A expressão do fator de crescimento endotelial vascular tipo C (VEGF-C) e de podoplanina pelas células malignas tem sido associada com a maior ocorrência de metástases regionais e/ou pior prognóstico para os pacientes com câncer de boca. O objetivo deste estudo foi avaliar o significado clinico da expressão de VEGF-C e podoplanina em 42 carcinomas espinocelulares (CEC) bem diferenciado de boca, com e sem comprometimento linfonodal, incluindo oito carcinomas verrucosos, tratados no Departamento de Cirurgia de Cabeça e Pescoço, do Hospital do Câncer A. C. Camargo, São Paulo, no período de 1980 a 2000. Os pacientes foram analisados quanto ao gênero, idade, cor, tabagismo, etilismo, localização do tumor primário, classificação pelo sistema TNM, tratamento, ocorrência de recidivas local e regional, metástase à distância, de segundo tumor primário, além da presença de infiltrações perineural, muscular, glandular e óssea e de embolizações vasculares. Analisou-se também o índice histopatológico de malignidade tumoral e as expressões imuno-histoquímica de VEGFC e de podoplanina pelas células malignas no front de invasão tumoral. A associação das expressões de VEGF-C e podoplanina com as variáveis estudadas foi calculada pelo teste quiquadrado. As probabilidades de sobrevida, acumuladas nos períodos de 5 e 10 anos calculadas pelo método de Kaplan-Meier e comparadas pelo teste de long-rank. A maioria dos CEC de boca, incluindo os carcinomas verrucosos, exibiu uma forte expressão de VEGF-C pelas células malignas. Houve uma tendência, sem associação estatisticamente significativa, dos pacientes com CEC de boca e forte expressão de VEGF-C apresentarem maior freqüência de recidivas locais e/ou regionais. A forte expressão de podoplanina foi significativamente associada com o gênero masculino (p=0,037), com o estadiamento T1 e T2 (p=0,037), com o estadio clínico I e II (p=0,027) e com a presença de infiltração glandular (p=0,003). As recidivas locais e regionais foram detectadas mais freqüentemente nos CEC de boca com forte expressão de podoplanina, porém sem diferença estatisticamente significativa, quando comparados com aqueles com expressão fraca da proteína. As taxas de sobrevida global e específica por câncer para os pacientes com tumores com forte expressão de VEGF-C e a taxa de sobrevida global para a forte expressão de podoplanina foram percentualmente menores do que aquelas dos pacientes com tumores com fraca expressão destas proteínas. O comprometimento linfonodal cervical se mostrou fator de prognóstico significativo (p=0,001) para os pacientes com câncer de boca. Estes resultados sugerem que a forte expressão de VEGF-C e podoplanina pelas células malignas juntamente com o comprometimento linfonodal regional são fatores indicativos de uma evolução clínica desfavorável e de um pior prognóstico para os pacientes com CEC bem diferenciados de boca. / The expression of vascular endothelial growth factor C (VEGF-C) and podoplanin by malignant cells has been associated with a greater incidence of regional metastasis and/or poor prognosis for patients with oral cancer. The purpose of this study was to evaluate the clinical significance of VEGF-C and podoplanin expression in 42 well-differentiated oral squamous cell carcinomas (OSCC), with and without lymph node involvement, including eight verrucous carcinoma, treated at the Department of the Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Hospital, São Paulo, from 1980 to 2000. Patients were evaluated according the following parameters: gender, age, ethnic group, tobacco and/or alcohol consumption, tumor location, TNM stage, treatment and clinical follow-up (recurrence, occurrence of a second primary tumor and death) and the presence of perineural, muscular, glandular and bone infiltrations or vascular embolizations. In addition, we investigated the histopathological malignancy index and the immunohistochemistry expression of VEGF-C and podoplanin by malignant cells in the invasive front tumor. Chisquare test or Fishers exact test was used to analyze the association of VEGF-C and podoplanin with demographic, clinical and microscopic variables in OSCC patients. The 5 and 10-year survival rates were calculated by Kaplan-Meier method and the comparison of the survival curves were performed using log rank test. Most of OSCC, including verrucous carcinoma, showed a high expression of VEGF-C by malignant cells. The OSCC patients with high expression of VEGF-C showed a tendency, without statistical significance, of local and/or regional recurrence. The overexpression of podoplanin was significantly associated with the male gender (p=0,037), with T1 and T2 stage (p=0,037), with I and II clinical stage (p=0,027) and with the presence of glandular infiltration (p=0,003). The local and regional recurrences were detected more frequently in OSCC with high expression of podoplanin, without statistical significant difference, when compared with those with low expression of the protein. The overall survival rates and cancer specific survival rates for OSCC patients with high VEGF-C expression and the overall survival rate for OSCC patients with podoplanin overexpression were lower than those of OSCC patients with low expression of these proteins. The cervical lymph node involvement was significant prognostic factor (p=0,001) for patients with oral cancer. These results suggest that the overexpression of VEGF-C and podoplanin by malignant cells and regional lymph node involvement are indicative factors of an unfavorable clinical outcome and a poor prognosis for patients with well-differentiated OSCC.

