hCLCA2 and hCLCA4 are chloride channel regulators that are expressed in normal breast epithelial cells and frequently downregulated in breast cancers. Recent investigations revealed that these two proteins may have a role in suppressing breast cancer progression. In this thesis, I will address their role in maintaining epithelial differentiating and inhibiting cell proliferation of breast epithelial cells. The epithelial to mesenchymal transition (EMT) is a developmental program in which epithelial cells downregulate their cell-cell junctions, acquire spindle cell morphology and exhibit cellular motility. In breast cancer, EMT facilitates invasion of surrounding tissues and correlates closely with cancer metastasis and relapse. We found previously that the candidate tumor suppressor hCLCA2 is a p53-inducible proliferation-inhibitor that is frequently lost in breast cancer. We show here that another member of the CLCA gene family, hCLCA4, is expressed in mammary epithelial cells and is similarly downregulated in breast tumors and in breast cancer cell lines. Like CLCA2, the gene is stress-inducible, and ectopic expression inhibits colony formation. Transcriptional profiling studies revealed that hCLCA4 and hCLCA2 together are markers for mammary epithelial differentiation, and both are downregulated by TGF beta. Moreover, knockdown of either on in immortalized cells by shRNAs caused downregulation of epithelial marker E-cadherin, while mesenchymal markers N-cadherin, vimentin, and fibronectin were upregulated, indicating an EMT program. Double knockdown of hCLCA2 and hCLCA4 enhanced the mesenchymal profile. These findings suggest that hCLCA4 and hCLCA2 play complementary but distinct roles in epithelial differentiation. Clinically, low expression of hCLCA2 and hCLCA4 signaled lower relapse-free survival in breast cancers. Cellular senescence is a program of irreversible cell cycle arrest in response to stressors such as DNA damage, ROS, telomere erosion, or oncogene activation. It is one of the primary tumor suppression mechanisms mediated by p53 and is often disabled in cancer cells. However, the downstream signaling pathway whereby p53 induces cellular senescence remains incomplete. We reported previously that hCLCA2 was a p53 inducible gene that is downregulated with breast cancer progression. We and other group noticed that hCLCA2 was induced in parallel with several types of senescence. Lentiviral transduction of CLCA2 into MCF7 cells inhibited cell proliferation and cells showed senescence phenotype. To investigate the mechanism biochemically, we used pAd-Easy to express hCLCA2 in the model breast cancer cell line CA1d. A protein expression profile of these cells over a 6 day period revealed induction of p21, p53, and the DNA damage-response pathway. To test whether hCLCA2 is required for the cellular senescence process, hCLCA2 was knocked down in HMLE. The knockdown cells (KD) and negative control were treated with a low concentration of doxorubicin, and cell proliferation was measured. The KD cells were more resistant to growth inhibition by doxorubicin. Moreover, a time course experiment showed that induction of SA beta-galactosidase, DNA damage response, and lysosomal markers IFI30 and CTSS was delayed in the knockdown cells. These results suggest that hCLCA2 plays an important role in DNA damage response and the senescence program.

