Les adénomes hépatocellulaires (AHC) sont des tumeurs bénignes rares qui se développent le plus souvent chez la femme jeune suite à la prise de contraceptifs oraux. Les complications principales sont l’hémorragie et plus rarement, la transformation maligne en carcinome hépatocellulaire (CHC). Des travaux récents ont permis d’identifier 3 groupes moléculaires principales d’AHC qui se définissent par (1) l’inactivation du facteur de transcription HNF1A (H-HCA), (2) l'activation de la voie Wnt/ß-caténine (bHCA) ou (3) la présence d’infiltrats inflammatoires (IHCA).Afin d’identifier les voies de tumorigenèse associées au développement d’AHC inflammatoires (IHCA), une analyse transcriptomique comparant des IHCA à des foies non tumoraux a été réalisée au laboratoire, ce qui a permis d’identifier dans ce groupe tumoral une activation de la voie IL-6/JAK/STAT3. Nous avons recherché de nouvelles altérations géniques et nous avons caractérisé le mécanisme d'activation de la voie IL-6/JAK/STAT dans les IHCA. Les conséquences fonctionnelles sur la voie STAT3 des différents mutants ont été analysées par une modélisation de leur expression dans des lignées hépatocellulaires. Par ailleurs, nous avons réalisé des études génomiques intégrées (analyse CGH-SNP, méthylome et séquençage exome) sur une large série de 250 AHC avec pour objectif d’affiner la classification moléculaire des AHC, d’identifier de nouveaux gènes altérés dans ces tumeurs et d’élucider les mécanismes de transformation maligne des AHC en CHC.Dans le groupe des IHCA, ces analyses nous ont permis d’identifier de nombreux oncogènes activés par mutation somatique ; de plus, trois de ces gènes n’avaient jamais été décrits comme étant mutés dans des tumeurs humaines. Nous avons identifié des mutations activatrices du récepteur à l’IL-6, gp130 dans 60% des IHCA. Nous avons aussi retrouvé des mutations de FRK, une src-like kinase, dans 10% des IHCA, du facteur de transcription STAT3 dans 5% des IHCA, du gène GNAS dans 5% des cas, et de la tyrosine kinase JAK1 dans 1% des cas. Toutes les mutations identifiées étaient somatiques, monoalléliques et mutuellement exclusives. Nous avons pu montrer, dans des systèmes de lignées cellulaires hépatocellulaires, que l'expression des formes mutées de ces gènes est capable d’activer la voie IL-6/STAT3 en absence du ligand IL-6, contrairement aux protéines sauvages. Nous avons identifié des inhibiteurs pharmacologiques qui permettent d’inhiber de façon spécifique ces mutants et qui pourraient être utilisés en clinique pour le traitement des IHCA.Grâce à une technique de CGH-SNP, nous avons identifié des événements récurrents de pertes et gains de chromosomes associés aux groupes moléculaires d’AHC. De façon similaire, l’étude de la méthylation dans les AHC a permis de mettre en évidence un pattern spécifique à chaque sous groupe. Nous avons montré que l’instabilité chromosomique augmente progressivement dans les lésions borderline et dans les CHC développés sur AHC comparés aux AHC classiques. Le séquençage exome de 5 transformations malignes de AHC en CHC a identifié un nombre plus important de mutations dans les AHC qui ont transformé comparé aux AHC classiques ; ce nombre est significativement augmenté dans la partie CHC des tumeurs. La comparaison de la partie bénigne et maligne des tumeurs a mis en évidence l'activation de ß-caténine comme un évènement précoce dans le processus de transformation et a révélé la présence de mutations somatiques fréquentes dans le promoteur de la télomèrase (TERT), identifiées principalement dans la partie maligne des tumeurs.En conclusion, cette étude a permis d’identifier des mécanismes distincts conduisant à l'activation de STAT3 dans les IHCA, renforçant le rôle de la voie JAK-STAT3 dans la tumorigenèse bénigne hépatocellulaire ainsi que le lien entre Src kinases et inflammation. Ces travaux ont permis d’affiner la classification moléculaire des AHC avec des corrélations étroites... / Hepatocellular adenomas (HCA) are rare benign tumors that develop most often in young women after taking oral contraception. The main complications are hemorrhage and rarely, malignant transformation to hepatocellular carcinoma (HCC). Recent work in the laboratory identified three main HCA molecular groups that are defined by (1) inactivation of the transcription factor HNF1A (H-HCA), (2) activation of the Wnt/ß-catenin pathway (bHCA) or (3) the presence of inflammatory infiltrates (IHCA).To identify tumorigenesis pathways associated with the development of inflammatory HCA (IHCA), a transcriptome analysis comparing IHCA to non-tumor liver was performed in the laboratory, leading to the identification of an activation of the IL-6/JAK/STAT3 pathway in these tumors. We sought new gene alterations and we characterized the activation mechanism of the IL-6/JAK/STAT pathway in IHCA. The functional consequences of the different mutants on the STAT3 pathway were analyzed by modeling their expression in hepatocellular cell lines. In addition, we performed integrated genomic studies (CGH-SNP analysis, methylome and exome sequencing) on a wide range of 250 HCA with the aim to refine the molecular classification of HCA, to identify new genes altered in these tumors and to elucidate the mechanisms of malignant transformation of HCA to HCC.In the group of the IHCA, we identified many oncogenes activated by somatic mutation; in addition, three of these genes were never been described