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The Australian paralysis tick, Ixodes holocyclus causes a potentially fatal paralysis in domestic animals, livestock and humans with companion animals (mainly dogs) most commonly affected. Current treatment regimes include administration of a commercial tick anti-serum (TAS), prepared as hyperimmune serum in dogs, to neutralise the effects of the toxin. However, each new batch must be standardised using an expensive and highly subjective bioassay performed in neonatal mice. There is currently an urgent need for a more cost effective and rapid in vitro assay that can be more objectively and accurately quantified. Further understanding of the composition of the toxin molecule is also required to develop toxin-specific reagents necessary for these assays. One of the main objectives of this study was to develop a suitable immunoassay to replace the existing mouse bioassay for assessing batches of tick anti-sera for use in tick paralysis therapy in dogs. Initially an enzyme-linked immunosorbent assay (ELISA) was established to detect and quantify antibody specific for I. holocyclus toxin in dog sera. Using a partially purified antigen extracted from I. holocyclus salivary glands, good discrimination was achieved between reactive (hyperimmune) and non-reactive (naïve) sera. The hyperimmune dog sera reacted very strongly with the antigen compared to negligible reactions of serum from dogs not exposed to I. holocyclus. The reactions of hyperimmune sera were also significantly weaker to a non-toxin antigen control extracted from the salivary glands of the non-toxic tick Rhipicephalus microplus, indicating the assay was detecting toxin-specific responses. Furthermore, each of the hyperimmune sera that reacted strongly and specifically with the I. holocyclus antigen in the ELISA also strongly neutralised toxin in the mouse bioassay. Together these findings support the suitability of this ELISA for assessing the potency of batches of commercial dog hyperimmune sera for use as therapy for tick paralysis in dogs. Sera from dogs that were experimentally infested with ticks and sera from patient dogs, presenting at veterinary clinics with signs of tick paralysis, were also screened for antibodies to I. holocyclus antigen using the ELISA. Twenty-eight out of 29 sera from animals with single or multiple exposures to ticks failed to recognise the I. holocyclus antigen indicating the ELISA is not suitable as a diagnostic test to detect toxin-specific antibodies in animals with limited exposure to I. holocyclus infestation. A panel of toxin-specific monoclonal antibodies (mAbs) was produced as research tools to analyse and purify tick toxin components. Rats were successfully immunised against tick toxin using a combination of inoculation of partially purified salivary gland antigen and exposure to tick infestation. The latter approach preserved the native confirmation of the toxin using a natural route of immunisation and rats were chosen due to their high tolerance of multiple tick infestations over several days. While fusion of rat spleen cells with mouse myeloma cells has been reported several times in the literature, the resulting hybridomas are unstable with fastidious culture requirements. Optimisation of the culture conditions revealed that most rat-mouse hybridoma lines grew best in serum-free medium supplemented with 5% foetal bovine serum. Of 600 hybridomas produced, only 12 were shown to be specific for the Ixodes antigen, as determined by ELISA. A selection of these hybridomas representing various patterns of affinity and/or antigen specificity were further analysed for toxin-neutralising ability in a mouse bioassay. Notably, the most potent toxin-neutralising mAb in mice, showed a specific but relatively moderate reaction to Ixodes antigen in the ELISA. The most potent toxin-neutralising mAbs inactivated toxin as strongly as the commercial TAS used for immunotherapy in dogs with tick paralysis. This suggests that mAbs may present an alternative source of immunotherapy, providing a potentially endless supply of a highly consistent reagent and negating the need to use live animals for both the production of tick antiserum and the continual testing of reagent batches. The toxin-neutralising mAbs were also used to analyse I. holocyclus toxin in polyacrylamide gel electrophoresis (PAGE) and Western blot to identify specific toxin proteins. The most potent neutralising mAbs consistently recognised high MW proteins (100-200 kDa) in a smeared pattern. Although this was contrary to previous reports of low molecular weight components (3-5 kDa) in holocyclotoxin, this study was the first to use mAbs prepared to native toxin. The large molecular weight structures likely represent presucursors to, or complexes of the smaller peptides, previously identified. When the Toxin-neutralising mAbs were assessed as ligands to affinity purify toxin components from crude Ixodes SG extracts, toxin components of 110 and 32 kDa were consistently identified. These purified proteins represent good candidates for N-terminal sequencing to further identify the toxin components in I.holocyclus salivary glands.

