Chapter 1 includes the Introduction and literature review which describes current developments within the field of in vitro/vivo imaging of cancers, with a particular emphasis on the techniques employing fluorescence emission-based spectroscopy and imaging modalities. Examples are cited whereby graphene and its congeners have been used in conjunction with various fluorophores and peptide sequences as a means of achieving highly specific imaging probes. This section discusses aspects of energy transfer and the possibility that molecular probes can be designed to achieve both therapeutic goals and diagnosis (Theranostics). This review concludes with a discussion of the use of organic supramolecularly assembled imaging agents as a means of achieving thermodynamically controlled nano-constructs for the functionalisation of graphenes and their potential future applications as theranostic agents. Chapters 2, 3 and 4 describe the synthesis of chiral and naphthalene diimides (NDIs) which are fluorescent. Spectroscopic investigations in the solution phase are described and the propensity for aggregation in these systems is discussed. The specific nature of the self-assembly processes involved is explored in different solvent systems and in the solid state. Fluorescence lifetime imaging microscopy (FLIM) and laser scanning confocal microscopy (LSCM) are used to investigate the cellular uptake of the NDI molecules and their capacity to image living prostate cancer cells (PC-3). The NDIs are subsequently complexed supramolecularly to poly-aromatic carbon systems such as C60 and coronene (Chapter 3), as well as thermally reduced graphene oxide (Chapter 4). Chapter 3 describes the explorations into the modelling of the donor-acceptor interactions between the NDIs and the C60/coronene in order to establish binding stoichiometry and association constants. Both Chapters 3 and 4 discuss fluorescence titration and time correlated single photon counting (TCSPC) experiments which were performed as a means of establishing the presence of excited state energy transfer mechanisms. The chapters conclude with investigations in living cells in order to establish retention of in vitro fluorescence, with particular attention being paid to confirming the graphene complex stability. Chapter 5 describes the synthesis and functionalisation of a seven amino acid sequence peptide known as the G-receptor protein (GRP) binding unit of the polypeptide bombesin. The sequence binds GRPs that are known to be up-regulated in prostate cancer carcinoma and it has been widely utilised in the literature as a means of enhancing the up-take of various cancer imaging agents that employ a variety of imaging modalities. The peptide was attached to the fluorescent NDIs via carbodiimide activation protocols with the purpose of providing added specificity to the imaging agent with respect to PC-3 cells. Prior to NDI derivatisation with bombesin, electrochemical impedance spectroscopy (EIS) has been performed to establish the extent to which the peptide sequence binds to prostate cancer cells over healthy ones. The chapter concludes with confocal microscopy of the bombesin derivative NDI complexed to thermally reduced graphene oxide as a means of validating the utility of the fluorescent targeted bioconjugate as synthetic scaffolds for future early diagnosis and sensing devices for prostate cancer. Chapter 6 constitutes the summary of this work and highlights several possible areas of future developments of relevance to the results discussed and related future experiments proposed to fully validate the device assembly for prostate cancer sensing. Chapter 7 contains the Experimental section and the relevant data gathered over the course of the investigations. Additional supporting figures or data referred to but not included in the main text of the thesis are reported in the Appendices.

Orientador: Renée Laufer Amorim / Banca: Antonio Carlos Alessi / Banca: Kellen de Sousa Oliveira / Resumo: A próstata canina pode desenvolver espontaneamente lesões proliferativas, associadas com a idade, inflamação e os hormônios, tais como: a hiperplasia prostática benigna (HPB), a atrofia inflamatória proliferativa (PIA) e o carcinoma prostático (CaP). Consequentemente, o cão pode ser usado para o estudo do processo carcinogênico da próstata no homem. Alterações na expressão gênica, proteica e na função do PTEN e TP53 foram detectadas nas lesões pré-neoplásicas e neoplásicas da próstata humana. A super-expressão da oncoproteína MDM2 e a perda de marcação nuclear do receptor andrógeno (AR) foram correlacionados com progressão tumoral e ineficiência ao tratamento anti-andrógeno do CaP no homem. Neste contexto, o objetivo deste estudo foi avaliar a expressão proteica de PTEN, MDM2, p53 e AR para determinar seu papel no processo carcinogênico da próstata canina e validar os resultados obtidos pelo grupo de pesquisa com a técnica de hibridação genômica comparativa (CHG) nesses genes. Com isso, foi construído um microarranjo de tecido (TMA), com 74 amostras da glândula prostática canina, divididas em 18 HPB, 22 PIA, 19 CaP e 15 próstatas de tecido normal. A técnica de imuno-histoquímica para os anticorpos PTEN, MDM2, p53, e AR, foi realizada pelo método de peroxidase e DAB. O PTEN, p53 e AR apresentaram perda de marcação nuclear nos carcinomas prostáticos quando comparados com o tecido prostático normal. Na oncoproteína MDM2, o tecido normal obteve marcação nuclear e citoplasmática discreta enquanto no CaP, mais de 85% das amostras apresentaram super-expressão citoplasmática/nuclear. A perda de marcação nuclear do PTEN, p53 e AR, e o ganho da expressão