as mutated in human tumors. We identified activating mutations in the IL-6 receptor gp130 in 60% of IHCA. We also found mutations in FRK, a src-like kinase, in 10% of IHCA, of the transcription factor STAT3 in 5% of IHCA, of the GNAS gene in 5% of cases, and of the tyrosine kinase JAK1 in 1% of the cases. All identified mutations were somatic and monoallelic and were mutually exclusive. We have shown in hepatocellular cell lines that the expression of mutated forms of these genes is able to activate the IL-6/STAT3 pathway in the absence of the IL-6 ligand, in contrast to wild-type proteins. We have identified pharmacological inhibitors that specifically inhibit the mutants and that could be used for the clinical treatment of IHCA.Using a CGH-SNP technique, we identified recurrent chromosomes gains and losses associated with the HCA molecular groups. Similarly, the study of methylation in HCA highlighted a specific pattern in each subgroup. We showed that chromosomal instability increases gradually in borderline lesions and in HCC developed on HCA compared to classical HCA. Exome sequencing of 5 malignant transformation of HCA to HCC identified a large number of mutations in the transformed HCA compared to classical HCA; and this number is significantly increased in HCC tumors counterpart. Comparison of benign and malignant tumors highlighted the activation of ß-catenin as an early event in the transformation process and revealed frequent somatic mutations in the promoter of the telomerase gene (TERT), identified mainly in the malignant part of tumors.In conclusion, this study has led to the identification of distinct mechanisms leading to the activation of STAT3 in IHCA, strengthening the role of the JAK-STAT3 pathway in benign hepatocellular tumorigenesis and the relationship between Src kinases and inflammation. This work helped to refine the molecular classification of HCA with tight correlations between genotype and phenotype, and led to advances in the identification of major genetic determinants involved in the process of malignant transformation.

Prostate cancer (PC) is the most common cancer in Sweden. Most patients have slow growing tumors that will not cause them any harm within their lifetime, but some have aggressive tumors and will die from their disease. The ability of current clinical practice to predict tumor behavior and disease outcome is limited leading to both over- and undertreatment of PC patients. The men who die from their disease are those that develop metastases. It is therefore of great value to find better and more sensitive prognostic techniques, so that metastatic spread can be detected (or predicted) at an early time point, and so that appropriate treatment can be offered to each subgroup of patients. The aim of this thesis was to investigate if, and by what means, highly aggressive prostate tumors influence extratumoral tissues such as the non-malignant parts of the prostate and regional lymph nodes (LN), and also if any of our findings could be of prognostic importance. Gene- and protein expression analysis were the main methods used to address these questions. Our research group has previously introduced the expression Tumor Instructed (Indicating) Normal Tissue (TINT), and we use the term TINT-changes when referring to alterations in non-malignant tissue due to the growth of a tumor nearby or elsewhere in the body. In the Dunning rat PC-model we found that MatLyLu (MLL)-tumors, having a high metastatic ability, caused pre-metastatic TINT-changes that differ from those caused by AT1-tumors who have low metastatic ability. Prostate-TINT surrounding MLL-tumors had elevated immune cell infiltration, and gene ontology enrichment analysis suggested that biological functions promoting tumor growth and metastasis were activated in MLL- while inhibited in AT1-prostate-TINT. In the regional LNs we found signs of impaired antigen presentation, and decreased quantity of T cells in the MLL-model. One of the downregulated genes in the MLL-LNs was Siglec1 (also known as Cd169), expressed by LN resident macrophages that are important for antigen presentation. When examining metastasis-free LN tissue from PC patients we found CD169 expression to be a prognostic factor for PC-specific survival, and reduced expression was linked to an increased risk of PC-specific death. Some of our findings in prostate- and LN-TINT could be seen already when the tumors were very small suggesting that differences in TINT-changes between tumors with different metastatic capability can be detected early in tumor progression. However, before coming of use in the clinic more research is needed to better define a suitable panel of prognostic TINT-factors as well as the right time window of when to use them. / Populärvetenskaplig sammanfattning Prostatacancer är den i särklass vanligaste cancerformen hos män i Sverige. De flesta patienter har en mycket långsamt växande tumör som inte orsakar dem några större besvär under deras livstid, men enbart i Sverige dör ca 2500 patienter/år av sjukdomen. Det är först vid uppkomst av metastaser som sjukdomen blir dödlig. Befintliga diagnos- och prognosmetoder är otillräckliga när det gäller att uppskatta och förutse tumörens aggressivitet och risk för att bilda metastaser. Detta gör att vissa patienter inte får tillräcklig behandling eller behandlas försent medan andra behandlas i onödan. Behovet av förbättrad diagnostik är