, e dos genes que codificam proteínas da via Hippo contribui para a patogênese e progressão da LMC. O desenvolvimento de fármacos e/ou a identificação de marcadores tumorais para a via de sinalização Hippo e família Aurora quinase, podem otimizar o tratamento da LMC, aumentando a susceptibilidade das células leucêmicas a apoptose e levando a um melhor prognóstico da doença / Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm resulting from clonal expansion of myeloid cells positive for the Philadelphia chromosome. The CML pathogenesis is associated with BCR-ABL1 oncogene expression, which encodes the Bcr-Abl protein with a constitutive tyrosine kinase activity, leading to leukemic cell high proliferation and resistance to apoptosis. CML patients are mainly treated with tyrosine kinase inhibitors (TKI), but some of CML patients in chronic phase are resistant and in advanced phases are refractory to TKI. Thus, it is still relevant to elucidate the CML pathogenesis and seek to new therapeutic targets, including the Hippo signaling pathway members and cell cycle regulatory genes such as those encoding the Aurora kinase family. The present study quantified the RNA expression level of genes encoding components from the Hippo cell signaling pathway (MST1, MOB1B, MOBKL1B, LATS1, LATS2, YAP, and TAZ) and Aurora kinase A and B in: 1) CML patients at different stages of the disease, in CML patients resistant or sensitive to imatinib mesylate therapy, healthy individuals and 2) in cell lines HL-60, HL-60.Bcr-Abl treated with TKI (imatinib mesylate, dasatinib and nilotinib), KCL22 and LAMA84 resistant and sensitive to IM. The RNA expression levels of the target genes were also correlated to the CML Sokal\'s prognostic score values. The main results revealed that there are alterations in the genes MST1, MOB1B, MOBKL1B, LATS1, LATS2, TAZ, AURKA and AURKB in patients with CML in relation to the controls. There was no correlation between the Sokal index and the gene expression of the Hippo, MST1, MOB1B, MOBKL1B, LATS1, LATS2 and TAZ genes, as well as the Aurora kinase genes A and B. Patients with advanced phase CML had higher values of expression of the TAZ and AURKB genes, compared to the patients in the chronic phase. Patients resistant to TKI had significantly higher MST1, TAZ and AURKB gene expression compared to MI-sensitive patients. The results of the studies in cell lines indicated primarily that the expression of the LATS1 gene can be modulated by the Bcr-abl tyrosine kinase activity and the BCR-ABL1 oncogene induces the expression of AURKA, AURKB, LATS1 and TAZ. Together, the data show that altered expression of Aurora kinase family genes, A and B, and genes coding for Hippo pathway proteins contribute to the pathogenesis and progression of CML. The development of drugs and/or identification of tumor markers for the Hippo signaling pathway and the Aurora kinase family can optimize CML treatment by enhancing the susceptibility of leukemic cells to apoptosis and leading to a better disease prognosis

Le cancer médullaire de la thyroïde (CMT), qui représente 5 à 8% des cancers de la thyroïde, est issu de la transformation maligne des cellules C du parenchyme thyroïdien. Ce cancer, sporadique dans 70 à 80% des cas et familial pour les 20 à 30% restants, est essentiellement lié à des anomalies du proto-oncogène RET, codant un récepteur à activité tyrosine kinase. La fréquence élevée des mutations activatrices de RET ont permis d’identifier ce récepteur comme une cible thérapeutique majeure. Si la chirurgie est le traitement de référence pour les formes localisées, les formes localement avancées ou métastatiques, de pronostic plus péjoratif étaient avant le développement des thérapies moléculaires ciblées, dans une impasse thérapeutique. La meilleure compréhension de la biologie des tumeurs a permis le développement de ces thérapies plus rationnelles et plus spécifiques, en particulier des inhibiteurs d’activité tyrosine kinase (ITK). L’optimisation de leur utilisation en clinique nécessite de mieux comprendre leurs mécanismes d’action.Dans ce contexte, les objectifs de cette thèse ont été à la fois cognitifs et cliniques, visant à améliorer la compréhension de la réponse moléculaire à deux ITKs, le sunitinib