Made available in DSpace on 2014-06-11T19:27:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-28Bitstream added on 2014-06-13T20:57:18Z : No. of bitstreams: 1 salgado_bs_me_botfm.pdf: 482776 bytes, checksum: 23c491910cd4c7da0d422455a7e9b2df (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Transição epithelial-mesenquimal (EMT) é a conversão de células epiteliais polarizadas para células migratórias com fenótipo fibroblasto-símile. A EMT está envolvida na progressão e metástase em diversos cânceres nos seres humanos, porém permanece a ser mais bem explorada na literatura veterinária. O objetivo desta pesquisa foi avaliar a imunoexpressão de proteínas relacionadas à EMT nos carcinomas mamários de cadelas (CMCs). Seis proteínas foram avaliadas por meio de imunoistoquímica em 94 amostras de CMCs. Tecidos mamários não neoplásicos de 17 cadelas e amostras de 9 tumores mamários benignos de cadelas foram avaliados de modo a determinar o perfil de imunoexpressão de Snai-1. Características anatomopatológicas foram comparadas com a imunoexpressão de proteínas relacionadas à EMT nos CMCs. A perda de proteínas epiteliais e/ou a aquisição de proteínas mesenquimais foi observada principalmente em neoplasias com evidência de invasão estromal; entretanto, somente foi observada significância estatística quando comparado S100A4 e invasão vascular. Snai-1 foi observado em células luminais de neoplasias simples malignas e em células mioepiteliais de tumores benignos ou malignos de caráter complexo, sendo também significativamente relacionado à baixa de expressão de Caderina-E. Conclui-se que a perda de proteínas epiteliais e/ou a aquisição de proteínas mesenquimais está associada com EMT e pode possuir importante papel na avaliação de CMCs. O padrão único de imunoexpressão de Snai-1 pode ajudar a distinção entre um adenoma e um carcinoma não metastático e aparenta estar relacionado à conversão de células mioepiteliais a um fenótipo mesenquimal completo. A perda de Caderina-E e citoqueratina e a mudança no padrão de imunoexpressão de Snai-1, Caderina-N, S100A4 e MMP-2 indica a ocorrência de EMT em carcinomas mamários de cadelas... / Epithelial-mesenchymal transition (EMT) is defined as switching of polarized epithelial cells to a migratory fibroblastoid phenotype. EMT is known to be involved in the progression and metastasis of various cancers in humans, but this specific process is still little explored in the veterinary literature. The aim of this research was to evaluate the expression of EMT-related proteins in canine mammary carcinomas (CMCs). The expression of six EMT-related proteins in CMC of 94 female dogs was evaluated by immunohistochemistry. Additionally, mammary tissues from 17 female dogs with no history of mammary tumor development and from 9 bitches with benign tumors were evaluated in order to determine Snai-1 immunoexpression patterns. Anatomopathological characteristics were compared with the expression of EMTrelated proteins in CMCs. Loss of epithelial protein and/or acquisition of the expression of mesenchymal proteins were observed, particularly in tumors with evidence of stromal invasion; however, significance was only observed between the S100A4 and vascular invasion. Snai-1 was only expressed in luminal cells of histologically malignant tumors and in myoepithelial cells of benign and malignant complex tumors and was significantly related to E-cadherin loss. In conclusion, loss of epithelial proteins and/or the acquisition of mesenchymal proteins are associated with EMT and may have an important role in the evaluation of CMC patients. The unique immunoexpression pattern of Snai-1 could help to distinguish between an adenoma and a non-metastatic carcinoma and seems to be related to conversion of myoepithelial cells to a complete mesenchymal-like phenotype. Loss of E-cadherin and cytokeratin and change of immunoexpression pattern of Snai-1, N-cadherin, S100A4 and MMP-2 indicate the occurrence of EMT in canine mammary carcinomas and should result in an en bloc resection or a close follow-up.

O desenvolvimento e a progressão do câncer bucal envolvem processos complexos de múltiplas etapas levando a modificações fenotípicas nas células epiteliais, aumento da proliferação e invasão dos tecidos subjacentes. Diversos fatores vem sendo associados à carcinogênese, dentre eles os mecanismos epigenéticos como a acetilação de histonas, que promovem mudanças na expressão de genes independente de mutações. O objetivo do presente estudo observacional transversal foi analisar a relação entre acetilação da histona 3 (acetil Histona H3) com proliferação celular e transição epitélio-mesênquima na mucosa bucal normal (MBN), leucoplasias bucais (LB) e carcinomas espinocelulares (CEC) de boca, bem como correlacioná-los com dados clínico-demográficos, graduação histopatológica e o comportamento das