därför stort. Om vi kan hitta markörer för potentiellt metastaserande sjukdom, och i bästa fall också behandla innan metastaser uppstår, skulle det förbättra chansen för överlevnad markant. För att kunna växa och spridas behöver en tumör inte bara förbereda närliggande vävnader utan förmodligen hela kroppen. Vår hypotes är att potentiell dödliga tumörer sannolikt är bättre på detta än mer ofarliga. Man vet från studier av andra cancerformer att farliga tumörer orsakar förändringar i det organ dit cancern senare sprids. Dessa förändringar sker för att de tumörceller som senare anländer ska kunna överleva, och processen har fått namnet pre-metastatisk nisch. Bl.a. har man sett att immunsystemet hämmas och nybildning av kärl ökar. Det är vanligt att metastaser uppstår i närliggande lymfkörtlar innan uppkomst av metastaser i andra organ. Dock är väldigt lite känt om pre-metastatiska förändringar i lymfkörtlar eftersom den forskning som hittills är gjord främst har tittat på andra organ. Inom prostatacancer finns det förvånande få studier av premetastatiska nischer överhuvudtaget, och man vet därför inte om de alls förekommer eller vilka förändringar som i så fall sker. Vår grupp har tidigare myntat uttrycket TINT som står för Tumor Instructed (Indicating) Normal Tissue (TINT är ett engelskt verb som betyder färga) och syftar på förändringar i normal vävnad som inducerats av tumören, dvs. att tumörer färgar av sig på omgivningen. Det kan vara förändringar i normal vävnad nära tumören, som i det här fallet resten av prostatan, eller i vävnad långt ifrån tumören som till exempel regionala lymfkörtlar, lungor och benmärg. Syftet med det här avhandlingsarbetet var att undersöka TINT-förändringar inducerade av aggressiv cancer och se om dessa skiljer sig från TINT-förändringar inducerade av mindre farliga tumörer, samt att utvärdera om någon TINT-förändring skulle kunna användas för att prognostisera vilka patienter som har hög risk att få metastaser. Vi har använt oss av en prostatacancer-modell i råtta där vi analyserat genoch proteinuttryck i pre-metastatiska regionala lymfkörtlar, tumörer och prostata-TINT (dvs. prostatavävnad utanför tumören). TINT-förändringar inducerade av MatLyLu (MLL), en tumör med hög metastaserande förmåga, jämfördes mot TINT-förändringar inducerade av AT1, en snabbväxande tumör men med låg förmåga att bilda metastaser. Vi kunde vi se flera skillnader mellan modellerna. Genuttrycket i MLL-prostata-TINT indikerade en aktivering av cellulära funktioner som visat sig stimulera tumörväxt och spridning såsom celldelning, viabilitet, migration, invasion, och angiogenes (nybildning av kärl). I AT1-prostata-TINT var genuttrycket kopplat till samma funktioner men verkade istället inhibera dessa. Genom att titta på vävnaderna i mikroskop kunde vi se att MLL-tumörer rekryterade färre T-celler (som har en viktig funktion i immunsvaret mot tumören), men istället fler makrofager och granulocyter till både tumören och prostata-TINT (dessa typer av immunceller har visats kunna hjälpa tumörer att växa och sprida sig). MLL-tumörer hade också fler blodkärl och lymfkärl strax utanför tumören. I de regionala lymfkörtlarna från djur med MLL-tumörer visade genuttrycket tecken på försämrad antigenpresentation, samt immunhämning och/eller induktion av immuntolerans. Immuntolerans innebär att immuncellen inte längre reagerar mot det specifika antigen den blivit tolerant emot. Detta är vanligt förekommande hos individer med cancer och är ett sätt för tumören att undkomma immunförsvaret. I vävnadsprover av lymfkörtlarna kunde vi se färre antigenpresenterande celler, och liksom i tumörerna fanns det färre T-celler i MLL-modellen, något vi kunde se redan när tumörerna var väldigt små. CD169 är ett protein som bl.a. uttrycks av sinus-makrofager i lymfkörtlar. Dessa makrofager har en central funktion i att aktivera ett tumör-specifikt immunsvar. I råttmodellen kunde vi se att regionala lymfkörtlar från djur med MLL-tumörer hade lägre nivåer av CD169 än regionala lymfkörtlar från djur med AT1-tumörer, och då antalet sinus-makrofager visat sig ha prognostiskt värde i t.ex. tjocktarmscancer, ville vi se om det kunde vara så även i prostatacancer. Därför kvantifierade vi uttrycket av CD169 i metastasfria regionala lymfkörtlar från prostatacancerpatienter och såg att låga nivåer av CD169 medförde en ökad risk för att dö i prostatacancer. Sammantaget tyder resultaten på att MLL-tumören jämfört med AT1- tumören bättre lyckas förbereda omgivande vävnad för att gynna tumörväxt och spridning, både lokalt i prostatan men också längre bort från tumören i de regionala lymfkörtlarna. Våra fynd stämmer väl överens med aktuell tumörbiologisk forskning om hur tumörer påverkar sin omgivning. Något som inte visats tidigare är att miljön utanför tumören verkar skilja sig drastiskt beroende på tumörens metastaserande förmåga, samt att dessa skillnader går att se relativt tidigt under sjukdomsförloppet och förmodligen även långt bort från tumören. Vi har också visat att särskilt aggressiv prostatacancer verkar inducera en pre-metastatisk nisch i tumördränerande lymfkörtlar likt det som beskrivits i andra modellsystem och i andra cancertyper, men hittills inte i prostatacancer. Fler studier behövs för att bättre karaktärisera de förändringar som en potentiellt dödlig prostatacancer orsakar i andra vävnader, och för att ta reda på hur denna kunskap kan användas för att förbättra diagnostik och behandling.

