INTRODUÇÃO: A metástase linfonodal em adenocarcinomas de endométrio reduz significativamente as taxas de sobrevida. Poucos estudos relacionando a microdensidade vascular linfática (MDVL) intratumoral e sobrevida em adenocarcinomas endometriais estão disponíveis atualmente. OBJETIVO: O propósito deste estudo foi avaliar a microdensidade vascular linfática intratumoral dos adenocarcinomas de endométrio e investigar a sua associação com fatores patológicos clássicos, metástase linfonodal e sobrevida. MÉTODOS: Cinquenta e sete pacientes com adenocarcinoma de endométrio, diagnosticadas entre 2000 a 2008 submetidas a estadiamento cirúrgico completo e avaliação da MDVL intratumoral e outras variáveis histológicas. Os micro vasos linfáticos foram identificados através de reação imunoistoquímica utilizando um anticorpo monoclonal contra a podoplanina humana (clone D2-40) e avaliados pela contagem do número de vasos linfáticos marcados em 10 campos com maior densidade vascular em aumento de 400 vezes. A MDVL foi expressa pela média do número de vasos nestes 10 campos microscópicos de maior densidade vascular. A seguir, investigamos a associação entre MDVL com achados clínico-patológicos e prognóstico. Nossos resultados demonstraram que a média do número de vasos linfáticos contados em todos os casos variou de 0 a 4.7. O valor da mediana obtida da média da MDVL foi de 0,5 e foi definido como valor de corte entre baixa e alta MDVL. RESULTADOS: Identificamos baixa MDVL intratumoral em 27 (47,4%) pacientes e alta MDVL em 30 (52,6%) das pacientes. A elevada MDVL intratumoral foi associada com menor comprometimento linfonodal e casos fatais, menor infiltração miometrial e de anexos e menor comprometimento cervical e peritoneal. Não foi obtida associação entre MDVL e idade, tipo histológico pelo sistema da FIGO, invasão vascular ou comprometimento linfonodal. CONCLUSÃO: Nossos resultados mostram associação entre elevada MDVL intratumoral com fatores prognósticos favoráveis no câncer endometrial / INTRODUCTION: Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. OBJECTIVE: Our aim was to assess the intratumoral LMVD of endometrial adenocarcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. METHODS: Fifty-seven patients with endometrial adenocarcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400X magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis. Our results demonstrated that the mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. RESULTS: We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser nodal involvement and fatal cases, lesser miometrial and adnaexal infiltration, and lesser cervical and peritoneal involvement. No association was seen between LMVD and age, FIGO staging histological type, vascular invasion, or lymph node involvement. CONCLUSION: Our results show association of high intratumoral LMVD with favorable prognosis in endometrial cancer

INTRODUÇÃO: A metástase linfonodal em adenocarcinomas de endométrio reduz significativamente as taxas de sobrevida. Poucos estudos relacionando a microdensidade vascular linfática (MDVL) intratumoral e sobrevida em adenocarcinomas endometriais estão disponíveis atualmente. OBJETIVO: O propósito deste estudo foi avaliar a microdensidade vascular linfática intratumoral dos adenocarcinomas de endométrio e investigar a sua associação com fatores patológicos clássicos, metástase linfonodal e sobrevida. MÉTODOS: Cinquenta e sete pacientes com adenocarcinoma de endométrio, diagnosticadas entre 2000 a 2008 submetidas a estadiamento cirúrgico completo e avaliação da MDVL intratumoral e outras variáveis histológicas. Os micro vasos linfáticos foram identificados através de reação imunoistoquímica utilizando um anticorpo monoclonal contra a podoplanina humana (clone D2-40) e avaliados pela contagem do número de vasos linfáticos marcados em 10 campos com maior densidade vascular em aumento de 400 vezes. A MDVL foi expressa pela média do número de vasos nestes 10 campos microscópicos de maior densidade vascular. A seguir, investigamos a associação entre MDVL com achados clínico-patológicos e prognóstico. Nossos resultados demonstraram que a média do número de vasos linfáticos contados em todos os casos variou de 0 a 4.7. O valor da mediana obtida da média da MDVL