lesões. Foram analisados 10 casos de mucosa bucal normal (MBN), 20 casos de LB e 75 casos de CEC de boca. Todos os casos foram submetidas a análise imunoistoquímica utilizando anticorpos anti-acetil Histona H3, Ki67, vimentina e TGF-β1. A imunomarcação da acetil histona H3 foi significativamente menor nos casos de CEC quando comparados a LB (p=0.03). Não foi encontrado diferença entre os casos de MBN e LB. Paralelamente, foi observado um aumento estatisticamente significativo na proliferação durante o processo de carcinogênese (p<0.00) e o mesmo foi observado quando avaliados os marcadores da transição epitélio-mesênquima, vimentina (p=0.03) e TGF-β1 (p<0.00). A análise da associação dos marcadores com fatores clínicos-demográficos não mostrou diferença significativa. Entretanto, maior média de acetil histona H3 foi associada ao bom prognóstico (p=0.01) e também, foi observado uma tendência de uma melhor taxa de sobrevida (p=0.06). Conclui-se que os CEC de boca são hipoacetilados, exibem maior perfil proliferativo e de transição epitélio-mesênquima. Além disso, a acetil histona H3 pode ser considerada um marcador prognostico nestas lesões. / The development and progression of oral cancer involve multi-step processes leading phenotypic changes in epithelial cells, proliferation increase and invasion of adjacent tissue. Several factors have been associated with carcinogenesis, including epigenetic mechanisms such as histone acetylation, which promote changes in the expression independent of gene mutations. The aim of the present study was to analyze the association of acetylation of histone 3 (acetyl-histone H3) with cell proliferation and epithelial-mesenchymal transition in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) and correlate them with data clinic-demographic, histopathological grading and the behavior of these lesions. We analyzed 10 cases of normal oral mucosa (NOM), 20 cases of OL and 75 cases of OSCC. All samples were submitted to immunohistochemical analysis using anti-acetyl histone H3, Ki67, vimentin and TGF-β1. Acetyl-histone H3 labeling was significantly lower in cases of OSCC compared to LB (p=0.03). It was not found difference between NOM and OL. In parallel, the proliferation analysis revealed a gradual increase on Ki67 labeling (p<0.00) during oral carcinogenesis with highest value detected in OSCC Also, an increase on EMT markers, vimentin (p=0.03) and TGF-β1 (p<0.00) were noted. A higher mean acetyl-histone H3 was associated with good prognosis (p= 0.01) and similarly a tendency to improved survival rate was observed (p=0.06). As conclusion, OSCC are hypoacetylated, exhibit higher proliferative profile and epithelial-mesenchymal transition characteristics. Furthermore, acetyl histone H3 can be considered a prognostic marker in OSCC.

A ação metastática do BPV permanece não clara. Este estudo avaliou a ação do BPV na transição epitélio-mesênquima (TEM), empregando linhagens celulares de papiloma (P), fibropapiloma (FB) e carcinoma de esôfago (CE). Os resultados mostraram a presença de infecção produtiva e o aumento do potencial proliferativo nestas células. Porém, foi verificada a redução do potencial de membrana mitocondrial em relação à pele saudável (controle) e o aumento do estresse oxidativo, resultante da ação da oncoproteína E6, justificando a clastogenicidade e a aquisição do fenótipo-tronco descrito nas linhagens de P, FB e CE. Estas linhagens mostram capacidade migratória decorrente do sequestro citoplasmático de E-caderina, e o aumento dos níveis de expressão de vimentina, vinculina e N-caderina como consequência da ativação dos fatores STAT3 e SLUG, sugerindo a ação do vírus na indução da TEM. Tais resultados foram validados em amostras de tecido, reforçando a ação do vírus na TEM, bem como demostrando o potencial destas linhagens celulares como modelo de estudo da metástase. / BPV metastatic action remains unclear. This study evaluated the BPV action on epithelial-mesenchymal transmition (EMT), using cell lines form papilloma (P), fibropapilloma (FB) and esophageal carcinoma (EC). Results showed the productive infection presence and the proliferative potential increase in these cells. However, it was verified the mitochondrial membrane potential loss in relation to normal skin (control) and the oxidative stress increase as result of E6 oncoprotein, justifying the clastogenicity and stem-cell phenotype acquisition described in P, FB and EC cells. This cell lines showed a migratory capability as result of cytoplasmic sequester of E-cadherin, and the increase levels of vimentin, vinculin and N-cadherin as consequence of STAT3 and SLUG factors activation, suggest the virus action on EMT. These results were also verified in tissue samples, reinforcing the BPV action on EMT, as well as demonstrating the potential of these cell lines as model to study the metastasis.