Les sarcomes épithélioides sont caractérisés dans 85% des cas par une perte d'expression nucléaire de la protéine SMARCB1, codée par un gène suppresseur de tumeurs situés en 22q11 impliqué dans la génèse des tumeurs rhabdoides malignes. L'exploration par BAC-FISH (Bacterial Artificial Chromosome- Fluorescence In Situ Hybridization) d'une série de 40 sarcomes épithélioides a permis d'établir que cette perte d'expression était secondaire dans 85% des cas à des délétions homozygotes et a mis en évidence le premier cas de sarcome épithélioide associé à une délétion germinale de SMARCB1, altération jusqu'alors uniquement identifiée dans les tumeurs rhabdoides malignes. Nous avons par la suite testé le gène suppresseur de tumeurs SMARCA4 comme gène candidat impliqué dans les sarcomes épithélioides SMARCB1-conservés à partir d'une série rétrospective de 16 cas. SMARCA4 code la sous-unité ATPase du complexe BAF dont SMARCB1 représente une sous unité. Ce screening initial a permis d'identifier 6 cas de sarcomes SMARCA4-inactivés dont la localisation était exclusivement thoracique et dont les caractéristiques clinique et anatomopathologique stéréotypées ont permis le recrutement prospectif et rétrospectif de nouveaux cas. L'étude par RNA-sequencing d'une fraction de notre cohorte (n=13/19) a confirmé leur homogénéité transcriptomique et souligné leur parenté avec les tumeurs rhabdoides SMARCB1 et SMARCA4 déficientes. L'absence de mutation germinale fréquente (n=1/11) a fait proposer le terme de sarcome thoracique SMARCA4-déficient (SMARCA4-DTS) en proscrivant l'utilisation du qualificatif « rhabdoide ». La parenté transcriptomique de ces tumeurs laisse entrevoir des vulnérabilités thérapeutiques communes qui restent à identifier / Epithelioid sarcomas (ES) display loss of SMARCB1 nuclear expression in 85% of cases. SMARCB1 is encoded by a tumor suppressor gene located in 22q11 which was first linked to cancer in malignant rhabdoid tumors. While investigating a series of 40 epithelioid sarcomas with BAC-FISH (Bacterial Artificial Chromosome-Fluorescence In Situ Hybridization), we demonstrated that SMARCB1 loss in ES occurred through genomic deletions in 85% of cases. We were also able to highlight the first case of ES associated with a heterozygous SMARCB1 deletion in the germ line, which feature was previously thought to be restricted to malignant rhadboid tumors (MRT). We subsequently investigated a series of 16 SMARCB1-retained ES to identify its underlying culprit gene with a focus on the candidate tumor suppressor gene SMARCA4. SMARCA4 encodes one of the ATPase subunit of BAF complexes. Interestingly, SMARCB1 is also a core submit of these complexes which regulate chromatin remodeling. We were able to identify a set of 6 cases displaying SMARCA4 inactivation with this discovery cohort. The review of medical records highlighted these cases had similar presentation : all tumors presented with large compressive and aggressive mediastinopulmonary masses. We further recruited 13 cases based on these characteristics including 5 prospective cases. The characterization of their transcriptomes by RNA-sequencing (n=13/19) confirmed their remarkable homogeneity, all our samples clustering together with MRT. However our variant diverge from malignant rhabdoid tumors as it lacks SMARCA4 alteration in the germline (n=0/11) and displays complex polyploidy genetic profiles. We therefore called this new tumor variant “SMARCA4-deficient thoracic sarcoma” (SMARCA4-DTS). The transcriptomic vicinity of SMARCA4-DTS and MRT let foresee they share common therapeutic vulnerabilities

La méthylation de l'ADN est une marque épigénétique répressive impliquée dans de nombreux processus physiologiques et pathologiques. Des hyperméthylations de promoteurs sont ainsi responsables de répressions transcriptionnelles de gènes suppresseurs de tumeurs dans les cancers. La méthylation de l'ADN serait capable d'induire une répression transcriptionnelle par la combinaison de deux mécanismes principaux : l'éloignement de facteurs de transcription activateurs, et le recrutement de protéines répressives liant spécifiquement l'ADN méthylé. MBD2 est une protéine de liaison à l'ADN méthylé capable de recruter les complexes répresseurs NuRD et SIN3A. ZBTB4 est capable de se lier à l'ADN méthylé in vitro et induit une répression de la transcription de plasmides méthylés lorsqu'elle est surexprimée. Son rôle de répresseur transcriptionnel dépendant de la méthylation de l'ADN reste toutefois peu documenté. Nous avons identifiés par RNAseq les modifications du transcriptome induites par une déplétion de MBD2 ou de ZBTB4. Les gènes surexprimés après déplétion de MBD2 ou ZBTB4 sont méthylés sur leur promoteur, et sont aussi surexprimés après traitement avec des agents déméthylants. Des résultats d'immuno-précipitations de chromatine réalisées contre les deux protéines endogènes montrent que la quasi-totalité des sites de fixation de MBD2 et qu'une partie des sites de fixations de ZBTB4 correspondent à des régions méthylés. Ces résultats confirment à l'échelle du génome que MBD2 endogène est bien un interprète majeur de la méthylation de l'ADN, et que ZBTB4 réprime bien la transcription de gènes méthylés. Nous avons aussi observé une redistribution importante de MBD2 sur le génome dans des modèles de progression tumorale. Nos résultats montrent que les gènes réprimés pendant la transformation oncogénique le sont en partie par MBD2. L'expression de certains de ces gènes peut être induite dans les lignées transformées par déplétion de MBD2 par siRNA / DNA methylation is an epigenetic mark that plays a role in many physiological and pathological processes. Indeed, silencing of tumor suppressor genes in cancer is frequently caused by promoter hypermethylations. Transcriptional repression