foi de 0,5 e foi definido como valor de corte entre baixa e alta MDVL. RESULTADOS: Identificamos baixa MDVL intratumoral em 27 (47,4%) pacientes e alta MDVL em 30 (52,6%) das pacientes. A elevada MDVL intratumoral foi associada com menor comprometimento linfonodal e casos fatais, menor infiltração miometrial e de anexos e menor comprometimento cervical e peritoneal. Não foi obtida associação entre MDVL e idade, tipo histológico pelo sistema da FIGO, invasão vascular ou comprometimento linfonodal. CONCLUSÃO: Nossos resultados mostram associação entre elevada MDVL intratumoral com fatores prognósticos favoráveis no câncer endometrial / INTRODUCTION: Lymph node metastasis in endometrial cancer significantly decreases survival rate. Few data on the influence of intratumoral lymphatic microvessel density (LMVD) on survival in endometrial cancer are available. OBJECTIVE: Our aim was to assess the intratumoral LMVD of endometrial adenocarcinomas and to investigate its association with classical pathological factors, lymph node metastasis and survival. METHODS: Fifty-seven patients with endometrial adenocarcinoma diagnosed between 2000 and 2008 underwent complete surgical staging and evaluation of intratumoral LMVD and other histologic variables. Lymphatic microvessels were identified by immunohistochemical staining using monoclonal antibody against human podoplanin (clone D2-40) and evaluated by counting the number of immunostained lymphatic vessels in 10 hot spot areas at 400X magnification. The LMVD was expressed by the mean number of vessels in these 10 hot spot microscopic fields. We next investigated the association of LMVD with the clinicopathologic findings and prognosis. Our results demonstrated that the mean number of lymphatic vessels counted in all cases ranged between 0 and 4.7. The median value of mean LMVD was 0.5, and defined the cut-off for low and high LMVD. RESULTS: We identified low intratumoral LMVD in 27 (47.4%) patients and high LMVD in 30 (52.6%) patients. High intratumoral LMVD was associated with lesser nodal involvement and fatal cases, lesser miometrial and adnaexal infiltration, and lesser cervical and peritoneal involvement. No association was seen between LMVD and age, FIGO staging histological type, vascular invasion, or lymph node involvement. CONCLUSION: Our results show association of high intratumoral LMVD with favorable prognosis in endometrial cancer

<p>The mechanisms behind many important aspects of blood- and lymphatic vessel formation have yet not been elucidated in detail. The primary objectives of this thesis have therefore been to study the effects of hypoxia, platelet-derived growth factor (PDGF) and vascular endothelial growth factors (VEGFs) on vascular development and function. </p><p>In conditions of low oxygen pressure, hypoxia, the survival of the organism is critically dependent on the ability to compensate for the reduced oxygen levels by promoting blood vessel growth and oxygen-independent energy production. Many direct effects of hypoxia in cells are attributed to the induction of a family of hypoxia-inducible transcription factors (HIFs) which control the expression of specific target genes. We found that capillary endothelial cells (ECs) respond to hypoxia with upregulation of genes involved in growth and remodeling of blood vessels. On the other hand, vein ECs responded to hypoxia with increased expression of genes involved in lymphatic vessel growth. Using differentiating embryonic stem (ES) cells, we have shown that hypoxia upregulates expression of VEGF receptor-3 (VEGFR-3) on blood vascular ECs. Furthermore, we have provided evidence for a critical role of VEGFR-3 in hypoxia-induced blood vessel development. </p><p>Activation of PDGF receptor-β (PDGFR-β) on early vascular progenitors in differentiating ES cells or in mice induces blood vessel differentiation, while negatively influencing early hematopoiesis. PDGFR-β expression on vascular progenitors may therefore play a role in guiding differentiation of the vascular lineages. </p><p>We have investigated the usefulness of differentiating ES cells as a model to study early lymphatic development. Administration of VEGF-C and VEGF-A induced formation of lymphatic vessel-like structures that seemed connected to the blood vasculature, supporting the general view that lymphatic ECs are derived from blood vascular ECs.</p><p>In summary, this thesis has provided new insights in the contribution of different growth factors in hematopoietic, blood- and lymphendothelial development. </p>