et la vandetanib,dans le CMT, et à identifier de nouveaux biomarqueurs de suivi thérapeutique. Dans un premier temps, nous avons montré les effets antiprolifératifs, antitumoraux et antiangiogéniques du sunitinib et du vandetanib dans un modèle de CMT muté RETC634W, mettant en évidence des profils d’activité proches entre les deux inhibiteurs. Puis, les principales voies de signalisation mises en jeu lors de la réponse à ces ITKs ont été explorées par Reverse-Phase Protein Array(RPPA). Par une approche transcriptomique haut-débit menée sur des modèles précliniques, les principales fonctions cellulaires impliquées dans la réponse au sunitinib et au vandetanib ont été identifiées. Le rôle de gènes participant à l’invasion tissulaire et au pouvoir métastatique a été mis en évidence. De nouveaux biomarqueurs potentiels de réponse au vandetanib et au sunitinib, tels que l’IL-8 et le TGF-2 dont les taux sériques sont significativement plus élevés chez les patients atteints de CMT, ont été identifiés. Enfin, l’intérêt de trois approches méthodologiques dans lesuivi de la réponse antitumorale chez les patients a été évalué. Ainsi, le développement d’une méthode de dosage du vandetanib par spectrométrie de masse a permis de suggérer un lien entre des taux sériques élevés et l’apparition de toxicités sévères. L’évaluation de biomarqueurs dans le sérum de patients traités par le vandetanib a souligné l’intérêt de l’IL-8 comme marqueur pronostic potentiel dans cette pathologie. Enfin les résultats préliminaires, évaluant la réponse au sunitinib par échographie doppler sur un modèle préclinique de souris xénogreffées, ont confirmé l’intérêt de l’imagerie fonctionnelle dans ce domaine. / Medullary thyroid carcinoma (MTC) accounts for 5-8% of all thyroid cancers and occurs as either a sporadic form or in a familial context (25% of cases). Mutations which activate the RET proto-oncogene, encoding a tyrosine kinase receptor, are responsible for familial forms and are also detected in one-third of sporadic tumors. MTC patients with local disease may be cured after initial surgery, but persistent or recurrent disease occurs in half of cases, and distant metastases are the major cause of tumor related death. Up to now there is no effective systemic treatment and new therapeutic strategies are needed for locally advanced or metastatic MTC patients. The constitutive activation of RET is crucial in MTC pathogenesis and led to the development of small compounds targeting its tyrosine kinase activity (TKI). Gaining an understanding of how cancer cells respond to drugs is challenging to improve clinical use of these new therapeutic agents. In this context, we aimed to characterize molecular mechanisms of action of sunitinib and vandetanib, two TKIs currently evaluated in MTC patients. Our results, in in vitro as well as in vivo MTC models based on the RETC634W TT cell line, demonstrate that sunitinib and vandetanib has similar antiproliferative, antitumoral and antiangiogenic properties. Using the Reverse Phase Protein Array (RPPA) large-scale technology, we identified major signalling pathways inhibited after TKIs’ treatment. Expression microarrays allowed us to investigate signaling pathways modified after sunitinib and vandetanib treatment and to show that TKIs’ treatment induced major changes in the expression of genes involved in tissue invasion and metastasis. We identified encoding secreted proteins as candidate soluble biomarkers of response and, among them, we demonstrated that metastatic MTC patients presented increased serum levels of IL-8 and TGF-2. Three modalities for determining early responses to targeted agents in MTC patients were evaluated. First, a sensitive mass spectrometry assay was developed for the quantitation of vandetanib, and applied in MTC patients, showing a potential relationship between toxic side-effects and vandetanib serum levels and suggesting that therapeutic drug monitoring may be a useful tool for MTC patients’ follow-up. Then, candidate biomarkers were investigated in MTC patients underlying the potential use of IL-8 as prognostic marker. Finally, using doppler imaging in xenografted mice model, we confirmed the utility of imaging techniques in clinical evaluation of TKI’s response.