induced by DNA methylation is likely caused by the combination of two mechanisms: the repulsion of activator transcription factors, and the recruitment of repressor proteins able to specifically recognize methylated DNA. MBD2 is a methyl DNA binding protein that cans recruits NuRD or SIN3A repressor complexes. ZBTB4 is able to bind methylated DNA in vitro, and can repress the transcription of methylated plasmids when overexpressed. Its methylationdependent transcriptional repressor function remains poorly documented. By RNAseq, we have identified transcriptomic modifications induced by the depletion of either MBD2 or ZBTB4. Genes up regulated after MBD2 or ZBTB4 depletion were methylated on their promoter, and were also up regulated after treatment with demethylating agents. Chromatin immunoprecipitations experiments against endogenous proteins showed that almost all MBD2 binding sites, and that a part of ZBTB4 binding sites, correspond to methylated DNA regions. These results confirmed at genome wide scale that endogenous MBD2 is a major reader of DNA methylation and that ZBTB4 does repress the transcription of methylated genes. We observed an important redistribution of MBD2 on the genome in models of tumor progression. Our results showed that MBD2 plays role in gene repressions occurring during oncogenic transformation. Some of those repressed genes can be re-expressed in transformed cell lines after depletion of MBD2 by siRNA

O objetivo deste trabalho foi estudar o processo pelo qual hormônios e fatores de crescimento controlam a proliferação celular em mamíferos. O modelo experimental utilizado foi linhagens de células estabelecidas em cultura. Os estudos centraram-se em dois tipos básicos de células: fibroblastos e células adrenais e o ataque experimental foi feito sob dois pontos de vista: bioquímico e genético. O ataque bioquímico envolveu desenvolver estudos cinéticos da síntese de DNA não só durante o carenciamento de células para soro, como também durante a reestimulação de células carenciadas por:soro, hormônios e fatores de crescimento. Medidas do conteúdo intracelular de cAMP foram efetuadas com o intuito de adquirir informações à respeito do mecanismo de ação destes fatores. Um modelo de ciclo celular foi proposto no qual o controle do crescimento seria exercido através de reguladores positivos e negativos que agiriam estimulando ou inibindo a passagem de células do estado de repouso (Go) para a fase proliferativa. Entre os reguladores positivos (estimuladores) do sistema fibroblasto, encontra-se hormônios clássicos, como esteróides e insulina, e fatores de crescimento de natureza hormonal como EGF, PF (fator proteico extraído de glândulas pituitárias) e prostaglandina F2α. O esteróide hidrocortisona pode agir como regulador negativo, inibindo o crescimento de fibroblastos. Medidas do período de tempo transcorrido desde a estimulação de células carenciadas (Go), até o aparecimento da onda de síntese de DNA (período definido operacionalmente como Gl) foram feitas. Em fibroblastos 3T3 este período foi de 12 a 13 horas tanto para células estimuladas com soro como com hormônios clássicos (hidrocortisona, insulina) ou fatores de crescimento (EGF, PF) ou ainda com combinações deles (EGF + PF + insulina; PF + hidrocortisona; PF + hidrocortisona + insulina). No sistema células adrenais, adrenocorticotropina (ACTH) foi o único hormônio clássico que apresentou atividade sobre o crescimento destas células e também o único efetuador negativo encontrado. Neste sistema PF mostrou-se como o único fator com atividade estimulatória sobre o crescimento. Gl aqui foi de 11 horas tanto para células estimuladas com soro como com PF. Além disso os hormônios clássicos hidrocortisona e insulina não apresentaram atividade estimulatória por si só ou em combinação com PF. A análise da ação de hidrocortisona no sistema fibroblasto e de ACTH no sistema células adrenais estimuladas, forneceu evidências de que após deixar Go, em direção a S, numa certa altura de Gl as células tornam-se irreversivelmente comprometidas com o processo replicativo. Este comprometimento parece ocorrer 5 horas antes de S, sendo referido como Glc. Em face destes resultados foi proposto que os reguladores agem estimulando ou inibindo a transição Go → Glc. Na tentativa de obter maior definição do sistema de controle do crescimento, aproveitamo-nos das vantagens oferecidas pelo modelo experimental usado, para a busca de mutantes do tipo regulatório. Esta busca resultou no isolamento das linhagens ST1 e AR-1, derivadas, respectivamente, de fibroblastos 3T3 e células adrenais Y-l. Entre os vários aspectos interessantes da linhagem ST1 destaca-se: a) o dramático efeito de hidrocortisona causando mudança nas características das células as quais passam de um fenótipo tipicamente transformado para normal. Este fenômeno foi observado tanto \"in vitro\" (através de medidas de parâmetros de crescimento) como \"in vivo\" (através de ensaios de tumorogenicidade); b) as alterações morfológicas de caráter antagônico provocadas, por um lado, pela adição de hidrocortisona (causando achatamento) e, por outro, pela retirada do soro ou adição de cAMP ao meio de cultura (arredondamento). Através do estudo da ação de inibidores, obteve-se evidências do envolvimento de microtúbulos nestas alterações morfológicas. A análise do conteúdo intracelular de cAMP indicou que este nucleotídeo não atua como mediador da ação de hidrocortisona. Sua ação parece ser devida à indução de alterações no sistema superfície celular - membrana -citoesqueleto. Ao contrário de outros variantes de células Y-l resistentes à ACTH, células AR-1 mostraram-se também resistentes a cAMP. A utilidade destas células nos estudos da postulada mediação deste nucleotídeo na ação de ACTH, é óbvia. / The aim of this work