The mechanisms behind many important aspects of blood- and lymphatic vessel formation have yet not been elucidated in detail. The primary objectives of this thesis have therefore been to study the effects of hypoxia, platelet-derived growth factor (PDGF) and vascular endothelial growth factors (VEGFs) on vascular development and function. In conditions of low oxygen pressure, hypoxia, the survival of the organism is critically dependent on the ability to compensate for the reduced oxygen levels by promoting blood vessel growth and oxygen-independent energy production. Many direct effects of hypoxia in cells are attributed to the induction of a family of hypoxia-inducible transcription factors (HIFs) which control the expression of specific target genes. We found that capillary endothelial cells (ECs) respond to hypoxia with upregulation of genes involved in growth and remodeling of blood vessels. On the other hand, vein ECs responded to hypoxia with increased expression of genes involved in lymphatic vessel growth. Using differentiating embryonic stem (ES) cells, we have shown that hypoxia upregulates expression of VEGF receptor-3 (VEGFR-3) on blood vascular ECs. Furthermore, we have provided evidence for a critical role of VEGFR-3 in hypoxia-induced blood vessel development. Activation of PDGF receptor-β (PDGFR-β) on early vascular progenitors in differentiating ES cells or in mice induces blood vessel differentiation, while negatively influencing early hematopoiesis. PDGFR-β expression on vascular progenitors may therefore play a role in guiding differentiation of the vascular lineages. We have investigated the usefulness of differentiating ES cells as a model to study early lymphatic development. Administration of VEGF-C and VEGF-A induced formation of lymphatic vessel-like structures that seemed connected to the blood vasculature, supporting the general view that lymphatic ECs are derived from blood vascular ECs. In summary, this thesis has provided new insights in the contribution of different growth factors in hematopoietic, blood- and lymphendothelial development.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

The food that we consume contain many dietary compounds which are biologically active. In this thesis we will discuss the biological effects of dietary compounds and the mechanisms behind their activities. First, we studied on the anti-metastatic effects of curcumin, a dietary compound derived from turmeric, through lymphangiogenesis inhibition. Curcumin inhibited vascular endothelial growth factor-C (VEGF-C)-induced lymphangiogenesis in vivo and in vitro. Curcumin inhibited lymphangiogenesis, in part through suppression of proliferation, cell cycle progression and migration of lymphatic endothelial cells. Curcumin inhibited expressions of VEGF receptors (VEGFR2 and VEGFR3), as well as down-stream signaling such as phosphorylation of ERK and FAK. Finally, curcumin sulfate and curcumin glucuronide, two major metabolites of curcumin in vivo, had little inhibitory effect on proliferation of HMVEC-dLy cells. Our results demonstrate that curcumin inhibits lymphangiogenesis in vitro and in vivo, which could contribute to the anti-metastatic effects of curcumin. Next, we investigated the mechanisms underlying the cytotoxic activity of tert-butylhydroquinone (TBHQ), a widely used synthetic food antioxidant. Here we found that the biological effects of TBHQ are mainly mediated by its oxidative conversion to a quinone metabolite tert-butylquinone (TBQ). Co-addition of cupric ion (Cu2+) enhanced, whereas ethylenediaminetetraacetic acid (EDTA) suppressed the oxidative conversion of TBHQ to TBQ, and the biological activities of TBHQ in MC38 colon cancer cells. Finally, a structure and activity relationship study was done and together, these results suggest that the biological activities of TBHQ and other para-hydroquinones are mainly mediated by their oxidative metabolism to generate more biologically active quinone metabolites.