The blood and lymphatic vascular systems coordinate to play critical roles in tissue fluid homeostasis and immune function and are fundamentally associated with diseases including inflammation, wound healing, edema, and tumor progression and metastasis. Their coordination during vascular growth and remodeling represents an under-investigated area of research in which a better understanding will provide insights into future therapeutic approaches. Angiogenesis and lymphangiogenesis are the growth of new blood or lymphatic vessels, respectively, from pre-existing vessels. The comprehensive goal of this work was to provide a new perspective on the relationships between angiogenesis and lymphangiogenesis in microvascular networks and develop tools needed to probe the mechanisms involved in lymphatic/blood vessel patterning and identity. The first aim of this study was to characterize the spatiotemporal relationships between lymphatic and blood vessel growth in response to an inflammatory stimulus. We found that lymphangiogenesis temporally lagged angiogenesis during inflammation and that the presence of lymphatic vessels attenuated angiogenesis. We also identified increased lymphatic/blood endothelial cells connections and a novel lymphatic marker. These results motivated the need for a system to probe the multicellular and multisystem interactions suggested by these findings. Our lab recently developed the rat mesentery culture model as an ex vivo model for investigating angiogenesis in the context of intact microvascular networks. The second aim was to determine whether this model can be used to study lymphangiogenesis. We found that vascular endothelial growth factor C stimulated lymphatic sprout formation in the rat mesentery culture model and confirmed the ability to observe angiogenesis and lymphangiogenesis simultaneously in an ex vivo environment. This suggests the rat mesentery culture model can be used to investigate the dynamics of lymphatic/blood vessel patterning and plasticity motivated by our in vivo work. The final aim of this work was to investigate the ability to induce phenotypic plasticity in intact vasculature by using lysophosphatidic acid, an agonist suggested to cause blood-to-lymphatic endothelial cell transition. We demonstrated that while lysophosphatidic acid stimulated angiogenesis, it was not sufficient to reprogram blood vessels to acquire a lymphatic phenotype. These results underscore the necessity of investigating these multisystem relationships in the context of intact microvascular networks. These studies as a whole demonstrate the coordination that exists between blood and lymphatic vessels and reinforce the need for novel models that incorporate the complexities of the entire microvasculature. / acase@tulane.edu

Το αδενοκαρκίνωμα του προστάτη αποτελεί σημαντικό πρόβλημα υγείας σε παγκόσμια κλίμακα. Οι διαθέσιμες μέθοδοι κλινικής σταδιοποίησης φαίνεται να μην επαρκούν εφόσον 10% περίπου των ασθενών στους οποίους διαγιγνώσκεται εντοπισμένη νόσος και υποβάλλονται σε ριζική προστατεκτομή εμφανίζουν ήδη μετάσταση στους λεμφαδένες. Το αναπτυσσόμενο ενδιαφέρον για τη μοριακή σταδιοποίηση βασίζεται στα αποτελέσματα μελετών που χρησιμοποιούν δείκτες λεμφαγγείων και λεμφαγγειογενετικούς παράγοντες στην πρόβλεψη της κατάστασης των λεμφαδένων. Ερευνητικές μελέτες στο καρκίνωμα του μαστού, του τραχήλου και του στομάχου υποδεικνύουν τη στενή σχέση ανάμεσα στη λεμφαγγειακή πυκνότητα (LVD) και τις λεμφαδενικές μεταστάσεις. Ο διατηρημένος στόχος της ραπαμυκίνης στα θηλαστικά (mTOR) αποτελεί κινάση σερίνης/θρεονίνης του σηματοδοτικού μονοπατιού (PI3K)/AKT. Μεγάλος αριθμός μελετών υποδεικνύει το πιθανό ρόλο του m-TOR στην αγγειογένεση μέσω της επαγωγής του VEGF-A. Αποτελέσματα μελετών συνδέουν τη κινάση m-TOR με την αγγειογένεση μέσω της επαγωγής του αυξητικού παράγοντα VEGF-A. Η συμμετοχή του mTOR στη λεμφαγγειογένεση δεν είναι τόσο σαφής εφόσον φαίνεται να κατέχει σημαντικό ρόλο στην επαγόμενη λεμφαγγειογένεση από τον VEGF-C αλλά όχι από τον VEGF-A. Επιπλέον παραμένει ασαφές εάν η έκφραση του m-TOR συνδέεται με την παρουσία λεμφαδενικών