The author of this work deals with the problems of the sialolithiasis. He summarizes current knowledge of the etiology of the disease, diagnostic and therapeutic procedures. There are described conventional therapeutic approaches, but the main part is dedicated to current practices which are used after the introduction of new technology-sialoendoscopy. The endoscopic technique is described in this work, the evaluation of its benefits, but also its limits. The author's efforts for conservative approach to the issue sialolithiasis, the exact localization of the sialith and extraction with preservation of the salivary gland is based on publications in the scientific literature. He documents this procedure with the resultes of his own research. There is evaluated using sialoendoscopy in treatment of the sialolithiasis in cases where the sialolith is located in hilum of the submandibular gland. This localization was in the past often an indication for extirpation of the submandibular gland. The author statistically rates files of extirpated submandibular glands in the author's workplace in two five-years periods. The first period is in the time when the sialoendoscopy is not used for examination and treatment of the sialolithiasis yet. In the second period the sialoendoscopy is available, there is also...

O câncer é um problema de saúde pública mundial, apresentando acréscimo na sua incidência a cada ano. O seu processo de evolução ainda não foi completamente desvendado, dificultando a elaboração de terapias adequadas. Na busca por um melhor prognóstico, pesquisas recentes têm discutido o papel das citocinas inflamatórias, do nicho perivascular e das células-tronco nos mecanismos de desenvolvimento e manutenção dos tumores malignos. Os tumores de glândula salivar representam uma pequena porcentagem das patologias malignas da região de cabeça e pescoço, podendo ocorrer em adultos e em crianças. O diagnóstico dificilmente é precoce e a taxa de sobrevida é extremamente baixa comparada aos demais tumores da região. Assim, este estudo teve como objetivo estudar as células provenientes dos tumores de glândula salivar do tipo adenoide cístico (CAC) e adenocarcinoma NOS (AdNOS) quanto ao seu perfil imunofenotípico, quanto à existência ou não de células-tronco tumorais nessa população, bem como investigar possíveis modificações na ativação de STAT3, Akt e ERK (moléculas envolvidas em vias de sinalização de manutenção do tumor), quando em contato com fatores secretados por células endoteliais. Foram coletados 5 CACs e 4 AdNOS, no Hospital da Universidade de Michigan (Ann Arbor, MI, EUA), durante 2010 e 2012. As células foram isoladas e caracterizadas em citometria de fluxo em P0 e P7, demonstrando um perfil de células CD44+ALDH+Lin- variando de 0,33 a 3,19% e 0,36 a 2,00%, respectivamente, entre 5 linhagens avaliadas. Na avaliação por western blotting, a e-caderina, o Snail e a actina de músculo liso foram ausentes em todos os tipos tumorais, enquanto que a citoqueratina 20 (Ck20) foi presente apenas nos AdNOS. Comparando os tumores com suas metástases, a presença de Ck20, p63 e β-catenina foi semelhante, enquanto que citoqueratina 7, a vimentina e o Bmi-1 foram maiores nas metástases. Tanto os AdNOS quanto CACs apresentaram receptores para IL-6, IL-8 e EGF. Foi observado que mediadores solúveis liberados pelas células endoteliais foram capazes de fosforilar STAT3, Akt e ERK em todas as células salivares estudadas, no entanto, a proteína recombinante humana IL-6, isoladamente, não foi capaz de ativar Akt. Orosferas foram geradas em todos os tipos tumorais, demonstrando o potencial de auto-renovação celular. Um maior número de esferas foi observado nas células metastáticas em relação às primárias. Células CD44+ALDH+, comparadas com CD44-ALDH-, geraram mais esferas, quando plaqueadas em alta densidade (5.000 células). No entanto, o inverso foi encontrado, quando uma única célula foi utilizada para o ensaio (p>0,05). Devido à dificuldade de obtenção e manipulação de células de tumores de glândula salivar, ainda há muito que se investigar mecanisticamente. Considerando a fosforilação de STAT3 na presença de IL-6, semelhante ao verificado em outros tumores, o uso de anticorpos contra IL-6, talvez sejam uma opção no futuro. / Cancer is a public health problem worldwide, with an increase in incidence every year. The process of its evolution is still not completely understood, hindering the development of appropriate therapies. In the search for a better prognosis, recent reports have discussed the role of inflammatory cytokines, perivascular niche and stem cells in the mechanisms of development and maintenance of malignant tumors. The salivary gland tumors represent a small percentage of malignancies of the head and neck and can occur in both adults and children. Early diagnosis is difficult and the survival rate is extremely low compared to other tumors in the same region. Thus, this study aimed to study cells from the adenoid cystic carcinoma (ACC) and adenocarcinoma NOS (AdNOS) tumors of salivary gland regarding its immunophenotypic profile and the existence or absence of tumor stem cells in this population, as well as investigate possible changes in the activation of STAT3, Akt and ERK (molecules involved in signaling pathways of tumor maintenance), when exposed to factors secreted by endothelial cells. ACCs (n=5) and AdNOS (n=4) were collected at the Hospital of the University of Michigan (Ann Arbor, MI, USA), during 2010 to 2012. Cells were isolated and characterized by flow cytometry at P0 and P7, showing a profile of ALDH+CD44+Lin- ranging from 0.33% to 3.19% and 0.36% and 2.00%, respectively, between 5 cell lines evaluated. In the protein profile, e-cadherin, Snail and SMA were absent in all tumor types. Ck20 was present only in AdNOS. Comparing primary tumors and their metastases, the presence of Ck20, and p63 β-catenin was similar, while Ck7, vimentin and Bmi-1 were higher in metastases. Both AdNOS as ACCs had receptors for IL-6, IL-8 and EGF. It was observed that soluble mediators released by endothelial cells were able to activate STAT3, Akt and ERK phosphorylation in all cells studied. However, recombinant human IL-6 alone was not able to activate Akt. Orospheres were generated in all tumor types, indicating the potential for cellular self-renewal. Highest number of spheres was observed in metastatic cells compared to primary. ALDH+CD44+ cells compared to ALDH-CD44- generated more spheres when plated in high density (5,000 cells), however, the opposite was found when one single cell seed was evaluated (p> 0.05). There is doubt if these cell markers would be consider for a stem cell model in salivary tumors. Due to the difficulty of obtaining and manipulating salivary gland tumor cells, there is still much to investigate mechanistically. As the phosphorylation of STAT3, in the presence of IL-6, was similar to that observed in other tumors, the use of antibodies against IL-6, may be an option in the future.

O carcinoma mucoepidermoide (CME) representa a neoplasia maligna de glândula salivar mais comum. Tumores com alto grau histológico e casos avançados, com metástase regional ou a distância, apresentam taxas de sobrevida extremamente baixas em decorrência da falta de terapias eficazes. A radioterapia é usualmente aplicada como terapia adjuvante ou primeira linha de tratamento de tumores inoperáveis, entretanto o perfil de resistência do CME à radioterapia permanece não elucidado. Outra abordagem em tumores avançados é a quimioterapia, usualmente a base de cisplatina, aplicada como tratamento meramente paliativo. Um dos principais pontos chave envolvidos na resistência tumoral às terapias convencionais é a manutenção de uma população celular com alto potencial tumorigênico, chamadas de células tronco tumorais (CTT). Estas células apresentam capacidade de evadir terapias convencionais e são responsáveis pelo aparecimento de metástases e recidivas. Evidências recentes sugerem que a utilização de terapias combinadas possuem maior potencial de reduzir a resistência tumoral. Desta forma, no primeiro estudo nosso objetivo foi identificar o perfil de resistência à radioterapia de linhagens celulares de CME, vias associadas com a radio-resistência adquirida e formas de sensibilizar farmacologicamente as células de CME, incluindo as CTT, à radiação ionizante. Os resultados demonstraram que as linhagens de CME apresentam diferentes perfis de resistência à radiação ionizante, sendo a linhagem mais resistente capaz de ativar intrinsicamente o NFκB frente a baixas doses de radiação. Além disso, a resistência das linhagens mais sensíveis foi estimulada quando a vida do NFκB foi excitada. A inibição farmacológica do NFκB com Emetine foi realizada com sucesso através da inibição do eixo IKK-β/IκBα/NFκB. A utilização de Emetine previamente a radiação ionizante foi capaz de aumentar a sensibilidade das células de CME assim como diminuir o percentual de CTT. No segundo estudo nosso objetivo foi identificar a resposta tumoral, incluindo das CTT, à terapia única ou combinada utilizando dois alvos terapêuticos distintos: NFκB (tratamento com Emetine) e acetilação de histonas (tratamento com SAHA). Os resultados mostraram que uma dose de Emetine é capaz de inibir a proliferação celular em todas as linhagens de CME analisadas, enquanto que o SAHA apresentou este efeito em apenas 50% das linhagens. Por outro lado, o SAHA foi mais eficaz em reduzir a população de CTT que o Emetine. A terapia combinada foi mais eficaz do que as terapias individuais em relação a proliferação celular e a depleção de CTT. Através da analise dos resultados dos dois estudos, podemos concluir que a resistência tumoral do CME é superada com maior êxito quando mais de uma forma de tratamento é empregada. A associação de Emetine com a irradiação ou de SAHA com Emetine se mostrou eficaz no controle do tumor através da erradicação da população de CTT. / Mucoepidermoid carcinoma (MEC) represents the most common salivary gland cancer. High-grade tumors and advanced cases, presenting regional or distant metastasis, exhibit extremely low survival rates due to a lack of effective therapies. Radiotherapy is frequently applied as adjuvant therapy or as first-line treatment in inoperable cases. Nevertheless, the resistance profile of MEC to radiotherapy remains unclear. Chemotherapy, most commonly cisplatin, used for advanced cases is considered merely palliative. A key point involved in tumor resistance to conventional therapies is the maintenance of a cell population with high tumorigenic potential, called cancer stem cells (CSC). These cells have the ability to evade conventional therapies and are responsible for metastases and recurrences. Recent evidences support that combined therapies are more effective in reducing tumor resistance. Therefore, in the first study our objective was to identify the resistance