Les carcinomes rénaux (RCC) sont subdivisés en plusieurs sous-types, définis selon des critères histologiques, phénotypiques et génétiques. Le diagnostic différentiel de ces tumeurs est primordial avec des conséquences pronostiques et thérapeutiques. Génétique et diagnostic : Nous avons étudié les données cliniques, histologiques, immunohistochimiques et génétiques d'une série de RCC papillaires (PRCC) de type 1 et 2. Une caractérisation génomique exhaustive complétée par NGS nous a permis de classer les PRCC de type 2 dans plusieurs groupes d'évolution variable. Nos résultats fournissent des informations inédites sur la pathogenèse des PRCC qui donnent des pistes pour un traitement personnalisé. Métabolisme, grade tumoral et phénotype : Dans une série de RCC à cellules claires (ccRCC), nous avons analysé les caractéristiques de ces tumeurs et l'expression des protéines impliquées dans le métabolisme et les isoformes de HIF. Cette étude nous a permis de mettre en évidence quantitativement une corrélation entre l'expression de MCT1, GLUT1 et CAXII et le grade de Fuhrman, et qualitativement une localisation périphérique de HIF2alpha et la co-localisation des protéines HIF2alpha et HAF. Stratégies théranostiques : Dans l’optique de définir les traitements les plus appropriés pour les patients atteints de RCC, nous avons fait un parallèle entre la sensibilité aux thérapies ciblées des patients (in vivo) et de cellules dérivées de la tumeur initiale (in vitro). Nous avons démontré que la réponse chez les patients et dans les cellules était équivalente et donc que des tests in vitro sont une piste pour définir des traitements personnalisés des patients atteints de ccRCC. / Renal carcinomas (RCC) are divided into several subtypes, defined by histological, genetic and phenotypic criteria. The differential diagnosis of these tumors is important with prognostic and therapeutic implications. Genetics and diagnosis: We studied the clinical, histological, immunohistochemical and genetic of papillary RCC (PRCC) type 1 and 2 cohort. An extensive genomic characterization completed by NGS has allowed us to classify type 2 PRCC in several groups of variable clinical evolution. Our results provide new information on the pathogenesis of PRCC that provide perspectives for personalized treatment. Metabolism, tumor grade and phenotype: In a series of clear cell RCC (ccRCC), we analyzed the characteristics of these tumors and the expression of proteins involved in the metabolism and isoforms of HIF. This study allowed us to demonstrate quantitative correlation between the expression of MCT1, GLUT1 and CA XII and Fuhrman grade, and qualitatively peripheral HIF2alpha localization and co-localization of proteins HIF2alpha and HAF. Theranostic strategies: In order to define the most appropriate treatment for patients with RCC, we made a parallel between sensitivity to targeted therapies of patients (in vivo), and cells derived from the original tumor (in vitro). We have demonstrated that the response in patients and in cells and was similar, thus in vitro assays are a way to define personalized treatment for ccRCC.

Made available in DSpace on 2014-06-11T19:26:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-19Bitstream added on 2014-06-13T19:53:57Z : No. of bitstreams: 1 pires_lc_me_sjrp.pdf: 2393717 bytes, checksum: a2b9ac8071136c02761c529a8ecaecef (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Os dados de seqüência genômicas humanas depositados em bancos públicos têm fornecido uma oportunidade sem precedentes para pesquisadores decifrarem a funcionalidade do genoma humano. Essas informações são extremamente valiosas na prevenção, diagnóstico e tratamento do câncer. O Cancer Genome Anatomy Project (CGAP), o Gene Expression Omnibus (GEO), o Genome Data Mining (GDM) e o Babelomics funtional analysis of genome-scale experiments representam quatro importantes ferramentas para o estudo da genética funcional. O objetivo do presente trabalho foi o de explorar bancos de dados públicos para selecionar e validar a expressão de genes relacionados com o desenvolvimento e a progressão de carcinoma renal de células claras (CRcc). Utilizando ferramentas de bioinformática foi analisada a expressão gênica diferencial entre duas bibliotecas de SAGE elaboradas a partir de tecidos renais normais e de CRcc. Os resultados obtidos demonstraram alterações na expressão de genes participantes de importantes vias metabólicas. Baseando-se nessas análises, os genes CDK7, CLDN1, CSTB, EPC2 e ZNF706 foram selecionados e a expressão gênica diferencial desses foi avaliada por PCR em tempo real em 35 amostras de pacientes portadores de CRcc em diferentes estágios de progressão da doença e 1 amostra metastática. Paralelamente, utilizando-se a metodologia de RaSH foram elaboradas bibliotecas subtrativas entre o tecido neoplásico e o tecidos normal, sendo selecionados os genes MATR3 e PITPNB. O ZNF706 apresentou super expressão em relação aos tecidos normais, nas amostras tumorais analisadas independentemente do grau de evolução tumoral. O mesmo comportamento foi apresentado pelo gene CSTB, sendo que os maiores níveis de expressão foram observados nas amostras de estágio III de progressão tumoral. O gene CDK7 apresentou níveis de expressão dependente do grau de evolução da... / The data of human genomic sequences available in public database have provided an unpredictable opportunity for researchers to decipher the utility of human genome. This information is extremely valuable in prevention, diagnosis and cancer treatment. The Cancer Genome Anatomy Project (CGAP), the Gene expression Omnibus (GEO), the Genome Data Mining (GDM) and the Babelomics Functional Analysis of Genome-Scale Experiments do represent four important tools for functional genetics studies. This work aimed to explore public database to select and validate expression of genes related to development and progression of Clear Cell Renal Cell Carcinoma (ccRCC). The differential gene expression of two SAGE libraries from normal renal tissues and ccRCC was analyzed using bioinformatics tools. The results showed altered gene expression pattern in genes that participate in important metabolic pathways. Based on these analysis, the genes CDK7, CLDN1, CSTB, EPC2 and ZNF706 were selected and their differential gene expression was evaluated by Real Time PCR in 35 tissue samples from patients with ccRCC in different stages of disease progression and one metastatic sample. Simultaneously through RaSH methodology were elaborated subtractive libraries between normal and neoplasic tissues so the genes MATR3 and PITPNB were selected. The ZNF706 presented over expression in tumor tissues independent of tumor progression grade. The same behavior was presented by CSTB where the higher expression levels were observed in samples from stage IV of tumor progression. The CDK7 gene presented expression levels dependent of disease evolution grade where the lowers levels were in stages I, II, III and presented over expression in samples from stage IV and retroperitoneal metastasis. This result shows a clear relationship between CDK7 expression and the aggressiveness of ccRCC and suggests that this gene... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:26:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-18Bitstream added on 2014-06-13T19:12:52Z : No. of bitstreams: 1 valsechi_mc_me_sjrp_parcial.pdf: 574533 bytes, checksum: a4733296b652ce8ac3b0aa3af78e4e48 (MD5) Bitstreams deleted on 2015-01-16T10:37:46Z: valsechi_mc_me_sjrp_parcial.pdf,Bitstream added on 2015-01-16T10:38:34Z : No. of bitstreams: 1 000590383.pdf: 1465270 bytes, checksum: 6abb1c740c0eb28b1d1eb0e5696f75a3 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O tumor renal é a mais letal das doenças urológicas. É uma doença histologicamente heterogênea, sendo o carcinoma renal de células claras o subtipo histológico mais comum. Embora a nefrectomia e imunoterapia sejam tratamentos bem estabelecidos, aproximadamente 30% dos pacientes tratados são acometidos por metástases. Alterações na expressão gênica e na inativação transcricional, devido ao mecanismo de metilação, são evidentes em células cancerosas. A metilação do DNA é um evento epigenético intimamente relacionado com o silenciamento da expressão gênica, e está envolvida em vários processos, dentre eles, a carcinogênese. Dessa forma, este trabalho teve como objetivos investigar se os genes selecionados, GPC3, CRABP2, KTN1 e ADAM23 apresentam expressão alterada nas amostras tumorais, verificar se a expressão gênica está associada com a progressão tumoral, e analisar o padrão de metilação de ilhas CpGs. Os quatro genes selecionados foram validados pela técnica de PCR em Tempo Real. Para validação desses genes foram utilizadas 35 amostras de carcinoma renal de células claras e 35 amostras de córtex renal normal. Os genes GPC3, CRABP2, KTN1 e ADAM23 apresentaram redução de expressão significativa em amostras de carcinoma renal de células claras quando comparadas ao pool de amostras de córtex renal normal. Observou-se que a redução da expressão do gene ADAM23 está diretamente relacionada com o avanço do estadiamento tumoral. Foi observada uma freqüência elevada de hipermetilação do gene ADAM23, entretanto, não houve associação do padrão de metilação com os dados clínicos. A análise da expressão gênica e dos mecanismos responsáveis pela inativação transcricional dos genes CRABP2, KTN1 e ADAM23, estudados pela primeira vez em carcinoma renal, e GPC3, podem fornecer informações relevantes para o conhecimento e desenvolvimento do carcinoma renal de células claras. / The renal tumor, which is the most lethal of urological diseases, is a histologically heterogeneous disease, and the clear cell renal cell carcinoma the most common histological subtype. Although the treatment of nephrectomy and immunotherapy are established, approximately 30% of patients are affected by metastases. Changes in gene expression and transcriptional inactivation, due to the methylation mechanism are evident in cancer cells. The DNA methylation is an epigenetic event closely related to the silencing of gene expression, and is involved in several cases, including the carcinogenesis. The aim of this study was to investigate the gene expression of GPC3, CRABP2, KTN1 and ADAM23, check if gene expression was associated with tumor progression and analyze methylation pattern of CpG island. The four selected genes were validated by the quantitative RT-PCR. Thirty five samples of clear cell renal cell carcinoma and 35 samples of normal renal cortex were used for validation. The genes GPC3, CRABP2, KTN1 and ADAM23 showed significant reduction of expression in samples of clear cell renal cell carcinoma when compared to a pool of samples of normal renal cortex. It was observed that the lower expression of ADAM23 is directly related to the advancement of the tumor staging. Despite the high frequency of hypermethylation of ADAM23, there was no association with the methylation pattern of the clinical data. The analysis of gene expression and the mechanisms responsible for the transcriptional inactivation of genes CRABP2, KTN1 and ADAM23, first studied in clear cell renal cell carcinoma, and GPC3, may provide relevant information for the clear cell renal cell carcinoma understanding and development.

Le carcinome à cellules rénales claires métastatique (CCC) demeure résistant aux thérapies actuelles. Les travaux précédents ont montré des similitudes mécanistiques entre tumorigenèse et néphrogenèse. Parmi les cibles de la voie oncogénique Sonic Hedgehog-Gli, le facteur développemental Lim1 a été identifié comme un nouvel oncogène dans le CCC. Les études préliminaires suggèrent que Lim1 aurait un rôle dans l’invasion cellulaire. Aucun inhibiteur de Lim1 n’est disponible; l’ARN interférence reste l’outil le plus efficace et le plus spécifique pour l’extinction des gènes. Dans le but de développer un nouvel outil d’inhibition de Lim1 applicable en clinique, basée sur des siRNAs véhiculés par des systèmes nanométriques, une nouvelle génération de véhicules de siRNAs a été étudiée. Il s’agit de polymères diacétyléniques photo-polymérisables sous forme de nanofibres (PDA-Nf). Ces travaux démontrent le rôle invasif de Lim1 dans la dissémination métastatique et identifient les PDA-Nf comme un nouvel outil de délivrance de siRNAs très prometteur en clinique. L’avantage du ciblage de Lim1 avec cette approche, est l’absence de son expression à l’âge adulte. / Clear cell renal cell carcinoma (CCC) remains resistant to current therapies, despite the development of anti-angiogenic and the new immunotherapeutic approaches. Previous work of the laboratory has shown mechanistic similarities between tumorigenesis and nephrogenesis. Among the targets of the Sonic Hedgehog-Gli pathway which is found oncogenic in CCC, the developmental factor Lim1 has been identified as a new oncogene in CCC. Preliminary studies suggest that Lim1 would have a role in cell invasion. No Lim1 inhibitors are available; RNA interference remains the most effective and specific tool for gene silencing. In order to develop a new clinically applicable inhibition tool for Lim1, based on siRNAs carried by nanoparticles, a new generation of siRNA vehicles has been investigated. These are photo-polymerizable diacetylenic polymers in the form of nanofibers (PDA-Nf). These works demonstrate the invasive role of Lim1 in metastatic dissemination and identifies PDA-Nf as a new promising siRNA delivery tool in clinical practice. The advantage of targeting Lim1 with this nano-carrier approach is that Lim1 is not expressed in adulthood.

Resumo: Os dados de seqüência genômicas humanas depositados em bancos públicos têm fornecido uma oportunidade sem precedentes para pesquisadores decifrarem a funcionalidade do genoma humano. Essas informações são extremamente valiosas na prevenção, diagnóstico e tratamento do câncer. O Cancer Genome Anatomy Project (CGAP), o Gene Expression Omnibus (GEO), o Genome Data Mining (GDM) e o Babelomics funtional analysis of genome-scale experiments representam quatro importantes ferramentas para o estudo da genética funcional. O objetivo do presente trabalho foi o de explorar bancos de dados públicos para selecionar e validar a expressão de genes relacionados com o desenvolvimento e a progressão de carcinoma renal de células claras (CRcc). Utilizando ferramentas de bioinformática foi analisada a expressão gênica diferencial entre duas bibliotecas de SAGE elaboradas a partir de tecidos renais normais e de CRcc. Os resultados obtidos demonstraram alterações na expressão de genes participantes de importantes vias metabólicas. Baseando-se nessas análises, os genes CDK7, CLDN1, CSTB, EPC2 e ZNF706 foram selecionados e a expressão gênica diferencial desses foi avaliada por PCR em tempo real em 35 amostras de pacientes portadores de CRcc em diferentes estágios de progressão da doença e 1 amostra metastática. Paralelamente, utilizando-se a metodologia de RaSH foram elaboradas bibliotecas subtrativas entre o tecido neoplásico e o tecidos normal, sendo selecionados os genes MATR3 e PITPNB. O ZNF706 apresentou super expressão em relação aos tecidos normais, nas amostras tumorais analisadas independentemente do grau de evolução tumoral. O mesmo comportamento foi apresentado pelo gene CSTB, sendo que os maiores níveis de expressão foram observados nas amostras de estágio III de progressão tumoral. O gene CDK7 apresentou níveis de expressão dependente do grau de evolução da... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The data of human genomic sequences available in public database have provided an unpredictable opportunity for researchers to decipher the utility of human genome. This information is extremely valuable in prevention, diagnosis and cancer treatment. The Cancer Genome Anatomy Project (CGAP), the Gene expression Omnibus (GEO), the Genome Data Mining (GDM) and the Babelomics Functional Analysis of Genome-Scale Experiments do represent four important tools for functional genetics studies. This work aimed to explore public database to select and validate expression of genes related to development and progression of Clear Cell Renal Cell Carcinoma (ccRCC). The differential gene expression of two SAGE libraries from normal renal tissues and ccRCC was analyzed using bioinformatics tools. The results showed altered gene expression pattern in genes that participate in important metabolic pathways. Based on these analysis, the genes CDK7, CLDN1, CSTB, EPC2 and ZNF706 were selected and their differential gene expression was evaluated by Real Time PCR in 35 tissue samples from patients with ccRCC in different stages of disease progression and one metastatic sample. Simultaneously through RaSH methodology were elaborated subtractive libraries between normal and neoplasic tissues so the genes MATR3 and PITPNB were selected. The ZNF706 presented over expression in tumor tissues independent of tumor progression grade. The same behavior was presented by CSTB where the higher expression levels were observed in samples from stage IV of tumor progression. The CDK7 gene presented expression levels dependent of disease evolution grade where the lowers levels were in stages I, II, III and presented over expression in samples from stage IV and retroperitoneal metastasis. This result shows a clear relationship between CDK7 expression and the aggressiveness of ccRCC and suggests that this gene... (Complete abstract click electronic access below) / Orientador: Paulo Peitl Junior / Coorientador: Paula Rahal / Banca: Raphael Bessa Parmagiani / Banca: Sônia Maria Oliani / Mestre

INTRODUÇÃO: O Carcinoma de Células Renais (CCR) é reposnsável por mais de 200.000 casos a cada ano no mundo, representando cerca de 2% de todos os cânceres. O CCR do tipo células claras (CRCC) é o subtipo mais comum da doença e é responsável por 75 a 80% dos casos, com maiores taxas de invasão local, desenvolvimento de metástases e mortalidade. As novas terapias alvo são baseadas em moléculas e anticorpos antiangiogênicos alterando o curso da doença, mas os resultados até agora não são satisfatórios. OBJETIVOS: Nosso objetivo nesse estudo foi estudar miRNAs e seus possíveis genes alvo relacionados com a angiogênese em CRCC tentando trazer novos conhecimentos relacionados às vias moleculares associadas à doença. MÉTODOS: Os níveis de expressão dos miRNAs miR-99a, 99b, 100, 199a, 106a, 106b, 29a, 29b, 29c, 126, 200a, 200b e seus respectivos genes alvo: mTOR, HIF1-alfa, VHL, PDGF, VEGF, VEGFR1 e VEGFR2 foram avaliados por alfaRT-PCR utilizando amostras de tecido tumoral de 56 pacientes com diagnóstico de CRCC e 5 amostras de tecido renal benigno como controle. Os resultados foram comparados com o tamanho tumoral, grau nuclear de Fuhrman e invasão microvascular, considerando os critérios de risco propostos por Dall\'Oglio et al (2007). RESULTADOS: Encontramos subexpressão da maioria dos genes, exceto VEGFA e PDGF, enquanto que a análise dos miRNAs mostrou subexpressão apenas dos miRs 100 e 126. Comparamos a expressão dos genes com seus possíveis miRNAs reguladores, e encontramos que mTOR apresentou subexpressão, enquanto miR99a apresentou superexpressão na maioria das amostras. Esta relação também ocorreu entre VEGFA e o miR126 e entre os miRNAs 106a, 106b, e seu gene alvo VHL. Considerando os grupos de risco, a superexpressão do miR200b foi associada com pacientes de alto risco (p = 0,01) e a superexpressão do miR126 foi associada com menor grau de Fuhrman (I-II) (p = 0,03). CONCLUSÕES: Os resultados mostram que em CRCC há um desequilíbrio na expressão de genes e miRNAs relacionadas com a angiogênese. Além disso através dos nossos achados podemos especular o papel do miR200b e do miR126 no prognóstico de CRCC / BACKGROUND: There are more than 200,000 cases of renal cell carcinoma (RCC) each year in the world, accounting for approximately 2% of all cancers. RCC clear cell type (ccRCC) is the most common subtype of RCC and accounts for 75 to 80% of the cases with highest rates of local invasion, development of metastasis and mortality. New target therapy is based on antiangiogenic antibodies and molecules, changing the course of the disease, but the results so far are disappointing. OBJECTIVES: Our aim is to study miRNAs and their target genes related to angiogenesis in ccRCC trying to bring some new knowledge to the molecular pathways related to the disease. METHODS: The expression levels of miRNAs miR-99a, 99b, 100; 199a; 106a; 106b; 29a; 29b; 29c; 126; 200a, 200b and their respective target genes: mTOR, HIF1-Î ±, VHL, PDGF, VEGF, VEGFR1 and VEGFR2 were evaluated using alfaRT-PCR.in snap-frozen tumor tissue samples from 56 patients diagnosed with ccRCC and 5 samples of benign renal tissue as control. The results were related to tumor size, Fuhrman nuclear grade and microvascular invasion, considering the risk criteria proposed by Dall\'Oglio et al. (2007). RESULTS: We compared the expression of genes with their possible regulatory miRNAs, and we found that mTOR was underexpressed while miR99a was overexpressed in most samples. This relationship also occurs between VEGFA and miR126 and between miRNAs 106a, 106b, and their target gene VHL. Considering the risk groups the overexpression of miR200b was associated with high-risk patients (p = 0.01) and the overexpression of miR126 was associated with lower Fuhrman grade (I-II) (p = 0.03). CONCLUSIONS: Our results show that in ccRCC there is an unbalance in the expression of genes and miRNAs related to angiogenesis and cell proliferation and survival. Furthermore with our findings we can speculate the role of miR200b and miR126 in the prognostic of ccRCC. We believe that the relationship between miRNAs and their respective genes should be more profoundly searched as markers and possible therapeutic agents in this neoplasia

Cette thèse présente des travaux de modélisation mathématique de la croissance tumorale. On détaille dans ce manuscrit la construction d’indicateurs de bio-imagerie, destinés à quantifier l’hétérogénéité tumorale. Un modèle d’équations aux dérivées partielles constitué de deux types de cellules tumorales est étudié par la suite. Le paramétrage de ce modèle est propre à chaque patient et à chaque lésion. Il est effectué grâce à des données d’imagerie médicale (IRM ou scanner), ce qui constitue une méthode non invasive pour le patient. Les indicateurs ainsi que le modèle décrit ont été utilisés dans le cadre du suivi des métastases des lésions rénales de 5 patients traités avec un médicament anti-angiogénique. Enfin, la dernière partie a pour objectif de distinguer différents types de lésions rénales (malignes ou non) grâce à l’imagerie afin de limiter les chirurgies inutiles. On s’est particulièrement attaché à distinguer les carcinomes rénaux à cellules claires des angiomyolipomes pauvres en graisse. / This document deals with mathematical modelling of tumour growth. Biological indicators based on medical images are constructed in order to quantify tumoral heterogeneity. In the first part, a partial differential equations model made of two distinct cell subtypes is being studied. The model’s parameters are unique for each patient and each lesion. They are computed thanks to medical images (MRI or scan), which is a non-invasive method for the patient. Both the indicators and the model described are used on the cases of 5 patients treated with an anti-angiogenic medicine. The last part of the document aims at distinguishing different renal tumour subtypes that can be malignant or benign. Angiomyolipomas and renal cells carcinomas were particulary studied in the last part of the document.

Les carcinomes rénaux représentent environ 3% des cancers chez l’adulte. Les plus fréquents parmi ces tumeurs sont les carcinomes rénaux à cellules claires (CRCC) (70% des cas). Dans une première partie, nous avons analysé le caryotype de 89 patients ayant subi une néphrectomie pour CRCC et avons corrélé les déséquilibres chromosomiques avec les principaux facteurs histo-pronostiques et cliniques de ces tumeurs. Cette étude nous a permis de confirmer l’impact diagnostique et/ou pronostique d’anomalies chromosomiques. Certaines étaient déja connues dans la littérature comme la perte du bras court d’un chromosome 3 à impact diagnostique ou la perte d’un chromosome 9 ou de son bras court associée à un pronostic défavorable. Nous avons ensuite, dans une seconde partie, sélectionné selon des critères cliniques et histologiques, deux lignées cellulaires R-180 et R-305 établies à partir de prélèvements chirurgicaux de CRCC de patients dont l’évolution clinique était défavorable pour le patient R-180 (survie de 1 an) et favorable pour le patient R-305 (survie de 7 ans). Nous avons analysé les profils cytogénétiques des deux lignées cellulaires et recherché des marqueurs d’intérêt. Nous avons mis en évidence une amplification du gène pard3 dans la lignée R-180 correspondant au patient qui est décédé 1 an après le diagnostic. Cette amplification a été associée à la surexpression de la protéine correspondante PAR-3 et à des modifications de l’organisation du cytosquelette. La diminution de l’expression de PAR-3 par transfection de siRNA dans les cellules R-180 a permis la restauration de l’organisation du cytosquelette et la réduction des capacités de migration cellulaire par rapport aux cellules non transfectées. Ce résultat suggère un rôle de PAR-3 dans la migration cellulaire des cellules R-180. Afin de valider la pertinence de ce nouveau biomarqueur dans le CRCC, nous avons étudié 101 tumeurs par immunohistochimie. Nous avons montré une corrélation significative entre la surexpression de PAR-3 dans la tumeur primitive des patients et une diminution de la survie globale et de la survie sans progression indépendamment d’autres facteurs pronostiques importants comme les métastases. De plus la surexpression de PAR-3 a été significativement associée aux facteurs histopathologiques et cliniques de mauvais pronostic : grades nucléaires de Fuhrman III ou IV, nécrose tumorale, composante sarcomatoide, atteinte surrénale, invasion de la graisse rénale ou hilaire, composante éosinophile, statut non-inactivé du gène VHL, grade tumoral plus élevé, envahissement ganglionnaire ou métastatique, et score ECOG (Eastern Cooperative Oncology Group) péjoratif. L’ensemble de nos résultats suggèrent que la surexpression de PAR-3 est associée à un risque significatif de progression et de mortalité dans le CRCC. Sa mise en évidence par immunohistochimie en routine hospitalière pourrait être utile pour identifier les patients à haut risque de progression, même en l’absence des paramètres pronostiques habituels. Des études complémentaires sont en cours pour intégrer ce biomarqueur dans les nomogrammes ainsi que pour évaluer l’impact de cette dérégulation dans la résistance des CRCC aux thérapies ciblées. / Kidney cancers represent about 3% of all adults’ malignancies. The most common form of kidney cancer is renal carcinoma of which 70 % of cases are defined as clear cell Renal Cell Carcinoma (ccRCC). We undertook a systematic review of all ccRCCs with a total of 89 patients who underwent nephrectomy surgery. We assessed the karyotype profile of all patients that we correlate with an immunohistochemical features and tumor symptoms. This study demonstrates a high impact of chromosomal abnormalities on patients’ diagnosis and prognosis. Some of these abnormalities have been submitted in other publications as the loss of the chromosome 3 p-arm which has a diagnosis impact, and the loss of the chromosome 9 or it s p-arm that have a poor prognosis impact. We selected two cell lines (R-180 and R-305) derived from ccRCC surgical specimens of a patient with unfavorable clinical course (R-180 cells) and a patient with favorable prognosis (R-305 cells) to identify genetic and molecular features that may explain the survival difference of the two patients. The cytogenetic analysis of these cell lines revealed that the pard3 gene was amplified only in the R-180 cell line that was derived from an aggressive ccRCC. The pard3 gene amplification was associated with overexpression of the encoded protein and altered cytoskeleton organization. PAR-3 knockdown in R-180 cell restored the cytoskeleton organisation and reduced cell migration in comparison to non-transfected cells. These results suggest PAR-3 role in R-180 migration cells line. With a view to corroborate the relevance of this new biomarker PAR-3 in ccRCC, we have studied 101 tumors using immunohistochemical methods. We proved a significant correlation between PAR-3 overexpression in the primitive tumor and, the decreasing of overall and free progression survival independently of other risk factors as metastasis. We also fund that the overexpression of PAR-3 is associated with an unfavorable clinical and immunohistochemical prognosis factors such as: stage III -IV in fuhrman system grading ,tumor necrosis, sarcomatoide component, supra renal metastasis, cancer spreading (surrounding fat and hilar), eosinophil component , none inactivate VHL gene, high tumor stage, lymph nodes spread, metastasis and ECOG scale. Our results reveal that the PAR-3 overexpression is associated with significant risk of ccRCCs mortality and spreading tumor. Immunohistochemical screening may be usefulness to identify patient’s high spreading risk whether the lack of the habitual prognosis parameters. Other studies are in progress to integrate this biomarker in nomograms and also to evaluate the impact on ccRCC’s resistance to targeted therapy.

O carcinoma de célula renal (CCR) subtipo célula clara é o câncer mais letal e prevalente do sistema urinário. A transformação maligna no CCR está possivelmente associada à mudanças no perfil de expressão de oncogenes e genes supressores de tumor, e acredita-se que estas alterações sejam críticas para o desenvolvimento do fenótipo maligno. Para identificar novos genes e vias moleculares associadas à transformação maligna no CCR célula clara, foram analisados perfis de expressão gênica de amostras pareadas de tumor e tecido não tumoral adjacente de 6 pacientes. Foi utilizada uma plataforma de microarrays de cDNA contendo 2.292 sondas mapeando éxons de genes codificadores e 822 sondas de RNAs não-codificadores mapeando em regiões intrônicas. A transcrição intrônica foi detectada em todos os tecidos normais e neoplásicos. Utilizando uma combinação de dois testes estatísticos e uma validação por leave-one-out, foi selecionado um subconjunto de 64 transcritos com expressão significativamente alterada em CCR célula clara em relação ao tecido não tumoral adjacente, estando a maior parte (86%) com expressão diminuída em CCR. Entre os transcritos com expressão diminuída, 49 mapearam em regiões não-traduzidas ou éxons de genes codificadores e 6 mapearam em regiões intrônicas de genes codificadores conhecidos. Os níveis de expressão diminuída de SIN3B, TRIP3, SYNJ2BP e NDE1 (p < 0,02), e de transcritos intrônicos derivados dos loci de SND1 e ACTN4 (p < 0,05), foram confirmados em CCR célula clara por Real-time RT-PCR. Um subconjunto de 25 transcritos se mostrou alterado em 6 amostras adicionais de CCR não célula clara, indicando alterações transcricionais comuns em CCR independentemente do subtipo histológico ou do estado de diferenciação do tumor. Além disso, foi analisado o perfil de metilação dos genes com expressão diminuída em tumor SIN3B, TRIP3, SYNJ2BP e GPX3. Nossos resultados indicam um novo conjunto de candidatos a gene supressor de tumor, que 8 podem desempenhar um papel importante na transformação maligna de células renais normais. / The clear cell subtype of renal cell carcinoma (RCC) is the most lethal and prevalent cancer of the urinary system. The carcinogenesis in RCC is thought to be associated with changes in the expression of several genes, and this alteration in gene expression is believed to be critical to the development of the malignant phenotype. To investigate new genes and molecular pathways associated with malignant transformation in clear cell RCC, gene expression profiles of matched samples of tumor and adjacent non-neoplastic tissue obtained from 6 patients were analysed. A custom-built cDNA microarray platform was used, comprising 2,292 probes that map to exons of genes and 822 probes for noncoding RNAs mapping to intronic regions. Intronic transcription was detected in all normal and neoplastic renal tissues. A subset of 64 transcripts with levels significantly deregulated in clear cell RCC relative to the matched non-tumor tissue, mostly (86%) downregulated in CCR, was

Dans les années 2000, la Dre Johanne Tremblay et son équipe identifient un gène régulé négativement par le calcium extracellulaire dans les glandes parathyroïdiennes de rat hypertendu (SHR). Initialement nommé Hypertension-related calcium regulated gene (HCaRG), puis COMM domain-containing 5 (COMMD5), ce gène codant pour une petite protéine de 24,67 kDa fait partie d’une famille de 10 protéines ayant une structure carboxy-terminale homologue nommée domaine COMM. De nombreux rôles ont été associés à cette famille de protéines et l’analyse expressionnelle dans différents types de cancers montre une modulation, laissant penser qu’elles auraient un rôle oncogénique ou suppresseur de tumeurs. Les études ont démontré que COMMD5 entraine une maturation des jonctions cellulaires, une diminution de la prolifération et favorise la migration cellulaire. La surexpression de COMMD5 dans les tubules proximaux de rein accélère la réparation suite à un dommage aigu en limitant d’une part la prolifération tout en favorisant la migration et la re-différenciation cellulaire. Partant de ces observations, nous avons focalisé nos études sur le développement du carcinome à cellules rénales, une pathologie affectant 300 000 personnes chaque année dans le monde. L’hypothèse que nous avons émise était que COMMD5 puisse potentiellement jouer un rôle anti-oncogénique dans le cancer du rein en contrôlant