As enzimas desempenham papel fisiológico fundamental nos organismos, seja em condições normais e patológicas, o que as tornam atrativos alvos para intervenções terapêuticas. Pequenas moléculas capazes de inibir enzimas alvos são utilizadas para o tratamento de diversas doenças inflamatórias, câncer, AIDS, entre outras. Contudo, a identificação de pequenas moléculas inibidores ainda é uma etapa limitante no desenvolvimento de fármacos. Nesse contexto, o aprimoramento e novos ensaios robustos e confiáveis para acelerar a descoberta e a caracterização de novos inibidores é de extrema relevância. Nesta tese apresentamos o desenvolvimento de apropriados métodos para a quantificação direta da atividade das enzimas alvos Nucleosídeo Difosfato Quinase B (NDKb), humana (NME2) e de Leishmania major (LmNDKb), livres em solução ou imobilizadas em colunas capilares (ICER). A separação dos produtos e substratos da reação foi realizada por cromatografia de par iônico, que possibilitou a quantificação direta da atividade enzimática da NDKb livre em solução, método 1D-LC-UV. Já para a quantificação da atividade das enzimas imobilizadas foi elaborado um método on-line ICER-LC-UV, no qual a reação enzimática do ICER foi transferida à coluna analítica, permitindo a separação e quantificação da atividade de fosfotransferência. Utilizando esses métodos foi possível determinar o pH ótimo e os parâmetros cinéticos das enzimas livres e imobilizadas. Inibidores de NDKb de diferentes potências e mecanismos de ação foram utilizados para modulação do sistema ICER-LC-UV como ensaio de triagem de inibidores. O (-)-Epicatequina galato (ECG) foi utilizado como prova de conceito, para validar a aplicação do método on-line ICER-LC-UV na identificação e caracterização de inibidores para as enzimas alvo NME2 e LmNDKb. Em suma, a quantificação direta associada ao uso de enzimas imobilizadas representa um grande avanço aos métodos consolidados para o monitoramento da atividade enzimática e triagem de inibidores das enzimas alvo. / Enzymes play a key physiological role in organisms, either under normal and pathological conditions, which make them attractive targets for therapeutic interventions. Small molecules capable to inhibit specific target enzymes are used for the treatment of several inflammatory diseases, cancer, AIDS, among others. However, to identify small inhibitory molecules is still a limiting step in drugs discovery. In this context, the improvement and development of robust and reliable novel assays to accelerate the discovery and characterization of new inhibitors have become extremely relevant. This study describes an appropriate direct method to quantify the enzymatic activity of Nucleoside Diphosphate Kinase B (NDKb) from human (NME2) and Leishmania major (LmNDKb). It can be applied to free enzyme in solution or immobilized enzyme into silica capillary (ICER). The separation of both the substrates and products was achieved using ion-pair chromatography, it can be applied to direct quantification of free NDKb activity, method 1D-LC-UV. In order to quantify the activity of the immobilized enzymes, an on-line ICER-LC-UV method was developed. Initially, the enzymatic catalysis occurred into the ICER. Sequentially, the reaction mixture was transferred to an analytical column, where analytes were separated. From this method, it was possible to determine the optimum pH and kinetic parameters for the immobilized enzymes. Well stablished NDKb inhibitors with different strenght and mechanisms of action were used to modulate the on-line ICER-LC-UV method as an inhibitor screening assay. (-)-Epicatechin gallate was used as proof of concept in order to validate the application of the on-line ICER-LC-UV method to identify and characterize the target\'s enzymes NME2 and LmNDKb inhibitors. In summary, the direct quantification method coupled to the immobilized enzymes increases the likelihood of identifying the enzymatic activity and screening of inhibitors of the target enzymes when compared methods well described in the literature.