profile of MEC cell lines to ionizing radiation, pathways associated with acquired resistance and ways to sensitize pharmacologically MEC cells, including CSC, to ionizing radiation. The results demonstrated that MEC cell lines present different resistance profile to ionizing radiation and the most resistant cell line is capable to activate intrinsically NFκB after low doses of irradiation. Moreover, resistance of sensitive cell lines can be triggered by NFκB activation. Pharmacological inhibition of NFκB with Emetine was achieved through IKK-β/IκBα/NFκB axis inhibition. The use of Emetine prior to irradiation was efficient in increasing cell sensibility as well as decrease the percentage of CSC. In the second study, our aim was to identify the tumor response, including of CSC, to single or combined therapy using two distinc therapeutic targets: NFκB (treated with Emetine) and histone acetylation (treated with SAHA). The results demonstrated that a single dose of Emetine was capable to inhibit cell proliferation in all MEC cell lines, while SAHA achieved this result in only 50% of cell lines analyzed. On the other side, SAHA was more efficient than Emetine in disrupting CSC population. The combined therapy was more effective than both single agent therapies regarding cell proliferation and CSC depletion. By analysing both studies results, we can conclude that the tumor resistance of MEC is overcome with greater success when more than one form of treatment is employed. The association of Emetine with irradiation or SAHA with Emetine is effective in tumor control by eradicating the CSC population.

As neoplasias de glândula salivar (NGS) são tumores raros que despertam interesse por sua diversidade histopatológica e comportamento clínico. A compreensão da patobiologia assim como, dos mecanismos envolvidos no comportamento invasivo destas lesões é necessária para melhor entender a biologia das NGS e posteriormente delinear novas estratégias terapêuticas. A presente tese foi dividida em dois artigos. O objetivo do primeiro estudo foi descrever os dados demográficos, clinicopatológicos e de prognóstico das NGS diagnosticados em um centro de atenção terciário. Para tal, foi realizada uma análise retrospectiva utilizando os dados de arquivos e de prontuários. Foram identificados 109 casos de NGS cuja média de idade dos pacientes foi de 46.47 anos e a relação homens:mulheres foi de 0.94:1. As glândulas salivares maiores foram mais acometidas (75.2%) e os tumores benignos os mais prevalentes (75.2%) sendo o adenoma pleomórfico o tumor benigno mais comum e o carcinoma adenóide cístico o principal maligno. O objetivo do segundo estudo foi analizar o padrão de expressão da via de sinalização do HGF/c-Me/PI3K em NGS e correlacionar com o perfi proliferativo e desfechos clínicos das lesões. Foram construídos microarranjos de tecido (TMAs) de 93 casos de NGs e as lâminas foram submetidas a análise imunoistoquímica para HGF, p-Met, p-Akt e Ki67. Foi observada maior expressão de HGF nos tumores benignos (p=0.04), enquanto que as protínas p-Met (p=0.03), p-Akt (p=0.00) e Ki-67 (p=0.00) foram mais expressas nos tumores malignos. Nas neoplasias malignas houve maior ativação da via HGF observada pela maior expressão do seu receptor fosforilado (p-Met) bem como, maior ativação da via do PI3k pela fosforilação de Akt (p-Akt) resultando em um maior perfil proliferativo. Pode-se concluir que a via de sinalização do HGF/c-Met/PI3k parece estar ativa nas NGS regulando a proliferação especialmente nas neoplasias malignas. / Salivary gland tumors (SGT) are rare yet interesting neoplasms due to their histopatological diversity and clinical behavior. Understanding the pathobiology as well as the mechanisms involved in the invasive behavior of these lesions is needed to better comprehend the biology of SGT and further delineate new therapeutic strategies. This thesis was divided in two papers. The aim of the first study was to describe the demographic, clincopathological and prognostic data of SGT diagnosed in a tertiary care center. For this purpose, a retrospective analysis using data from the archives and records was performed. One hundred and nine cases of SGT were identified. The patients mean age was 46.47 years and the male:female ratio was 0.91:1. The major salivary glands were the most affected (75.2%) and the benign SGT were more prevalent (78%) being pleomorphic adenoma the most common benign tumor and adenoid cystic carcinoma the most common malignant tumor. The objective of the second study was to analyze the expression pattern of HGF/c-Met/PI3K signaling pathway in SGT and correlate the findings with the proliferative profile and clinical outcomes of cases. Tissue microarrays (TMAs) of 93 cases of SGT were constructed; the slides were submitted to immunohistochemical analysis for HGF, p-Met, p-Akt and Ki-67. Increased expression of HGF was observed in benign tumors (p = 0.04), while p-Met (P = 0.03), p-Akt (p = 0:00) and Ki-67 (p = 0:00) were most expressed in malignant tumors. In salivary glands carcinomas there was a higher activation of the HGF pathway observed by the higher expression of its phosporylated receptor (p-Met) as well as the higher activation of PI3k pathway through Akt (p-Akt) phosphorilation, resulting in a higher proliferative profile. It can be concluded that HGF/c-Met/PI3K signaling pathway appears to be active in SGT regulating the proliferation specially in malignant tumors.