was to study the process by which hormones and growth factors control proliferation of mammalian cells. Cell lines established in culture were used as the experimental model. The studies were centered on two basic types of cells: fibroblasts and adrenal cells and the experimental approach was made from two viewpoints: biochemical and genetic. The biochemical approach involved kinetic studies of the DNA synthesis process not only during serum starvation but also during restimulation of serum starved cells by serum, hormones and growth factors. Intracellular cyclic AMP determinations were made in order to gain informations on the mechanism of action of these factors. A cell cycle model was proposed in which cell growth control would be exerted by positive and negative regulators that would act by stimulating or inhibiting the flow of cells from a resting state (Go) to the proliferative phase. Among the positive regulators (stimulators) found for the fibroblast system are: classical hormones, like steroids and insulin, and growth factors of homonal nature, like EGF, PF (protein factor extracted from pituitary glands) and prostaglandin F2α. The steroid hydrocortisone can also act as a negative regulator, inhibiting fibroblast growth. Measurements of the time interval between stimulation of serum starved (Go) cells and the onset of DNA synthesis (period that is operationally defined as Gl) were made. In 3T3 fibroblasts this period was 12 to 13 hours for cells stimulated not only by serum but also by classical hormones (hydrocortisone, insulin) or growth factors (EGF, PF) or even by combinations of these factors (EGF + PF + insulin; PF + hydrocortisone; PF + hydrocortisone + insulin). In the adrenal system, adrenocorticotropin (ACTH) was the only classical hormone to present activity on the growth of these cells and also the only negative regulator found. In this system PF was shown to be the only factor with growth stimulatory activity. GL was estimated as 11 hours for cells stimulated with serum or PF. Moreover hydrocortisone and insulin had no stimulatory activity \"per si\" or in combination with PF. The analysis of hydrocortisone action on the fibroblast system on one hand and of that of ACTH on the adrenal system, on the other, indicated that upon leaving Go, towards S, at a certain point in Gl, cells become irreversibly committed to the replicative process. This commitment seems to occur 5 hours before S and is referred to as Glc. In view of these data we proposed that regulators act by stimulating or inhibiting the transition Go → Glc. In an attempt to obtain a better definition of the growth control system and taking advantage of the experimental model utilized, we searched for mutants of the regulatory type. This search resulted in the isolation of the lines ST1 and AR-l from 3T3 fibroblasts and Y-l adrenal cells, respectively. Among several interesting aspects of the STl cell line, we point out: a) the dramatic effect of hydrocortisone changing the characteristics of these cells from a typically transformed phenotype to a normal pattern. This phenomenon was observed both \"in vitro\" (by measuring a number of growth parameters) and \"in vivo\" (by tumorogenicity assays). b) morphological alterations of antagonistic nature caused by hydrocortisone (flattening) on one hand, and by the removal of serum or cAMP addition to the culture medium (rounding) on the other. Evidence for the involvement of microtubules in these alterations were obtained through studies on the action of several inhibitors. Quantitative analysis of intracellular cAMP indicated that this nucleotide does not act as a mediator of hydrocortisone action. Rather, this action seems to be due to the induction of alterations on the cell surface-membrane-cytoskeleton system. Contrary to other variants of the Y-1 line which are resistant to ACTH, AR-1 cells are also resistant to cAMP. The usefulness of these cells in studies of the postulated mediation by cAMP of the ACTH action, is obvious.

Patients and methods: Malignant supratentorial glioma (anaplastic astrocytoma, oligoastrocytoma, oligodendroglioma and glioblastoma incl. gliosarcoma), age 16-70y, KPS 50-100. Postoperative randomization to chemotherapy with either BCNU (B) (80 mg/m2 x 3 every 6 weeks) alone or additional VM 26 (V) (50 mg/m2 x 3 every 6 weeks) starting concomitant with radiotherapy. Central histopathological review was required. Primary endpoints were survival time (ST) and progression free survival (PFS) . In addition confirmative analysis of prognostic factors and their interaction with therapy was performed. Results: Eligible: 501 of 522 randomized pts: 82% WHO grade IV gliomas, 18% grade III gliomas. 57% male, mean KPS 74, mean age 50.9 years. The high incidence of lung toxicity – with a cumulative risk of 19% during the first year - was alarming. Survival was not significantly different ( median 50.3 (B) versus 52.4 (V) (weeks), but an increase in long term survivors was observed (18 months: 29% B, 34% V, 5 years 5% B, 12% V) and PFS showed a significant difference with a median of 31.4 (B) versus 34.3 (V) weeks. Qualitative interaction between KPS and therapy (p < 0.01) was demonstrated: pts with a KPS ≥ 70 benefited from additional VM26, those with reduced KPS < 70 did better with BCNU-monotherapy. Conclusion: Adding VM26 to BCNU is effective in the chemotherapy of malignant gliomas. Because of the demonstrated interaction with therapy performance status, not tumor grade is the crucial factor to determine application and aggressiveness of chemotherapy. With risk adapted therapy a significant proportion of patients even with glioblastoma survive for years in good general condition. BCNU should be replaced by an equipotent alkylans to avoid the unacceptable high rate of lung toxicity.