O objetivo deste trabalho foi avaliar a eficácia do mesilato de imatinibe, em comparação com a quimioterapia usual com vimblastina e prednisona, no tratamento do mastocitoma canino e descrever os efeitos colaterais apresentados pelas medicações. Bem como analisar a expressão do VEGF (fator de crescimento endotelial), a relação da expressão do gene c-kit por RT-PCR e marcação imunoistoquímica do KIT com a presença de mutações na justamembrana e a relação desta mutação com a resposta à terapia. Para tanto foram incluídos 29 animais com diagnóstico citológico de mastocitoma, estes animais foram submetidos a tomografia computadorizada para determinação das medidas das formações cutâneas e em seguida divididos em 2 grupos. O grupo 1 foi tratado com o protocolo quimioterápico de vimblastina e prednisona por 12 semanas e o grupo 2 com o mesilato de imatinibe na dose de 10 mg/Kg a cada 24 horas por 8 semanas. A avaliação da resposta ao tratamento foi realizada com mensurações periódicas das formações com paquímetro e nova tomografia ao final do tratamento para mensuração do maior diâmetro e volume tumoral. Um fragmento das formações cutâneas foi coletado antes do início do tratamento para graduação histológica da neoplasia, determinação do índice mitótico e imunomarcação para KIT, VEGF e Ki- 67. Parte do material coletado teve o DNA e RNA extraídos e posterior sequenciamento dos exons 11 do gene c-kit e determinação da expressão deste e do seu ligante por RT-PCR. A toxicidade a medicação foi avaliada segundo as normas do VCOG 1.1.A taxa de resposta do grupo VP foi de 7,7 % e no grupo MI de 28,6%, embora os pacientes tratados com mesilato de imatinibe tenham apresentado maior chance de resposta a terapia, não foi observado diferença entre os dois grupos. Os dois protocolos foram bem tolerados, os pacientes do grupo MI d menor número de efeitos colaterais. O grau histológico, Indice mitótico, padrão imunohistoquimico do KIT, além da quantificação do ki-67 foram homogêneos nos dois grupos e não influenciaram na resposta ao tratamento. A quantificação do VEGF foi mais intensa nos pacientes com remissão parcial e total. Não foi observado relação entre a quantificação do KIT e a expressão do gene c-kit, que foi maior nos pacientes que responderam ao tratamento, porém a associação desta com a resposta a terapia não pode ser determinada. Mutações ativantes no exon11 do gene c-kit não foram identificadas. O tratamento com o mesilato de imatinibe é bem tolerado pelos animais, no entanto este não se mostrou superior ao protocolo padrão de quimioterapia para o tratamento do mastocitoma; este resultado pode ter sido influenciado pelo número de animais incluídos no estudo. Mutações em outros domínios do receptor KIT e a ação do ITK em receptores como do PDGF e o VEGF podem estar relacionados a resposta a esta classe de fármacos observada neste estudo, a despeito da ausência de mutações ativantes no exon 11 do gene c-kit. / The objective of this study was to evaluate the efficacy of imatinib mesylate, compared with the usual chemotherapy with vinblastine and prednisone in the treatment of canine mast cell tumor and describe the side effects submitted by medications. Well as analyzing the expression of VEGF (vascular endothelial growth factor), the relationship between the expression of c-kit gene by RT-PCR and immunohistochemical staining of KIT with the presence of mutations in the juxtamembrane and the relationship of this mutation with response to therapy. For both 29 animals with cytological diagnosis of mast cell tumor were included, these animals underwent computed tomography to determine the measured skin formations and then divided into 2 groups. Group 1 was treated with the chemotherapeutic protocol vinblastine and prednisone for 12 weeks and the second group with the imatinib mesylate in a dose of 10 mg / kg every 24 hours for 8 weeks. The assessment of response to treatment was performed with periodic measurements of the formations Caliper and a new computed tomography in the end of treatment to measure the largest tumor diameter and volume. A fragment of skin formations was collected before the initiation of treatment for histological grading, determination of mitotic index, KIT and VEGF staining patterns and the proliferation marker Ki67. Part of the collected material was extracted RNA and DNA and subsequent sequencing of 11 exons of the c-kit gene and determination and expression of its ligand by RT-PCR. The medication toxicity was evaluated according to the standards of VCOG 1.1.A response rate of the VP group was 7.7% and 28.6% MI group, although patients treated with imatinib had a higher chance of response therapy, no difference in response between the two groups was observed. The two protocols were well tolerated, patients in the MI group had a smaller number of side effects. The histological grade, mitotic index, staining patterns KIT, beyond the quantification of Ki-67 were homogeneous in both groups and did not influence the response to treatment. Quantification of VEGF was intensely in patients with partial and total remission. It was no relationship between KIT and quantification of the expression of c-kit gene, which was higher in patients who responded to treatment, but its association with response to therapy cant be determined. Exon11 activating mutations in the c-kit gene were not identified. Treatment with imatinib mesylate is well tolerated by the animals, however this was not superior to standard chemotherapy protocol for the treatment of mast cell tumors; this result may have been influenced by the number of animals included in the study. Mutations in other domains of the KIT receptor and action in ITK receptors as PDGF and VEGF may be related to response to this class of drugs in this study, despite the absence of activating mutations in exon 11 of c-kit gene.