Le carcinome à cellules rénales (RCC) exprimant le facteur inductible de l'hypoxie (HIF) en raison de l'inactivation du gène de von Hippel Lindau (vhl), représente un modèle d'hypoxie chronique. Le devenir des patients dépend du stade de dissémination des cellules tumorales. Par conséquent, déchiffrer les mécanismes de métastase est une préoccupation majeure. Le développement dépendant du VEGF-C (Vascular Endothelial Growth Factor C) d'un réseau lymphatique est en première ligne de propagation métastatique. Pour étudier le rôle de VEGFC dans la dissémination du RCC, nous avons étudié son expression dans l'hypoxie et nous avons invalidé son gène dans des lignées cellulaires humaines et murines. L'hypoxie régule négativement l'ARNm de VEGFC par une diminution de la transcription et de la stabilité de l'ARNm mais l'expression de la protéine VEGF-C est induite par l’hypoxie. Des capacités accrues de prolifération et de migration, et une meilleure expression des marqueurs mésenchymateux et des marqueurs souches caractérisent les cellules vegf-c -/-. Alors que les cellules vegfc -/- ne forment pas de tumeurs chez les souris immunodéficientes, elles développent des tumeurs agressives chez les souris immunocompétentes. La surexpression de VEGFC, est liée à une augmentation de la survie sans progression et globale chez les patients atteints de tumeurs non métastatiques alors qu'une diminution de la survie sans progression et globale est observée chez les patients métastatiques. Nos expériences décrivent une régulation subtile du VEGF-C par hypoxie et mettent en évidence son rôle bénéfique ou péjoratif. Par conséquent, le ciblage VEGF-C pour la thérapie doit être considéré avec prudence. / Hypoxic zones are common features of metastatic tumors. Renal cell carcinoma (RCC) expressing the Hypoxia Inducible Factor (HIF) because of inactivation of the von Hippel Lindau gene (vhl), represent models of chronic hypoxia. Their outcome depends on the extent of their dissemination at diagnosis. Therefore, deciphering the mechanisms of metastasis is a major concern. The Vascular Endothelial Growth Factor C (VEGFC)-dependent development of a lymphatic network is in front line of metastatic spreading. To address the role of VEGFC in RCC dissemination, we studied its expression in hypoxia and we invalidated its gene in human and mouse model cell lines of RCC. Hypoxia down-regulates VEGFC mRNA through a decrease in transcription and mRNA stability but concomitantly induced VEGFC protein expression. Increased proliferation and migration abilities, over-activation of the AKT signaling pathway and enhanced expression of mesenchymal and stem cell markers characterized vegfc-/- cells. Whereas vegfc-/- cells do not form tumors in immuno-deficient mice, they develop aggressive tumors in immuno-competent mice. Moreover, mouse RCC cells generate fast-growing tumors in mice invalidated for six1 or eya2, two major regulators of VEGFC expression. Lymphangiogenic markers overexpression including VEGFC is linked to increased disease-free and overall survival in patients with non-metastatic tumors whereas decreased progression-free and overall survival is observed for metastatic patients. Our experiments describe a subtle regulation of VEGFC by hypoxia and highlight its beneficial or pejorative role. Therefore, targeting VEGFC for therapy must be considered with caution.