Das Glioblastom ist der häufigste hirneigene Tumor des Erwachsenen und mit einer 5-Jahres-Überlebensrate von weniger als 5 % eine der aggressivsten Hirntumorerkrankungen (Batash et al., 2017). Verbunden mit einer schlechten Prognose und geringen Remissionsraten ergibt sich die Notwendigkeit, bestehende Therapieoptionen zu optimieren und zu erweitern. Im Rahmen dieser Arbeit wurde das vor einigen Jahren entwickelte und aktuell in klinischen Studien angewandte Konzept der Therapie von Malignomen mit elektrischen Wechselfeldern, den sog. Tumor Treating Fields (TTFields), aufgegriffen. Basis der anti-tumoralen Wirkung der im Rahmen von Glioblastom-Studien applizierten TTFields bildet eine Tumor-spezifische Frequenz von 200 kHz sowie geringe Intensitäten, die einen nebenwirkungsarmen anti-mitotischen Effekt erzielen (Kirson et al., 2004; Kirson et al., 2007; Clark et al., 2017; Porat et al., 2017). Dieser resultiert sowohl aus alternierenden elektrischen Feldern, die während der Metaphase über eine Irritation des Dipolmoments von Tubulin-Untereinheiten die Assemblierung des Spindelapparates inhibieren, als auch aus inhomogenen elektrischen Feldern, die während der Telophase die Trennung der Tochterzellen behindern. Mit dieser Behandlungsoption konnten schon einige gute Ergebnisse für die Behandlung von Glioblastomen in klinischen Studien erreicht werden (Stupp et al., 2017). Eine weitere anti-mitotische Therapieoption stellt die Inhibierung der Aurora B Kinase mittels AZD1152 dar. Die Aurora B Kinase ist Teil des Chromosomal Passenger Complex (CPC), der bei Inhibierung der Kinase seine Kontrollfunktionen während der Mitose und Zytokinese nicht wahrnehmen kann. Diese fehlende Kontrolle führt zu Polyploidie, die einen Zelltod verursachen kann (Wiedemuth et al., 2016). Aufgrund dieses ähnlichen biologischen Hintergrundes wurde zu Beginn dieser Arbeit die Hypothese aufgestellt, dass eine kombinierte Therapie mittels TTFields und AZD1152 einen additiven zytotoxischen Effekt im Vergleich zur Monotherapie mit TTFields erzielen kann. Es konnte zunächst für die etablierte Zelllinie U87-MG ein signifikanter additiver Effekt in der Kombinationstherapie der TTFields mit AZD1152 im Vergleich zur alleinigen Therapie mittels TTFields nachgewiesen werden. Die mediane Tumorzellzahl konnte hierbei in der Kombinationstherapie um 60 % reduziert werden. Dieser additive Effekt konnte ebenfalls an zwei Primärkulturen reproduziert werden. Hierbei konnte die relative mediane Tumorzellzahl der Primärkultur HT18584 ebenfalls um 60 % in der Kombinationstherapie gesenkt werden. Diese tetraploide Zellreihe zeigte außerdem einen außergewöhnlich großen zytotoxischen Effekt bei der Behandlung mit AZD1152. Signifikant zeigte ebenso die Primärkultur HT12347 einen medianen Verlust von 56 % der Tumorzellen nach einer kombinierten Behandlung. Qualitativ und zellmorphologisch konnte mittels konfokaler Laser-Scanning- sowie Lichtmikroskopie die Akkumulation von mitotischen Defekten detektiert werden, die auch in den Monotherapien aber vor allem in der Kombinationstherapie zu finden waren. Die in der quantitativen Analyse gezeigte additive Zytotoxizität der Kombinationstherapie konnte hier nochmals visualisiert und bestätigt werden. Für eine klinische Phase I-Studie zur Überprüfung der Effektivität sollten zunächst weitere zellkulturtechnische Daten erfasst werden, um die Universalität der kombinierten Behandlung zu überprüfen. Weiterhin wäre die Entwicklung einer selektiven/lokalen Therapie mittels AZD1152 wünschenswert, um die Nebenwirkungen des Medikamentes abzumildern. Es sollte außerdem das im Rahmen dieser Arbeit detektierte sensitivere Ansprechen der tetraploiden Zelllinie HT18584 genauer untersucht werden, um eine potentiell prognostisch günstige Verbindung zwischen der Behandlung mit AZD1152 und tetraploiden Zellen herstellen zu können.:1 EINLEITUNG 1 1.1 Glioblastoma multiforme – Definition, Inzidenz und Ätiologie 1 1.1.1 Symptomatik und Diagnostik des Glioblastoms 2 1.2 Molekulare Klassifizierung 3 1.2.1 Primäre und sekundäre Glioblastome und einige allgemeine Marker 3 1.2.2 Der MGMT-Status 5 1.3 Der eukaryotische Zellzyklus und sequentielle Kontrollpunkte 6 1.3.1 Der Chromosomal Passenger Complex (CPC) 8 1.3.2 Die Familie der Aurorakinasen 9 1.4 Therapie maligner Gliome 10 1.4.1 Standardtherapie eines Glioblastoms 10 1.4.2 Tumor Treating Fields (TTFields) – Biologischer Effekt und Studienlage 11 1.4.3 Aurora Kinase-Inhibitoren 14 1.5 Zielstellung der Arbeit 15 2 METHODEN UND MATERIALIEN 17 2.1 Methoden 17 2.1.1 Zellkultivierung allgemein 17 2.1.2 Passagieren adhärenter Zellen 17 2.1.3 Kultivierung von primärem Patientenmaterial 18 2.1.4 Kryokonservierung und Rekultivierung eukaryotischer Zelllinien 18 2.1.5 Bestimmung der Lebendzellzahl mittels Neubauer-Zählkammer 19 2.1.6 Durchflusszytometrische Analyse 19 2.1.7 Bestimmung der Lebendzellzahl mittels Propidiumiodid (PI) 20 2.1.8 Durchflusszytometrische