de MDM2 também foi relatado no CaP do homem, sugerindo que existem semelhanças nas alterações moleculares da rede PTEN/MDM2/p53 e AR em ambas as espécies no processo de carcinogênese prostática. Por conseguinte, a espécie cão é um ... / Abstract: The canine prostate may spontaneously develop prostatic proliferative lesions, associated with aging, inflammation and hormones, such as: benign prostatic hyperplasia (BPH), proliferative inflammatory atrophy (PIA) and prostatic carcinoma (PCa). Consequently, the dog can be used for the study of carcinogenesis process in the prostate of men. Changes in PTEN and TP53 gene and protein expression and function were detected in preneoplasic and neoplasic lesion of human prostate. MDM2 oncoprotein overexpression and loss of nuclear staining of androgen receptor (AR) were correlated with tumor progression and inefficiency antiandrogen treatment of PCa in men. In this context, the aim of this study was to evaluate PTEN, MDM2, p53 and AR protein expression to determine their role in carcinogenic process of the canine prostate. We built a tissue microarray (TMA), with 74 samples of canine prostate, divided into 18 BPH, PIA 22, 19 PCa and 15 prostates of normal tissue. The immunohistochemistry was carried for PTEN, MDM2, p53, and AR antibodies with peroxidase method and DAB. The PTEN, p53 and AR showed loss of nuclear staining in canine prostate carcinoma compared with normal prostate tissue. MDM2 oncoprotein, in normal tissue was discrete cytoplasmic and we observed nuclear staining in CaP, while more than 85% of the samples showed cytoplasmic/nuclear overexpression. The loss of nuclear staining of PTEN, p53 and AR, and the gain of MDM2 expression was also reported in human PCa, suggesting that there are similarities in the molecular alterations of PTEN/MDM2/p53 network and AR in both species in the process prostate carcinogenesis. Therefore, the dog is a potential model for the study of molecular signaling pathways as PTEN/MDM2/p53 and AR involved in human PCa / Mestre

研究背景與研究目的 / 細胞衰老是指細胞進入不可逆的永久化的生長停滯狀態。目前，細胞衰老作為重要的抑癌機制受到廣泛認可，对其相關信號通路的研究為腫瘤的靶向治療提供了新的依據和策略。TLX核受體基因属于核受體亞家族2組E成員1，是一種孤兒受體。雞和老鼠TLX基因最初作為果蠅末端/间隙基(tailless) 的同源基因而被發現，而人TLX 基因是在檢索惡性淋巴癌中的抑癌細胞而從人胚胎的腦cDNA文庫中克隆出來的。TLX基因敲除的轉基因老鼠的研究表明TLX基因對維持胚胎腦和成体腦神經幹細胞的分裂增殖起重要作用。最近的研究發現，TLX在臨床神經胶质瘤組織中高表達。並且，在轉基因鼠中，TLX的高表達会引起神經幹細胞的大量增殖而形成腦腫瘤，提示TLX可能參與腦腫瘤的發生和發展。但是，TLX对包括前列腺癌在内的人類惡性腫瘤的發生發展中所起的功能及作用機制尚不清楚。表達譜研究發現，TLX在前列腺細胞中的表達水平高於永生化的正常前列腺上皮細胞的表達，並且，TLX在臨床惡性程度高的前列腺癌中呈高表達趨勢，預示TLX可能參與促進前列腺癌的惡性進展。因此本研究的主要目的是TLX在前列腺癌細胞中的功能研究。 / 研究材料與方法 / 為了研究TLX對前列腺癌細胞生長的影響以及相關機制，本論文主要採用以下方法：1）運用免疫組化的方法檢測TLX在臨床前列腺癌組織中的表達，並應用實時螢光定量PCR方法檢測TLX在永生化的非惡性前列腺上皮細胞以及前列腺癌細胞株中的表達；2）根據不同的p53表達狀態選擇雄激素依賴（LNCaP）和雄激素非依賴（PC-3, DU145）的前列腺癌細胞株，分別采用慢病毒感染和逆轉錄病毒感染的方法建立TLX-敲除和TLX-過表達的細胞株，並研究這些穩轉細胞系離體和在體的生長表型（包括檢測細胞生長，細胞週期，細胞衰老，細胞的遷移和侵染，化療藥物抗性，缺氧耐受性以及體內成瘤能力）；3）採用檢測β-半乳糖苷酶活性的方法檢測TLX穩轉系細胞在衰老因素誘導和非誘導狀態下TLX缺失和高表達對細胞衰老的影響；4）采用免疫印跡（western blot）的方法檢測TLX穩轉系細胞中參與細胞衰老的關鍵蛋白的表達情況；5）利用雙螢光素酶報告基因方法和染色質免疫沉澱技術，研究TLX對靶基因的調控；6）構建TLX缺失變異體（△ZF1 和 △LBD-AF2），在前列腺細胞系和非前列腺細胞系中外源性表達相應的變異體進一步驗證TLX的功能。 / 結果 / 本論文研究結果總結如下：1）TLX在前列腺癌細株中和惡性程度高的前列腺癌組織中高表達；2）在前列腺癌中進行TLX基因敲除能顯著抑制細胞體外和體內的生長並誘導前列腺癌細胞的衰老；3）相反，TLX的過表達能促進前列腺癌細胞體外和體內的惡性生長，包括促進細胞的錨定和非錨定性生長、促進細胞的遷移與侵染、增強細胞缺氧耐受、對化療藥物抗性、以及增強細胞異位移植瘤的成瘤能力；4）TLX 的高表達抑制了前列腺癌細胞衰老，並保護細胞免受多柔比星誘導的細胞衰老以及持續性激活的癌基因H-RAS（H-RAS{U+1D33}¹²{U+2C7D}）誘導的細胞衰老；5）TLX可以結合到p21{U+1D42}{U+1D2C}{U+A7F1}¹/{U+A7F0}{U+1D35}{U+1D3E}¹基因（其後縮寫為p21）的啟動子序列並抑制p21的啟動子的轉錄活性，並且在TLX-過表達細胞中外源性高表達p21能誘導前列腺癌細胞重新進入衰老狀態；6）TLX也能結合到SIRT1基因的啟動子序列並激活SIRT1的轉錄活性，在TLX-過表達細胞中對SIRT1進行基因沉默能誘導這些細胞的再次衰老；7）TLX介導的衰老抑制效應以及對其靶基因的轉錄調控作用需要完整的DNA-結合域以及配體結合域，對TLX兩個區域的缺失變異影響TLX在前列腺細胞和非前列腺細胞中的生理功能及轉錄調控活性。 / 結論 / 本論文的研究結果提示TLX通過抑制前列腺癌細胞的衰老在前列腺癌發生發展過程中起重要作用，並且這種衰老抑制作用是通過介導p21基因的轉錄抑制以及對SIRT1基因的轉錄激活而實現的。此研究首次證實了TLX在前列腺癌中高表達，並且TLX能夠抑制前列腺癌細胞的衰老從而促進前列腺癌的發生發展，提示TLX有可能成為前列腺癌治療潛在的重要靶點。 / Background and aims of the study / Cellular senescence represents an irreversible form of permanent cell-cycle arrest and it acts a key process of tumor suppression, while targeting to pathways involved in this process can provide potential and promising therapeutic strategies to cancer treatments. TLX belongs to the NR2E1 orphan nuclear receptor subfamily. The chicken and mouse TLX genes were initially isolated as a vertebrate homolog to the Drosophila terminal-gap gene tailless (tll), while the human TLX was cloned from a fetal brain cDNA library in a search for putative tumor suppressor genes in lymphoid malignancies. Functional studies in transgenic mouse model of TLX-knockdown show that TLX plays important regulatory roles in the maintenance and self-renewal control of both embryonic and adult neural stem cells. Recent studies of transgenic mice with TLX overexpression combined with its expression studies in human clinical gliomas revealed that TLX is overexpressed in primary human glioblastomas and its dysregulation may contribute to the initiation and development of some brain tumors. However, the exact functional contributions of TLX and the involved mechanism(s) in human malignancies, including prostate cancer, are still far from clear. In an expression profile study, it was demonstrated that TLX exhibited an up-regulated expression pattern in many prostate cancer cell lines and also the high-grade clinical prostate cancer, suggesting that TLX might play a positive regulatory role in the advanced progression of prostate cancer. The overall aim of this study was to elucidate the functional role of TLX in prostate cancer cell growth. / Materials and methods / In order to elucidate the functional roles of TLX in prostate cancer growth and the involved mechanisms, the following experiments were conducted: 1) To investigate and