Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 5 uppsatser.

Research in the field of neuroendocrine tumors (NETs) has increased over the last decade, including studies focused on biochemical markers (biomarkers) of the disease. There is also growing interest in how NETs impact patients' quality of life (QOL). Consequently, there is a paucity of information about whether the expression of the specific disease biomarkers affects QOL as well as whether the primary tumor site impacts QOL. Using the explanatory model of health promotion and quality of life in chronic disabling conditions as the theoretical framework and data collected with the Norfolk QOL-NET instrument, this study's purpose was to fill that gap in knowledge through research questions addressing the relationship between the primary tumor site and NET patients' total QOL score as well as the effect of specific NET biomarkers on NET patients' total QOL score. Data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), regression analysis, and post hoc tests to determine significance. Results from an ANOVA showed that abnormal NET biomarkers affected total QOL (p = 0.011). In the analyses of whether the independent biomarker variables affected the dependent total QOL variable, only the result for Serotonin Normal was significant (p = 0.002). The presence of abnormal biomarker measurements also affected two of the Norfolk QOL-NET domains significantly, gastrointestinal and physical functioning (p = 0.005 and p = 0.030, respectively). By understanding the relationship between NETs and patient QOL, the potential positive social change implications are helping NET patients assess the severity of their condition, determining what affects their well-being, and using this information to help monitor their treatment/progress.

Diss. (sammanfattning) Göteborg : Univ., 2010.

Les TNE-GEPs constituent un groupe de tumeurs hétérogènes pour lesquelles il convient d’élargir les approches thérapeutiques. Les thérapies ciblées, particulièrement l’inhibition de la voie mTOR par l’évérolimus, sont la référence pour les TNE-GEPs pancréatiques. Néanmoins, le bénéfice thérapeutique de l’évérolimus n’a pas été évalué dans le sous-groupe des carcinomes neuroendocrines GEPs peu différenciés (pdCNE-GEPs). A travers un modèle préclinique in vivo, nous montrons que l’inhibition de mTOR pourrait constituer une option thérapeutique pour les pdCNEGEPs. Ensuite, une étude protéomique a mis en évidence de nouveaux facteurs impliqués dans la progression de TNE-GEPs. Certaines protéines identifiées présentent un rôle dans la régulation du cytosquelette. Parmi celles-ci, CRMP2 est un acteur clé de la voie de signalisation des sémaphorines de classe 3 (sema3). Un profil d’expression de ces sema3 montre que l’expression de la sema3F est diminuée dans les TNE-GEPs. La ré-expression de ce facteur dans des modèles cellulaires de TNEGEPs montre que la sema3F induit une baisse de la survie et de la prolifération. In vivo, la sema3F permet de ralentir le développement tumoral. Des études complémentaires sont nécessaires pour mieux comprendre le rôle de la voie de signalisation de la sema3F dans la progression des TNE-GEPs / GEP-NETs are heterogeneous tumors for which therapeutic options are limited and must therefore be enlarged. Targeted therapies, and mainly everolimus-directed mTOR inhibition, constitute standard treatments for GEP-NETs of pancreatic origin. Nevertheless, the therapeutic benefits of everolimus have not been evaluated in the poorly-differentiated GEP neuroendocrine carcinomas (pdGEP-NECs) subgroup. By using a preclinical in vivo model, we demonstrated that mTOR inhibition could be considered as a therapeutic option for pdGEP-NECs. Then, a proteomic study highlighted novel proteins involved in GEP-NETs progression with all identified factors displaying function in cytoskeleton regulation. Among them, CRMP2 is a key member of class 3 semaphorin (sema3) signaling. An expression profile of sema3 revealed that sema3F expression was decreased in GEP-NETs. The re-expression of this protein in TNE-GEPs cellular models showed that sema3F is responsible of the reduction of cell viability and proliferation. In vivo, sema3F hampered tumor development. Further studies are thus needed to better understand the role of the sema3F signaling pathway in the progression of GEP-NETs