Lymphatic metastasis in breast cancer (BC) is one of the most important prognostic factors for patient survival. The escaped tumor cells reach distant vital organs and their unopposed expansion in these organs may cause mortality to patient. Tumor cells are transported to lymph node (LN) exclusively by tumor lymphatic vessels (LV). Increased tumor lymphangiogenesis, i.e., the formation of new LV is currently thought to be promoted by soluble factors such as VEGF-C and –D that activate VEGFR-3 expressed in lymphatic endothelial cells (LEC). These factors are secreted by malignant, tumor-infiltrating immune and stromal cells and create a favorable environment for formation of new vessels. However, emerging evidence suggests that tumor lymphangiogenesis is also promoted by Myeloid-derived Lymphatic Endothelial Cell Progenitors (M-LECP). We recently showed that M-LECP are abundant in mouse and human breast tumors and that their density strongly correlates with both lymphatic formation and nodal metastasis. Characterization of M-LECP showed that nearly all these cells express typical markers of the M2-type of macrophages such as CD163, CD204, and CD209. These cells are consider to be strongly immunosuppressive as exemplified by their inhibition of mobilization, activation, and survival of the key defenders against cancer cells, cytotoxic CD8+ T lymphocytes. Here, we compare the in vitro differentiation of M-LECP derived from bone marrow (BM) myeloid precursors primed with CSF-1 followed by secondary stimulants such as LPS, an immunomodulatory ligand for TLR4, and IL-4, IL-13, and IL-10 downstream targets of this receptor that are known to promote M2-macrophage development. Expression of these stimulants was analyzed by qPCR, flow cytometry, and ELISA during M-LECP differentiation. Our study describes the expression and functionality of these Th2 cytokines and their receptors during M-LECP differentiation. We found that each of the Th2 pathways singularly promotes M-LECP differentiation but there is an absent additive effect. We also found that IL-10 but no other Th2 cytokines is upregulated along with its receptor and contributes to the expression of the lymphatic properties similarly to LPS. To our knowledge, the role of IL-10 in development of lymphatic phenotype through differentiation of M-LECP has not been reported previously. Lastly, we show recruitment of M-LECP in a mouse BC model and the co-expression of the Th2 cytokine receptors in these cells. These studies have a potential to identify new regulators of M-LECP production in the bone marrow that could serve as biomarkers and targets for inhibiting tumor lymphatic formation, and by extension, lymph node metastasis.

Το λεμφαγγειακό σύστημα διαδραματίζει σημαντικό ρόλο στη διατήρηση της ομοιόστασης των ιστών, στην ανοσολογική απόκριση του οργανισμού, στην απορρόφηση των λιπών από τον πεπτικό σωλήνα, και στη διασπορά των καρκινικών κυττάρων. Η πρόσφατη ανακάλυψη ειδικών για τα λεμφαγγειακά ενδοθηλιακά κύτταρα δεικτών και αναπτυξιακών παραγόντων, όπως επίσης και η δημιουργία γενετικών μοντέλων ποντικιών με διαταραγμένη τη λειτουργία του λεμφαγγειακού συστήματος, παρείχαν σημαντικότατες πληροφορίες για τη μοριακή ρύθμιση της εμβρυικής ανάπτυξης του λεμφαγγειακού συστήματος και της φυσιολογίας του. Τα σχετικά πρόσφατα αναγνωρισμένα μοριακά σηματοδοτικά μονοπάτια από τα οποία ρυθμίζεται η λεμφαγγειογένεση επέτρεψαν τη μελέτη της σχετιζόμενης με όγκους λεμφαγγειογένεσης. Οι μελέτες αυτές κατέδειξαν ότι η σχετιζόμενη με τους όγκους λεμφαγγειογένεση αποτελεί σημαντικό στοιχείο της μεταστατικής διαδικασίας, ενώ παράλληλα αναδεικνύουν συνεχώς καινούρια μόρια/σηματοδοτικά μονοπάτια-ρυθμιστές της εν λόγω διαδικασίας. / The lymphatic vascular system plays an important role in the maintenance of fluid homeostasis, in the afferent immune response, in the intestinal lipid uptake and in the metastatic spread of malignant cells. The recent discovery of specific markers and growth factors for lymphatic endothelium and the establishment of genetic mouse models with impairment of lymphatic function have provided novel insights into the molecular control of the lymphatic system in physiology and in embryonic development. Recently, molecular pathways that signal for lymphangiogenesis have been described allowing analyses of tumor lymphangiogenesis to be performed. These studies demonstrate that tumor lymphangiogenesis is a major component of the metastatic process, while at the same time new molecules and transduction pathways are discovered to regulate tumor lymphatics growth.

