.

A review on the peripheral nervous system (PNS) with emphasis on Schwann cells and neoplastic lesions of the system was performed. Schwann cells functions during PNS development as well as their importance during repair of nerve fibers and myelin within the nervous system were approached. Literature review points to numerous functions of Schwann cells and to new growth factors and genes that influence PNS development. A retrospective study of PNS tumors was made from the files of the Veterinary Pathology Laboratory of the Federal University of Santa Maria, Brazil, between 1964 and 2004. Peripheral nerve tumors summed up 12, 7 schwannomas and 5 neurofibromas. From those, 9 were studied from their clinical and macroscopical aspects, and histologically by histochemistry and immunohistochemistry. Histological features as neoplastic cell type, shape, cell differentiation, mitotic index, atypic cellular changes, encapsulation, eoplastic cells infiltration on surrounding tissues, edema, hemorrhage, necrosis, and inflammation were evaluated. Masson´s trichrome and Picrosírius red staining methods heightened connective tissue components that were more prevalent in neurofibromas with a characteristic deployment of collagens I and III. In AgNOR techniques both benign and malignant schwannomas and neurofibromas did not show significant statistic differences. Mast cells stained by toluidine blue were more prevalent in neurofibromas which are rich in reactive endoneurium. Schwannomas (100%) and nurofibromas (100%) were positive for vimentin and S100 protein, so they prove to be reliable for the diagnosis of PNS tumors. GFAP marked cells were randomly found within schwannomas and Schwann cells within neurofibromas, and this labelling must be used together with other techniques to reach and accurate diagnosis. / Foi realizada uma revisão sobre os nervos periféricos (NP) com ênfase nas suas neoplasias e nas células de Schwann. As funções das células de Schwann durante o desenvolvimento do SNP bem como sua importância na reparação e remielinização do sistema nervoso foram enfocadas. A literatura consultada mostra a descoberta de numerosas funções dessas células assim como novos fatores de crescimento e genes que influenciam o desenvolvimento do SNP. Foi realizado um levantamento retrospectivo das neoplasias de SNP nos arquivos do Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (UFSM) entre 1964 e 2004. Foram registrados 12 tumores, 7 schwannomas e 5 neurofibromas. Destes, 9 (4 schwannomas e 5 neurofibromas) foram submetidos a técnicas histoquímicas e imunoistoquímicas e avaliados sob os aspectos clínicos e morfológicos. Histologicamente, aspectos como caracterização do tipo celular neoplásico, forma, diferenciação celular, número de mitoses, atipia celular, presença de cápsula, infiltração das células neoplásicas no tecido além de outras alterações como edema, hemorragia, necrose e inflamação foram avaliados. Através da técnica do tricrômico de Masson e do Picrosírius red observou-se que o tecido conjuntivo era mais abundante nos neurofibromas e que os colágenos tipo I e tipo III foram característicos dessas neoplasias. No presente estudo, a técnica de AgNOR não foi eficiente como indicador de prognóstico já que não houve diferença estatística significativa entre os neurofibromas benignos e malignos e os schwannomas benignos e malignos. Os neurofibromas foram caracterizados, através da técnica do azul de toluidina, por uma concentração alta e difusa de mastócitos. Nos schwannomas essa população celular era restrita a poucas áreas. Essa marcada diferença entre as neoplasias deve-se ao fato de que os neurofibromas são constituídos de tecido endoneural reativo onde os mastócitos são normalmente encontrados. Imunoistoquímicamente houve forte marcação para a vimentina (100%) e S100 (100%) comprovando a eficiência desses anticorpos no diagnóstico dos tumores de SNP. O GFAP marcou aleatoriamente os schwannomas e todas as células de Schwann presentes nos fascículos nervosos dos neurofibromas. O GFAP deve ser usado junto com outros marcadores imunoistoquímicos e com outras técnicas de laboratório para promover um diagnóstico preciso.