O desenvolvimento de moléculas radiomarcadas com alta especificidade para um órgão ou tumor tem contribuído para a obtenção de um diagnóstico de precisão em medicina nuclear.Um caso particular são os peptídeos radiomarcados para a localização de tumores neuroendócrinos como os derivados sintéticos da somatostatina.Atualmente, o DTPA-octreotideo-111In é o radiofármaco mais utilizado com o propósito de visualizar tumores que expressem receptores para somatostatina. Contudo, o uso do indio-111 como radionuclídeo oferece limitações em relação a sua disponibilidade (produto de ciclotron), suas características físicas como meia-vida (67 horas) e emissor de fótons de média energia (171 keV e 245 keV) que não favorecem a obtenção de imagens tipo SPECT (Single Photon Emission Computed Tomography). As propriedades físicas favoráveis do tecnécio-99m (99mTc) fazem dele o radioisótopo mais adequado para substituir o indio-111 (111In) na marcação desses peptídeos. Este trabalho avaliou a preparação e marcação do reagente liofilizado HYNIC-Tyr3-octreotato (HYNIC-octreotato) com 99mTc, baseado em metodologia descrita na literatura, utilizando tricina e EDDA (ácido etilenodiaminadiacetico) como coligantes. Foram estudados os parâmetros de marcação (tempo de incubação, temperatura, volume e atividade do pertecnetato de sódio) e estabilidade do liofilizado. Adicionalmente, estudou-se a influência de pré-congelamento com nitrogênio (N2) líquido na estabilidade do liofilizado, bem como a influência de manitol na pureza radioquímica e biodistribuição do complexo. Os estudos de estabilidade revelaram que o método de liofilização utilizado, empregando o pré-congelamento com nitrogênio líquido possibilitou a obtenção de um reagente liofilizado com estabilidade de 4 meses quando armazenado sob refrigeração. A estabilidade do reagente liofilizado obtido sem pré-congelamento com nitrogênio líquido foi semelhante à obtida com o pré-congelamento.Os estudos de marcações determinaram as melhores condições de marcação, para as quais se obteve pureza radioquímica maior que 90%.A presença de manitol na formulação não influenciou na formação do complexo HYNIC-Octreotato-99mTc, conforme avaliação realizada por CLAE e estudos cintilográficos de distribuição do composto em coelhos.Estudos de biodistribuição invasivos realizados em camundongos Nude com tumor (células AR42J de tumor pancreático) e camundongos Swiss normais, bem como estudos cintilográficos realizados em coelhos e camundongos Nude revelaram cinética de distribuição rápida, acúmulo renal e captação tumoral significativa do peptídeo radiomarcado. Os resultados dos estudos de marcação com 99mTc, produção de reagente liofilizado e biodistribuição sugerem que o radiofármaco HYNIC-octreotato-99mTc apresenta potencial para aplicação em diagnóstico de tumores neuroendócrinos em medicina nuclear. / The development of radiolabeled molecules with high specificity for an organ or tumor has been contributed to the precise diagnostic in nuclear medicine. Somatostatin labeled derivatives constitutes a particular example of labeled peptide applied in the localization of neuroendocrine tumors. Nowadays, the 111In-DTPA-octreotideo is the radiopharmaceutical applied in diagnostic procedures for the visualization of tumors with high expression of somatostatin receptors. However, the 111-indium is a radionuclide that presents some limitations related to availability (cyclotron production), half-life (67 hours) and the emission of medium energy photons (171 keV e 245 keV), not favorable to the acquisition of images in SPECT (Single Photon Emission Computed Tomography). The favorable physical properties of the 99m-technetium (99mTc) make this radionuclide the more favorable to substitute the 111-indium on peptide labeling procedures. This work studied the preparation and labeling of a lyophilized kit of HYNIC-Tyr3-octreotate (HYNIC-octreotate) with 99mTc, base on previously described procedures and using tricine and EDDA (ethylendiaminediacetic acid) as coligands. It was studied the labeling parameters (incubation time, temperature, volume and perthecnetate activity) and the stability of the lyophilized preparation. Additionally, it was studied the influence of the pre-freezing using liquid nitrogen in the stability of the lyophilized preparation, as well as the influence of manitol in the labeling yield and biological distribution of the complex. The stability studies showed that the lyophilization using liquid nitrogen pre-freezing resulted in a lyophilized preparation with stability over 4 month when stored under refrigeration. The stability of the lyophilized preparation obtained without liquid nitrogen pre-freezing was similar.The labeling studies determined the best labeling conditions, resulting in a radiochemical yield superior than 90%. The use of manitol in the formulation did not influence the formation of the complex 99mTc-HYNIC-Octreotate, as evidenced in HPLC and in the scintigraphic studies of the complex biodistribution in rabbits. Invasive biodistribution studies using xenographed Nude mice (pancreatic tumor cells AR42J) and healthy Swiss mice, and scintigraphic studies in rabbits showed the fast kinetic distribution, renal uptake and significative tumoral uptake of the labeled peptide. The results of labeling studies with 99mTc, the production of the lyophilized kit and the biodistribution studies suggest that the 99mTc-HYNIC-Octreotate is a potential radiopharmaceutical to be applied in the diagnostic of neuroendocrine tumors in nuclear medicine.