determine the expression pattern of TLX in clinical prostatic tissues by immunohistochemistry, and to survey the expression profile of TLX in a panel of prostatic immortalized epithelial and prostate cancer cell lines by quantitative real-time PCR analysis; 2) To generate stable TLX-knockdown prostate cancer cells by lentiviral transduction and TLX-stable expressing cells by retroviral transduction in both hormone-sensitive (LNCaP) and -insensitive (DU145 and PC-3) prostate cancer lines with different expression status of p53; and to conduct growth phenotype characterization studies (including cell growth, cell cycle, cellular senescence, cell migration and invasion, resistance to chemotherapy drugs, hypoxic cell growth assays, and tumorigenesis) on these TLX-transfectants in vitro and in vivo; 3) To characterize cellular senescence phenotype of TLX-infectants by senescence-associated β-galactosidase (SA-β-Gal) staining method with or without senescence inducers; 4) To investigate the expression status of markers involved in cellular senescence in TLX-infectants by immunoblotting; 5) To demonstrate the transcriptional regulation targets of TLX by dual-luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay; 6) To confirm the cellular function of TLX in prostatic and non-prostatic cells expressing different TLX deletion mutants (△ZF1 and △LBD-AF2). / Results / Results obtained in this study are summarized as follows: 1) TLX displayed an increased expression pattern in many prostate cancer cell lines and also high-grade (Gleason score ≥ 7) prostate cancer tissues; 2) Depletion of TLX mRNA by RNA interference dramatically suppressed in vitro and in vivo tumor cell growth and triggered cellular senescence (SA-β-Gal histochemical marker) in prostate cancer cells; 3) On the contrary, TLX overexpression significantly enhanced multiple advanced malignant growth capacities (including enhanced anchorage-dependent and -independent cell growth, cell migration and invasion, hypoxia adaptation, resistance to chemotherapy drug Doxorubicin as well as in vivo tumorigenicity) in prostate cancer cells; 4) TLX overexpression significantly suppressed cellular senescence and protected cells against doxorubicin-induced or oncogenic H-RAS (H-RAS{U+1D33}¹²{U+2C7D})- induced senescence; 5) TLX could directly bind to p21{U+1D42}{U+1D2C}{U+A7F1}¹/{U+A7F0}{U+1D35}{U+1D3E}¹ gene (hereafter p21) promoter and repress the transcriptional activity of p21 promoter, while ectopic restoration of p21 expression in TLX-overexpressed cells could rescue cellular senescence with enhanced SA-β-Gal staining; 6) protein deacetylase SIRT1 gene was also activated by TLX through its direct transcriptional regulation, while knockdown of SIRT1 in TLX-overexpressed cells could rescue cellular senescence; 7) TLX-induced suppression of cellular senescence and also its direct gene regulation would require an intact DBD and LBD domain, as truncated deletion of DBD or LBD domain could both abolish the cellular function and transcriptional activity of TLX in prostatic and non-prostatic cells. / Conclusions / The results obtained in this study suggested that TLX could play a positive growth regulatory or tumor-promoting role in prostate cancer development by its suppression of cellular senescence and this senescence suppression was mediated via its direct transcriptional regulation of both p21 (repression) and SIRT1 (transactivation) genes. Moreover, this study also showed for the first time that TLX, which was overexpressed in prostate cancer tissues, might function to suppress premature senescence in prostate cancer progression and also targeting to TLX could be a potential therapeutic approach for prostate cancer treatment. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wu, Dinglan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 135-151). / Abstract also in Chinese. / Thesis /Assessment Committee --- p.I / ABSTRACT --- p.II / 摘 要 --- p.VI / ACKNOWLEDGEMENT --- p.IX / PUBLICATIONS RELATED TO THIS THESIS --- p.XI / CONTENTS --- p.XII / ABBREVIATION --- p.XV / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Prostate cancer --- p.2 / Chapter 1.1.1 --- Epidemiology --- p.2 / Chapter 1.1.2 --- Nature history --- p.4 / Chapter 1.1.3 --- Androgen Axis prostate cancer --- p.7 / Chapter 1.1.3.1 --- Androgen receptor --- p.7 / Chapter 1.1.3.2 --- Function of the androgen receptor in prostate cancer --- p.7 / Chapter 1.1.3.3 --- Mechanisms of CRPC progression --- p.8 / Chapter 1.1.3.4 --- Androgen receptor pathway-directed therapies --- p.10 / Chapter 1.1.4 --- Treatment of prostate cancer --- p.11 / Chapter 1.2 --- Cellular senescence --- p.13 / Chapter 1.2.1 --- What is senescence --- p.13 / Chapter 1.2.1.1 --- Replicative cellular senescence --- p.13 / Chapter 1.2.1.2 --- Oncogene induced senescence (OIS) --- p.15 / Chapter 1.2.1.3 --- Tumor suppressor loss-induced senescence --- p.17 / Chapter 1.2.2 --- Establishment of cellular senescence --- p.19 / Chapter 1.2.3 --- The p16/pRb and ARF/p53/p21 pathway of senescence induction --- p.21 / Chapter 1.2.3.1 --- p16/pRb senescence pathway --- p.22 / Chapter 1.2.3.2 --- ARF/p53/p21 senescence pathway --- p.23 / Chapter 1.2.4 --- Markers of senescence --- p.24 / Chapter 1.2.4.1 --- Cell cycle arrest and morphology --- p.24 / Chapter 1.2.4.2 --- Senescence-associated β-galactosidase --- p.25 / Chapter 1.2.4.3 --- p16/pRb and p53/p21 pathways --- p.26 / Chapter 1.2.4.4 --- γ-H2AX staining as a marker for DNA damage --- p.27 / Chapter 1.2.4.5 --- Senescence-associated heterochromatin foci (SAHF) --- p.27 / Chapter 1.2.5 --- Pro-senescence therapy for cancer treatment --- p.29 / Chapter 