Orientador: Luiz Eduardo Blumer Rosa / Banca: Decio dos Santos Pinto Junior / Banca: Carlos Eduardo Dias Colombo / Resumo: A carcinogênese consiste em um processo de alterações genéticas após contato celular com agentes físicos, químicos ou biológicos. Esta interação pode culminar em manifestações de fenótipos malignos celulares. No estudo experimental da carcinogênese em glândulas salivares animais, os autores são unânimes em apontar os hidrocarbonetos policíclicos aromáticos (HPA) como potentes agentes carcinogênicos. O 7,12 - dimetilbenzantraceno (DMBA), pertencente ao grupo dos HPA, é considerado o carcinógeno químico de eleição para a tumorigênese de glândulas salivares animais. Este trabalho visou o estudo de DMBA injetado em glândulas salivares submandibulares de ratos. Foram utilizados 28 ratos (Rattus norvegicus), com três meses de idade e peso aproximado de 300g. Os resultados revelaram, na 5ª semana, sete casos de sialadenite crônica. Na 10ª semana, um caso com atipia celular ductal, dois casos de carcinoma epidermóide e quatro de sialadenite crônica. Entre a 15ª e 20ª semanas, foram observados três casos de hiperemia, três casos de carcinoma epidermóide, um caso de sarcoma e sete casos de carcinossarcoma. A análise dos dados, em porcentagem, revelou: 3,6% de atipia celular, 3,6% de sarcoma, 10,7% de hiperemia, 17,9% de carcinoma epidermóide, 25% de carcinossarcoma e 39,4% de sialadenite crônica. Conclusão: Os dados obtidos permitiram o estudo da história natural da carcinogênese glandular por DMBA desde os processos inflamatórios iniciais até à formação de neoplasias mesenquimais, epiteliais e mistas. / Abstract: The carcinogenesis consists in a process in which the direct contact between cells and some physical, chemical or biological agents results in cell malignization. In the scope of experimental salivary gland carcinogenesis there is a consensus in the use of polycyclic aromatic hydrocarbons (PAH) as carcinogens. The 7,12 - dimethylbenzanthracene (DMBA) is the most used PAH. This paper aims the investigations of the DMBA injected in rats submandibular glands. For this purpose, 28 rats (Rattus norvegicus), three months old (300 gr. weight, approximately) were used. The animals were divided into four groups of seven each. All animals were anesthetized and shaved in the neck. After antisepsis, one ventral neck incision, followed by dissection was performed in each animal. The left submandibular gland was injected with 0.1 ml of 2% DMBA in acetone. The skin was closed with 3-Ø silk suture. By the end of the 5th, 10th, 15th and 20th weeks the animals were sacrificed by lethal doses of anesthetics. The results in the 5th week presented seven cases of chronic sialadenitis. After 10 weeks one case of ductal cell atypia was evident, two cases of squamous cell carcinoma and four cases of chronic sialadenitis were also seen. Between the 15th and 20th weeks the cases were diagnosed as follows: three cases of hyperemia, three cases of squamous cell carcinoma, one case of sarcoma and seven cases of carcinosarcoma. The data analysis showed 3.6% of cellular atypia, 3.6% of sarcoma, 10.7% of hyperemia, 17.9% of squamous cell carcinoma, 25% of carcinosarcoma and 39.4% of chronic sialadenitis. Conclusion: the results allowed the investigation of the glandular carcinogenesis natural history after DMBA injection, from the beginning of inflammatory changes to the neoplastic manifestation of mesenquimal, epithelial and mixed tumours. / Mestre

O carcinoma mucoepidermoide (CME) representa a neoplasia maligna de glândula salivar mais comum. Tumores com alto grau histológico e casos avançados, com metástase regional ou a distância, apresentam taxas de sobrevida extremamente baixas em decorrência da falta de terapias eficazes. A radioterapia é usualmente aplicada como terapia adjuvante ou primeira linha de tratamento de tumores inoperáveis, entretanto o perfil de resistência do CME à radioterapia permanece não elucidado. Outra abordagem em tumores avançados é a quimioterapia, usualmente a base de cisplatina, aplicada como tratamento meramente paliativo. Um dos principais pontos chave envolvidos na resistência tumoral às terapias convencionais é a manutenção de uma população celular com alto potencial tumorigênico, chamadas de células tronco tumorais (CTT). Estas células apresentam capacidade de evadir terapias convencionais e são responsáveis pelo aparecimento de metástases e recidivas. Evidências recentes sugerem que a utilização de terapias