INTRODUÇÃO: O papel da linfangiogênese no transplante renal em humanos é desconhecido até o momento. As poucas publicações disponíveis acerca do assunto revelam resultados controversos. O presente estudo visa a avaliar a influência dos vasos linfáticos sobre aspectos clínicos e patológicos no transplante renal. MÉTODOS: Biópsias de indicação clínica de pacientes submetidos a transplante renal com enxertos oriundos de doadores falecidos na Unidade de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de janeiro de 2007 a dezembro de 2009 foram selecionadas e os dados clínicos destes pacientes foram coletados do banco de dados. Estas biópsias foram classificadas de acordo com a Classificação de Banff. Reação imuno-histoquímica foi empregada para identificar vasos linfáticos, linfócitos T, linfócitos B e macrófagos. Análise histomorfométrica foi empregada para quantificar estes quatros elementos e a fibrose intersticial cortical. RESULTADOS: A presença de vasos linfáticos foi significativamente mais intensa em biópsias com rejeição aguda mediada por linfócitos T e com distúrbios infecciosos (nefropatia do poliomavírus e pielonefrite), quando comparadas à expressão de linfáticos com biópsias sem rejeição e com biópsias com fibrose intersticial e atrofia tubular de etiologia indeterminada. Biópsias com expressão de vasos linfáticos apresentaram escores semiquantitativos da Classificação de Banff mais altos. Os linfócitos B túbulo-intersticiais apresentaram maior concentração em amostra com presença de vasos linfáticos. A linfangiogênese não demonstrou influência sobre desfechos clínicos relevantes, como função renal e sobrevida do enxerto. CONCLUSÃO: O presente estudo associa a linfangiogênese com distúrbios inflamatórios túbulo-intersticiais do enxerto (rejeição aguda mediada por linfócitos T e infecções) e com infiltrado de linfócitos B. No entanto, a expressão de linfáticos não foi associada à influência sobre a função e a sobrevida do enxerto / INTRODUCTION: The role of lymphangiogenesis in human kidney allograft is currently unknown. Controversial results have arisen from few publications available. This study intends to evaluate the influence of lymphatics on relevant clinical and pathological aspects of renal transplantation. METHODS: Clinically indicated biopsies from patients who underwent renal transplantation with allografts from deceased donors at the Renal Transplantation Unit of the Clinics Hospital of the University of São Paulo Medical School from January of 2007 to December of 2009 were selected and clinical data of these patients were retrieved from the database. These biopsies were classified according to the Banff Classification. Immunohistochemistry was used to identify lymphatic vessels, T lymphocytes, B lymphocytes, and macrophages. Morphometric analysis was employed to quantify their expression and cortical interstitial fibrosis. RESULTS: Lymphatic vessel formation was significantly higher in biopsies with acute T-cell mediated rejection and infectious disorders (polyomavirus-associated nephropathy and pyelonephritis) compared with no rejection and interstitial fibrosis and tubular atrophy without evidence of any specific etiology. Biopsies with expression of lymphatics presented higher levels of semiquantitative scores of the Banff Classification. B lymphocytes infiltrate was more intense in biopsies with lymphatics compared with those without the vessels. Lymphangiogenesis had no effect on important clinical parameters examined (graft function and graft survival two years post transplant). CONCLUSION: The present results associate lymphangiogenesis with kidney allograft tubulointerstitial inflammation (ATCMR and infectious disorders) and with B lymphocytes infiltrate. However, the presence of lymphatic vessels was not associated with any influence on graft function and survival