1.2.5.1 --- Why pro-senescence therapy --- p.29 / Chapter 1.2.5.2 --- Critical factors of pro-senescence therapy --- p.31 / Chapter 1.2.5.3 --- Strategies of senescence induction --- p.32 / Chapter 1.2.5.4 --- Targeting to senescence-associated secretory phenotype (SASP) --- p.38 / Chapter 1.2.6 --- Future direction --- p.40 / Chapter 1.3 --- TLX --- p.41 / Chapter 1.3.1 --- Nuclear receptor --- p.41 / Chapter 1.3.2 --- Identification of tailless/TLX --- p.42 / Chapter 1.3.3 --- Tailless in drosophila --- p.43 / Chapter 1.3.4 --- Functional role of tll/TLX --- p.45 / Chapter 1.3.4.1 --- Role of tll/TLX in brain development --- p.45 / Chapter 1.3.4.2 --- Role of tll/TLX in visual system developments --- p.46 / Chapter 1.3.4.3 --- Role of TLX in neural stem cell self-renewal --- p.47 / Chapter 1.3.5 --- Target genes of TLX --- p.49 / Chapter 1.3.6 --- Transcriptional regulation of tll/TLX --- p.51 / Chapter 1.3.7 --- TLX in cancer --- p.52 / Chapter CHAPTER 2 --- STUDY AIMS --- p.54 / Chapter CHAPTER 3 --- MATERIALS AND METHODS --- p.57 / Chapter 3.1 --- Human prostatic tissues and Immunohistochemistry --- p.58 / Chapter 3.2 --- Cell lines and cell cultures --- p.59 / Chapter 3.3 --- Antibody and reagents --- p.63 / Chapter 3.3.1 --- Generation of rabbit anti-TLX polyclonal antibody --- p.63 / Chapter 3.3.2 --- Commercial antibody --- p.64 / Chapter 3.4 --- RNA isolation and Reverse transcriptional-PCR --- p.65 / Chapter 3.4.1 --- RNA isolation --- p.65 / Chapter 3.4.2 --- Reverse transcription reaction (RT) --- p.66 / Chapter 3.4.3 --- Polymerase Chain Reaction (PCR) --- p.66 / Chapter 3.5 --- Western blotting --- p.68 / Chapter 3.5.1 --- Protein extraction --- p.68 / Chapter 3.5.2 --- Electrophoresis, Protein blotting and Colorimetric detection --- p.69 / Chapter 3.6 --- Plasmids construction --- p.70 / Chapter 3.6.1 --- PCR for sub-cloning --- p.70 / Chapter 3.6.2 --- PCR for mutant generation --- p.71 / Chapter 3.6.3 --- Restriction enzymes digestion and ligation --- p.72 / Chapter 3.7 --- Retroviral, lentiviral transduction and generation of TLX-stable cells --- p.73 / Chapter 3.8 --- RNA interference --- p.75 / Chapter 3.9 --- In vitro cell growth assay --- p.76 / Chapter 3.9.1 --- Cell counting --- p.76 / Chapter 3.9.2 --- MTT assay --- p.76 / Chapter 3.9.3 --- Soft agar assay for anchorage independent growth --- p.77 / Chapter 3.10 --- Cell cycle assay --- p.77 / Chapter 3.11 --- Cell invasion assay --- p.78 / Chapter 3.12 --- In vivo tumor growth assay --- p.78 / Chapter 3.13 --- In vitro and in vivo SA-β-Gal staining --- p.79 / Chapter 3.14 --- In vitro treatment with doxorubicin --- p.80 / Chapter 3.15 --- Transient Transfection and Luciferase Reporter Assay --- p.81 / Chapter 3.16 --- Chromatin immunoprecipitation (ChIP) assay --- p.82 / Chapter 3.16.1 --- Cross-linking and harvesting cells --- p.82 / Chapter 3.16.2 --- Cell lysis --- p.83 / Chapter 3.16.3 --- Sonication --- p.83 / Chapter 3.16.4 --- Immunoprecipitation --- p.83 / Chapter 3.16.5 --- Washing --- p.84 / Chapter 3.16.6 --- Elution --- p.85 / Chapter 3.16.7 --- Reverse cross-linking and DNA purification --- p.85 / Chapter 3.16.8 --- PCR --- p.86 / Chapter 3.17 --- Statistical analysis --- p.86 / Chapter CHAPTER 4 --- RESULTS --- p.87 / Chapter 4.1 --- TLX is up-regulated in prostate carcinoma and prostate cancer cell lines --- p.88 / Chapter 4.2 --- Knockdown of TLX suppresses in vitro cell growth and triggers cellular senescence in prostate cancer cells --- p.93 / Chapter 4.3 --- Knockdown of TLX inhibits in vivo tumor growth and induces cellular senescence of prostate cancer cells --- p.97 / Chapter 4.4 --- Ectopic expression of TLX enhances in vitro cell growth and multiple advanced malignant phenotypes in prostate cancer cells --- p.100 / Chapter 4.5 --- Ectopic expression of TLX suppresses cellular senescence in prostate cancer cells --- p.105 / Chapter 4.6 --- TLX suppresses cellular senescence via its direct transcriptional repression of p21{U+1D42}{U+1D2C}{U+A7F1}¹/{U+A7F0}{U+1D35}{U+1D3E}¹ gene --- p.110 / Chapter 4.7 --- TLX also suppresses cellular senescence via its transcriptional regulation of SIRT1 gene --- p.116 / Chapter CHAPTER 5 --- DISCUSSION --- p.121 / Chapter CHAPTER 6 --- SUMMARY --- p.131 / REFERENCES --- p.135

A partir de um melhor entendimento sobre a radiossensibilidade do câncer de próstata, com a redefinição de parâmetros radiobiológicos, atualmente os esquemas hipofracionados de próstata tornaram-se um dos principais desafios da radioterapia moderna. Associado a este conhecimento, o emprego de técnicas precisas de radioterapia possibilitaram a entrega de maiores doses por fração, com manutenção da toxicidade e melhor controle de qualidade dos planos de tratamento. Pretendemos avaliar a implementação da radioterapia tridimensional computadorizada (3D-CRT) ou intensidade modulada do feixe (IMRT) utilizando o regime de hipofracionamento moderado (70 Gy em 28 frações) em pacientes com neoplasia localizada da próstata na rotina do departamento de radioterapia do Hospital das Clínicas da FMRP-USP. Avaliação da viabilidade técnica e do impacto financeiro na utilização da radioterapia hipofracionada na instituição. / Evaluate the implementation of computerized three-dimensional radiation therapy (3D-CRT) or intensity modulated beam (IMRT) using moderate hypofractionation schedule (70 Gy in 28 fractions) in patients with localized prostate cancer (no metastasis lymph node or distant metastasis) in routine of department of radiotherapy of the Hospital of FMRP-USP. Assessment of technical feasibility and financial impact on the use of hypofractionated radiotherapy in the institution.