O desenvolvimento e a progressão do câncer bucal envolvem processos complexos de múltiplas etapas levando a modificações fenotípicas nas células epiteliais, aumento da proliferação e invasão dos tecidos subjacentes. Diversos fatores vem sendo associados à carcinogênese, dentre eles os mecanismos epigenéticos como a acetilação de histonas, que promovem mudanças na expressão de genes independente de mutações. O objetivo do presente estudo observacional transversal foi analisar a relação entre acetilação da histona 3 (acetil Histona H3) com proliferação celular e transição epitélio-mesênquima na mucosa bucal normal (MBN), leucoplasias bucais (LB) e carcinomas espinocelulares (CEC) de boca, bem como correlacioná-los com dados clínico-demográficos, graduação histopatológica e o comportamento das lesões. Foram analisados 10 casos de mucosa bucal normal (MBN), 20 casos de LB e 75 casos de CEC de boca. Todos os casos foram submetidas a análise imunoistoquímica utilizando anticorpos anti-acetil Histona H3, Ki67, vimentina e TGF-β1. A imunomarcação da acetil histona H3 foi significativamente menor nos casos de CEC quando comparados a LB (p=0.03). Não foi encontrado diferença entre os casos de MBN e LB. Paralelamente, foi observado um aumento estatisticamente significativo na proliferação durante o processo de carcinogênese (p<0.00) e o mesmo foi observado quando avaliados os marcadores da transição epitélio-mesênquima, vimentina (p=0.03) e TGF-β1 (p<0.00). A análise da associação dos marcadores com fatores clínicos-demográficos não mostrou diferença significativa. Entretanto, maior média de acetil histona H3 foi associada ao bom prognóstico (p=0.01) e também, foi observado uma tendência de uma melhor taxa de sobrevida (p=0.06). Conclui-se que os CEC de boca são hipoacetilados, exibem maior perfil proliferativo e de transição epitélio-mesênquima. Além disso, a acetil histona H3 pode ser considerada um marcador prognostico nestas lesões. / The development and progression of oral cancer involve multi-step processes leading phenotypic changes in epithelial cells, proliferation increase and invasion of adjacent tissue. Several factors have been associated with carcinogenesis, including epigenetic mechanisms such as histone acetylation, which promote changes in the expression independent of gene mutations. The aim of the present study was to analyze the association of acetylation of histone 3 (acetyl-histone H3) with cell proliferation and epithelial-mesenchymal transition in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) and correlate them with data clinic-demographic, histopathological grading and the behavior of these lesions. We analyzed 10 cases of normal oral mucosa (NOM), 20 cases of OL and 75 cases of OSCC. All samples were submitted to immunohistochemical analysis using anti-acetyl histone H3, Ki67, vimentin and TGF-β1. Acetyl-histone H3 labeling was significantly lower in cases of OSCC compared to LB (p=0.03). It was not found difference between NOM and OL. In parallel, the proliferation analysis revealed a gradual increase on Ki67 labeling (p<0.00) during oral carcinogenesis with highest value detected in OSCC Also, an increase on EMT markers, vimentin (p=0.03) and TGF-β1 (p<0.00) were noted. A higher mean acetyl-histone H3 was associated with good prognosis (p= 0.01) and similarly a tendency to improved survival rate was observed (p=0.06). As conclusion, OSCC are hypoacetylated, exhibit higher proliferative profile and epithelial-mesenchymal transition characteristics. Furthermore, acetyl histone H3 can be considered a prognostic marker in OSCC.

No description available.