Contexte : Le schwannome vestibulaire (SV) est une tumeur bénigne de la gaine du nerf vestibulaire. La plupart des SV présentent une inactivation somatique bi-allèlique du gène suppresseur de tumeur NF2. L’inactivation congénitale du gène NF2 est impliquée dans le développement de la Neurofibromatose de type 2, une maladie génétique autosomique dominante prédisposant au développement de tumeurs multiples du système nerveux central et en particulier de schwannomes vestibulaires bilatéraux. Le traitement des schwannomes vestibulaires repose sur la chirurgie ou la radiothérapie délivrée en conditions stéréotaxiques. La réduction de la dose d’irradiation des schwannomes vestibulaires a permis d’améliorer le pronostic fonctionnel auditif tout en garantissant un taux de réponse satisfaisant. Pourtant de nombreux patients présenteront une surdité neurosensorielle progressive. Afin de poursuivre cette réduction de dose d’irradiation, des modèles biologiques fidèles récapitulant le statut d’inactivation du gène NF2 et la surdité neurosensorielle sont nécessaires à l’élaboration d’une approche préclinique.Problématique : Nous avons proposé de développer des systèmes modèles in-vitro et in-vivo compatibles avec l’étude de la radiosensibilité des schwannomes vestibulaires en combinaison avec des thérapies ciblant les voies de signalisation spécifiquement activées par la perte de fonction NF2.Méthodes : Les lignées cellulaires humaines de schwannomes vestibulaires NF2 (HEI_193, HEI_182), et de cellules de Schwann vestibulaire contrôle (HEI_286) ont été cultivées en essai clonogénique afin de déterminer le nombre d’unité formatrices de colonies à doses croissantes d’inhibiteur mTOR (Rapamycine), PI3K (GDC_0941), mTOR et PI3K (BEZ_235) pour déterminer le 50% d’inhibition de croissance (GI50%) puis en combinaison à doses croissantes de radiation gamma (Co60). La lignée cellulaire murine inactivée pour nf2 (SC4#9) a été utilisée pour réaliser des greffes syngéniques orthotopiques. La croissance des tumeurs a été suivie par IRM et bioluminescence et l’audition déterminée par potentiels évoqués auditifs. L’analyse histologique des cochlées a été réalisée par coloration en hématoxyline et éosine puis par fluorescence après clarification cochléaire. Des volumes complets ont été obtenus par microscopie confocale à balayage laser.Résultats : Les essais clonogéniques réalisés en Agarose ont identifié une radiorésistance relative des lignées humaines de schwannomes mutées pour NF2 par comparaison au contrôle humain non muté. Cette résistance identifiée en réponse à l’exposition à une dose unique d’irradiation gamma peut être contournée par l’inhibition de la voie mTOR au moment de l’irradiation restituant une sensibilité comparable au contrôle humain non muté. Une tendance à un bénéfice de l’association d’une inhibition mTOR à un inhibiteur PI3 kinase a été retrouvée à une dose maximum d’irradiation. Un modèle murin de schwannome vestibulaire qui récapitule la croissance dans l’angle ponto-cérébelleux et la perte d’audition a été développé par injection stéréotaxique dans le paquet acoustico faciale. Le suivi de croissance de ce schwannome a été caractérisé par IRM et bio-luminescence in-vivo. Enfin un protocole de clarification cochléaire a été adapté aux mammifères murins pour permettre l’étude histologique de cochlées intactes compatible avec l’étude de l’otoxicité des schwannomes et/ou de leur traitement .Conclusion : Les modèles décrits dans cette thèse permettent l’évaluation pré-clinique de stratégies thérapeutiques combinant thérapie ciblée et irradiation gamma en dose unique. L’amélioration des connaissances des mécanismes participant à l’ototoxicité des schwannomes et de leur traitement permettra d’améliorer le ciblage moléculaire afin de réduire les effets auditifs secondaires de la radiochirurgie. / Context: Vestibular schwannomas (VS) are benign neoplasm arising from the Schwann cells of the vestibular nerve. Most of sporadic VS carry a bi-allelic inactivation of the tumor suppressor gene NF2. Congenital inactivation of the NF2 gene is linked to the onset of Neurofibromatosis type 2 (NF2), a genetic condition predisposing to the development of multiple benign tumor of the central nervous system with bilateral VS as a hallmark. Treatment of VS is either surgical or by use of radiation therapy delivered in stereotactic condition. A significant dose reduction has led to improving the hearing outcomes while maintaining good tumor control. Meanwhile a significant number of treated patients will develop a progressive sensorineural hearing loss (SNHL). Laboratory models that faithfully recapitulate NF2 gene inactivation and SNHL are needed to pursue the reduction of the dose delivered.Aim: We aimed at developing new models in-vitro and in-vivo for the study of vestibular schwannoma radio sensitivity in combination with selected compounds that selectively target the pathways activated secondary to NF2 loss of function.Methodes: Human vestibular schwannoma cell lines (HEI_193, HEI_182) and control human Schwann cell line (HEI_286) were used in clonogenic assay to determine the number of colony forming unit (CFU) spontaneously and at increasing dosing of