μεταστάσεων. Παρόλο που ο COUP-TFII είναι απαραίτητος για τη λεμφαγγειογένεση, ελάχιστα είναι γνωστά για τη σχέση ανάμεσα στον μεταγραφικό παράγοντα το mTOR και τη δημιουργία λεμφαδενικών μεταστάσεων στο αδενοκαρκίνωμα του προστάτη. Σκοπός της παρούσας μελέτης ήταν ο προσδιορισμός της έκφρασης της ενεργοποιημένης κινάσης (p-mTOR) και η σύγκριση της με παραμέτρους που σχετίζονται με τα λεμφαγγεία (LVD, παρουσία καρκινικών εμβόλων κτλ) σε ασθενείς με αρνητικούς και θετικούς λεμφαδένες. Τα λεμφαγγεία καθορίσθηκαν από τους ειδικούς δείκτες D2-40 και LYVE-1. Επιπλέον εξετάσαμε την έκφραση του μεταγραφικού παράγοντα COUP-TFII και των αυξητικών παραγόντων VEGF-A και VEGF-C σε σχέση με την έκφραση του p-mTOR τη μέση λεμφαγγειακή πυκνότητα την παρουσία εμβόλων και την κατάσταση των λεμφαδένων. Για να επιτευχθεί ο στόχος της μελέτης χρησιμοποιήθηκαν ιστοί εγκλεισμένοι σε παραφίνη από 92 ασθενείς οι οποίοι υποβλήθηκαν σε ριζική προστατεκτομή. Εφαρμόσθηκε ανοσοϊστοχημική μέθοδος, χρησιμοποιώντας αντισώματα έναντι των p-mTOR, D2-40, CD-31, LYVE-1, VEGF-C, VEGF-A και COUP-TFII. Οι σχέσεις ανάμεσα στα αποτελέσματα εξετάσθηκαν με πρωτόκολλα στατιστικής ανάλυσης. Στην παρούσα μελέτη, η περιφερική του όγκου LVD η οποία καθορίσθηκε από το D2-40 ήταν αυξημένη στα περιστατικά με pN1. Η ένταση και η κατανομή της ανοσοϊστοχημικής χρώσης για το p-mTOR ήταν αυξημένη στα καρκινώματα με λεμφαδενικές μεταστάσεις σε σχέση με αυτά που παρουσίαζαν αρνητικούς λεμφαδένες. Επιπλέον, τα περιστατικά με εντονότερη κυτταροπλασματική έκφραση του p-mTOR παρουσίασαν αυξημένη LVD και μεγαλύτερο αριθμό διηθημένων λεμφαγγείων. Αντίστοιχα οι περιπτώσεις με pN1 παρουσίασαν εντονότερο ανοσοϊστοχημικό εντοπισμό των VEGF-C, VEGF-A και COUP-TFII που επίσης σχετίσθηκε με την παρουσία περισσότερων λεμφαγγειακών εμβόλων και με υψηλότερα επίπεδα έκφρασης του p-mTOR. Τέλος ο αριθμός των COUP-TFII θετικών αγγείων ήταν μεγαλύτερος στα περιστατικά με λεμφαδενικές μεταστάσεις και διηθημένα λεμφαγγεία. Τα ευρήματα μας υποδεικνύουν ότι τόσο το D2-40 όσο και το LYVE-1 αποτελούν ειδικούς δείκτες για τον εντοπισμό των λεμφαγγείων. Παρόλα αυτά η έκφραση του LYVE-1 περιοριζόταν σε έναν υποπληθυσμό λεμφαγγείων ελαττώνοντας την ευαισθησία του μορίου ως δείκτη. Η ενεργοποίηση του mTOR σηματοδοτικού μονοπατιού φαίνεται να διευκολύνει τη δημιουργία λεμφαδενικών μεταστάσεων πιθανώς επάγοντας την έκφραση των VEGF-C και VEGF-A. Η επαγωγή των αυξητικών παραγόντων έχει ως επακόλουθο την δημιουργία νέων λεμφαγγείων και πιθανόν την αύξηση της διαπερατότητας τους. Επιπλέον τα αποτελέσματα μας υποδηλώνουν ότι ο COUP-TFII ευοδώνει όχι μόνο τη νέο-λεμφαγγειογένεση αλλά και τη λεμφαγγειακή διήθηση. Τέλος μπορεί να υποτεθεί ότι τα νεοδημιουργηθέντα λεμφαγγεία είναι σημαντικότερα από τα ώριμα για τη εξάπλωση του προστατικού αδενοκαρκινώματος στους επιχώριους λεμφαδένες. / Adenocarcinoma of prostate is a major health problem worldwide. The available methods for clinical staging seem to be inefficient, since approximately 10% of patients who will undergo radical prostatectomy for clinically localized disease, harbor metastasis in the regional lymph nodes. Recent studies that utilize lymphangiogenic factors and lymphangiogenesis markers to predict the nodal status trigger the interest in molecular staging. Research studies in breast, cervical and gastric cancers suggest a high correlation between the lymphatic microvessel density (LVD) and nodal metastasis. The conserved mammalian target of rapamycin (mTOR) is a serine/threonine kinase of the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway. Many studies suggest a role of m-TOR in angiogenesis via the upregulation of VEGF-A. In lymphangiogenesis the participation of mTOR is more complicated as it seems to be essential for the VEGF-C induced lymphangiogenesis but not for lymphangiogenesis that is induced from VEGF-A. Furthermore it is unclear if the expression of m-TOR correlates with the presence of lymph node metastasis or not. Although studies indicate that the transcription factor COUP-TFII is indispensable for lymphangiogenesis, little is known about the relationship between the transcription