la prolifération et la différenciation cellulaires. Afin de vérifier notre hypothèse, nous avons étudié le rôle de COMMD5 dans le maintien de l’intégrité épithéliale des cellules via la régulation de la transition épithélio-mésenchymateuse (EMT) et le contrôle du récepteur du facteur de croissance épidermique (EGFR). Nos résultats ont démontré que COMMD5 est diminuée dans les carcinomes rénaux et est corrélée avec la survie des patients. La présence du facteur de transcription induit par l’hypoxie 1 (HIF1α), exprimé dans la majorité des tumeurs solides rénales a induit une diminution de COMMD5. La perte de COMMD5 dans les cellules de tubules proximaux de reins humains (HK-2) a favorisé la dé-différenciation et la tumorigénicité des cellules, médiées par l’activation de la transition épithélio-mésenchymateuse. De plus, cette perte de COMMD5 a entrainé également une réorganisation du cytosquelette d’actine ayant pour conséquence la dérégulation endosomale du récepteur de l’EGF et favorisant une activation prolongée. Dans les carcinomes rénaux, la surexpression de COMMD5 a diminué la prolifération cellulaire suivie d’une re-différenciation grâce à deux mécanismes. D’une part, COMMD5 a régulé négativement la protéine HIF1α, induisant ainsi une transition mésenchymo-épithéliale (MET), tout en séquestrant le facteur de transcription SNAIL dans le cytoplasme. D’autre part, COMMD5 contrôle négativement l’expression transcriptionnelle des récepteurs ErbB par une hyperméthylation de leurs promoteurs. Dans son ensemble, les résultats innovant de cette thèse démontrent que COMMD5 est un gène ayant des caractéristiques anti-oncogéniques en contrôlant la différenciation cellulaire via le mécanisme de transition épithélio-mésenchymateux et la régulation de l’expression des récepteurs ErbB. / In the 2000s, Dr. Johanne Tremblay and her team identified a gene that was negatively regulated by extracellular calcium in hypertensive rat parathyroid glands. Originally named Hypertension-related calcium regulated gene (HCaRG) and renamed COMM Domaincontaining 5 (COMMD5), this gene encoding a small protein of 24.67 kDa is part of a family of 10 proteins sharing a homologous structure in the carboxy-terminal position named COMM domain. Many roles have been associated and expressional analysis of different types of cancer shows a modulation suggesting that they have an oncogenic or tumor suppressor roles. Studies have shown that COMMD5 induces maturation of the cell junctions, decreased cell proliferation and promotes migration. The overexpression of COMMD5 in the renal proximal tubules accelerates repair by promoting cell proliferation and ultimately induces cell migration and redifferentiation after acute injury. Based on these observations, we focused on the development of renal cell carcinoma, a disease affecting 300,000 people each year worldwide. Our hypothesis is that COMMD5 plays a tumor suppressor role in kidney cancer by controlling cell proliferation and differentiation. To test our hypothesis, we investigated the role of COMMD5 in maintaining the epithelial integrity of cells through the regulation of epithelial to mesenchymal transition (EMT) and the control of epidermal growth factor receptors (EGFR). The results showed that COMMD5 is decreased in kidney carcinomas resulting of a great negative indicator of the survival prognostic. The presence of hypoxia-inducible factor 1a (HIF1α), expressed in the majority of solid tumors, leads to a decrease of COMMD5 in the proximal tubule cells (HK-2). Inhibition of COMMD5 promotes dedifferentiation and tumorigenicity of cells mediated by epithelial to mesenchymal transition. The loss of COMMD5 induces a reorganization of the actin cytoskeleton resulting in endosomal dysregulation of the EGFR receptor and promoting its activation. In renal cell carcinoma, COMMD5 overexpression decreases cell proliferation and induces their redifferentiation by two mechanisms: firstly, COMMD5 induces an inhibition of the HIF1α protein expression resulting in a mesenchymal to epithelial transition and sequesters the SNAIL transcription factor in the cytoplasm; secondly, COMMD5 negatively regulates the transcriptional expression of the ErbB receptors. Taken together, these results of this thesis show that COMMD5 is a gene showing tumor suppressor characteristics by controlling cellular differentiation and by regulating the expression of ErbB receptors.