Cheung Chun Pan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 192-227). / Abstracts in English and Chinese. / Acknowledgements --- p.I / Abstract (English) --- p.II / Abstract (Chinese) --- p.VI / Contents --- p.VIII / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Nuclear hormone receptor: a general review --- p.1 / Chapter 1.1.1 --- Classification of nuclear hormone receptors --- p.1 / Chapter 1.1.2 --- Mechanism of action --- p.2 / Chapter 1.1.3 --- Domains structure and functions --- p.3 / Chapter 1.1.4 --- Orphan nuclear receptors --- p.4 / Chapter 1.2 --- Prostate gland - a male accessory reproductive organ --- p.6 / Chapter 1.2.1 --- "Anatomy, histology and physiology of the prostate gland" --- p.6 / Chapter 1.2.2 --- Endocrinology of the prostate gland --- p.8 / Chapter 1.2.3 --- Pathogenesis of the prostate gland --- p.8 / Chapter 1.3 --- The role of estrogen receptors in the prostate gland and prostate cancer --- p.9 / Chapter 1.3.1 --- Estrogens in male --- p.10 / Chapter 1.3.2 --- Effects of estrogens in the prostate gland --- p.11 / Chapter 1.3.3 --- Estrogen receptors - two isoforms --- p.13 / Chapter 1.3.4 --- Expression of ERs in the prostate gland --- p.14 / Chapter 1.3.5 --- Estrogen-modulated transgenic mice 226}0ؤ functional studies of ERs --- p.16 / Chapter 1.4 --- Estrogen receptor-related receptors: orphan receptors --- p.18 / Chapter 1.4.1 --- Estrogen receptor-related receptors: Three isoforms --- p.18 / Chapter 1.4.2 --- Expression of ERRs in different tissues --- p.20 / Chapter 1.4.3 --- Promoter binding and genes regulated by of ERRs --- p.22 / Chapter 1.4.4 --- Coregulators of ERRs --- p.24 / Chapter 1.4.5 --- Ligand of ERRs --- p.25 / Chapter 1.4.6 --- Functional roles of ERRs --- p.29 / Chapter 1.4.7 --- Cross talk between ERRs and ERs --- p.31 / Table 11 --- p.33 / Figure 1.1 - 15 --- p.35 / Chapter Chapter 2 --- Aims of the Study --- p.40 / Chapter Chapter 3 --- Methods and Materials / Chapter 3.1 --- "Expression patterns of ERRs and steroid hormone receptors in the human prostate cell lines, tumor xenografts and prostatic tissues" --- p.41 / Chapter 3.1.1 --- Human prostatic tissues --- p.41 / Chapter 3.1.2 --- Cell cultures --- p.41 / Chapter 3.1.3 --- Human prostate cancer xenografts --- p.42 / Chapter 3.1.4 --- Full length clones of ERR isoforms --- p.42 / Chapter 3.1.5 --- Reverse transcription-polymerase chain reactions (RT-PCR) --- p.43 / Chapter 3.1.6 --- Semi-quantitative RT-PCR analysis --- p.45 / Chapter 3.1.7 --- Southern blot analysis --- p.46 / Chapter 3.1.8 --- Generation and characterization of polyclonal antibodies --- p.49 / Chapter 3.1.9 --- Western blot analysis --- p.55 / Chapter 3.1.10 --- Immunohistochemistry --- p.56 / Chapter 3.2 --- Relationship of ERR and ER expressions in the prostatic cells --- p.57 / Chapter 3.2.1 --- "Expression vectors of ERRa, ERRγ and ERa" --- p.57 / Chapter 3.2.2 --- "Transient transfection of ERRa, ERRγ and ERa expression vectors in PC-3 cells" --- p.58 / Chapter 3.2.3 --- Semi-quantitative RT-PCR analysis --- p.59 / Chapter 3.3 --- Intracellular trafficking and transcriptional activity of GFP-tagged ERRs in the prostatic cells --- p.59 / Chapter 3.3.1 --- Construction of GFP-tagged ERR fusion plasmids --- p.59 / Chapter 3.3.2 --- Examination of transcriptional activity of GFP-tagged ERRs by luciferase assay --- p.61 / Chapter 3.3.3 --- Subcellular localization of GFP-tagged ERRs in the living prostatic cells --- p.63 / Chapter 3.3.4 --- Immunofluorescent staining GFP-tagged ERRs --- p.63 / Chapter 3.4 --- The Role of ERRs in the growth of the prostatic cells --- p.64 / Chapter 3.4.1 --- Evaluation the transfection efficiencies of PC-3 and PNT2 cells --- p.64 / Chapter 3.4.2 --- Cells proliferation assays in ERRs transient transfected prostatic cells --- p.66 / Chapter 3.4.3 --- Flow cytometry of ERRs transient transfected PC-3 cells --- p.66 / Chapter 3.4.4 --- RT-PCR of cell cycle-related genes in ERRs transient transfected PC-3 cells --- p.67 / Chapter 3.4.5 --- Generation of PNT2 and DU145 cells stably transfected with ERRy --- p.68 / Chapter 3.4.6 --- Cell proliferation assay of ERRy stable-transfected PNT2 and DU 145cells --- p.72 / Chapter 3. 4.7 --- Anchorage independent growth assay of ERRy stable-transfected PNT2 and DU 145 cells --- p.72 / Chapter 3.4.8 --- Flow cytometry of ERRγ stable-transfected PNT2 and DU145 cells --- p.74 / Chapter 3.4.9 --- RT-PCR of cell cycle-related genes in ERRγ stable-transfected PNT2 and DU 145 cells --- p.74 / Chapter 3.4.10 --- Western blot analysis of p21 in ERRγ stable-transfected PNT2 cells --- p.75 / Chapter 3.5 --- Statistical analysis --- p.75 / Table 3.1 - 3.2，Figure 3.1 - 35 --- p.76 / Chapter Chapter 4 --- Results / Chapter 4.1 --- "Expression patterns of ERRs and steroid hormone receptors in the human prostate cell lines, tumor xenografts and prostatic tissues" --- p.93 / Chapter 4.1.1 --- "mRNA expression patterns of ERR isoforms in the prostatic cell lines, prostate cancer xenografts and human prostatic tissues" --- p.93 / Chapter 4.1.2 --- mRNA expression patterns of steroid hormone receptors and prostatic differentiation markers in the prostatic cell lines and xenografts --- p.95 / Chapter 4.1.3 --- Characterization of antisera against human ERRs by ERR recombinant proteins --- p.97 / Chapter 4.1.4 --- Protein expression of ERR isoforms in the human prostatic cell lines --- p.98 / Chapter 4.1.5 --- "Immunolocalization of ERR isoforms in the normal, dysplastic and neoplastic prostates" --- p.98 / Chapter 4.2 --- Interrelationship of ERR and ER expression in PC-3 prostate cancer cells --- p.100 / Chapter 4.2.1 --- "Expressions of ERRγ, ERa and ERβ in the ERRa transient transfected PC-3 cells" --- p.100 / Chapter 4.2.2 --- Expression of ERRa in the ERRγ and ERa transient transfected PC-3 cells --- p.101 / Chapter 4.3 --- Intracellular trafficking and transcriptional activities of ERRs in the prostatic cells with fused green fluorescence protein 一 ERRs --- p.102 / Chapter 4.3.1 --- Trans activation of ERE response element 226}0ؤ driven reporter by ERR isoforms in the PC-3 cells in the presence or absence of serum --- p.102 / Chapter 4.3.2 --- Trans activation of SF-1 response element driven reporter by ERR isoforms in the PC-3 cells in the presence or absence of serum --- p.104 / Chapter 4.3.3 --- Subcellular localizations of three ERR isoforms in the PC-3 cells in the presence or absence of serum --- p.105 / Chapter 4.4 --- The role of ERRs in the growth of prostatic cells --- p.106 / Chapter 4.4.1 --- "The growth of ERRs transient transfected PC-3, PNT2 prostatic cells" --- p.107 / Chapter 4.4.2 --- Cell cycle analysis of ERRs transient transfected PC-3 cells --- p.108 / Chapter 4.4.3 --- Expression of cyclin-dependent kinase (CDK) inhibitors and p53 in the ERRs transient transfected PC-3 cells --- p.108 / Chapter 4.4.4 --- Establishment of ERRγ stable-transfected PNT2 and DU145 cells --- p.109 / Chapter 4.4.5 --- Transcriptional activation of ERE response element in ERRγ stable-transfected PNT2 cells --- p.111 / Chapter 4.4.6 --- Effect of over-expression of ERRγ on the growth of PNT2 and DU145 stable-transfected cells --- p.112 / Chapter 4.4.7 --- Efficiencies of colony formation of ERRγ stable-transfected PNT2 and DU145 cells --- p.113 / Chapter 4.4.8 --- Cell cycle analysis of ERRγ stable-transfected PNT2and DU 145 cells --- p.114 / Chapter 4.4.9 --- Expression of cell cycle-related genes in the ERRy stable-transfected PNT2 and DU 145 cells --- p.116 / Figure 4.1 - 4.38，Table 4.1 - 43 --- p.119 / Chapter Chapter 5 --- Discussion / Chapter 5.1 --- "Expression study in human prostatic cells, tumor xenografts" --- p.159 / Chapter 5.1.1 --- "Differential expression patterns of ERRs in prostatic cells, cancer xenografts and tissues" --- p.160 / Chapter 5.1.2 --- Co-localization of ERRs and ERβ in the human prostate --- p.166 / Chapter 5.1.3 --- Differential expression patterns of steroid hormone receptors and prostatic specific markers in prostatic cells and xenografts --- p.168 / Chapter 5.2 --- ERRα acts as a expression repressor of ERRγ and ERα in PC-3 cells --- p.173 / Chapter 5.3 --- ERRs are nuclear localized and constitutively active in PC-3 cells --- p.176 / Chapter 5.4 --- ERRs acts as the negative growth regulators in the prostatic cells --- p.179 / Chapter 5.4.1 --- Cell cycle control of mammalian cells --- p.180 / Chapter 5.4.2 --- The roles of AR and ERs in the cell cycle regulation --- p.181 / Chapter 5.4.3 --- Inhibition of cell proliferation in ERRs transient transfected PC-3 cells and ERRγ stable-transfected PNT2 and DU145 cells --- p.184 / Chapter 5.4.4 --- Inhibition of anchorage independent growth in ERRγ stable-transfected PNT2 and DU 145 cells --- p.188 / Chapter Chapter 6 --- Conclusion --- p.191 / Chapter Chapter 7 --- References --- p.192 / Chapter Chapter 8 --- Publications --- p.227

With ever increasing advancements in imaging, there is an increasing abundance of images being acquired in the clinical environment. However, this increase in information can be a burden as well as a blessing as it may require significant amounts of time to interpret the information contained in these images. Computer assisted evaluation is one way in which better use could be made of these images. This thesis presents the combination of texture analysis of images acquired during the treatment of cancer with machine learning in order to improve radiotherapy. The first application is to the prediction of radiation induced pneumonitis. In 13- 37% of cases, lung cancer patients treated with radiotherapy develop radiation induced lung disease, such as radiation induced pneumonitis. Three dimensional texture analysis, combined with patient-specific clinical parameters, were used to compute unique features. On radiotherapy planning CT data of 57 patients, (14 symptomatic, 43 asymptomatic), a Support Vector Machine (SVM) obtained an area under the receiver operator curve (AUROC) of 0.873 with sensitivity, specificity and accuracy of 92%, 72% and 87% respectively. Furthermore, it was demonstrated that a Decision Tree classifier was capable of a similar level of performance using sub-regions of the lung volume. The second application is related to prostate cancer identification. T2 MRI scans are used in the diagnosis of prostate cancer and in the identification of the primary cancer within the prostate gland. The manual identification of the cancer relies on the assessment of multiple scans and the integration of clinical information by a clinician. This requires considerable experience and time. As MRI becomes more integrated within the radiotherapy work flow and as adaptive radiotherapy (where the treatment plan is modified based on multi-modality image information acquired during or between RT fractions) develops it is timely to develop automatic segmentation techniques for reliably identifying cancerous regions. In this work a number of texture features were coupled with a supervised learning model for the automatic segmentation of the main cancerous focus in the prostate - the focal lesion. A mean AUROC of 0.713 was demonstrated with 10-fold stratified cross validation strategy on an aggregate data set. On a leave one case out basis a mean AUROC of 0.60 was achieved which resulted in a mean DICE coefficient of 0.710. These results showed that is was possible to delineate the focal lesion in the majority (11) of the 14 cases used in the study.

A partir de um melhor entendimento sobre a radiossensibilidade do câncer de próstata, com a redefinição de parâmetros radiobiológicos, atualmente os esquemas hipofracionados de próstata tornaram-se um dos principais desafios da radioterapia moderna. Associado a este conhecimento, o emprego de técnicas precisas de radioterapia possibilitaram a entrega de maiores doses por fração, com manutenção da toxicidade e melhor controle de qualidade dos planos de tratamento. Pretendemos avaliar a implementação da radioterapia tridimensional computadorizada (3D-CRT) ou intensidade modulada do feixe (IMRT) utilizando o regime de hipofracionamento moderado (70 Gy em 28 frações) em pacientes com neoplasia localizada da próstata na rotina do departamento de radioterapia do Hospital das Clínicas da FMRP-USP. Avaliação da viabilidade técnica e do impacto financeiro na utilização da radioterapia hipofracionada na instituição. / Evaluate the implementation of computerized three-dimensional radiation therapy (3D-CRT) or intensity modulated beam (IMRT) using moderate hypofractionation schedule (70 Gy in 28 fractions) in patients with localized prostate cancer (no metastasis lymph node or distant metastasis) in routine of department of radiotherapy of the Hospital of FMRP-USP. Assessment of technical feasibility and financial impact on the use of hypofractionated radiotherapy in the institution.

O câncer de próstata é o tumor maligno mais freqüente nos homens com idade superior a 50 anos, excetuando-se os tumores cutâneos. No Brasil estima-se para o ano de 2012 cerca de 60.180 casos novos deste tipo de neoplasia. Os marcadores tumorais permitem fazer o rastreamento do câncer, o diagnóstico diferencial entre uma neoplasia benigna e maligna, a avaliação de prognóstico e o acompanhamento terapêutico, assim como a detecção da recidiva tumoral. Dentre estes marcadores tumorais, tem-se dado muito atenção para as proteínas que mediam e participam da progressão do ciclo celular. A ciclina D1 é uma proteína nuclear de vida curta que é destruída pela via da ubiquitina ATP dependente, e está envolvida na transição celular da fase do ciclo G1 (repouso) para a fase S (síntese) tanto em células normais como em células neoplásicas. A super expressão de ciclina D1 remove a regulação normal do ciclo celular causando proliferação celular descontrolada, um crescimento anormal dos tecidos e a transformação para um fenótipo neoplásico, atuando como oncogene. No presente trabalho foi estudado a expressão de ciclina D1 em adenocarcinomas de próstata, tendo como objetivo avaliar a relação desta proteína com parâmetros epidemiológicos, clínicos e histopatológicos. Adicionalmente também foi feita comparação de escore de Gleason e lateralidade tumoral entre biópsias prostáticas com agulha e de prostatectomias radicais. No ensaio para ciclina D1 foram analisados 85 casos através de imunoistoquímica (IHQ) de material proveniente de prostatectomias radicais diagnosticados com adenocarcinoma de próstata entre os anos de 2005 e 2010 em nosso serviço. O método de avaliação se utilizou de microscopia ótica comum e contagem semi-quantitativa, comparado-se a expressão com achados clínicos, epidemiológicos e histopatológicos utilizando-se Teste T de Fisher, Qui Quadrado, Mann-Whitney, Curva ROC e correlação de Spearman. Os resultados demonstraram correlação positiva de ciclina D1 com escore de Gleason (p<0,05), com volume prostático (p=0,01) e uma tendência a correlação positiva com invasão perineural (p=0,07). Não houve correlação estatística entre ciclina D1 e o aumento de PSA, assim como outros achados histopatológicos. As biópsias prostáticas com agulha apresentaram subestimação em 40% dos casos para escore de Gleason e de 62,3% dos casos para lateralidade tumoral quando comparadas a prostatectomia radical. Já que as taxas de subestimação de escore de Gleason e lateralidade tumoral são relativamente altas e visto a urgência em se padronizar novos biomarcadores para o câncer prostático, sugerimos que ciclina D1 pode ser utilizada como biomarcador em patologia cirúrgica da próstata auxiliando numa gradação histológica mais precisa em biópsias com agulha colaborando para melhor vigilância e escolha terapêutica. / Prostate cancer is the most common malignant tumor in men older than 50 years, except for skin tumors. In Brazil it is estimated for the year 2012 about 60,180 new cases of this type of neoplasm. Tumor markers allow to cancer screening, differential diagnosis between a benign and malignant, assessment of prognosis and therapeutic monitoring, and detection of tumor recurrence. Among these tumor markers, has been given much attention for proteins that mediate and participate in cell cycle progression. Cyclin D1 is a short-lived nuclear protein that is destroyed by the ATP ubiquitin dependent pathway, and is involved in the transition of cell cycle G1 phase (resting) to the S phase (synthesis) cells both in normal and neoplastic cells. The overexpression of cyclin D1 removes the normal regulation of cell cycle causing uncontrolled cell proliferation, abnormal growth of tissues and transformation to a neoplastic phenotype, acting as an oncogene. In the present work we studied the expression of cyclin D1 in prostate adenocarcinomas, and to evaluate the relationship of this protein with epidemiologic factors, clinical and histopathological features. Additionally comparison was also made of Gleason score and laterality between tumor biopsies and prostate needle radical prostatectomies. In the assay for cyclin D1 were 85 cases analyzed by immunohistochemistry (IHC) of material from radical prostatectomies diagnosed with prostate adenocarcinoma between the years 2005 and 2010 at our institution. The evaluation method utilized were light microscopy and semi-quantitative score, comparing the cyclin D1 expression with clinical, epidemiological and histopathological features using Fisher\'s exact test, chi square test, Mann-Whitney test, ROC curve and Spearman correlation. The results showed a positive correlation of cyclin D1 with Gleason score (p <0.05), prostate volume (p = 0.01) and a trend toward positive correlation with perineural invasion (p = 0.07). There was no statistical correlation between cyclin D1 and increased PSA, as well as other histopathologic features. Prostate needle biopsies showed underestimation in 40% of cases for Gleason score and 62.3% of cases for tumor laterality when compared to radical prostatectomy. Since the rates of underestimation of Gleason score and tumor laterality are relatively high and the urgency to standardize new biomarkers for prostate cancer, we suggest that cyclin D1 may be used as biomarkers in surgical pathology of the prostate assisting more accurate histological grading in needle biopsies and collaborating for better surveillance and therapeutic choice.

Thesis Portfolio Abstract Background Whilst the role of Psychological Flexibility on psychosocial outcomes has been assessed in some chronic health conditions and cancers, its role in psychosocial outcomes in men with prostate cancer has not been established. Fear of cancer recurrence has been shown to be associated with poorer psychosocial outcomes. The relationship of Psychological Flexibility on the impact of fear of cancer recurrence has not be evaluated. Research into the measurement of Psychological Flexibility in individuals with chronic ill health has not revealed a definitive measure. Methods A systematic review of the reliability and validity of measures of Psychological Flexibility in individuals with chronic health conditions was conducted. A quality assessment of the included studies was conducted and relevant results were synthesised. A cross-sectional study utilising a survey methodology was conducted to establish the role of Psychological Flexibility and fear of cancer recurrence in psychological distress and quality of life in men with prostate cancer. Regression analyses were used to establish whether fear of cancer recurrence or Psychological Flexibility significantly predicted any variance in distress or quality of life. Whether Psychological Flexibility mediated or moderated the relationship between fear of cancer recurrence and psychosocial outcomes was assessed with conditional process analysis. Results The systematic review revealed no single definitive measure of Psychological Flexibility, and that many measures currently in use within research and clinical settings have not been fully validated in individuals with chronic ill health conditions. The cross-sectional study found that Psychological Flexibility and fear of cancer recurrence each significantly predict variance in psychological distress and quality of life. Psychological Flexibility mediated and moderated the relationship between fear of cancer recurrence and psychological distress and mediated the relationship between fear of cancer recurrence and quality of life. Conclusions In the absence of a definitive measure of Psychological Flexibility, information on the measures identified were provided to allow clinicians and researchers to choose the most appropriate measure for their use. Future research might focus on further validation of existing measures of Psychological Flexibility rather than the development of additional measures. The challenges underlying using a psychometric approach to measure contextual science concepts was discussed. Due to the role of Psychological Flexibility within psychosocial outcomes in prostate cancer, it was suggested as a potential treatment target. The relevance of treatments such as Acceptance and Commitment Therapy, which aim to increase Psychological Flexibility, for men with prostate cancer was discussed. Future research avenues to further assess the role of Psychological Flexibility in psychosocial outcomes was discussed.

Cancer cell esterases are often overexpressed and some have chiral specificities different from those of corresponding normal cells. Carboxylesterases in particular are known to be overexpressed in several cancers. Additionally, cancer cells often exhibit high levels of intrinsic oxidative stress that is required for survival and an aggressive phenotype. We hypothesized that these 2 characteristics of cancer cells could be exploited to aid in the detection and treatment of prostate cancer. We have developed a fluorogenic ester probe that is activated by carboxylesterase to help distinguish tumorigenic cells from nontumorigenic prostate cells. Ester prodrugs have the same activation mechanism and have been thought to be a promising approach in cancer therapy. Prodrugs are inactive drugs that can be selectively activated by a specific enzyme. We have developed a chiral ester prodrug strategy using native polyacrylamide gel electrophoresis (n-PAGE) and proteomic methods to compare and identify the esterase profiles of several tumorigenic and nontumorigenic prostate cell lines. Our results showed that cell lysates from LNCaP, DU 145, and PC3 prostate cancer cell lines exhibit differential esterase activity compared with non-tumorigenic RWPE-1 prostate cell lysates when incubated with α- naphthyl acetate or α-naphthyl N-acetyl-alaninate ester substrates and a diazonium salt. We have identified oxidized protein hydrolase (OPH), a serine esterase/protease that catalyzes the removal of N-acylated residues from proteins, to be differentially expressed between some tumorigenic and nontumorigenic prostate cell lines. OPH was found to have high hydrolytic activity towards the S-isomer of α-naphthyl N-acetylalaninate (S-ANAA) chiral ester. LNCaP lysates incubated with N-acetyl-alanyl-p-nitroanilide, a known OPH substrate, had twofold higher OPH activity compared with RWPE-1 lysates. We have also developed and tested novel glutathione depleting prodrugs modeled after S-ANAA that increase oxidative stress and induced apoptosis in tumorigenic prostate cells with little effect on nontumorigenic RWPE-1 cells. These results suggest that ester molecular beacon probes and ester prodrugs may be effective in identifying and treating prostate cancer tumors that overexpress esterases with little effect on normal prostate cells.