At present, the combination of high drug development costs and external pressure to lower consumer prices is forcing the pharmaceutical industry to innovate in ways unlike ever before. One of the main drivers of increased productivity in research and development recently has been the application of computational methods to the drug discovery process. While this investment has generated promising insights in many cases, there is still much progress to be made.<div><br></div><div>There currently exists a dichotomy in the types of algorithms employed which are roughly defined by the extent to which they compromise predictive accuracy for computational efficiency, and vice versa. Many computational drug discovery algorithms exist which yield commendable predictive power but are typically associated with overwhelming resource costs. High-throughput methods are also available, but often suffer from disappointing and inconsistent performance. <br></div><div><br></div><div>In the world of kinase inhibitor design, which often takes advantage of such computational tools, small molecules tend to have myriad side effects. These are usually caused by off-target binding, especially with other kinases (given the large size of the enzyme family and overall structural conservation), and so inhibitors with tunable selectivity are generally desirable. This issue is compounded when considering therapeutically relevant targets like Abelson Protein Tyrosine Kinase (Abl) and Lymphocyte Specific Protein Tyrosine Kinase (Lck) which have opposing effects in many cancers. <br></div><div><br></div><div>This work attempts to solve both of these problems by creating a methodology which incorporates high-throughput computational drug discovery methods, modern machine learning techniques, and novel protein-ligand binding descriptors based on backbone hydrogen bond (dehydron) wrapping, chosen because of their potential in differentiating between kinases. Using this approach, a procedure was developed to quickly screen focused chemical libraries (in order to narrow the domain of applicability and keep medicinal chemistry at the forefront of development) for detection of selective kinase inhibitors. In particular, five pharmacologically relevant kinases were investigated to provide a proof of concept, including those listed above.</div><div><br></div><div>Ultimately, this work shows that dehydron wrapping indeed has predictive value, though it's likely hindered by common and current issues derived from noisy training data, imperfect feature selection algorithms, and simplifying assumptions made by high-throughput algorithms used for structural determination. It also shows that the procedure's predictive value varies depending on the target, leading to the conclusion that the utility of dehydron wrapping for drug design is not necessarily universal, as originally thought. However, for those targets which are amenable to the concept, there are two major benefits: relatively few features are required to produce modest results; and those structural features chosen are easily interpretable and can thereby improve the overall design process by pointing out regions to optimize within any given lead. Of the five kinases explored, Src and Lck are shown in this work to fit particularly well with the general hypothesis; given their importance in treating cancer and evading off-target related side effects, the developed methodology now has the potential to play a major role in the development of drug candidates which specifically inhibit and avoid these kinases.<br></div>

De plus en plus d’inhibiteurs de kinase (IKs) sont testés dans le cancer de la prostate qui représente chez l’homme un enjeu de santé publique majeur de par son incidence (1er cancer) et sa mortalité (4ème cancer). Les essais cliniques pour évaluer l'efficacité des IKs dans cette indication ont donné des résultats mitigés malgré la présence de leurs cibles pharmacologiques dans les tumeurs de prostate (VEGF, EGFR, CMET..), pouvant faire penser que l’inefficacité serait en partie liée à la molécule elle-même et à sa pharmacocinétique/pharmacodynamie. En effet, les IKs sont sujets à un métabolisme et un transport intense via des enzymes de phase I et II et des transporteurs contrôlés pour la majorité par le récepteur nucléaire PXR (Pregnane X Receptor, gène NR1I2). En plus d’être abondamment exprimé dans le foie et le long du tractus gastro-intestinal, PXR est également exprimé dans certaines tumeurs épithéliales et pourrait être impliqué dans la résistance aux chimiothérapies par augmentation du catabolisme et de l’efflux de ces agents anticancéreux. A ce jour une seule étude a révélé l’expression de PXR dans le cancer de la prostate sans en avoir évalué l’impact sur la réponse aux traitements utilisés dans cette indication. En collaboration avec le Pr G. Fromont, nous avons observé dans une cohorte de 449 patients que l’expression de PXR était plus fréquemment retrouvée dans les cancers résistants à la castration et les métastases, par rapport aux cancers cliniquement localisés dans lesquels l’expression de PXR était corrélée avec le stade TNM et le score ISUP. Ces résultats confirment donc l’intérêt d’étudier le rôle que peut jouer PXR et les gènes du métabolisme et du transport qu’il régule, dans la sensibilité aux IKs dans les cancers de la prostate.Nous avons mesuré l’expression de PXR et de ses gènes