mTOR inhibitor (Rapamycin), PI3 kinase inhibitor (GDC_0941), PI3K-mTOR dual inhibitor (BEZ_235) to determine the 50% growth inhibitory threshold (GI50%) then in combination with increasing radiation regimen of gamma radiation emitted by a source of Co60. The mouse cell line inactivated for nf2 (SC4#9) was used to generate orthotropic syngrafts. The growth of the tumor was monitored using MRI and bioluminescence imaging and hearing was tested by recording auditory brainstem responses. Pathology of the cochlea were obtained from paraffin embedded sections and then using fluorescence confocal microscopy of whole mounted transparent cochleae.Results: Soft agar clonogenic assays were used and identified a resistance to radiation therapy in human cell lines of VS inactivated for NF2 when compared to the non-mutated control. This radiation resistance could be overcome by pre-exposure to the mTOR inhibitor Rapamycin allowing a return to the radiosensibility of non-mutated control. There was a tendency toward a beneficial effect when using a dual inhibition of the mTOR and PI3 kinase at a maximum dose of exposure to radiation. A mouse model of VS has been developed by stereotactic seeding of nf2 deficient cell line SC4#9 targeting the cochleo-vestibular nerve complex. It recapitulates the growth in the suitable micro-environment and secondary SNHL. The growth has been characterized using MRI and in-vivo bioluminescence imaging. Hearing loss was confirmed using sequential ABR. Last a protocol for the clarification of whole mounted cochleae has been adapted to species of rodents suitable for the pathological study of ototoxic change secondary to VS and/or its treatment.Conclusion: The models presented in this thesis may be used for the preclinical evaluation of combined therapeutic approaches with single dose gamma radiation. A better understanding of the mechanisms involved in ototoxicity secondary to VS and of its treatment would improve the molecular targeting in order to warrant better auditory outcomes.

Les schwannomes sont des tumeurs bénignes se développant à partir d’une hyper-prolifération des cellules de Schwann suite à l’inactivation bi-allélique du gène NF2. Signe pathogonomique d’une pathologie rare et héréditaire, la Neurofibromatose de type 2 (NF2), ils peuvent aussi apparaître de façon sporadique. Hormis la chirurgie ou la radiothérapie, peu d’options pharmacologiques sont proposées aux patients porteurs de schwannomes, principalement à cause du peu de cibles thérapeutiques identifiées. Dans les cellules de Schwann, le phénotype cellulaire associé à la perte NF2 est une perte d’inhibition de la prolifération par le contact. Deux fonctions majeures de Merlin, produit de NF2, ont émergé au cours de ces dix dernières années. La première, démontrée par notre groupe, concerne la régulation de l’expression membranaire des récepteurs à activité tyrosine kinase (RTK) qui s’accumulent à la membrane plasmique des schwannomes humains. Le second implique Merlin dans la régulation de la voie de signalisation Hippo. Cette dernière, activée par le contact cellulaire réprime l’activité de deux co-facteurs de transcription, Yap et Taz, et régule ainsi et aussi l’inhibition de contact. Les mécanismes moléculaires par lesquels Merlin inhibe l’activité de Yap/Taz sont toutefois méconnus. Le but de nos études a été de déterminer une signature moléculaire associée à la croissance des schwannomes humains et l’importance relative de Yap/Taz. Dans une analyse protéomique à grande échelle sur des biopsies humaines, nous avons identifié à la fois l’activation spécifique de cinq RTKs que sont le PDGFRβ, Her2, Her3, Axl et Tie2 ainsi qu’une accumulation nucléaire spécifique de Yap. Nous montrons que sur la totalité des protéines étudiées, seules Yap, le PDGFRβ et P-Her3 corrèlent avec la prolifération des cellules de schwannomes humain. De plus, Yap induit la transcription des RTK activés (à l’exception de Tie2). Nous plaçons donc Yap au centre des mécanismes de régulation de la croissance des schwannomes humains et proposons que son inhibition pourrait représenter une nouvelle et prometteuse stratégie thérapeutique pour réduire la croissance de ces tumeurs. Nous apportons une nouvelle lecture des fonctions de Merlin, qui, par une potentielle interaction directe avec Yap, inhibe spécifiquement sa translocation dans le noyau indépendamment d’une régulation par la densité cellulaire ou par la voie Hippo. Par ailleurs, Merlin ne semble pas essentiel à l’activation de la voie Hippo dans les cellules de Schwann soulignant une fonction nouvelle et inattendue de Merlin dans la régulation de Yap et de la voie Hippo. Enfin nous avons étudié le rôle d’AmotL1, un puissant partenaire de Merlin et membre de la voie Hippo, dans la migration et la progression des cancers du sein. Nous mettons en évidence une fonction antagoniste de Merlin et AmotL1 dans la promotion de ces mécanismes soulignant une autre fonction nouvelle de Merlin en tant que suppresseur de la progression de cancers non associés à NF2. / Schwannomas are benign tumors arising from Schwann cell hyper-proliferation under NF2 bi-allelic inactivation. They appear in the context of a rare hereditary disease called