combinadas possuem maior potencial de reduzir a resistência tumoral. Desta forma, no primeiro estudo nosso objetivo foi identificar o perfil de resistência à radioterapia de linhagens celulares de CME, vias associadas com a radio-resistência adquirida e formas de sensibilizar farmacologicamente as células de CME, incluindo as CTT, à radiação ionizante. Os resultados demonstraram que as linhagens de CME apresentam diferentes perfis de resistência à radiação ionizante, sendo a linhagem mais resistente capaz de ativar intrinsicamente o NFκB frente a baixas doses de radiação. Além disso, a resistência das linhagens mais sensíveis foi estimulada quando a vida do NFκB foi excitada. A inibição farmacológica do NFκB com Emetine foi realizada com sucesso através da inibição do eixo IKK-β/IκBα/NFκB. A utilização de Emetine previamente a radiação ionizante foi capaz de aumentar a sensibilidade das células de CME assim como diminuir o percentual de CTT. No segundo estudo nosso objetivo foi identificar a resposta tumoral, incluindo das CTT, à terapia única ou combinada utilizando dois alvos terapêuticos distintos: NFκB (tratamento com Emetine) e acetilação de histonas (tratamento com SAHA). Os resultados mostraram que uma dose de Emetine é capaz de inibir a proliferação celular em todas as linhagens de CME analisadas, enquanto que o SAHA apresentou este efeito em apenas 50% das linhagens. Por outro lado, o SAHA foi mais eficaz em reduzir a população de CTT que o Emetine. A terapia combinada foi mais eficaz do que as terapias individuais em relação a proliferação celular e a depleção de CTT. Através da analise dos resultados dos dois estudos, podemos concluir que a resistência tumoral do CME é superada com maior êxito quando mais de uma forma de tratamento é empregada. A associação de Emetine com a irradiação ou de SAHA com Emetine se mostrou eficaz no controle do tumor através da erradicação da população de CTT. / Mucoepidermoid carcinoma (MEC) represents the most common salivary gland cancer. High-grade tumors and advanced cases, presenting regional or distant metastasis, exhibit extremely low survival rates due to a lack of effective therapies. Radiotherapy is frequently applied as adjuvant therapy or as first-line treatment in inoperable cases. Nevertheless, the resistance profile of MEC to radiotherapy remains unclear. Chemotherapy, most commonly cisplatin, used for advanced cases is considered merely palliative. A key point involved in tumor resistance to conventional therapies is the maintenance of a cell population with high tumorigenic potential, called cancer stem cells (CSC). These cells have the ability to evade conventional therapies and are responsible for metastases and recurrences. Recent evidences support that combined therapies are more effective in reducing tumor resistance. Therefore, in the first study our objective was to identify the resistance profile of MEC cell lines to ionizing radiation, pathways associated with acquired resistance and ways to sensitize pharmacologically MEC cells, including CSC, to ionizing radiation. The results demonstrated that MEC cell lines present different resistance profile to ionizing radiation and the most resistant cell line is capable to activate intrinsically NFκB after low doses of irradiation. Moreover, resistance of sensitive cell lines can be triggered by NFκB activation. Pharmacological inhibition of NFκB with Emetine was achieved through IKK-β/IκBα/NFκB axis inhibition. The use of Emetine prior to irradiation was efficient in increasing cell sensibility as well as decrease the percentage of CSC. In the second study, our aim was to identify the tumor response, including of CSC, to single or combined therapy using two distinc therapeutic targets: NFκB (treated with Emetine) and histone acetylation (treated with SAHA). The results demonstrated that a single dose of Emetine was capable to inhibit cell proliferation in all MEC cell lines, while SAHA achieved this result in only 50% of cell lines analyzed. On the other side, SAHA was more efficient than Emetine in disrupting CSC population. The combined therapy was more effective than both single agent therapies regarding cell proliferation and CSC depletion. By analysing both studies results, we can conclude that the tumor resistance of MEC is overcome with greater success when more than one form of treatment is employed. The association of Emetine with irradiation or SAHA with Emetine is effective in tumor control by eradicating the CSC population.

O câncer é um problema de saúde pública mundial, apresentando acréscimo na sua incidência a cada ano. O seu processo de evolução ainda não foi completamente desvendado, dificultando a elaboração de terapias adequadas. Na busca por um melhor prognóstico, pesquisas recentes têm discutido o papel das citocinas inflamatórias, do nicho perivascular e das células-tronco nos mecanismos de desenvolvimento e manutenção dos tumores malignos. Os tumores de glândula salivar representam uma pequena porcentagem das patologias malignas da região de cabeça e pescoço, podendo ocorrer em adultos e em crianças. O diagnóstico dificilmente é precoce e a taxa de sobrevida é extremamente baixa comparada aos demais tumores da região. Assim, este estudo teve como objetivo estudar as células provenientes dos tumores de glândula salivar do tipo adenoide cístico (CAC) e adenocarcinoma NOS (AdNOS) quanto ao seu perfil imunofenotípico, quanto à existência ou não de células-tronco tumorais nessa população, bem como investigar possíveis modificações na ativação de STAT3, Akt e ERK (moléculas envolvidas em vias de sinalização de manutenção do tumor), quando em contato com fatores secretados por células endoteliais. Foram coletados 5 CACs e 4 AdNOS, no Hospital da Universidade de Michigan (Ann Arbor, MI, EUA), durante 2010 e 2012. As células foram isoladas e caracterizadas em citometria de fluxo em P0 e P7, demonstrando um perfil de células CD44+ALDH+Lin- variando de 0,33 a 3,19% e 0,36 a 2,00%, respectivamente, entre 5 linhagens avaliadas. Na avaliação por western blotting, a e-caderina, o Snail e a actina de músculo liso foram ausentes em todos os tipos tumorais, enquanto que a citoqueratina 20 (Ck20) foi presente apenas nos AdNOS. Comparando os tumores com suas metástases, a presença de Ck20, p63 e β-catenina foi semelhante, enquanto que citoqueratina 7, a vimentina e o Bmi-1 foram maiores nas metástases. Tanto os AdNOS quanto CACs apresentaram receptores para IL-6, IL-8 e EGF. Foi observado que mediadores solúveis liberados pelas células endoteliais foram capazes de fosforilar STAT3, Akt e ERK em todas as células salivares estudadas, no entanto, a proteína recombinante humana IL-6, isoladamente, não foi capaz de ativar Akt. Orosferas foram geradas em todos os tipos tumorais, demonstrando o potencial de auto-renovação celular. Um maior número de esferas foi observado nas células metastáticas em relação às primárias. Células CD44+ALDH+, comparadas com CD44-ALDH-, geraram mais esferas, quando plaqueadas em alta densidade (5.000 células). No entanto, o inverso foi encontrado, quando uma única célula foi utilizada para o ensaio (p>0,05). Devido à dificuldade de obtenção e manipulação de células de tumores de glândula salivar, ainda há muito que se investigar mecanisticamente. Considerando a fosforilação de STAT3 na presença de IL-6, semelhante ao verificado em outros tumores, o uso de anticorpos contra IL-6, talvez sejam uma opção no futuro. / Cancer is a public health problem worldwide, with an increase in incidence every year. The process of its evolution is still not completely understood, hindering the development of appropriate therapies. In the search for a better prognosis, recent reports have discussed the role of inflammatory cytokines, perivascular niche and stem cells in the mechanisms of development and maintenance of malignant tumors. The salivary gland tumors represent a small percentage of malignancies of the head and neck and can occur in both adults and children. Early diagnosis is difficult and the survival rate is extremely low compared to other tumors in the same region. Thus, this study aimed to study cells from the adenoid cystic carcinoma (ACC) and adenocarcinoma NOS (AdNOS) tumors of salivary gland regarding its immunophenotypic profile and the existence or absence of tumor stem cells in this population, as well as investigate possible changes in the activation of STAT3, Akt and ERK (molecules involved in signaling pathways of tumor maintenance), when exposed to factors secreted by endothelial cells. ACCs (n=5) and AdNOS (n=4) were collected at the Hospital of the University of Michigan (Ann Arbor, MI, USA), during 2010 to 2012. Cells were isolated and characterized by flow cytometry at P0 and P7, showing a profile of ALDH+CD44+Lin- ranging from 0.33% to 3.19% and 0.36% and 2.00%, respectively, between 5 cell lines evaluated. In the protein profile, e-cadherin, Snail and SMA were absent in all tumor types. Ck20 was present only in AdNOS. Comparing primary tumors and their metastases, the presence of Ck20, and p63 β-catenin was similar, while Ck7, vimentin and Bmi-1 were higher in metastases. Both AdNOS as ACCs had receptors for IL-6, IL-8 and EGF. It was observed that soluble mediators released by endothelial cells were able to activate STAT3, Akt and ERK phosphorylation in all cells studied. However, recombinant human IL-6 alone was not able to activate Akt. Orospheres were generated in all tumor types, indicating the potential for cellular self-renewal. Highest number of spheres was observed in metastatic cells compared to primary. ALDH+CD44+ cells compared to ALDH-CD44- generated more spheres when plated in high density (5,000 cells), however, the opposite was found when one single cell seed was evaluated (p> 0.05). There is doubt if these cell markers would be consider for a stem cell model in salivary tumors. Due to the difficulty of obtaining and manipulating salivary gland tumor cells, there is still much to investigate mechanistically. As the phosphorylation of STAT3, in the presence of IL-6, was similar to that observed in other tumors, the use of antibodies against IL-6, may be an option in the future.