O desenvolvimento de moléculas radiomarcadas com alta especificidade para um órgão ou tumor tem contribuído para a obtenção de um diagnóstico de precisão em medicina nuclear.Um caso particular são os peptídeos radiomarcados para a localização de tumores neuroendócrinos como os derivados sintéticos da somatostatina.Atualmente, o DTPA-octreotideo-111In é o radiofármaco mais utilizado com o propósito de visualizar tumores que expressem receptores para somatostatina. Contudo, o uso do indio-111 como radionuclídeo oferece limitações em relação a sua disponibilidade (produto de ciclotron), suas características físicas como meia-vida (67 horas) e emissor de fótons de média energia (171 keV e 245 keV) que não favorecem a obtenção de imagens tipo SPECT (Single Photon Emission Computed Tomography). As propriedades físicas favoráveis do tecnécio-99m (99mTc) fazem dele o radioisótopo mais adequado para substituir o indio-111 (111In) na marcação desses peptídeos. Este trabalho avaliou a preparação e marcação do reagente liofilizado HYNIC-Tyr3-octreotato (HYNIC-octreotato) com 99mTc, baseado em metodologia descrita na literatura, utilizando tricina e EDDA (ácido etilenodiaminadiacetico) como coligantes. Foram estudados os parâmetros de marcação (tempo de incubação, temperatura, volume e atividade do pertecnetato de sódio) e estabilidade do liofilizado. Adicionalmente, estudou-se a influência de pré-congelamento com nitrogênio (N2) líquido na estabilidade do liofilizado, bem como a influência de manitol na pureza radioquímica e biodistribuição do complexo. Os estudos de estabilidade revelaram que o método de liofilização utilizado, empregando o pré-congelamento com nitrogênio líquido possibilitou a obtenção de um reagente liofilizado com estabilidade de 4 meses quando armazenado sob refrigeração. A estabilidade do reagente liofilizado obtido sem pré-congelamento com nitrogênio líquido foi semelhante à obtida com o pré-congelamento.Os estudos de marcações determinaram as melhores condições de marcação, para as quais se obteve pureza radioquímica maior que 90%.A presença de manitol na formulação não influenciou na formação do complexo HYNIC-Octreotato-99mTc, conforme avaliação realizada por CLAE e estudos cintilográficos de distribuição do composto em coelhos.Estudos de biodistribuição invasivos realizados em camundongos Nude com tumor (células AR42J de tumor pancreático) e camundongos Swiss normais, bem como estudos cintilográficos realizados em coelhos e camundongos Nude revelaram cinética de distribuição rápida, acúmulo renal e captação tumoral significativa do peptídeo radiomarcado. Os resultados dos estudos de marcação com 99mTc, produção de reagente liofilizado e biodistribuição sugerem que o radiofármaco HYNIC-octreotato-99mTc apresenta potencial para aplicação em diagnóstico de tumores neuroendócrinos em medicina nuclear. / The development of radiolabeled molecules with high specificity for an organ or tumor has been contributed to the precise diagnostic in nuclear medicine. Somatostatin labeled derivatives constitutes a particular example of labeled peptide applied in the localization of neuroendocrine tumors. Nowadays, the 111In-DTPA-octreotideo is the radiopharmaceutical applied in diagnostic procedures for the visualization of tumors with high expression of somatostatin receptors. However, the 111-indium is a radionuclide that presents some limitations related to availability (cyclotron production), half-life (67 hours) and the emission of medium energy photons (171 keV e 245 keV), not favorable to the acquisition of images in SPECT (Single Photon Emission Computed Tomography). The favorable physical properties of the 99m-technetium (99mTc) make this radionuclide the more favorable to substitute the 111-indium on peptide labeling procedures. This work studied the preparation and labeling of a lyophilized kit of HYNIC-Tyr3-octreotate (HYNIC-octreotate) with 99mTc, base on previously described procedures and using tricine and EDDA (ethylendiaminediacetic acid) as coligands. It was studied the labeling parameters (incubation time, temperature, volume and perthecnetate activity) and the stability of the lyophilized preparation. Additionally, it was studied the influence of the pre-freezing using liquid nitrogen in the stability of the lyophilized preparation, as well as the influence of manitol in the labeling yield and biological distribution of the complex. The stability studies showed that the lyophilization using liquid nitrogen pre-freezing resulted in a lyophilized preparation with stability over 4 month when stored under refrigeration. The stability of the lyophilized preparation obtained without liquid nitrogen pre-freezing was similar.The labeling studies determined the best labeling conditions, resulting in a radiochemical yield superior than 90%. The use of manitol in the formulation did not influence the formation of the complex 99mTc-HYNIC-Octreotate, as evidenced in HPLC and in the scintigraphic studies of the complex biodistribution in rabbits. Invasive biodistribution studies using xenographed Nude mice (pancreatic tumor cells AR42J) and healthy Swiss mice, and scintigraphic studies in rabbits showed the fast kinetic distribution, renal uptake and significative tumoral uptake of the labeled peptide. The results of labeling studies with 99mTc, the production of the lyophilized kit and the biodistribution studies suggest that the 99mTc-HYNIC-Octreotate is a potential radiopharmaceutical to be applied in the diagnostic of neuroendocrine tumors in nuclear medicine.

Os insulinomas são os mais comuns neoplasmas endócrinos pancreáticos, constituindo cerca de 17% de todos os tumores neuroendócrinos do trato digestivo. São tumores raros, que tem, como principal manifestação clínica, a hipoglicemia, a qual é ocasionada por secreção exagerada de insulina pelo tumor. Devido ao fato de serem tumores raros, o conhecimento das mudanças genéticas associadas à iniciação e progressão desses tumores é muito limitado. Em função disto, o objetivo deste trabalho é a identificação de genes diferencialmente expressos em insulinomas benignos humanos, visando o melhor entendimento dos mecanismos moleculares do processo tumorigênico dos insulinomas e a descoberta de novos alvos moleculares para terapia. Utilizando-se a plataforma de \"bioarrays\" CodeLink foram identificados 354 genes mais expressos nos insulinomas benignos, sendo que 16% estavam envolvidos em proliferação. Dentre estes genes foram escolhidos 6 genes para validação por \"Real-Time PCR\", onde os genes SPARCL1, PRSS11 STAT4, ECRG4, ASCL1 confirmaram sua expressão diferencial nos tumores, porém a diferença do gene IGFALS não foi estatisticamente significativa. Através da técnica \"Representational Difference Analysis\", isolou-se o clone FLJ13072, como super-expresso nos insulinomas benignos quando comparado à ilhotas normais, sendo que a seqüência protéica putativa deste gene apresenta um domínio conservado de helicase, podendo estar envolvido em eventos de transcrição, tradução, reparo de DNA e remodelamento de cromatina. Uma das dificuldades encontradas no estudo dos insulinomas é a falta de linhagens celulares humanas. Por esta razão, iniciou-se o estabelecimento de culturas primárias e precoces de insulinomas humanos visando sua utilização como modelos celulares para futuros estudos funcionais dos genes identificados. / Insulinomas are the most common pancreatic endocrine neoplasms, comprising around 17% of all neuroendocrine tumors of the digestive tract. These rare tumors have hypoglycemia as the main clinical manifestation, caused by over secretion of insulin by the tumor. Based on that, the objective of this work is the identification of differentially expressed genes in human benign insulinomas, aiming at the better understanding of the molecular mechanisms of their tumorigenic process and the discovery of new molecular targets for therapeutics. Using the CodeLink bioarrays platform (GE Healthcare) 354 genes upregulated in human benign insulinomas were identified, among which, 16% are involved in cell proliferation. From these genes, 6 were chosen for validation by Real Time PCR, where SPARCL1, PRSS11, STAT4, ECRG4 and ASCL1 were shown to be upregulated in all benign tumors, however the expression difference of IGFALS gene were not statistically significant. Using the RDA (Representational Difference Analysis) methodology, the unknown gene FLJ13072 was shown to be upregulated in benign isulinomas when compared to normal pancreatic islets. The putative protein product from this gene has an helicase domain, being possibly involved in processes like transcription, translation, DNA repair and chromatin remodeling. An important drawback for the study of insulinomas is the lack of human cell lines. Because of that, the establishment of early primary cultures of human insulinomas was initiated, aiming at its use as a cell model for future functional studies of the genes identified.

The aim of this thesis was to characterize the expression of the peptides ghrelin and obestatin, as well as other neuroendocrine markers in human normal tissues, in invasive breast cancer and a wide panel of neuroendocrine tumors (NETs). In normal tissues the expression of ghrelin and obestatin was mainly localized to the gastric mucosa, and in lesser extent in the remaining gastrointestinal tract, endocrine pancreas and mammary glands. Double immunofluorescence studies demonstrated that ghrelin and obestatin were co-localized in the same cells displaying the same cytoplasmic distribution. In normal breast tissue, ghrelin, obestatin, adrenomedullin, apelin and vesicular monoamine transporter 2 were specifically demonstrated in the luminal epithelial cells. Consecutive sections indicated that mammary epithelial cells could express several of these peptides. Secretogranin II and III were also detected in breast tissue, but their presence was restricted to the outer layer of myoepithelial cells, whereas chromogranin B immunoreactivity was found in both the epithelial and myoepithelial cells. Ghrelin and obestatin immunoreactivity was seen in invasive breast cancer, where the expression could be correlated to factors associated with prognosis. Furthermore, multivariate analysis indicated that ghrelin expression was a possible independent prognostic factor for prolonged recurrence-free and breast cancer-specific survival. In a panel of NETs and endocrine-related disorders it was revealed that ghrelin and obestatin immunoreactivity was primarily found in tumors originating from the respective normal tissues. The two proteins were detected in only a few cases and only occasional tumor cells were immunoreactive. In conclusion, ghrelin and obestatin are localized in the gastrointestinal tract, endocrine pancreas and mammary glands. This thesis has contributed to our understanding of the distribution of ghrelin and obestatin in both normal tissue and tumor cells. A potential role of ghrelin as a prognostic factor in invasive breast cancer has been identified and should be further explored.

Small intestinal neuroendocrine tumors (SI-NETs) originate from serotonin-producing enterochromaffin (EC) cells in the intestinal mucosa. Somatostatin analogs (SSAs) are mainly used to control hormonal secretion and tumor growth. However, the molecular mechanisms leading to the control of SI-NETs are unknown. Although microRNAs (miRNAs) are post transcriptional regulators deeply studied in many cancers, are not well-defined in SI-NETs. We adopted a two-pronged strategy to investigate SSAs and miRNAs: first, to provide novel insights into how SSAs control NET cells, and second, to identify an exclusive SI-NET miRNA expression, and investigate the biological functions of miRNA targets. To accomplish the first aim, we treated CNDT2.5 cells with octreotide for 16 months. Affymetrix microarray was performed to study gene variation of CNDT2.5 cells in the presence or absence of octreotide. The study revealed that octreotide induces six genes, ANXA1, ARHGAP18, EMP1, GDF15, TGFBR2 and TNFSF15. To accomplish the second aim, SI-NET tissue specimens were used to run genome-wide Affymetrix miRNA arrays. The expression of five miRNAs (miR-96, -182, -183, -196a and -200a) was significantly upregulated in laser capture microdissected (LCM) tumor cells versus LCM normal EC cells, whereas the expression of four miRNAs (miR-31, -129-5p, -133a and -215) was significantly downregulated in LCM tumor cells. We also detected nine tissue miRNAs in serum samples, showing that the expression of five miRNAs is significantly increased in SSA treated patients versus untreated patients. Conversely, SSAs do not change miRNA expression of four low expressed miRNAs. Silencing miR-196a expression was used to investigate functional activities in NET cells. This experimental approach showed that four miR-196a target genes, HOXA9, HOXB7, LRP4 and RSPO2, are significantly upregulated in silenced miR-196a NET cells. In conclusion, ANXA1, ARHGAP18, EMP1, GDF15, TGFBR2 and TNFSF15 genes might regulate cell growth and differentiation in NET cells, and play a role in an innovative octreotide signaling pathway. The global SI-NET miRNA profiling revealed that nine selected miRNAs might be involved in tumorigenesis, and play a potential role as novel markers for follow-up. Indeed, silencing miR-196a demonstrated that HOXA9, HOXB7, LRP4 and RSPO2 genes are upregulated at both transcriptional and translational levels.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb 25, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Silvia Jurisson and Dr. Mike Lewis. Vita. Includes bibliographical references.