Neurofibromatosis type 2 (NF2) or in sporadic cases. To this day, surgery and radiotherapy remain the only options to treat these patients, mainly due to the lack of therapeutical targets identified. The NF2 loss associated cellular phenotype is the loss of cell contact inhibition. Two main functions of Merlin, the NF2 product, have emerged in the last decade. The first was shown by our group and consists in the accumulation of tyrosine kinase receptors (RTK) at the plasma membrane in schwannomas. The second involves Merlin in the regulation of the Hippo signaling pathway. This pathway is activated by cell contact and inactivates a couple of transcription co-factors, Yap and Taz, then participating in cell contact inhibition of proliferation. However, the mechanisms by which Merlin inactivates Yap and Taz remain unknown. In our studies, we aimed to determine both the molecular signature of human schwannomas taking advantage of a large proteomic study, and the relative importance of Yap in the tumor suppressor function of Merlin. We could show both a specific activation of five RTKs : PDGFRβ, Her 3, Her2, Axl and Tie2 and a specific nuclear accumulation of Yap in human schwannoma. Among all the protein studied, Yap, PDGFRβ and P-Her3 are the only ones to correlate with the proliferation of human schwannoma cells. Furthermore, the activated RTK (excepted Tie2) are transcriptional targets of Yap. Hence, we found Yap as a pivotal regulator of schwannoma growth and proposed its inhibition as a new and promising therapeutical target to reduce human schwannoma growth. In addition, we show that Merlin specifically inhibits Yap nuclear translocation into the nucleus of Schwann cells by a direct interaction which is independent from the regulation by cell density and by the Hippo pathway. Moreover, Merlin expression seems not to be essential for Hippo activation in Schwann cells which brings a new and unexpected role of Merlin in Yap and Hippo regulation. In the end, we studied the role of AmotL1, a strong Hippo partner of Merlin in the migration and progression of breast cancer. We could show an antagonist function of Merlin and AmotL1 in the promotion of these mechanisms highlighting a new progression suppressor function of Merlin in cancer which are not linked to NF2 mutations.

Introduction: In Positron Emission Tomography (PET), the use of resolution modelling (RM) in iterative image reconstruction enables the modelling of aspects of detection which result in mispositioning of measured data and the subsequent blurring of reconstructed images. RM reconstruction can result in significant improvements in spatial resolution, voxel variance and count rate bias and could be a software alternative to detection hardware that is able to achieve higher resolution. Such hardware typically consists of small scintillation crystals, small bore diameters and depth of interaction discrimination, such as for the High Resolution Research Tomograph (HRRT, Siemens), which used a double crystal layer phoswich detector system. However, RM implementation comes with penalties such as slower rates of convergence, potentially higher region of interest variance and Gibbs artefacts. Methods: Assessment of the benefits and drawbacks of RM was done in the first part of this thesis together with the measurement and modelling of spatially varying resolution kernels for different scanner configurations and PET isotopes for the HRRT. It is also unclear as to whether high resolution scanning offers significant advantages over clinical PET-CT scanners for applications in the head. Through direct comparison to our HRRT, we explore whether there are significant advantages of high resolution scanning for an application in the head over clinical PET-CT. For this comparison our Biograph TruePoint TrueV (Siemens) optimised for whole body imaging was used and a novel clinical study using both scanners was set where we scanned Neurofibromatosis 2 (NF2) patients with vestibular schwannomas (VS) using [18F]fluorodeoxyglucose (FDG) and [18F]fluorothymidine (FLT). The clinical objective was to assess if uptake within VS of FLT and FDG could be measured and whether this uptake was predictive of tumour growth. Finally an assessment of the feasibility and impact of reducing the original injected activities in our clinical study was performed using bootstrapping resampling. Conclusions: RM provides greater but additive improvements in image resolution compared to DOI on the HRRT. Isotope specific image based RM could be estimated from published positron range distributions and measurements using fluorine-18. With the clinical project, uptake of FDG and FLT within the VS lesions was observed, these uptake values were correlated to each other, and high uptake was predictive of tumour growth with little differences in predictive power between FLT and FDG. Although there were benefits of the HRRT for imaging small lesions, in our clinical application there was little difference between the two scanners to discriminate lesion growth. Using the PET-CT scanner data and knowledge of lesion location, doses could be reduced to 5-10% without any significant loss of ability to discriminate lesion growth.