Chaque année 610 000 cancers sont diagnostiqués dans le monde induits par une infection à papillomavirus humains à haut-risque (HPV-HR). Bien que les carcinomes des voies aéro-digestives supérieures (VADS) soient principalement associés à une forte consommation de tabac et d’alcool, 20 à 25% sont causés par une infection à HPV, particulièrement l’HPV de type 16. Les patients HPV positifs présentent un meilleur survi global, pourtant ils sont diagnostiqués avec plus de métastases à distance que les patients HPV négatifs. Au travers d’une étude sur des lignées cellulaires dérivées des VADS, nous avons montré que toutes les lignées cellulaires HPV+ présentaient une intégration du génome d’HPV au sein du génome cellulaire, avec des profils d’intégration différents. Les lignées pouvant être utilisées comme modèles caractéristiques des tumeurs HPV+ et HPV- sont respectivement les lignées UPCI:SCC090 et FaDu. La première par ses capacités migratoire et proliférative et la seconde par sa faible agressivité et une mutation du gène cellulaire p53. Dans une étude portant sur une série rétrospective de cancers de l’oropharynx éligible à une résection chirurgicale, 6 cancers sur 40 soit 15% présentaient une infection à HPV16 active (expression de l’ARNm E6*I). Nous avons étudié les marqueurs de TEM dans ces cancers oropharyngés en fonction du statut HPV. Nous avons retrouvé une perte plus importante du marqueur épithélial cadhérine-E au sein du groupe HPV+, associée à une moins bonne survie globale.Au total, nous montrons que le statut HPV et les marqueurs de TEM semblent être deux facteurs indépendants, qui peuvent se combiner pour définir des niveaux pronostiques différents. / Each year, 610,000 cancers are diagnosed worldwide attributed to high risk human papillomavirus (HR-HPV) infection. Although head and neck squamous cell carcinoma (HNSCC) is mainly associated with tobacco and/or alcohol consumption, 20 to 25% are caused by HPV infection, particularly HPV type 16. Although patients with HPV+ tumors present a better overall survival, they are diagnosed with more lymph node metastasis than HPV-negative patients.Through a study of HNSCC derived cell lines, we showed that all HPV-positives cell lines harbored HPV genome integration through host genome, with different integration profiles. Cell lines identified as good HPV+ and HPV- tumors models are UPCI:SCC090 and FaDu respectively. The first one by its migratory and proliferative properties, the second through its poor aggressiveness and mutation of p53 cellular gene.In a study on a retrospective series of oropharyngeal carcinomas with surgical resection, 6 out of 40 cancers shown HPV16 active infection (expressing E6*I mRNA). We studied epithelial-to-mesenchymal transition (EMT) markers on this oropharyngeal cancers, according to HPV status. We found a larger loss of epithelial marker E-cadherin in HPV+ group and loss of this marker is associated with a worse overall survival.We showed that HPV and EMT status seem to be two independent factors that could combine differently to define different prognostic levels.

Le cancer du sein est une pathologie hétérogène au plan clinique et au moins 5 sous-types moléculaires ont pu être définis sur la base de différences d’expression ARNm. Ces sous-types présentent des différences de profils d’anomalies génomiques et de méthylation des cytosines. Ces différences génétiques et épigénétiques s’expliqueraient par des types cellulaires d’origines distincts au sein de l’épithélium mammaire, toutefois, ceci n’a pas été confirmé clairement à ce jour. Alternativement, il a été proposé que l’activation de voies oncogéniques différentes pouvait avoir un impact significatif sur les modifications génétiques ou épigénétiques. Dans ce travail nous avons voulu vérifier cette hypothèse en l’appliquant à un modèle de cellules épithéliales mammaires normales primaires humaines, que nous avons isolé des à partir de glandes mammaires. Ces cellules ont été transformées en deux étapes par transduction avec (i) un shARN ciblant TP53, (ii) un oncogène. Nous avons sélectionné 3 oncogènes qui activent des voies de signalisations distinctes CCNE1, HRAS-v12 et WNT1. Nous avons établi un modèle de transformation tumorale en trois étapes, cellules normales, immortalisées et transformées, permettant de suivre les modifications moléculaires associées à chaque étape et de vérifier si l’activation de voies oncogéniques distinctes produisait des profils d’anomalies différents. Les différents modèles ont été analysés par CGH-array, RRBS, transcriptome et miRNA à des temps de culture définis.Nos résultats montrent que l’activation de la voie RAS aboutit à des profils d’anomalies génétiques et de méthylation des CpG radicalement différents de ceux obtenus après surexpression des gènes CCNE1 et WNT1. Ces différences apparaissent très rapidement après transduction des oncogènes alors que les profils des cellules CCNE1 et WNT1 divergent plus tardivement. Enfin, l’inactivation de p53 n’induit pas par elle-même une instabilité