factor, mTOR and lymph node metastasis in prostate adenocarcinoma. The aim of this study was to determine the expression status of the activated kinase p-mTOR and compare it with lymphatic parameters (LVD, lymphatic invasion etc.) in patients that were found to have positive lymph nodes and patients with negative lymph node status. The lymphatics were determined with the lymphatic-specific markers D2-40 and LYVE-1. Moreover, we examined the expression of the transcription factor COUP-TFII, the vascular endothelial growth factors A and C (VEGF-A, VEGF-C) in relation to each other, p-mTOR expression, mean LVD, lymphatic invasion and lymph node status. In order to accomplish our objective paraffin-embedded tissues obtained from 92 patients who underwent radical prostatectomy were immunostained with p-mTOR, D2-40, CD-31, LYVE-1, VEGF-C, VEGF-A and COUP-TFII antibodies. The associations between the results were analyzed with statistical analysis protocols. In the current study, peritumoral (but not intratumoral) mean LVD assessed by D2-40 was higher in pN1 tumors. Intensity of p-mTOR staining was higher in carcinomas with lymph node metastasis than in those with negative lymph nodes. Furthermore, higher p-mTOR cytoplasmic expression was strongly associated with LVD and lymphatic invasion. Intense VEGF-C, VEGF-A and COUP-TFII immunostaining was observed in N1 cases and correlated with the presence of lymphatic emboli and higher p-mTOR expression. Finally the number of COUP-TFII positive vessels was positively associated with lymph node metastasis and lymphatic invasion. Our findings suggest that both D2-40 and LYVE-1 are useful markers that may reveal lymphatic vasculature, the latter however showing lower expression, probably limited to a specific lymphatic vessel cellular sub-population. Activation of mTOR pathway may facilitate nodal metastasis, possibly due to increased lymphangiogenesis and lymphatic vessel invasion via increased VEGF-C and VEGF-A expression. Additionally our results indicate that COUP-TFII may facilitate not only neo-lymphangiogenesis but also promotes lymphatic invasion. Finally it seems that newly formed lymphatic vessels are more important than mature ones for lymphatic spread in prostate adenocarcinoma.

Η λεμφαγγειογένεση η σχετιζόμενη με όγκους πρόσφατα έχει θεωρηθεί σαν ένας νέος μηχανισμός εξάπλωσης του καρκίνου. Όμως υπάρχει μεγάλη ετερογένεια στα αποτελέσματα των μελετών που συσχετίζουν την έκφραση λεμφαγγειακών δεικτών στο ενδοθήλιο των λεμφαγγείων με κλινικοπαθολογοανατομικές παραμέτρους των όγκων και με την πρόγνωση των ασθενών. Επίσης ένα μεγάλο θέμα διαφωνίας είναι το ποια είναι η σημασία των περιογκικών σε σχέση με τα ενδοογκικά λεμφαγγεία για την μετάσταση των όγκων. Στην παρούσα μελέτη διερευνήσαμε την έκφραση και την πιθανή προγνωστική σημασία των δεικτών του λεμφαγγειακού ενδοθηλίου, VEGFR-3, Ρodoplanin και LYVE-1 σε διηθητικά καρκινώματα εκ πλακώδους επιθηλίου του τραχήλου της μήτρας . Υλικά και Μέθοδοι: Το υλικό της μελέτης αποτέλεσαν 51 παρασκευάσματα υστερεκτομών με διηθητικό καρκίνωμα εκ πλακώδους επιθηλίου τραχήλου. Με την μέδοδο της Ανοσοϊστοχημείας εξετάσθηκε η πρωτεϊνική έκφραση των δεικτών CD31, VEGFR-3, Ρodoplanin και LYVE-1.Ο έλεγχος της παρουσίας ανοσοθετικών αγγείων για όλα τα ανωτέρω μόρια έγινε σε όλη την έκταση της ιστολογικής τομής, μέσα στο παρέγχυμα και σε όλη την περιφέρεια του όγκου με μικρή μεγέθυνση φωτονικού μικροσκοπίου( x 4 ).Η αγγειακή πυκνότης εκτιμήθηκε στις περιοχές με την μεγαλύτερη αγγειοβρίθεια (hot spots) σε πέντε συνεχόμενα μεγάλα οπτικά πεδία (HPF=. x 400) και ορίσθηκε ως ο μέσος όρος του αριθμού των αγγείων στα πεδία αυτά. Χρησιμοποιήθηκε στατιστικό πρόγραμμα ανάλυσης SPSS for windows με σκοπό την εκτίμηση της πιθανής συσχέτισης μεταξύ του βαθμού της αγγειακής πυκνότητας και κλινικοπαθολογοανατομικών παραμέτρων όπως είναι ο βαθμός κακοηθείας ,το στάδιο του όγκου και η παρουσία λεμφαδενικών μεταστάσεων.. Αποτελέσματα: Η Ρodoplanin και LYVE-1 εκφράσθηκαν στο ενδοθήλιο των λεμφαγγείων ενώ έκφραση του VEGFR-3 παρατηρήθηκε στα λεμφαγγεία αλλά και στα αιμοφόρα αγγεία.. Η αγγειακή πυκνότης με βάση την έκφραση του VEGFR3 συσχετίσθηκε στατιστικά σημαντικά με την αγγειακή πυκνότητα με βάση την έκφραση του CD31 .