INTRODUÇÃO: O câncer constitui-se na principal causa de mortalidade entre indivíduos de 45 a 84 anos, configurando-se em um dos principais problemas de saúde pública dos países em desenvolvimento. As reações de hipersensibilidade aos quimioterápicos têm aumentado, impedindo muitas vezes a utilização de terapias de primeira linha no tratamento de neoplasias primárias ou recidivantes. O procedimento de dessensibilização é uma abordagem alternativa, por meio do qual o paciente passa a tolerar a medicação que antes desencadeava reações potencialmente letais. Quimioterápicos do grupo das platinas são exemplos de drogas passíveis de readministração por meio do processo de dessensibilização, no entanto faltam biomarcadores preditivos de reações durante o procedimento. OBJETIVOS: O objetivo principal do estudo foi avaliar o papel do teste de ativação de basófilos (BAT) como biomarcador para reações de hipersensibilidade ocorridas durante a dessensibilização em pacientes alérgicas às platinas. Como objetivo secundário, avaliou-se a prevalência e o impacto da mutação dos genes BRCA 1 e 2 em pacientes com hipersensibilidade imediata à carboplatina submetidas à dessensibilização. MÉTODOS: Padronizou-se o BAT, com análise da expressão de CD63 e CD203c na superfície de basófilos de pacientes com hipersensibilidade imediata às platinas submetidas à dessensibilização. Foram realizados BATs em 15 pacientes portadoras de neoplasias malignas submetidas a 27 dessensibilizações devido à anafilaxia a quimioterápico do grupo das platinas e em 12 indivíduos de dois grupos controle (Grupo 1: seis pacientes tolerantes às platinas e Grupo 2: seis voluntários sadios que nunca foram expostos às platinas). Os resultados dos BATs foram comparados entre os três grupos. Correlacionou-se o BAT com a ocorrência ou não de reação durante a dessensibilização e com os níveis de triptase sérica. Para análise da prevalência e impacto da mutação dos genes BRCA 1 e 2 nas dessensibilizações, realizou-se análise retrospectiva de prontuários de 138 portadoras de neoplasias malignas ginecológicas submetidas à dessensibilização à carboplatina. RESULTADOS: O BAT foi positivo em 11 das 15 pacientes alérgicas (n= 11; 73,3%), com aumento de expressão de CD203c e CD63 em 11 (73,3%) e 6 (40%) pacientes, respectivamente. Todos os participantes dos grupos controles apresentaram testes negativos. Maior expressão de CD63 foi observada em pacientes com reações iniciais mais graves. O BAT foi positivo em 92,3% das reações ocorridas durante as dessensibilizações (n=12/13), sendo positivo em todas as reações que apresentaram aumento concomitante de triptase sérica (n=5). Com relação à mutação dos genes BRCA 1 e 2, sua prevalência foi de 34% nas pacientes com hipersensibilidade às platinas (n=47/138), sendo que 51% das portadoras reagiram durante a dessensibilização. CONCLUSÕES: O BAT positivo, com aumento da expressão de CD63 e/ou CD203c na superfície do basófilo, identificou pacientes alérgicos às platinas com especificidade de 100% e sensibilidade de 73,3%. O BAT e a mutação dos genes BRCA 1 e 2 identificaram pacientes mais propensos a reagir durante o procedimento de dessensibilização. A utilização de biomarcadores preditores de reações durante a dessensibilização aos quimioterápicos do grupo das platinas pode aumentar a segurança do procedimento e auxiliar na manutenção do esquema quimioterápico de primeira linha do paciente / INTRODUCTION: Cancer is the leading cause of death in the age group of 45 to 84 years, and one of the main public health issues in developing nations. Hypersensitivity reactions to chemotherapeutic agents have been increasing, sometimes hindering the use of first-line therapies in the treatment of primary or relapsed tumors. Rapid drug desensitization (RDD) is an alternative approach, through which a patient becomes tolerant to the medication that once triggered a potentially lethal hypersensitivity reaction. Platinum-based compounds are examples of drugs that can be readministered through the desensitization procedure, but currently there are no known biomarkers that could help predict reactions during RDD. OBJECTIVES: The main goal of our study was to assess the basophil activation test (BAT) as a biomarker of breakthrough reactions occurred during RDD in patients allergic to platinum-based agents. As a secondary goal, we evaluated the prevalence and impact of the BRCA 1/2 mutation in carboplatin-allergic patients undergoing RDD. METHODS: We standardized the BAT by evaluating CD63 and CD203c expressions on the basophils of patients with immediate hypersensitivity reactions to platinum-based agents undergoing RDD. We analyzed BATs of 15 patients with malignant neoplasms who had undergone 27 RDD procedures due to anaphylaxis to platinum-based agents, and of 12 control subjects (Group 1: six patients tolerant to platinum-based agents, and Group 2: six healthy volunteers who had never been exposed to platinum-based agents). BAT results were compared among the three groups. We correlated BAT results with the occurrence of breakthrough reactions during RDD and with serum tryptase levels. To conduct the analysis of the BRCA 1/2 mutation prevalence and its impact on RDD, a retrospective review of 138 medical records of patients with gynecological malignancies who underwent RDD to carboplatin was performed. RESULTS: BAT was positive in 11/15 allergic patients (73.3%), with increased expression of CD203c and CD63 in 11 (73.3%) and 6 (40%) patients, respectively. All control subjects presented negative BATs. A higher CD63 expression was observed in patients with severe initial reactions. BAT was positive in 92.3% of the breakthrough reactions occurred during RDD (n=12/13), and in all reactions with concomitant increased tryptase levels (n=5). Regarding the BRCA1/2 mutation, its prevalence was 34% in patients allergic to platinum-based agents (n=47/138), and 51% of the mutation carriers had breakthrough reactions during RDD. CONCLUSIONS: A positive BAT, with an increased expression of CD63 and/or CD203c, identified patients allergic to platinum-based agents with a specificity of 100% and a sensitivity of 73.3%. The BAT and the BRCA 1/2 mutation helped identify patients at risk of breakthrough reactions during RDD. The use of predictive biomarkers of breakthrough reactions during RDD to platinum-based agents might enhance RDD safety and help maintain a patient`s first-line treatment

INTRODUÇÃO: O câncer constitui-se na principal causa de mortalidade entre indivíduos de 45 a 84 anos, configurando-se em um dos principais problemas de saúde pública dos países em desenvolvimento. As reações de hipersensibilidade aos quimioterápicos têm aumentado, impedindo muitas vezes a utilização de terapias de primeira linha no tratamento de neoplasias primárias ou recidivantes. O procedimento de dessensibilização é uma abordagem alternativa, por meio do qual o paciente passa a tolerar a medicação que antes desencadeava reações potencialmente letais. Quimioterápicos do grupo das platinas são exemplos de drogas passíveis de readministração por meio do processo de dessensibilização, no entanto faltam biomarcadores preditivos de reações durante o procedimento. OBJETIVOS: O objetivo principal do estudo foi avaliar o papel do teste de ativação de basófilos (BAT) como biomarcador para reações de hipersensibilidade ocorridas durante a dessensibilização em pacientes alérgicas às platinas. Como objetivo secundário, avaliou-se a prevalência e o impacto da mutação dos genes BRCA 1 e 2 em pacientes com hipersensibilidade imediata à carboplatina submetidas à dessensibilização. MÉTODOS: Padronizou-se o BAT, com análise da expressão de CD63 e CD203c na superfície de basófilos de pacientes com hipersensibilidade imediata às platinas submetidas à dessensibilização. Foram realizados BATs em 15 pacientes portadoras de neoplasias malignas submetidas a 27 dessensibilizações devido à anafilaxia a quimioterápico do grupo das platinas e em 12 indivíduos de dois grupos controle (Grupo 1: seis pacientes tolerantes às platinas e Grupo 2: seis voluntários sadios que nunca foram expostos às platinas). Os resultados dos BATs foram comparados entre os três grupos. Correlacionou-se o BAT com a ocorrência ou não de reação durante a dessensibilização e com os níveis de triptase sérica. Para análise da prevalência e impacto da mutação dos genes BRCA 1 e 2 nas dessensibilizações, realizou-se análise retrospectiva de prontuários de 138 portadoras de neoplasias malignas ginecológicas submetidas à dessensibilização à carboplatina. RESULTADOS: O BAT foi positivo em 11 das 15 pacientes alérgicas (n= 11; 73,3%), com aumento de expressão de CD203c e CD63 em 11 (73,3%) e 6 (40%) pacientes, respectivamente. Todos os participantes dos grupos controles apresentaram testes negativos. Maior expressão de CD63 foi observada em pacientes com reações iniciais mais graves. O BAT foi positivo em 92,3% das reações ocorridas durante as dessensibilizações (n=12/13), sendo positivo em todas as reações que apresentaram aumento concomitante de triptase sérica (n=5). Com relação à mutação dos genes BRCA 1 e 2, sua prevalência foi de 34% nas pacientes com hipersensibilidade às platinas (n=47/138), sendo que 51% das portadoras reagiram durante a dessensibilização. CONCLUSÕES: O BAT positivo, com aumento da expressão de CD63 e/ou CD203c na superfície do basófilo, identificou pacientes alérgicos às platinas com especificidade de 100% e sensibilidade de 73,3%. O BAT e a mutação dos genes BRCA 1 e 2 identificaram pacientes mais propensos a reagir durante o procedimento de dessensibilização. A utilização de biomarcadores preditores de reações durante a dessensibilização aos quimioterápicos do grupo das platinas pode aumentar a segurança do procedimento e auxiliar na manutenção do esquema quimioterápico de primeira linha do paciente / INTRODUCTION: Cancer is the leading cause of death in the age group of 45 to 84 years, and one of the main public health issues in developing nations. Hypersensitivity reactions to chemotherapeutic agents have been increasing, sometimes hindering the use of first-line therapies in the treatment of primary or relapsed tumors. Rapid drug desensitization (RDD) is an alternative approach, through which a patient becomes tolerant to the medication that once triggered a potentially lethal hypersensitivity reaction. Platinum-based compounds are examples of drugs that can be readministered through the desensitization procedure, but currently there are no known biomarkers that could help predict reactions during RDD. OBJECTIVES: The main goal of our study was to assess the basophil activation test (BAT) as a biomarker of breakthrough reactions occurred during RDD in patients allergic to platinum-based agents. As a secondary goal, we evaluated the prevalence and impact of the BRCA 1/2 mutation in carboplatin-allergic patients undergoing RDD. METHODS: We standardized the BAT by evaluating CD63 and CD203c expressions on the basophils of patients with immediate hypersensitivity reactions to platinum-based agents undergoing RDD. We analyzed BATs of 15 patients with malignant neoplasms who had undergone 27 RDD procedures due to anaphylaxis to platinum-based agents, and of 12 control subjects (Group 1: six patients tolerant to platinum-based agents, and Group 2: six healthy volunteers who had never been exposed to platinum-based agents). BAT results were compared among the three groups. We correlated BAT results with the occurrence of breakthrough reactions during RDD and with serum tryptase levels. To conduct the analysis of the BRCA 1/2 mutation prevalence and its impact on RDD, a retrospective review of 138 medical records of patients with gynecological malignancies who underwent RDD to carboplatin was performed. RESULTS: BAT was positive in 11/15 allergic patients (73.3%), with increased expression of CD203c and CD63 in 11 (73.3%) and 6 (40%) patients, respectively. All control subjects presented negative BATs. A higher CD63 expression was observed in patients with severe initial reactions. BAT was positive in 92.3% of the breakthrough reactions occurred during RDD (n=12/13), and in all reactions with concomitant increased tryptase levels (n=5). Regarding the BRCA1/2 mutation, its prevalence was 34% in patients allergic to platinum-based agents (n=47/138), and 51% of the mutation carriers had breakthrough reactions during RDD. CONCLUSIONS: A positive BAT, with an increased expression of CD63 and/or CD203c, identified patients allergic to platinum-based agents with a specificity of 100% and a sensitivity of 73.3%. The BAT and the BRCA 1/2 mutation helped identify patients at risk of breakthrough reactions during RDD. The use of predictive biomarkers of breakthrough reactions during RDD to platinum-based agents might enhance RDD safety and help maintain a patient`s first-line treatment