cibles dans les lignées de cancer de la prostate 22RV1, LnCap, PC3 et DU145. Les résultats montrent une expression significative des enzymes et transporteurs responsables de la détoxication des IKs mais une faible expression de PXR liée à des phénomènes d’hyperméthylation NR1I2 dans nos lignées Cela nous a conduit à établir des modèles de surexpression stable de PXR dans lesquels l’agoniste SR12813 est capable d’induire l’activité transcriptionnelle de ce xénorécepteur, indiquant la compétence métabolique de ces lignées. À l'aide de ces modèles, nous avons démontré que la surexpression de PXR module la réponse à l’erlotinib, le dasatinib, le dabrafénib et l’afatinib démontrant que PXR joue un rôle fonctionnel dans la sensibilité à ces IKs. Nous avons également démontré que certains inhibiteurs avaient des propriétés agonistes de PXR, notamment le dabrafénib qui montre un effet agoniste plus marqué que le composé de référence SR12813, ce qui n’a jamais été démontré. Cette découverte originale nous a conduit à engager une collaboration pour tenter de cristalliser le complexe PXR/dabrafénib et à tester l’hypothèse que l’induction de l’activité PXR pouvait entraîner une modification du métabolisme et/ou du transport d’autres médicaments co-administrés. Or, nous avons observé dans la lignée 22RV1 un effet additif entre le dabrafénib et le tramétinib, une combinaison approuvée dans le traitement du mélanome, qui devient antagoniste lorsque PXR est surexprimé, résultat qui va effectivement dans le sens de notre hypothèse même s’il reste à démontrer que cet effet est bien lié à une altération du métabolisme de ces IKs, ce que nous sommes en train d’évaluer en dosant les métabolites de ces IKs. L’ensemble de nos données pourraient servir de rationnel biologique dans le choix des IKs ou de leurs combinaisons à tester avec les hormonothérapies et chimiothérapies déjà utilisés dans le traitement du cancer de la prostate, afin de potentialiser la réponse tumorale. / More and more kinase inhibitors (KIs) are tested in prostate cancer that represents a major health issue in men with its incidence and mortality rates. Clinical trials to evaluate KIs efficacy in prostate cancer gave disapointing results depsite the presence of KIs pharmacological targets in prostate tumors (VEGF, EGFR, CMET..), suggesting that inefficiency of these drugs would be at least in part linked to the inhibitor itself or its pharmacodynamics/pharmacokinetics parameters. Indeed KIs are metabolized and transported via phase I and II enzymes that are mainly controlled by the xenoreceptor PXR (Pregnane X Receptor, gène NR1I2). It is mainly expressed in liver and gastro-intestinal tract but also in epithelial tumors. PXR is also involved in the resistance to chemotherapies by increasing the catabolism and the efflux of these anticancer agents. To date only one study evaluated PXR expression in prostate cancer without evaluating its impact on treatment efficacy. In collaboration with Pr G. Fromont we analyzed a cohort of 449 prostate tumors and observed that PXR was more frequently detected in castration resistant or metastatic tumors as compared to clinically localized forms in which PXR expression was significantly correlated with TNM and ISUP Score. These results confirmed the interest to study the potential role of PXR and its target genes in the sensitivity to kinase inhibitors in prostate cancer models.We measured the expression of PXR and its target genes in prostate cancer cell lines 22RV1, LnCap, PC3 and DU145. The results showed that enzymes and transporters involved in KI detoxification was significantly expressed in these cells whereasPXR was poorly expressed due to hypermethylation of NR1I2 in our cells. This lead us to develop specific prostate cancer cell models stably overexpressing PXR in which transcriptional activity of PXR can be induced by its known agonist SR12813 further indicating that prostate cancer cells are metabolically competent. Using these models we showed that PXR overexpression modulates the sensitivity of 22RV1 cells to erlotinib, dasatinib, dabrafenib and afatinib, demonstrating that PXR plays a functional role in the sensitivity to KIs. We also demonstrated that several KIs were PXR agonists, including dabrafenib that displayed enhanced agonistic properties as compared to SR12813, a result that was never published before. This original finding led us to engage the cristalization of PXR/dabrafenib complex and to test whether induction of PXR could lead to an alteration of metabolism and transport of other drugs that are co-administered. In this line we have observed that in 22RV1 cells the additive effect of the combination of dabrafenib with trametinib that is already approved in the treatment of melanomas, became antagonistic when PXR was overexpressed in these cells. This result is supporting our hypothesis though we still need to demonstrate that this effect is linked to a change in drugs metabolism, which is currently under investigation by the measurement of the known metabolites of these KIs.Altogether, our data could serve as rational basis for the choice of kinase inhibitors or their potential combinations that could be tested in further clinical trials alone or in association with hormone therapies or with chemotherapies that are currently prescribed in the treatment of advanced prostate cancers, in order to potentiate tumor response.

Les Inhibiteurs de l'activité Tyrosine Kinase (ITK) de BCR-ABL (Imatinib (IMA), Nilotinib (NIL) et Dasatinib (DAS)) ont révolutionné le traitement de la Leucémie Myéloïde Chronique (LMC), mais la cinétique et l'intensité des réponses thérapeutiques restent variables. Par ailleurs, plusieurs travaux démontrent qu'il persiste chez la majorité des patients des cellules souches leucémiques (CSL) CD34+ résistantes aux ITK et capables de reconstituer la maladie. Partant du principe que la thérapie ciblée (les ITK) devait atteindre le compartiment cellulaire et du constat qu'aucune méthode ne permettait d'évaluer la quantité d'ITK dans les cellules malignes vivantes, nous avons développé un procédé en cytométrie en flux pour quantifier ces molécules dans les cellules de la LMC. Nous avons ainsi démontré que la mort cellulaire des lignées K562 et KCL22 à 24h est étroitement corrélée à la quantité d'IMA accumulée dès la 1ère heure. L'application du procédé aux cellules primaires a montré un taux intracellulaire d'ITK dépendant des caractéristiques des cellules et variable d'un sujet à l'autre (Article 1). Pour l'instant, en raison de l'hétérogénéité de notre cohorte, nous n'avons pas pu mettre en évidence de corrélation entre l'accumulation des ITK et la réponse thérapeutique de la LMC. Notre procédé nous a permis de suivre l'accumulation in vivo du DAS dans les blastes circulants d'un patient LMC en phase d'acutisation, en parallèle de la réactivation de pSyk348 - que nous avons identifié comme marqueur de progression - au moment de l'échappement au DAS (Article 2). Un avantage majeur du procédé est la possibilité d'analyser les différentes sous-populations, dont les cellules CD34+ de LMC. Ces dernières ont un taux d'ITK intracellulaire plus faible que les cellules matures, voire absent chez certains patients. Pour l'instant une corrélation significative avec les tests clonogéniques effectués en parallèle est retrouvée seulement avec le DAS. Enfin, nos résultats préliminaires suggèrent des différences entre les cellules CD34+ du sang et de la moelle. En conclusion, ce procédé permet d'évaluer la quantité d'ITK dans des sous-populations cellulaires précises et viables. Nous envisageons de poursuivre ce projet par l'évaluation de l'intérêt d'un dosage précoce du taux d'ITC intracellulaire in vivo (après la 4ème prise) d'une part et d'autre part par l'étude de l'influence du microenvironnement sur la résistance des CSL de LMC aux ITK et sur certaines dérégulations propres à ce compartiment cellulaire. / The Tyrosine Kinase Inhibitors (TKI) of BCR-ABL (Imatinib (IMA), Nilotinib (NIL) and dasatinib (DAS)) have revolutionized the treatment of Chronic Myeloid Leukemia (CML). However therapeutic responses remain variable. Moreover, several studies showed that most patients have persistent CD34+ leukemic stem cells (LSCs) resistant to TKI and the origin of disease relapse. Given that the targeted therapy (TKI) should reach malignant cells and that no method was able to assess the amount of TKI in viable target cells, we have developed a process by flow cytometry for TKI quantification in target cells. By using K562 and KCL22 cell lines we showed that cell death at 24hrs was closely related to IMA uptake after one hour of incubation. We then applied our method to primary cells and showed an intracellular level of IMA, NIL and DAS dependent on cell characteristics and heterogeneous from one subject to another (Article 1). Probably because of the heterogeneity of our series, we did not find any correlation between the accumulation of TKI and therapeutic response of CML. Moreover, we used our process to observe a decrease in DAS accumulation in vivo in circulating blasts of a CML patient with acute transformation, in spite of significant DAS uptake, we observed a recurrence of Syk phosphorylation in Y348 that we identified as a potential marker of acutisation, at the same time of disease resistance (Article 2). A major advantage of our process is the possibility to analyze the different cell subsets, including