Η αγγειακή πυκνότης όπως αναδείχθηκε με την έκφραση του VEGFR3 σχετίσθηκε σημαντικά με όγκους αυξημένου βαθμού κακοηθείας .Αυξημένη ενδοογκική λεμφαγγειακή πυκνότης όπως αναδείχθηκε με την έκφραση LYVE-1 σχετίσθηκε επίσης στατιστικά σημαντικά με όγκους προχωρημένου σταδίου. Όμως δεν παρατηρήθηκε συσχέτιση της έκφρασης των λεμφαγγειακών δεικτών με την παρουσία λεμφαδενικών μεταστάσεων. Συμπέρασμα: Τα αποτελέσματα αυτής της μελέτης δηλώνουν ότι ο VEGFR-3 δεν αποτελεί πιθανόν ένα ειδικό δείκτη λεμφαγγείων αλλά φαίνεται να εμπλέκεται και στην αγγειογένεση των όγκων .Ο VEGFR3 και LYVE-1 αλλά όχι η Ρodoplanin συσχετίσθηκαν με προγνωστικές παραμέτρους του καρκινώματος του τραχήλου όπως είναι ο βαθμός κακοηθείας και το στάδιο της νόσου. Αυτό το γεγονός υποδηλώνει ότι η χρήση πολλαπλών λεμφαγγειακών δεικτών είναι απαραίτητη για την εκτίμηση της προγνωστικής σημασίας της λεμφαγγειογένεσης που σχετίζεται με όγκους .Λόγω του ότι δεν βρέθηκε συσχέτιση μεταξύ της λεμφαγγειακής πυκνότητος και της μετάστασης σε λεμφαδένες , η σχετιζόμενη με όγκους λεμφαγγειογένεση πιθανόν να αποτελεί μία επιπλέον οδό καρκινικής διασποράς αλλά όχι απαραίτητη προϋπόθεση για την μετάσταση του καρκίνου του τραχήλου της μήτρας. / Tumor-associated lymphangiogenesis has now been firmly established as a novel mechanism of cancer progression. However, results regarding correlation of lymphatic markers expression to clinicopathological tumor parameters and prognosis of cancer patients are heterogenous. In the present study we assessed the expression and prognostic significance of the lymphatic endothelial markers VEGFR-3, podoplanin and LYVE-1 and the panendothelial marker CD31 in invasive squamous cell carcinoma (SCC) of the uterine cervix. Design. The study comprised of 51 hysterectomy specimens with invasive SCC of the uterine cervix. Protein expression of CD31, VEGFR-3, podoplanin and LYVE-1 was examined by means of immunohistochemistry.Vessel counting was performed in whole tumor histologic section as well as in inner tumor areas and invasive tumor fronts separately. Vessel density scores were evaluated in areas of higher vascularization (hot spots). Statistical analysis was performed using SPSS v.12 to evaluate potential correlation between vessel density scores and clinicopathological parameters such as tumor grade, presence of lymph node metastases and disease stage. Results. While podoplanin and LYVE-1 was mainly expressed in lymphatic endothelium VEGFR-3 expression was observed in both lymphatic and blood vessels. Intratumoral vessel density for all markers used was significantly higher in intratumoral compared with peritumoral areas. There was a significant correlation between vessel density scores as assessed by VEGFR3 and CD31 (p<0.001, r=0.5). Intratumoral and peritumoral VEGFR3 vessel density significantly correlated with advancing tumor grade (p=0.001 and p=0.035 respectively). Intratumoral LVD (lymph vessel density) as assessed by LYVE-1 immunostaining was also significantly higher in high stage tumors (p=0.008). However there was no correlation of lymphatic markers expression with nodal metastases. Conclusions. Our results suggest that VEGFR-3 does not probably represent a specific lymphatic marker but it is also implicated in tumor angiogenesis. VEGFR3 and LYVE-1 but not podoplanin correlated with prognostic parameters of cervical carcinomas such as grade and stage, suggesting that the use of multiple lymphatic markers is required for the evaluation of the prognostic significance of tumor associated lymphangiogenesis. While both intratumoral and peritumoral VEGFR3 correlated with grade only intratumoral LVD for LYVE-1 correlated with stage suggesting that the relative significance of intartumoral versus peritumoral lymphatics remains a matter of debate. Finally, since there was no correlation between LVD scores and nodal status, tumor associated lymphatics should be regarded as an additional pathway rather than a necessity for lymph node metastasis in cervical cancer.

To maintain human health, the lymphatic system requires a structurally and functionally sound network of lymph vessels to absorb lipid-based nutrients, preserve extracellular fluid homeostasis, and mediate immune responses. Aside from lymphedema, investigations in the past few decades have found that impairment of the lymphatic vasculature is also involved in processes such as inflammation, tumor metastasis, fat metabolism, and obesity. However, despite a long history of study and rekindled vigor in the field of lymphatic vascular research, our knowledge of lymph vessel development and physiology is still quite limited. Recently, mutations in a protein family known as connexins (Cxs) were identified as the cause of lymphatic dysfunction in some cases of inherited lymphedema. This dissertation explores the role of primarily two specific connexins, Cx37 and Cx43, and the transcription factor Foxc2 in the morphogenesis and function of the lymphatic vasculature in mice. To accomplish this, phenotypic characterization of mice with genetic deficiencies (knockout mice) in Cx37, Cx43, and/or Foxc2 was performed principally via necropsy, histological techniques (immuno-fluorescence microscopy and H&E staining), and Evans blue dye (EBD) injections. Developmental abnormalities were found in lymphatic vascular growth, patterning, and remodeling in mice lacking Cx37, Cx43, Foxc2 or a combined deficiency of these proteins. Reductions or complete loss of lymphatic valves were a common finding in mice lacking one or more of these proteins. These valve deficits underlay lymphatic insufficiencies that resulted in lymphedema and chylothorax in some genotypes. Foxc2 was found to be a regulator of Cx37 expression. Moreover, Foxc2 was also dependent on Cx37 function for proper morphogenesis of lymph vessels. These findings pertaining to the expression of connexins in the lymphatic vasculature, their role in lymphatic valvulogenesis, and the interdependence of Cx37 and Foxc2 during lymph-vascular development represent my original contributions to human knowledge.

Elevation of VEGFR-3, the primary mediator of lymphangiogenesis (i.e., new lymphatic vessel formation), is frequently associated with inflammation related to chronic disease and cancer. In the latter case, VEGFR-3 dependent lymphangiogenesis induced by inflamed tumors increases the incidence of distant metastasis, leading to decreased patient survival. However, the molecular mechanisms underlying inflammation-induced VEGFR-3 elevation and lymphangiogenesis are currently unknown. Two potential candidate genes that may regulate expression of VEGFR-3 are Prox1, the primary mediator of embryonic lymphangiogenesis, and NF-κB, the key intracellular regulator of inflammation-induced transcription. We hypothesized that the key inflammatory mediator, NF-κB, regulates transcription of key mediators of lymphangiogenesis, VEGFR-3 and Prox1. We further hypothesized that inflammation-induced elevation of VEGFR-3 and Prox1 are essential steps required for robust lymphangiogenesis in response to inflammation. The three primary goals of this study were to (1) delineate the time-course of events leading to inflammation-induced lymphangiogenesis in vivo; (2) clone and characterize the VEGFR-3 promoter and identify factors regulating VEGFR-3 expression in vitro; and (3) characterize the lymphatic phenotype of NF-κB p50 knockout mice. To begin testing these hypotheses, we used a mouse model of peritonitis to characterize induction of lymphangiogenesis and expression kinetics of NF-κB, Prox1 and VEGFR-3. In vivo time-course analysis of inflammation-induced lymphangiogenesis showed activation of NF-κB followed by sequential upregulation of Prox1 and VEGFR-3 that preceded lymphangiogenesis by 4 and 2 days, respectively. Characterization of the VEGFR-3 promoter by luciferase-reporter and ChIP assays showed direct activation by Prox1, NF-κB p50 and p65 transcription factors. This also revealed that Prox1 and NF-κB p50 bind in close proximity and synergistically activate the VEGFR-3 promoter. Characterization of p50 knockout mice revealed significantly decreased lymphatic vessel density in several organs that corresponded to reduced VEGFR-3 and Prox1 expression. Activation of NF-κB by inflammatory stimuli also elevated expression of NF-κB, Prox1 and VEGFR-3 in cultured lymphatic endothelial cells, which enhanced proliferation and migration in response to the VEGFR-3-specific ligand, VEGF-C152S. Collectively, our findings suggest that induction of the NF-κB pathway by inflammatory stimuli activates Prox1, and both NF-κB and Prox1 activate the VEGFR-3 promoter leading to increased receptor expression in lymphatic endothelial cells. This, in turn, enhances the responsiveness of pre-existing lymphatic endothelium to VEGFR-3 binding factors, VEGF-C and VEGF-D, ultimately resulting in robust lymphangiogenesis.

Orientador: Edgard Graner / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-21T21:26:22Z (GMT). No. of bitstreams: 1 Bastos_DeboraCampanella_D.pdf: 2999887 bytes, checksum: 8cc36631bdfe28b13c872fff12fdf00e (MD5) Previous issue date: 2012 / Resumo: A enzima ácido graxo sintase (FASN) é responsável pela síntese endógena de ácidos graxos e tem alta expressão em diversas neoplasias malignas. Cerulenina e orlistat são inibidores farmacológicos da atividade de FASN e têm sido descritos como potenciais agentes anti-tumorais. O sistema linfático constitui a via primária de metástases de diversas neoplasias malignas, dentre elas o melanoma. Em estudos prévios, realizados no Laboratório de Patologia Bucal da FOP-UNICAMP, a inibição da FASN com orlistat foi capaz de reduzir significantemente as metástases linfonodais em modelo murino de melanoma e no modelo ortotópico de carcinoma espinocelular oral. Além disso, o meio condicionado por células de melanoma humano tratadas com inibidores da FASN inibiu a formação de capilares in vitro em matrigel, efeito este mediado pela isoforma anti-angiogênica VEGF-A165b. A correlação entre a FASN e a linfangiogênese ainda não está descrita na literatura, neste trabalho investigamos os efeitos da inibição farmacológica da FASN sobre os fatores de crescimento endotelial vascular (VEGF-C e -D) em células de melanoma murino (B16-F10) e humano (SK-Mel-25) através de RT-PCR quantitativo e ELISA e verificamos os efeitos do bloqueio de FASN sobre a linfangiogênese por meio de culturas tridimensionais de células endoteliais linfáticas humanas (HDLEC) e culturas primárias de endotélio linfático de camundongo. Avaliamos também, o efeito da exposição de células SK-Mel-25 os inibidores da FASN sobre a proliferação de xviii células HDLEC. O tratamento de células B16-F10 e SK-Mel-25 com cerulenina ou orlistat modulou de forma diferencial a expressão de VEGF-C e -D, inibindo o primeiro ao mesmo tempo em que estimulou o último. Além disto, estas mesmas drogas reduziram em células endoteliais linfáticas a viabilidade, a proliferação, migração e formação de capilares em ensaio ex vivo, além de provocar apoptose. O tratamento com inibidores farmacológicos de FASN em células SK-Mel-25 também induziu um fenótipo anti-linfangiogênico, observado em experimentos com meio condicionado. Em conjunto, nossos resultados sugerem que a inibição farmacológica da FASN inibe a linfangiogênese por atuar ao mesmo tempo nas células dos vasos linfáticos e de melanoma. Esses resultados explicam, pelo menos em parte, a redução do número de metástases linfonodais em modelos animais tratados com orlistat e reforçam a teoria de que o bloqueio da FASN é um alvo terapêutico em potencial para os melanomas / Abstract: Fatty acid synthase (FASN) is responsible for de novo synthesis of long-chain fatty. FASN has emerged as a potential therapeutic target for human cancers since it's over expression is associated with depth of invasion and poor prognosis. Cerulenin and orlistat are pharmacological inhibitors of FASN and have been described as potential anti-tumor agents. Lymphatic vessels are the primary route of metastasis in several malignancies including melanomas. In previous studies performed in our laboratory, we demonstrated that FASN activity is essential for melanoma and oral squamous cell carcinoma progression, as its pharmacological inhibition with orlistat reduces lymphatic metastasis in both experimental intraperitoneal and subcutaneous melanomas and orthotopic tongue carcinomas. We also reported that cell culture medium previously conditioned by human melanoma cells in the presence of orlistat induces an anti-angiogenic phenotype mediated by VEGFA165b. Therefore, in order to understand a possible correlation between FASN and lymphangiogenesis, here we investigate the effects FASN inhibitors on the secretion of vascular endothelial growth factors (VEGF) -C and -D by murine (B16-F10) and human (SK-Mel-25) melanoma cells with the aid of qRT-PCR and ELISA assays. We also analyzed the effect of FASN blockage on tridimensional cultures of human lymphatic endothelial cells (HDLEC) and primary cultures of murine lymphatic endothelium. In addition, we also evaluated an indirect effect of the treatment with cerulenin and orlistat in SK-Mel-25 cells on HDLEC xx proliferation. The incubation of B16-F10 or SK-Mel-25 cells with cerulenin or orlistat modulated VEGF-C and -D expression by significantly inhibiting the former and increasing the latter. In addition, these drugs reduced the viability, proliferation, and migration as well as promoted apoptosis in human lymphatic endothelial cells (HDLEC). These compounds also inhibited lymphatic capillary formation in a murine ex vivo assay. Finally, conditioned media from orlistat-treated human melanoma cells resulted in an anti-lymphangiogenic phenotype. These data suggest that FASN inhibitiors reduce lymphangiogenesis by acting simultaneously in the lymphatic endothelium and melanoma cells. Taken together, the studies here presented explain, at least in part, the anti-metastatic effect of orlistat observed in experimental tumors and further suggest that FASN is a potential therapeutic target for melanomas / Doutorado / Patologia / Doutora em Estomatopatologia

No description available.

Yes / Backgorund Prior data suggest pre-diagnostic aspirin use impacts breast tumour biology and patient outcome. Here, we employed faithful surgical resection models of HER2+ and triple-negative breast cancer (TNBC), to study outcome and response mechanisms across breast cancer subtypes. Method NOD/SCID mice were implanted with HER2+ MDA-MB-231/LN/2-4/H2N, trastuzumab-resistant HER2+ HCC1954 or a TNBC patient-derived xenograft (PDX). A daily low-dose aspirin regimen commenced until primary tumours reached ~250 mm3 and subsequently resected. MDA-MB-231/LN/2-4/H2N mice were monitored for metastasis utilising imaging. To interrogate the survival benefit of pre-treatment aspirin, 3 weeks post-resection, HCC1954/TNBC animals received standard-of-care (SOC) chemotherapy for 6 weeks. Primary tumour response to aspirin was interrogated using immunohistochemistry. Results Aspirin delayed time to metastasis in MDA-MB-231/LN/2-4/H2N xenografts and decreased growth of HER2+/TNBC primary tumours. Lymphangiogenic factors and lymph vessels number were decreased in HER2+ tumours. However, no survival benefit was seen in aspirin pre-treated animals (HCC1954/TNBC) that further received adjuvant SOC, compared with animals treated with SOC alone. In an effort to study mechanisms responsible for the observed reduction in lymphangiogenesis in HER2+ BC we utilised an in vitro co-culture system of HCC1954 tumour cells and mesenchymal stromal cells (MSC). Aspirin abrogated the secretion of VEGF-C in MSCs and also decreased the lymph/angiogenic potential of the MSCs and HCC1954 by tubule formation assay. Furthermore, aspirin decreased the secretion of uPA in HCC1954 cells potentially diminishing its metastatic capability. Conclusion Our data employing clinically relevant models demonstrate that aspirin alters breast tumour biology. However, aspirin may not represent a robust chemo-preventative agent in the HER2+ or TNBC setting. / Funding is acknowledged from the Irish Cancer Society Collaborative Cancer Research Centre under BREAST- PREDICT grant CCRC13GAL (www.breas tpred ict.com). I.S.M, E.M and A.T.B, are members of the EurOPDX Consortium, and receive funding from the European Union's Horizon 2020 research and innovation programme, grant agreement no. #731105 (EurOPDX Research Infrastructure, www.europ dx.eu).

This study explored hydrostatic pressure as a mechanobiological parameter to control in vitro endothelial cell tubulogenesis in 3-D hydrogels as a model microvascular tissue engineering approach. For this purpose, the present investigation used an endothelial spheroid model, which we believe is an adaptable microvascularization strategy for many tissue engineering construct designs. We also aimed to identify the operating magnitudes and exposure times for hydrostatic pressure-sensitive sprout formation as well as verify the involvement of VEGFR-3 signaling. For this purpose, we used a custom-designed pressure system and a 3-D endothelial cell spheroid model of sprouting tubulogenesis. We report that an exposure time of 3 days is the minimum duration required to increase endothelial sprout formation in response to 20 mmHg. Notably, exposure to 5 mmHg for 3 days was inhibitory for endothelial spheroid lengths without affecting sprout numbers. Moreover, endothelial spheroids exposed to 40 mmHg also inhibited sprouting activity by reducing sprout numbers without affecting sprout lengths. Finally, blockade of VEGFR-3 signaling abolished the effects of the 20-mmHg stimuli on sprout formation. Based on these results, VEGFR-3 dependent endothelial sprouting appears to exhibit a complex pressure dependence that one may exploit to control microvessel formation.