As neoplasias de glândula salivar (NGS) são tumores raros que despertam interesse por sua diversidade histopatológica e comportamento clínico. A compreensão da patobiologia assim como, dos mecanismos envolvidos no comportamento invasivo destas lesões é necessária para melhor entender a biologia das NGS e posteriormente delinear novas estratégias terapêuticas. A presente tese foi dividida em dois artigos. O objetivo do primeiro estudo foi descrever os dados demográficos, clinicopatológicos e de prognóstico das NGS diagnosticados em um centro de atenção terciário. Para tal, foi realizada uma análise retrospectiva utilizando os dados de arquivos e de prontuários. Foram identificados 109 casos de NGS cuja média de idade dos pacientes foi de 46.47 anos e a relação homens:mulheres foi de 0.94:1. As glândulas salivares maiores foram mais acometidas (75.2%) e os tumores benignos os mais prevalentes (75.2%) sendo o adenoma pleomórfico o tumor benigno mais comum e o carcinoma adenóide cístico o principal maligno. O objetivo do segundo estudo foi analizar o padrão de expressão da via de sinalização do HGF/c-Me/PI3K em NGS e correlacionar com o perfi proliferativo e desfechos clínicos das lesões. Foram construídos microarranjos de tecido (TMAs) de 93 casos de NGs e as lâminas foram submetidas a análise imunoistoquímica para HGF, p-Met, p-Akt e Ki67. Foi observada maior expressão de HGF nos tumores benignos (p=0.04), enquanto que as protínas p-Met (p=0.03), p-Akt (p=0.00) e Ki-67 (p=0.00) foram mais expressas nos tumores malignos. Nas neoplasias malignas houve maior ativação da via HGF observada pela maior expressão do seu receptor fosforilado (p-Met) bem como, maior ativação da via do PI3k pela fosforilação de Akt (p-Akt) resultando em um maior perfil proliferativo. Pode-se concluir que a via de sinalização do HGF/c-Met/PI3k parece estar ativa nas NGS regulando a proliferação especialmente nas neoplasias malignas. / Salivary gland tumors (SGT) are rare yet interesting neoplasms due to their histopatological diversity and clinical behavior. Understanding the pathobiology as well as the mechanisms involved in the invasive behavior of these lesions is needed to better comprehend the biology of SGT and further delineate new therapeutic strategies. This thesis was divided in two papers. The aim of the first study was to describe the demographic, clincopathological and prognostic data of SGT diagnosed in a tertiary care center. For this purpose, a retrospective analysis using data from the archives and records was performed. One hundred and nine cases of SGT were identified. The patients mean age was 46.47 years and the male:female ratio was 0.91:1. The major salivary glands were the most affected (75.2%) and the benign SGT were more prevalent (78%) being pleomorphic adenoma the most common benign tumor and adenoid cystic carcinoma the most common malignant tumor. The objective of the second study was to analyze the expression pattern of HGF/c-Met/PI3K signaling pathway in SGT and correlate the findings with the proliferative profile and clinical outcomes of cases. Tissue microarrays (TMAs) of 93 cases of SGT were constructed; the slides were submitted to immunohistochemical analysis for HGF, p-Met, p-Akt and Ki-67. Increased expression of HGF was observed in benign tumors (p = 0.04), while p-Met (P = 0.03), p-Akt (p = 0:00) and Ki-67 (p = 0:00) were most expressed in malignant tumors. In salivary glands carcinomas there was a higher activation of the HGF pathway observed by the higher expression of its phosporylated receptor (p-Met) as well as the higher activation of PI3k pathway through Akt (p-Akt) phosphorilation, resulting in a higher proliferative profile. It can be concluded that HGF/c-Met/PI3K signaling pathway appears to be active in SGT regulating the proliferation specially in malignant tumors.