élevée, mais produit un contexte de plasticité favorable aux modifications génétiques et épigénétique.Par ailleurs, nous avons noté des différences phénotypiques entre les HMEC RAS (mésenchymateuses) et les HMEC CCNE1 et les HMEC WNT1 (épithéliales). Dans ce travail, je montre que les HMEC shp53 immortalisées présentent une plasticité phénotypique, une partie des cellules entrant en EMT spontanément, l’autre restant épithéliales. J’ai montré que la transduction RAS sélectionnait les cellules ayant effectué une EMT, alors que la transduction de CCNE1 ou WNT1 sélectionnait les cellules épithéliales. J’ai cherché à identifier les déterminants de ces changements phénotypiques et mes résultats suggèrent qu’ils résultent d’une balance entre une signalisation TGFB1/BMP1, qui favorise l’EMT, et BMP4/WNT7 qui favorise la MET. / Breast cancer is a heterogeneous pathology. Based on the differences of mRNA expression, at least five molecular subtypes have been defined. These subtypes show differences in profiles of genomic abnormalities and CpG methylation. These molecular subtypes are thought to originate from different cell lineages in the mammary gland. However, this has not yet been clearly demonstrated. Alternatively, it has been proposed that the activation of different oncogenic pathways could have a significant impact on genetic or epigenetic changes.We wanted to verify this hypothesis by applying it to a normal primary human mammary epithelial cells (HMEC) model, which we isolated from normal mammary explants. These cells were transformed in two step process by sequential transduction of (i) a shRNA targeting TP53, (ii) an oncogene. We selected 3 oncogenes that activate distinct signaling pathways CCNE1, HRAS-v12 and WNT1. Our tumor transformation model was established in three-step, normal, immortalized and transformed cells, allowing us to monitor the molecular changes associated with each step and to verify whether the activation of distinct oncogenic pathways produced different profiles of genetic and epigenetic modifications. The different models were analyzed at defined culture times by CGH-array, RRBS, transcriptome and miRNA. Our results show that genetic abnormalities and CpG methylation profiles are different between cells where the RAS pathway was activated and cells overexpressing WNT1 or CCNE1. These differences appear rapidly after oncogene transduction, whereas the profiles of the CCNE1 and WNT1 cells diverged later. Finally, inactivation of p53 by itself does not induce high instability, but produces a context of plasticity favorable to genetic and epigenetic changes.In addition, we noted phenotypic differences between HMEC RAS (mesenchymal) and HMEC CCNE1 and HMEC WNT1 (epithelial). In this work, I show that the immortalized HMEC shp53 exhibit a phenotypic plasticity, where some cells enter a spontaneous EMT and the others remain epithelial. I showed that RAS transduction selected cells that are undergoing an EMT, whereas transduction with CCNE1 or WNT1 selected the epithelial cells. I have sought to identify the determinants of these phenotypic changes and my results suggest that a balance exists between TGFβ1 / BMP1 signaling, which promotes EMT, and BMP4 / WNT7a which promotes TEM.

In the late stages of cancer, tumors acquire the ability to spread throughout the body and invade distant tissues in a process called metastasis. Studies have shown that metastasis is responsible for 90% of all cancer-related deaths, making this an important field of study. In breast cancers, 30% of patients overexpress the HER2 oncoprotein, causing a more invasive and metastatic disease. Invasion can be stimulated in vitro using the soluble ligand transforming growth factor-β (TGFβ) to induce a process called EMT (epithelial-to-mesenchymal transition), where epithelial cells transition into a migratory phenotype through cell-cell junction breakdown. SLK is a Ste20-like kinase that has been linked to many processes, including cell migration and signaling downstream of the HER2 receptor complex. Here we show that the cellular migration and invasion of TGFβ-treated normal mammary epithelial cells is significantly impaired in the absence of SLK. Additionally, immunofluorescence analyses demonstrate that SLK knockdown conditions decrease a cell’s ability to progress through EMT due to the visible staining of epithelial markers. We find that SLK-depleted cultures express significantly lower levels of Snail1,and fibronectin mRNA levels following TGF-β treatment. Surprisingly, our data demonstrates that SLK kinase activity is not activated downstream of TGF-β stimulation, and that a kinase-dead SLK rescues Snail1 mRNA expression levels. Together these data suggest that SLK plays a novel role in TGFβ-induced epithelial-to-mesenchymal transition in a kinase activity-independent manner.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22005号 / 医博第4519号 / 新制||医||1038(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 松原 和夫, 教授 萩原 正敏 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM