This PhD aimed to elucidate the mechanisms by which polymorphisms may alter androgen-induced transactivation of androgen receptor (AR) target genes which may be important in prostate cancer aetiology. The second aspect of this PhD focused on identifying and characterising functional polymorphisms that may have utility as predictive risk indicators for prostate cancer and which may aid in earlier therapeutic intervention and better disease management. Analyses were carried out on the kallikrein-related peptidase 3 (KLK3), also known as the prostate specific antigen (PSA), gene and the kallikrein-related peptidase 4 (KLK4) gene. The PSA and KLK4 genes are part of the serine protease family that have trypsin or chymotrypsin like activity and are thought to play a role in the development of hormone-dependent cancers in tissues such as those in the prostate, breast, endometrium and ovaries. In the prostate, PSA is regulated by androgens and three androgen response elements (AREs) have been described in the promoter and upstream enhancer region. The PSA ARE I harbours a polymorphism at -158 bp from the transcription initiation site (TIS) that results in a G to A transition (G-158A). This PhD investigated the functional significance of the PSA G-158A polymorphism which has been reported to be associated with prostate cancer risk. Electromobility shift assays (EMSAs) investigating the interaction of ARE I variants with the AR DNA binding domain (AR-DBD) demonstrated that the A allele had a two-fold increased binding affinity for the AR-DBD when compared with the G allele. This was confirmed with endogenous AR in limited proteolysis-EMSA experiments. The limited proteolysis-EMSA experiments also demonstrated differential sensitivities of PSA ARE I alleles to trypsin digestion, which suggests that the G-158A polymorphism has an allosteric effect on the AR that alters AR/ARE I complex stability. Furthermore, Chromatin Immunoprecipitation (ChIP) assays suggest that the A allele more readily recruited the AR in vivo when compared with the G allele and is consistent with the in vitro binding data. Luciferase reporter assays carried out in both LNCaP and 22Rv1 prostate cancer cells, and using the natural (dihydrotestosterone; DHT) ligand demonstrated that the A allele was more responsive to androgens in LNCaP cells. Hence, this study has elucidated the potential mechanisms by which the G-158A polymorphism may differentially regulate PSA expression (of which up-regulation of PSA is thought to be important in prostate cancer development and progression). KLK4 has similar tissue-restricted expression as PSA and is up-regulated by steroid hormones in many endocrine cells including those in the prostate. A putative ARE (KLK4-pARE) located at -1,005 to -1019 relative to the more predominantly used transcription initiation site, TIS3, was initially found in supershift assays using AR antibodies to interact with endogenous AR. However, subsequent EMSA analysis using purified AR-DBD suggest that KLK4-pARE may be interacting with the AR indirectly. To investigate this hypothesis, a tandem construct of KLK4-pARE was cloned into the pGL3-Promoter vector for hormone-induced reporter assays. However, reporter assays did not demonstrate any responsiveness of KLK4-pARE to androgens, estradiol or progestins. Consequently, Real-Time PCR was carried out to reassess the hormonal regulation of KLK4 at the mRNA level. Consistent with the literature, data from this study suggests that KLK4 may be up-regulated by androgens, progestins and estradiol in a cyclical manner. Hormone-induced luciferase reporter assays were then carried out on seven promoter constructs that span 2.8 kb of the KLK4 promoter from TIS3. However, none of the seven promoter constructs demonstrated any significant responsiveness to androgens, estradiol or progestins. This study suggests that hormone response elements (HREs) that may drive the hormonal regulation of KLK4 in prostate cancer may be located further upstream from the promoter region investigated in this PhD, or alternatively, may lie 3' of TIS3. The characterisation of KLK4 promoter polymorphisms and their flanking sequences were also carried out in parallel to the functional work with the intent to assess the functional significance of any polymorphisms that may be located within HREs. In total 19 polymorphisms were identified from the public databases and from direct sequencing within 2.8 kb of the KLK4 promoter from TIS3. However, the functional and clinical significance of these 19 polymorphisms were not further pursued given the negative findings from the functional work. The PSA AR enhancer region was also assessed for potential polymorphisms that may be associated with prostate cancer risk. A total of 12 polymorphisms were identified in the PSA enhancer of which two (A-4643G and T-5412C) have been reported to alter functionality of the enhancer region and thus, prioritised for further analysis. Association analysis for prostate cancer risk was then carried out on these PSA enhancer polymorphisms as none of the KLK4 promoter polymorphisms were found in functional HREs. No significant association for either the A-4643G or T-5412C polymorphism with prostate cancer risk was found at the P = 0.05 level. However, under an age-adjusted dominant model a 1.22- (95% CI = 1.16-1.26) and 1.23-fold (95% CI = 1.17-1.29) increased risk for prostate cancer was found for the A-4643G or T-5412C polymorphisms, respectively. Both polymorphisms were also assessed for association with tumour grade and stage and PSA levels. Genotypes were significantly different for the A-4643G and T-5412C polymorphisms with tumour stage and PSA levels, respectively. However, these results are likely to be biased by the case population which consist primarily of men who presented with incidental (pT1) and organ-confined (pT2) tumours. To summarise, the A-4643G and T-5412C polymorphisms are unlikely to be associated with prostate cancer risk, PSA levels or stage/grade of disease. However, further analyses in a larger cohort is warranted given that these polymorphisms alter androgen responsiveness of the PSA enhancer and that elevated PSA levels are indicative of men with prostate cancer. To summarise, this PhD has elucidated the functional significance of the PSA G-158A polymorphism in prostate cancer and which may be important in prostate cancer patho-physiology. This PhD has also furthered the understanding of the hormonal regulation of KLK4 in prostate cancer cells. Finally, this PhD has carried out a pilot study on two functional PSA enhancer polymorphisms (A-4643G and T-5412C) with prostate cancer risk.

Le traitement d’un premier cancer de la prostate et les mois qui suivent, sont une période stressante pour les patients et leur conjointe. Les objectifs de cette étude sont, d’une part, de déterminer l’évolution de variables psychosociales (soutien social, qualité de la relation conjugale, ajustement dyadique et stratégies de coping) et du bien-être émotionnel et physique, et d’autre part, d’identifier les effets acteurs-partenaires, c'est-à-dire les effets des variables psychosociales d’un membre du couple sur son bien-être et sur celui de l’autre membre. Nous avons mené une étude longitudinale auprès de 132 patients atteints d’un cancer de la prostate et de 100 de leurs conjointes. Une évaluation psychologique leur a été proposée au début, au milieu, à la fin du traitement et quatre mois après. Les résultats montrent que les patients ont un état émotionnel et une qualité de vie satisfaisants et que les conjointes présentent une symptomatologie dépressive. Chez les patients, on observe des effets acteurs positifs du soutien social, de la relation conjugale et des stratégies de coping, centrées sur le problème ou sur la recherche de soutien social, sur leur bien-être, et des effets partenaires positifs de ces mêmes variables sur le bien-être de leur conjointe. Chez les conjointes, la relation conjugale a un effet acteur positif sur leur bien-être, mais le soutien social et les stratégies de coping centrées sur l’émotion ont des effets acteurs négatifs. De plus, l’effet partenaire soutien social des conjointes est positif sur le bien-être des patients, alors que celui des stratégies de coping centrées sur l’émotion est négatif. Celui de la relation conjugale est positif quand il s’agit de la disponibilité et de l’intensité du soutien, et négatif quand il s’agit de l’ajustement dyadique. De façon générale, le soutien social, la relation conjugale et les stratégies de coping sont de bons prédicteurs de la qualité de vie, directement ou par le biais du partenaire. / The treatment of a first prostate cancer and the following months are a stressful period for the patients and their spouse. The first aim of this study was to determine the evolution of psychosocial variables (social support, quality of conjugal relationships, dyadic adjustment and coping strategies) and of emotional and physical well-being. The second aim was to identify actors-partners effects - that is the effect of one of partner’s psychosocial variables on his/her well-being and on that of the other. A longitudinal study was carried on 132 patients with prostate cancer and 100 of their spouses. A psychological evaluation was conducted at the beginning, half way through, at the end of the treatment and four months afterwards. Results showed that patients had a good emotional state and a good quality of life and, that the spouses developed a depressive symptomatology. For patients, positive actor effects of social support, conjugal relationships and coping strategies (problem-focused or seeking social support focused) on their well-being and, positive partner effects of the same variables on the spouses’ well-being were observed. For the spouses, conjugal relationships had a positive actor effect on their well-being, but social support and emotion-focused coping strategies had negative actor effects. Also, spouses’ social support had a positive partner effect on the patients’ well-being while emotion-focused coping strategies had a negative effect. Conjugal relationship effect was positive when referring to availability and intensity of support and, negative when referring to dyadic adjustment. Overall, social support, conjugal relationship and coping strategies were found to be good predictors of quality of life, directly or indirectly through the partner.

La voie de signalisation du récepteur des androgènes (RA) est la principale cible thérapeutique des cancers de la prostate métastatiques. Toutefois, l'émergence de variants constitutivement actifs du RA dépourvus de leur partie C-terminale conduit à une résistance au traitement. Pendant ma thèse, j'ai montré que les variants du RA induisent une transition épithélio-mésenchymateuse (EMT) partielle, un phénomène observé lors de la progression tumorale. J'ai ensuite étudié les mécanismes conduisant à cette expression différentielle de marqueurs de l’EMT en me focalisant sur la N-cadhérine (CDH2). Le RA entier (AR-FL) et les variants du RA interagissent tous les deux au niveau des éléments de réponse aux androgènes dans l'intron1 de CDH2. Cependant, une augmentation du niveau d’acétylation des histones est observée uniquement avec les variants du RA. Mes données nous mène à un modèle où l'AR-FL réprimerait l'expression de CDH2 alors que les variants du RA induiraient son expression. / Androgen receptor (AR) pathway is the main therapeutic target for metastatic prostate cancer (Pca).However, the expression of AR variants lacking the carboxy-terminal end lowers therapy efficacy. During myphD, I showed that AR variants induce a partial epithelial-mesenchymal transition (EMT), a phenomenon observed during tumor progression. To understand the mode of action of AR variants, I explored the mechanisms leading to this differential expression of EMT markers focusing my research on N-cadherin(CDH2). While both the full length AR (AR-FL) and AR variants could interact with androgen response elements present in intron 1 of CDH2, I highlighted that they had opposite effects concerning histone modifications. Indeed, increased histone acetylation in this genomic region was observed only in the presence of AR variants. My data lead us to propose a model in which AR-FL represses CDH2 gene, while AR variants favor its expression.

Introdução: O diagnóstico precoce de câncer de próstata (CaP) é essencial para aumentar a sobrevida dos pacientes, mas os marcadores e métodos atuais não possuem sensibilidade e especificidade suficientes, tornando o diagnóstico ainda muito impreciso. Recentemente, as células tumorais circulantes (CTCs) têm surgido não como método de rastreio do CaP, mas sim como marcadores de prognóstico utilizando um arsenal de diversos alvos para a captura dessas células. Contudo, a busca por um método ou marcadores comuns para o rastreio, diagnóstico, prognóstico e monitoramento da doença ainda se apresenta com um dos principais objetivos técnico-científicos a ser alcançado. Objetivo: apresentar um novo marcador, o aptâmero A4 selecionado previamente por 3DCell SELEX na linhagem PC3, e avaliar sua capacidade de detectar CTCs por citometria de fluxo no sangue de pacientes com CaP virgens de tratamento e sob diferentes regimes terapêuticos. Material e métodos: o estudo avaliou 34 homens com CaP e 16 homens sem alterações prostáticas. Foi coletado o sangue em tubo com EDTA, e após proceder a lise de hemácias, as células nucleadas de cada paciente foram incubadas com o aptâmero A4 conjugado à biotina, e em seguida lavadas e incubadas com estreptoavidina-FITC para posterior análise em citometria de fluxo. Os percentuais de CTCs foram comparados entre os dois grupos de pacientes e correlacionados com idade, níveis de PSA, estadiamento e procedimentos terapêuticos adotados (bloqueio hormonal, radioterapia e cirurgia). O limite de detecção acima de 1% de CTCs foi considerado positivo, utilizando como base o percentual observado em todos os 16 controles negativos. Resultados: todos os pacientes foram diagnosticados como positivos independentemente do tempo de terapia ou do estadiamento, exceto um paciente sob bloqueio hormonal que não apresentou CTCs. O percentual de CTCs apresentou alta correlação com idade (R=0,75) e com os níveis de PSA (R=0,80) de forma exponencial, embora seis pacientes com altos índices de células circulantes apresentaram PSA<0,02ng/mL, considerados como falha bioquímica. Conclusão: nossos resultados preliminares indicam uma acurácia elevada de 98% e demonstra um grande potencial de aplicação dessa nova tecnologia diagnóstica tanto no rastreamento, quanto no monitoramento do tratamento do CaP, o qual deverá ser melhor investigado em população de risco. / Introduction: prostate cancer (PCa) early diagnosis is essential to boost patients’ life expectance. Although, current biomarkers and diagnosis methods do not present reliable sensibility and specificity, making the diagnosis rather imprecise. Recent methodologies have been using circulating tumor cells (CTCs), not for screening of PCa, but as prognosis indicators, employing a vast array of techniques to capture those cells. However, the search for a new biomarkers or diagnosis methods able to screen, diagnosis, assist in prognosis and in the disease monitoring still one of the major technical and scientific objectives to be achieved. Objective: To present a new biomarker for PCa, the aptamer A4, previous screened in the prostate cancer cell line PC3, using 3DCell SELEX. And to able to detect, by flow cytometry, CTCs in blood samples of PCa patients undergoing various treatment regimen. Material and methods: the study evaluated 34 PCa patients and 16 health controls. Blood samples were collected in EDTA tubes, and after erythrocytes lysis, nucleated cells were incubated with A4 aptamer conjugated with biotin, them the cells were washed and incubated with streptavidin-FITC for later flow cytometer analysis. Percentage of CTCs were compared between patient’s groups and correlated against age, PSA levels, staging and treatment regimen (hormonal blockade, radiotherapy and surgery). Detection limit above 1% of CTCs was considered positive, based on the percentage observed on all of the 16 negative controls. Results: all patients were positively diagnosed independently of therapy time or staging, except for one patient undergoing hormonal blockade therapy, which does not present detectable CTCs. CTCs percentage presented high correlation against age (R=0.75) and with PSA levels (R=0.80) with exponential behavior, although, six patients with high CTCs count presented PSA levels <0.02 ng/mL, and were considered was biochemical errors. Conclusion: Our preliminary results indicated high accuracy (98%) and demonstrate a potential application of this technology for diagnosis and screening, as well as in the monitoring of PCa evolution, which should be better investigated in the risk population. / Dissertação (Mestrado)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Prostate cancer is the second cause of death in men by tumor, surpassed only by lung cancer. Its occurrence is estimated to be 51 to 100,000 cases per year. The increasing incidence levels observed may be partially explained by the evolution of diagnostic methods, quality of information systems and longer life expectancy. The identification of new cancer specific antigens and genes may provide important biomarkers for diagnosis and instruments for the development of new treatment strategies. The Phage Display technology may be able to select peptides with different aims, such as the discovery of mimetic antigens that are recognized by specific antibodies. Selected peptides may become potential tumor biomarkers for prostate cancer diagnosis. It could be possible to use this technology to identify proteins that are able to detect cancer earlier than the conventional methods, to predict disease staging, and to develop new treatment strategies based on more efficient biological targets. The immunization of SPF (specific pathogen free) male chickens with total proteins of tissues of prostate cancer has generated polyclonal specific IgY sera, which were used in biopanning procedures against random peptide libraries. Selected phages were characterized by sequencing and bioinformatics, and subsequently by dot immunoblotting and ELISA to validate their specificity. Selected peptides were mimotopes of putative proteins involved in the carcinogenesis process. These peptides were further tested for their possible use in the immune response diagnostics associated with tumor processes. In this work, we have also successfully developed a general immunosensor for diagnostics, performed on an exclusion liquid chromatography system based on a micro column resin separation, using the selected bacteriophages as carriers of antigens and antibodies. These phage are coupled to colored latex beads, which are activated with different chemical groups. The presence of phage in the process is of fundamental importance, once they favor the formation of the antigen-antibody complex, peptide-protein or peptide-substrate, amplifying the optical detection during chromatographic separation or by micro-agglutination in slides for optical microscopy detection. The new technology is practical and simple, and may also be used for detection of other biomolecules or chemical substances associated with infectious and genetic diseases, with high precision, sensitivity, specificity, and rapidity, using low sample volumes and presenting a low cost. / O câncer de próstata é a segunda causa de óbitos por câncer em homens, sendo superado apenas pelo câncer de pulmão. A ocorrência estimada é de 51 casos novos para cada 100 mil homens por ano para este tipo de câncer. O aumento observado nas taxas de incidência pode ser parcialmente justificado pela evolução dos métodos diagnósticos, pela melhoria na qualidade dos sistemas de informação do país e pelo aumento na expectativa de vida do brasileiro. A identificação de novos antígenos ou genes específicos do câncer de próstata pode prover novos biomarcadores e também fornecer instrumentos para o desenvolvimento de novas modalidades de tratamento. A tecnologia de Phage Display é capaz de selecionar peptídeos com diversas finalidades, como mimetizar antígenos reconhecidos por anticorpos. Peptídeos selecionados por esta técnica são potenciais marcadores tumorais para o diagnóstico do câncer de próstata. Por meio desta metodologia pode ser possível identificar proteínas capazes de detectar a resposta imune contra o tumor mais precocemente do que os métodos tradicionais, predizer o estadio atual do tumor, além de permitir o desenvolvimento de tratamentos mais eficientes. Pela imunização de galos SPF (livre de patógenos específicos) com proteínas totais de tecidos tumorais da próstata, foram obtidas IgY policlonais específicas que foram utilizadas no biopanning contra uma biblioteca de peptídeos recombinantes randômicos. Os fagos selecionados foram caracterizados por seqüenciamento e subsequentemente testados por dot immunoblotting e ELISA para validar a especificidade dos mesmos. Selecionou-se peptídeos que mimetizam proteínas prostáticas, possivelmente proteínas envolvidas no processo de tumorigênese. Esses peptídeos foram testados quanto a sua possível utilização no diagnóstico da resposta imune associada a processos tumorais. Neste trabalho, também foi desenvolvido com sucesso um imunossensor para diagnóstico que tem como base de detecção um sistema de cromatografia líquida por exclusão em micro colunas cromatográficas com bacteriófagos filamentosos carreadores de antígeno(s) e/ou anticorpo(s), selecionados por phage display, acoplados microesferas de látex coloridas, ativadas com diferentes grupamentos químicos. A presença do fago é de grande importância no processo, pois favorece a formação dos complexos antígeno-anticorpo, peptídeo-proteína ou peptídeo-substrato, ampliando a detecção ótica durante a separação por cromatografia ou por microaglutinação em microscopia ótica. A nova tecnologia pode também ser usada para a detecção de biomoléculas ou substâncias químicas associados a doenças infecciosas, parasitárias e genéticas, com rapidez, precisão, sensibilidade e reprodutibilidade, utilizando-se pequenos volumes de amostras e reagentes, apresentando praticidade e baixos custos. / Doutor em Genética e Bioquímica

No description available.

A indicação de biópsia para o diagnóstico precoce do câncer prostático baseia-se na dosagem sérica do PSA e nos achados do toque retal. O PSA é uma kalecreina estando seus genes reguladores ligados aos andrógenos. Drogas que afetam o metabolismo dos andrógenos podem afetar a produção de PSA. A finasterida é uma droga sintética que inibe a conversão de testosterona em DHT pela enzima 5 AR. O uso da finasterida na dose de 5mg/dia para o tratamento da HPB causa redução do volume prostático de 20 a 30% e diminuição dos valores dos PSA em aproximadamente 50% do seu valor inicial após 6 meses. O uso da finasterida na dose de 1mg/dia para o tratamento da AAM foi aprovado pelo FDA em 1997. Um estudo realizado em 2007 avaliou a alteração do nível do PSA em homens com mais de 40 anos fazendo uso de finasterida 1mg/dia para tratamento da AAM. Os resultados revelaram redução dos valores do PSA semelhante à verificada nos pacientes portadores de HPB. Não existem estudos prospectivos sobre o tema incluindo pacientes mais jovens. O objetivo do nosso trabalho foi verificar as alterações da dosagem do PSA, da testosterona sérica total e do volume prostático em indivíduos com menos de 40 anos de idade com em uso de finasterida 1mg/dia. Selecionamos 52 pacientes que após avaliação inicial preenchiam os critérios de inclusão. Foram dosados os níveis séricos do PSA e da testosterona, e mensurado o volume prostático através da ultrassonografia transabdominal, no início do estudo (T0) e um ano após o uso da finasterida (T2). No intervalo, 6 meses após o início da droga, foi solicitada apenas nova dosagem de PSA (T1). O valor médio na avaliação inicial (T0) da dosagem do PSA, da testosterona total plasmática e do volume prostático mensurado pela ultrassonografia transabdominal foi de 0,398 ng/ml (0,14- 0,78); 735,77 ng/dl (548-927) e 21,35 ml (15-31ml) respectivamente. Foi observada uma redução do valor médio do PSA de 9,21% após 6 meses do uso da droga (p=0,001). Após 12 meses do uso da finasterida verificamos uma redução de 10,51% do valor do PSA em relação à dosagem inicial (p<0,001) e uma diminuição do valor médio do volume prostático 21,37 ml para 20,03 ml (p<0,001). Não foi detectada alterações nos níveis de testosterona. Diferentemente de estudos anteriores em que, em homens fazendo uso de finasterida 1mg/dia, houve redução de 40% e 50% dos valores do PSA nas faixas etárias de 40 a 49 anos e 50 a 59 anos, nosso trabalho revelou reduções inferiores. Nosso estudo traz importantes questionamentos em relação a como deve ser feita a correção dos valores do PSA nos pacientes que começaram a utilizar finansterida 1mg antes dos 40 anos de idade e que se apresentam para avaliação prostática. Outro ponto de interesse é se a hiperplasia do componente epitelial observada durante envelhecimento masculino poderia ser inibida pelo uso da finasterida desde a juventude, pois sabemos que indivíduos portadores de deficiência congênita de 5AR não apresentam alopecia e nem tão pouco desenvolvem HPB. / The indication of biopsy for early diagnosis of prostate cancer is based on serum PSA levels and digital rectal examination findings. PSA is a kalecreine and its regulatory genes are modulating by androgens. Drugs affecting the androgens metabolism can affect the production of PSA. Finasteride is a synthetic drug, which inhibits the conversion of testosterone to DHT by the enzyme 5 AR. There are two subtypes of 5AR enzymes, Type 1 that predominates in non-prostatic tissues such as liver and skin, and Type 2, which predominates in the prostate and scalp but is also expressed in other tissues. The use of Finasteride 5mg / day for the treatment of BPH is well known. After six months we observe a decrease in prostate volume by 20 to 30% and also a decrease in total serum PSA concentration of approximately 50%. The use of Finasteride at 1mg / day for the treatment of MAA has been approved by the FDA in 1997. In 2007 a study evaluated the change in total serum PSA concentration in men over 40 years taking Finasteride 1 mg / day to treat MAA. The results showed a reduction in PSA values similar to that observed in patients treated of BPH. There are no prospective studies including younger patients. The aim of our study was to assess the changes in total serum PSA concentration, total serum testosterone concentration and prostate volume in patients younger than 40 years of age in use of Finasteride 1mg / day for MAA. We prospectively selected 52 patients with MAA and indication for treatment with Finasteride who met the inclusion criteria. Serum levels of total PSA and total testosterone and prostate volume, measured by transabdominal ultrasound, were obtained at baseline (T0) and one year after started the drug (T2). In the interval, 6 months after started drug, only serum total PSA concentration was measured (T1). The median value at baseline (T0), for total PSA, total testosterone and prostate volume was 0.398 ng / ml (0.14 to 0.78); 735.77 ng / dl (548-927) and 21.35 ml (15-31ml) respectively. A reduction of 9.21% on total PSA concentration was detected 6 months after started the drug (p = 0.001). After 12 months we observed a 10.51% decrease in total serum PSA concentration, when compared with the baseline value, (p <0.001). A reduction in the median value of prostate volume from 21.37 ml to 20.03 ml (p < 0.001) was also detected at the same period. There were no detectable changes in testosterone levels. They reported a decrease of 40% and 50% in total PSA concentration for groups between 40-49 and 50-59 of age respectively. In our study we observed lower reductions. Our finding may be explained by the fact that the epithelial component of the prostate gland has not yet started the hyperplasia process, so the conversion of testosterone into DHT by blocking 5AR by Finasteride would cause less impact. The fact that the values of plasma testosterone not have changed is not surprising since Finasteride is not considered an anti androgenic drug, it means that the synthesis of the testosterone is not affected by its use. Our study highlights important questions about how the adjustment of PSA values should be done in patients who began taking Finasteride 1mg / day before 40 years of age and present for prostate evaluation. Another point of interest is whether the hyperplasia of the epithelial component, observed during the aging process, could be inhibited by the use of Finasteride. This hypothesis can be corroborate by the fact that individuals with congenital deficiency of 5AR do not present alopecia or develop BPH. In conclusion the use of Finasteride 1mg /day reduces the total serum PSA value by 10,51% after one year. Prostate volume is also reduced by 6,3% in the same period.

Nous avons développé un nouveau test de prédiction de l’efficacité de thérapies anti-cancéreuses. Ce concept se base sur la détermination d’une signature moléculaire tumorale par RT-qPCR. Cette signature est issue d’un algorithme de normalisation innovant de comparaison des données d’expression relative des cibles de la tumeur avec celles de tissus de référence. Cette normalisation offre à chaque cible de la signature un rang et un score spécifique permettant de hiérarchiser les voies pro-tumorales afin de trouver la ou les cibles dominantes responsables du développement de la tumeur. La signature comprend des cibles donnant des informations générales sur le statut et l’hétérogénéité de la tumeur, sur l’angiogenèse et la lymphangiogenèse, sur le microenvironnement tumoral et enfin sur l’activité migratoire. Une validation préclinique dans les modèles du cancer colorectal, de la prostate et du glioblastome, a montré que le test est prédictif de l’efficacité thérapeutique. / We developed a new tool for prediction of cancer treatment efficacy. Our process is based on the determination of the molecular signature which is intended to provide a clinician’s decision tool helping to select which tumor signaling pathway(s) has/have to be targeted for best therapeutic effect. This signature representing a scoring obtained by RT-qPCR through a sequential normalization process of the expression level of target genes in the tumor compared to cancer type-specific references. These genes were selected because of a good knowledge of related biological functions, a correlation between expression level and aggressiveness of the tumor, the existence of a therapeutic arsenal already in clinical use. This signature is validated in a preclinical model of colorectal cancer and prostate cancer and glioblastoma. The results obtained show that the test we developed allows to identify the most important signaling pathway implicated in the disease and to choose the best drug.

L'objectif de cette thèse est de développer et d'évaluer des paramètres quantitatifs de l'IRM de la prostate en discriminant les cancers de score de Gleason (GS) ≥7. Nous supposons que les paramètres quantitatifs de l'IRM pourraient aider à standardiser le diagnostic, et à diminuer la variation inter-lecteur et/ou inter-institution du diagnostic du cancer de la prostate. Cette thèse est divisée en trois chapitres. Le premier chapitre, intitulé « IRM T2 quantitatif de la prostate », est une étude rétrospective sur une base de données des patients avant prostatectomie radicale. Le deuxième chapitre, intitulé « IRM multiparamétrique quantitative de la prostate », est aussi une étude rétrospective avant prostatectomie radicale. Le troisième chapitre, intitulé « Élastographie IRM de la prostate par voie trans-périnéale» est une étude expérimentale. Notre première étude montre que le T2 est robuste sur les machines de constructeurs différents. Le T2 est un prédicteur significatif, mais de faible performance, d'agressivité du cancer de la prostate à 3T. Notre deuxième étude montre que la combinaison du 10ème centile de l'ADC avec le Time-topeak (TTP) améliore la performance du diagnostic, et ce modèle est lui aussi robuste entre des machines de constructeurs différents. Notre troisième étude montre les résultats préliminaires sur l'élasticité de la prostate. Ces résultats montrent que l'élastographie IRM de la prostate en haute fréquence d'excitation (>100 Hz) par voie trans-périnéale est faisable. L'élastographie pourrait à l'avenir être intégrée à l'IRM multiparamétrique quantitative pour améliorer la performance de diagnostic / The purpose of this thesis is to develop and evaluate the quantitative methods of multiparametric MRI of prostate in discriminating Gleason score (GS) ≥7 cancers. We suppose that the quantitative parameter of MRI could help standardizer the diagnostic, reduce the inter-lecture and/ or inter-institution variation in diagnostic of prostate cancer. This thesis is divided into three chapters. The firs chapter, entilted « Quantitative T2 MRI of prostate » is a retrospective study on a database of prostate cancer patients before radical prostatectomy. The second chapter, entilted « Multi-parametric Quantitative MRI of prostate » is also a retrospective study before radical prostatectomy. The third chapter, entitled « MR elastography of prostate by transperineal approach », is an experimental study. Our first study shows that T2 value is robust between machines of different constructors. T2 value is significant predictor, but of weak performance, of aggressively cancer of prostate at 3T. Our second study shows that the combination of ADC_10th percentile with Time-to-peak (TTP) improved the diagnosis performance, and this model is also robust between two machines of different constructors. Our third study shows the initial results on elasticity of the prostate. These results show that MRI elastography of prostate at high excitation frequency (>100 Hz) by trans-perineale approach was feasible. The elastography may, in the future, be integrated in quantitative multi-parametric MRI to improve the diagnosis performance

Le cancer de la prostate (PCa) est le deuxième cancer le plus courant chez les hommes au niveau mondial. Le suppresseur de la signalisation des cytokines 1 (SOCS1) est considéré comme un suppresseur de tumeur en raison de la fréquente répression épigénétique de ce gène dans de nombreux cancers. Il a été reporté que SOCS1 inhibait l’activation de STAT3 induite par l’IL-6, ainsi que les cyclines et les kinases dépendantes des cyclines dans les cellules malignes de la prostate. D’autre part, il a été montré que SOCS1 n’était pas essentiel lors du contrôle de la signalisation de l’IL-6 dans les hépatocytes dépourvus de cette protéine, cependant elle est essentielle pour atténuer la signalisation du facteur de croissance des hépatocytes (HGF) via son récepteur MET. MET est un récepteur de tyrosine kinases qui est surexprimé dans le PCa agressif et métastatique. Notre hypothèse de recherche propose que la répression de SOCS1 par méthylation du promoteur et la dérégulation de l’expression de MET et de sa signalisation, sont des mécanismes pathogéniques liés au développement et à la progression du PCa. Nous avons généré des lignées de cellules PC3 et DU145 stables exprimant SOCS1. Les cellules ont été stimulées avec HGF et l’activation des voies de signalisation a été évaluée par immunobuvardage. Des essais in vitro de migration, de prolifération et d’invasion ont été effectués en présence de HGF. Des gènes de transition épithélio-mésenchymateuse ont été évalués par PCR quantitatif en présence ou non du facteur de croissance. Les cellules du PCa transfectées ou pas avec SOCS1 ont été inoculées dans des souris NOD SCID gamma de façon sous-cutanée ou orthoptique afin d’évaluer respectivement la croissance tumorale et la formation de métastases. Les tumeurs reséquées ont été analysées histologiquement et biochimiquement. Nos résultats montrent que SOCS1 atténue l'activation de MET induite par HGF et la phosphorylation d’ERK dans les cellules PC3, ainsi que la phosphorylation d’ERK et d’AKT dans les cellules DU145. SOCS1 inhibe également la prolifération cellulaire induite par HGF, ainsi que la migration et l’invasion in vitro. De plus, SOCS1 réduit l’expression des gènes de transition épithélio-mésenchymateuse impliqués dans la dégradation des composants de la matrice extracellulaire dans les cellules DU145 mais pas dans les cellules PC3. La surexpression de SOCS1 a stimulé l’augmentation de déposition de collagène, in vivo. Les tumeurs formées par les cellules exprimant SOCS1 étaient de taille significativement plus petites avec une réduction de la prolifération comparé aux tumeurs provenant des cellules contrôles. En outre, SOCS1 a inhibé la formation de métastases à distance dans un modèle orthotopique. En conclusion, nous suggérons que SOCS1 est un suppresseur de tumeur indispensable de la prostate, et qu’au moins une partie de sa fonction a lieu via la régulation négative de la signalisation du récepteur MET. / Abstract : Prostate cancer (PCa) is the second most common cancer among men worldwide. Suppressor of cytokine signaling 1 (SOCS1) is considered a tumor suppressor due to frequent epigenetic repression of the SOCS1 gene in several human malignancies. Inactivation of SOCS1 also occurs in PCa by gene methylation and micro-RNA-mediated repression. SOCS1 has been reported to inhibit IL-6-induced STAT3 activation and down-regulates cyclins and cyclin-dependent kinases in PCa cells. It has been shown that SOCS1 is not required to control IL-6 signaling in SOCS1-deficient hepatocytes, but is essential to attenuate hepatocyte growth factor (HGF) signaling via its receptor MET. This protein is a receptor tyrosine kinase (RTK), overexpressed in aggressive and metastatic PCa. Thus we hypothesized that the repression of SOCS1 via promoter methylation and deregulated MET expression and signaling are inter-related pathogenic mechanisms in PCa development and progression. We generated stable SOCS1-expressing PCa cell lines (PC3 and DU145) using lentiviral transduction followed by clonal selection via limiting dilution. Cells were stimulated with HGF and downstream signaling events were assessed by Western blot. Proliferation, migration and invasion assays were also conducted in the presence of HGF in vitro. Epithelial mesenchymal transition genes were evaluated by qPCR in the presence or absence of the growth factor. The PCa cells transfected with SOCS1 and non-transfected controls were inoculated into NOD SCID gamma mice as xenografts or as orthotopic tumors to assess tumor growth and metastasis formation, respectively. Resected tumors were further analyzed histologically and biochemically. Our results showed that SOCS1 attenuates HGF-induced MET activation and ERK phosphorylation in PC3 and DU145 PCa cell lines. SOCS1 inhibited HGF induced cell proliferation, migration and invasion in vitro. Additionally, SOCS1 decreased epithelial mesenchymal transition genes involved in the degradation of extracellular matrix components in DU145 cells but not in PC3. In vivo, SOCS1 overexpression leads to an increase of collagen deposition. Tumors formed by SOCS1 expressing cells were significantly smaller in size with reduced cell proliferation compared to tumors arising from control cells. Furthermore, SOCS1 inhibited distant metastasis formation in the orthotopic model. Overall our results suggest that SOCS1 has a tumor suppressor role in PCa evolution and part of this function is mediated by the negative regulation of MET receptor signalling and down-regulation of genes supporting migration and invasion processes such as matrix metalloproteinases.