<P align="justify">Le but du travail de doctorat est la mise au point et l’étude fondamentale de voies de synthèse de diamines sous forme de leurs énantiomères optiquement purs. Ces derniers doivent être testés comme complexes dichloroplatiniques afin de quantifier leur pouvoir antitumoral. Les qualités souhaitées de ces synthèses sont leur application à des molécules de structure variées, les meilleures énantiosélectivité et diastéréosélectivité et les méthodes les plus simples possibles.</P><p><P align="justify">Les énantiomères des 1,2-diamino-1-(4-fluorophényl)propanes ainsi que les 1,2-diamino-1-(4-fluorophényl)-3-méthylbutanes ont été obtenus avec des rendements approximatifs globaux de 10 %. Les premières diamines ont été synthétisées par la méthode de Tytgat permettant l’obtention des deux séries d’énantiomères (érythro et thréo) au départ d’un énantiomère aminoalcool intermédiaire érythro. Les diamines érythro sont obtenues par une synthèse de Gabriel stéréospécifique tandis que la série thréo l’est par formation et ouverture par NH3 d’une aziridine, de manière stéréo- et régiosélective. Les butanediamines ont été synthétisées à partir des acides aminés optiquement purs (D- et L-alanine). Les thréos sont obtenues par une réaction de Grignard sur la nitrone dérivée de l’acide aminé N-boc. Les isomères érythro ont été fournis par la formation et l’ouverture régiosélective d’un N,Ndibenzylaziridinium, formé à partir de N,N-dibenzyl-2-amino-1-(4-fluorophényl)-3-méthylbutan-1-ol.</P><p><P align="justify">La synthèse des 1,2-diamino-1-(4-fluorophényl)butanes a été entreprise de la même manière mais les aminoalcool intermédiaires n’ont pu être isolés, suite à une réaction secondaire lors de la débenzylation des N,N-dibenzyl-2-amino-1-(4-fluorophényl)butan-1-ol, et ayant conduit à la 2,5-diéthyl-3,6-di(4-luorophényl)pyrazine-[1,2].</P><p><P align="justify">L’obtention des 1,2-diamino-1-(2-méthoxyphényl)propanes n’a pu être menée à bien suite aux effets négatifs de l’encombrement stérique et de l’effet mésomère du OMe sur le C-. Ni la voie de Tytgat, ni la synthèse via les diols produits par dihydroxylation asymétrique de Sharpless n’ont abouti.</P><p><P align="justify">La pureté énantiomérique a été vérifiée par dérivation chimique au (1R)-(-)-myrténal et enregistrement du spectre RMN 1H des imines obtenues. La réaction est réalisée in situ dans le tube RMN, avec le CDCl3 comme solvant. Cette technique a également permis la confirmation de la configuration absolue par comparaison avec les valeurs déjà obtenues avec les composés non-substitués. La méthode a été vérifiée quant à son étendue et ses limites sur toute une série de composés comprenant des acides-aminés, des amines primaires aliphatiques et des b-aminoalcools. On a pu ainsi prouver que les a-et b-phénylalkylamines sont les seules molécules sur lesquelles la technique est efficace.</P><p><P align="justify"> Les tests pharmacologiques préliminaires ont été effectués au moyen des complexes dichloroplatiniques de nos produits, sur les cellules cancéreuses mammaires MCF-7. L’introduction du fluor a augmenté l’activité des produits de façon importante, par rapport aux complexes non substitués. L’activité est fortement diastéréosélectives et modérément énantiosélective. Les isomères thréo sont toujours plus actifs que les érythro.</P><p><P align="justify">L’examen des résultats a permis de faire l’hypothèse qu’il existe, si pas un transport énantiosélectif, du moins un mécanisme de résistance qui favorise un énantiomère par rapport à l’autre. L’isomère thréo-1S2S est le seul à être cytotoxique à une dose de 1µM.</P> / Doctorat en sciences pharmaceutiques / info:eu-repo/semantics/nonPublished

Les dérivés du platine (i.e. cisplatine et oxaliplatine) représentent une des classes pharmacologiques les plus utilisées en oncologie, notamment dans les cancers colorectaux. Cependant, leur efficacité est limitée par l’émergence de résistances acquises. Nous avons alors étudié in vitro dans différentes lignées cancéreuses coliques humaines (HCT116, LoVo, SW480, HT29) les conséquences à long terme des dérivés du platine lorsqu’ils sont utilisés dans des conditions tenant compte de la sensibilité cellulaire. Ils provoquent des cassures double-brin (objectivées par l’expression de -H2AX), dont le taux dépend du système p53/p21, du complexe MRN et du niveau de stabilité microsatellitaire. Ils induisent aux plus fortes concentrations ( IC50), une cytostase qui s’accompagne de la formation de cellules géantes macrocytaires et endopolyploïdes, dont certaines acquièrent un phénotype sénescent. Dans le même temps, l’activation des mécanismes de réparation des CDB varie en fonction du dérivé du Pt et de la lignée considérée. A plus long terme, des cellules « résistantes » se développent : elles ont une ploïdie normale, et se caractérisent par une plus grande résistance aux dérivés du platine et la présence de novo d’anomalies chromosomiques récurrentes leur conférant un avantage sélectif potentiel en terme de prolifération. Ces mécanismes pourraient contribuer à expliquer en clinique la survenue d’une résistance à une chimiothérapie pourtant initialement efficace. Parallèlement, nous avons évalué in vitro et in vivo de nouveaux complexes de platine obtenus par pharmacomodulation, et associant un noyau intercalant dérivé de la phénanthroline ou de l’acridine. Les résultats in vitro montrent globalement une amélioration significative de la cytotoxicité. Toutefois, un des composés les plus cytotoxiques in vitro, le [(5,6-diméthyl-1,10-phénanthroline) (S,S-diaminocyclohexane)platine(II)], n’exerce pas d’effet antitumoral dans un modèle syngénique de cancer colique chez le rat BD-IX, mais montre une néphrotoxicité marquée. Ces données soulignent l’insuffisance du criblage in vitro et la discordance in vitro/in vivo. / Platinum compounds (i.e. cisplatin and oxaliplatin) represent a class of DNA-damaging agents widely used in clinic especially in the treatment of colorectal cancer. However, their effectiveness is restricted because of emergence of acquired resistance. Therefore, long-term effects of platinum compounds, used at conditions reflecting the in vitro cellular sensibility, were assessed in vitro in several human colon cancer cell lines (HCT116, LoVo, SW480, HT29). Their cytotoxicity is related to double-strand break formation (objectived by -H2AX expression), which depends on p53/p21 status, MRN complex and microsatellite stability of the cell line. Furthermore, at the highest concentrations ( IC50), cells stopped their proliferation and exhibited phenotypic alterations resulting from progressive polyploidy and/or senescence. In the same time, DNA repair systems are activated differently according to the platinum derivate and the cell line. At later stages, cells that are more resistant to platinum compounds than their parental counterpart emerged. They have recovered their basal level of ploidy and acquired de novo recurrent chromosomal aberrations. Such mechanisms could contribute to the recurrence of clinical malignancies, even after an effective initial response to chemotherapy. On the other hand, pharmacological evaluation of new platinum compounds with phenanthroline or acridine intercalating ligand was performed in vitro and in vivo. Globally, many compounds exhibited a higher cytotoxic effect than cisplatin or oxaliplatin in all cell lines studied. Unfortunately, in vivo investigations of one of the most cytotoxic compounds ([(5,6-dimethyl-1,10-phenanthroline) (S,S-diaminocyclohexane)platinum(II)]) did not exhibit antitumor effect in BD-IX rats bearing peritoneal carcinomatosis, whatever the route of administration used (systemic or local), but it displayed nephrotoxicity. These results query the in vitro/in vivo correlation and reconsider the place of the in vivo screening.

Проведено исследование цитотоксического действия синтезированных препаратов платины на нормальные клетки человека и различные линии опухолевых клеток. Выполнена оценка фрагментации ДНК методом электрофореза. Исследована целостность цитоплазматической мембраны клеток, подверженных действию препаратов платины. Выявлено наиболее перспективное соединение платины как возможный субстрат для разработки фармацевтических препаратов для лечения онкологических заболеваний. / Within the framework of this work, reviews of the literature on tumor cells and methods of combating malignant neoplasms, including those using platinum preparations, are collected. A study was made of the cytotoxic effect of the synthesized platinum preparations on normal human cells and various tumor cell lines. DNA fragmentation was studied by electrophoresis. A study was made of the integrity of the cytoplasmic membrane of cells exposed to platinum preparations. The most promising platinum compound has been identified as a possible substrate for the development of pharmaceutical preparations for the treatment of oncological diseases.