Immunphänotypisierung von Glioblastomzellen 20 2.1.9 In vitro-Applikation der Tumor Treating Fields (TTFields) 21 2.1.10 Titration der effektiven Aurora B Kinase-Inhibitorkonzentrationen mittels PI 22 2.1.11 Titration inhibitorischer Temozolomidkonzen-trationen mittels AlamarBlue-Assay 23 2.1.12 Konfokale Laser-Scanning-Mikroskopie 23 2.2. Materialien 25 2.2.1 Geräte 25 2.2.2 Chemikalien und Reagenzien 25 2.2.3 Lösungen 26 2.2.4 Medien 27 2.2.5 Kommerzielle Kits 28 2.2.6 Antikörper 28 2.2.7 Software 28 2.2.8 Statistik 29 2.2.9 Zelllinien 29 3 ERGEBNISSE 30 3.1 Wahl des Designs der Kontrollgruppen 30 3.2 Typisierung der verwendeten Primärkulturen 32 3.2.1 Befunde der Pathologie des Universitätsklinikums Dresden 33 3.2.2 Immunphänotypisierung der Primärkultur HT18584 34 3.2.3 Immunphänotypisierung der Primärkultur HT12347 35 3.3 Titrationen mit AZD1152 36 3.3.1 Titration mit AZD1152 für die Primärkultur HT18584 36 3.3.2 Titration mit AZD1152 für die Primärkultur HT12347 37 3.4 Kombinationstherapie mittels AZD1152 und TTFields 38 3.4.1 Quantitativer Effekt der Kombinationstherapie an U87-MG 39 3.4.2 Quantitativer Effekt der Kombinationstherapie an HT18584 40 3.4.3 Quantitativer Effekt der Kombinationstherapie an HT12347 41 3.4.4 Qualitativer Effekt der Kombinationstherapien 42 3.4.4.1 Die Kombinationstherapie mit U87-MG 43 3.4.4.2 Die Kombinationstherapie mit HT18584 44 3.4.5 Zytotoxischer Effekt der Kombinationstherapie an HT12347 45 3.5 Titrationen mit Temozolomid 47 3.5.1 Therapie mit Temozolomid an U87-MG 48 3.5.2 Therapie mit Temozolomid an Primärkulturen 48 4 DISKUSSION 52 4.1 Vorversuche 52 4.1.1 Wachstumsanalyse der Kontrollgruppen 52 4.1.2 Charakterisierung der Primärkulturen 53 4.2 Die neuen Behandlungsoptionen 54 4.2.1 Applikation der TTFields 54 4.2.2 Die Behandlung mit AZD1152 55 4.2.3 Die Kombinationstherapie 57 4.3. Die Behandlung mit Temozolomid (TMZ) 59 5 ZUSAMMENFASSUNG 62 LITERATURVERZEICHNIS 64 TABELLENVERZEICHNIS 73 ABBILDUNGSVERZEICHNIS 74 ABKÜRZUNGSVERZEICHNIS 75 ANHANG 77 Anhang 1: Einverständniserklärung der Patienten 77 Anhang 2: Erlaubnis zur Nutzung der Patientendaten der Pathologie 78 Anhang 3: Erklärungen zur Eröffnung des Promotionsverfahrens 79 Anhang 4: Erklärung über die Einhaltung gesetzlicher Vorgaben 81

Beside tumor cells themselves, tumors consist of many non-malignantly transformed cellular elements and an extracellular matrix. This so-called tumor microenvironment, or stroma, significantly influences the biological properties of the tumor through intercellular interactions. In this thesis I have focused on the study of tumor-associated fibroblasts in squamous cell carcinomas of the head and neck, malignant melanoma and glioblastoma. The data show the presence of cells with mesenchymal characteristics, present even in the glioblastoma stroma, which could potentially have a positive effect on proliferative activity and invasiveness of glioblastoma cells. In malignant melanoma, the presence of keratinocytes should also be considered, as they are the major cells of the epidermis influencing tumor melanocytes. The conditioned medium from UVB irradiated keratinocytes and non-irradiated fibroblasts stimulates the invasion of malignant melanoma cells. Targeting the tumor stroma may be a new direction in oncological therapy, so we have focused on the influence of synthetic polyamine on the formation of myofibroblasts, which are an active part of the population of tumor-associated fibroblasts. The tested polyamine prevents the formation of myofibroblasts but has no effect on those already formed nor on...

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Introduction: Epoxyeicosatrienoic acids (EETs) are converted by the enzyme soluble epoxid hydrolase (sEH) to the biologically inactive dihydroxyeicosatrienoic acids (DHETs). EETs are significantly involved in the control of blood pressure, they influence vascular tone and renal transport mechanism. sEH inhibitor reduce blood pressure by increasing the bioavailability of EETs in many models of hypertension. Aim of the study: To determine that sEH inhibitor decreases blood pressure and improves the renal function during the development of malignant hypertension in transgenic rats after the induction of the mouse renin gene. Methods: Hypertension in Cyp1a1-Ren-2 transgenic rats was induced through a dietary administration of the natural xenobiotic indole-3-carbinol (I3C, 0.3 %) for 3 and 11 days. I3C activates the renin gene. At the same time, during a three-day induction of hypertension, the inhibitor of nitric oxide synthase L-NAME (600 mg/l) was administered in drinking water. The sEH inhibitor c-AUCB was given in drinking water at a dose of 13 or 26 mg/l, starting 48 hours before the initiation of I3C and L-NAME administration. Radiotelemetric measurement of blood pressure was performed and renal excretory parameters were monitored in the conscious animals. The effects on renal hemodynamics and...