CD34+ CML cells. These cells had a lower (even absent in cells from some patients) level of intracellular TKI compared to mature cells. The clonogenic assays performed in parallel showed a significant correlation with DAS only. Finally, our preliminary results suggest differences between CD34+ cells from blood and those from bone marrow. In conclusion, our process allows evaluating the amount of TKI in viable cell subpopulations. This project will be continued with i) the study of the potential interest of the early evaluation of in vivo intracellular level of TKI (after the fourth dose) and ii) the influence of the microenvironment on CSL resistance to TKI and epigenetics deregulations.

Spinal muscular atrophy (SMA) is the leading genetic cause of death of young children. It is an autosomal recessive disease caused by the mutation and/or the deletion within the ubiquitously expressed survival motor neuron 1 (SMN1) gene. SMA pathology is characterized by spinal cord motor neuron degeneration, neuromuscular junction (NMJ) defects and muscular atrophy. Upon disease onset, SMA patients progressively become paralyzed and in the most severe cases, they die due to respiratory complications. Over the years, it has become clear that SMN is a multi-functional protein with important roles in small nuclear ribonucleoprotein (snRNP) assembly, RNA metabolism, axonal outgrowth and pathfinding, mRNA transport as well as in the functional development of NMJs, skeletal muscle and cardiac muscle. However, it remains unclear which of these functions, and the respective perturbed molecular pathways, dictate SMA pathogenesis. Here, we have established Smn-depleted PC12 cells and an intermediate SMA mouse model to characterize a role for Smn in the regulation of actin cytoskeleton dynamics. We find that Smn depletion results in the increased expression of profilin IIa and active RhoA (RhoA-GTP) as well as the decreased expression of plastin 3 and Cdc42. Importantly, the inhibition of rho-kinase (ROCK), a direct downstream regulator of RhoA, significantly increased the lifespan of SMA mice and shows beneficial potential as a therapeutic strategy for SMA. In an addition, we have uncovered a muscle- and motor neuron-independent role for SMN in the regulation of pancreatic development and glucose metabolism in SMA mice and type 1 SMA patients. This finding highlights the importance of combining a glucose tolerance assessment of SMA patients with their existing clinical care management. Thus, our work has uncovered two novel and equally important roles for the SMN protein, both of which contribute significantly to SMA pathogenesis.

Multiple modulating genes and environmental factors have been implicated in the pathogenesis of high-altitude pulmonary edema (HAPE). However, at the present time, there exists an incomplete understanding of the molecular mechanisms and pathways which underlie constitutional susceptibility. Genome-wide measurements of gene expression in peripheral blood mononuclear cells (PBMCs) were performed using microarray technology. Comparison of gene expression profiles of HAPE-susceptible and resistant individuals resulted in the identification of several previously undescribed candidate genes. RhoA and Rho-kinase (ROCK), regulators of vascular smooth muscle contraction, were differentially regulated in the HAPE-susceptible cohort, as compared to both HAPE-resistant patients with acute mountain sickness (AMS+) and healthy controls (p=0.0014; p=0.0020). Furthermore, biological pathways involving RhoA and Rho-kinase were strongly upregulated in subjects with HAPE. These findings represent the first description of the RhoA/Rho-kinase signaling pathway in HAPE. Currently, few pharmacologic therapies have been demonstrated to be effective in the prevention and treatment of HAPE. The results of this study provide early evidence that Fasudil, a selective Rho-kinase inhibitor, may represent a novel therapeutic intervention effective in the prevention and/or treatment of high-altitude pulmonary edema.