The typical response of cancer patients to treatment is only temporary, and is often followed by relapse. The failure of various therapeutic strategies is commonly attributed to the emergence of drug resistance. The response patterns for patients under such treatments indicate that complex dynamics regulate the response of the tumour to the therapy. The environment in which the tumour lives (the stroma) is known to be a modulator of multiple mechanisms that lead to drug resistance and seems to be a likely candidate for explaining some of this complexity. Understanding the role of stromal cells in the promotion of drug resistance is critical for the design of optimal treatment strategies, and for the development of novel therapies that selectively target both the tumour and the stroma. In this thesis we design two novel mathematical models that describe cancer growth within its environment and the evolution of drug resistance within spatially complex and temporally dynamic tumours. A compartment model captures clinically observed dynamics and allows direct comparison with experimental data, facilitating model parametrisation and the understanding of inter-tumour heterogeneity. An individual cell-based model highlights the key role of local interactions, determining heterogeneity at the tissue scale, that will eventually determine treatment outcome. A non-spatial approximation of this second model allows us to find analytic guidelines for the design of effective therapy. These tools allow the simulation of a range of treatment strategies (including combination of different drugs and variation of schedule) as well as the investigation of therapy response based on patient- or organ-specic parameters. The work developed in this dissertation is based on the paradigmatic biology of melanoma and non-small cell lung cancer. Its results are therefore applicable to a variety of cancer treatments that target similar processes, and whose therapeutic failure can be attributed to environment-mediated drug resistance.

Les chordomes sont des tumeurs rares. Elles représentent 1-4% de toutes les tumeurs osseuses. Ces tumeurs à histogénèse notochordienne sont d'origine mésodermique exprimant des marqueurs épithéliaux. Elles sont dans la majorité des cas de bas grade et d’évolutions insidieuses, mais toujours infiltrantes et destructrices pouvant donner des métastases. Au plan thérapeutique, ce sont des lésions réputées pour leur résistance aux cytotoxiques, aux rayonnements ionisants et aux thérapies ciblées actuelles. Leur prise en charge standard consiste en une chirurgie première suivie d'une radiothérapie complémentaire à haute dose. Le taux de contrôle local est de 70% et 50% à 5 ans et 10 ans respectivement et la survie médiane est de 6 ans. Les futurs challenges consistent à mieux définir le volume cible par l’imagerie multimodalité pour une radiothérapie personnalisée voire adaptative tenant compte des modifications tumorales morphologiques et métaboliques en cours de traitement. L’hypoxie est connue depuis longtemps comme un facteur de radiorésistance aux traitements. En effet, l'hypoxie induit un phénotype agressif avec un haut potentiel métastatique, favorisant la progression tumorale. Ces caractéristiques sont intimement liées à certaines modifications biologiques comme l’angiogenèse tumorale et le dérèglement du métabolisme cellulaire du glucose. Une meilleure connaissance de ces facteurs régulateurs des cibles biologiques constitue un vrai challenge pour le clinicien et les industriels dans le cadre du développement de nouvelles thérapeutiques. Dans ce cadre, mon projet de thèse a été construit en trois étapes : (i) nous avons récemment rapporté, pour la première fois, la présence de composantes cellulaires hypermétaboliques et de composantes cellulaires très hypoxiques quiescentes par l'imagerie TEP/CT, (ii) mettre en évidence sur des prélèvements de chordomes provenant de patients, les facteurs régulateurs de l'hypoxie (HIF-1, HIF-2) du métabolisme (GLUT1 ; MCT1 ; MCT4 ; Basigine, CAIX - CAXII) et de l’autophagie (BNIP3) par des techniques d'immunohistochimie ; (iii) quantification de ces marqueurs par des techniques de Western Blot. La corrélation de ces résultats biologiques aux résultats cliniques obtenus, montre que les patients présentant des lésions arborant un métabolisme glycolytique et un processus de survie autophagique présentent un phénotype agressif et radiorésistant. La présence de ces mécanismes de survie est fortement corrélée avec un contrôle local faible et une survie réduite. La mise en évidence de ces mécanismes et de leurs facteurs régulateurs nous permet d’envisager des traitements ciblés en association avec la chirurgie et la radiothérapie. / Chordomas are rare tumors. They represent 1-4% of all bone tumors. These tumors are notochordal histogenesis and mesodermal origin expressing epithelial markers. They are in most cases low grade and have insidious development with destructive and invasive power. Therapeutically, they are known for their resistance to cytotoxic drugs, ionizing radiation and targeted therapies. "Gold standart" treatment for these lesions is a primary surgery followed by high doses of radiotherapy. The local control rate is 70% and 50% at 5 years and 10 years respectively and median survival is 6 years. Future challenges are to define better the target volume by multimodality imaging for radiation therapy or adaptive personalized taking into account changes in tumor metabolic and morphological processing. Hypoxia has long been known as a radioresistance factor. Indeed, hypoxia induces an aggressive phenotype with a high metastatic potential, promoting tumor progression. These characteristics are closely related to certain biological changes such as tumor angiogenesis and disruption of cellular metabolism of glucose. A better understanding of these regulators factors of biological targets is a real challenge for clinicians and industry in the development of new therapies. In this context, my thesis project was built in three steps: (i) we recently reported, for the first time, the presence of quiescent and hypoxic cellular components and hypermetabolic cellular components by PET / CT, (ii) highlight on samples from patients with chordoma, the hypoxia regulatory factors (HIF-1, HIF-2) metabolism (GLUT1, MCT1, MCT4; Basigine, CAIX - CAXII) and autophagy (BNIP3) by immunohistochemistry, (iii) quantification of these markers by immunoblotting techniques. The correlation of these laboratory findings to clinical results showed that patients with lesions displaying a glycolytic metabolism and survival autophagic process have an aggressive and radioresistant phenotype. The presence of these mechanisms is strongly correlated with poor local control and survival reduced. The highlight of these mechanisms and their regulatory factors allow us to consider targeted therapies in combination with surgery and radiotherapy.

The central hypothesis supporting the present work is that the effectiveness of radiation therapy for cancer is often limited due to defects in key apoptosis regulators, such as Bcl-2 family members, that contribute to cancer ability to evade apoptosis. One way to bypass this resistance to radiotherapy is to target cell death pathways, aiming to sensitize tumours to radiation and enhance the therapeutic ratio in cancer. To test this central hypothesis, we took a dual approach: one targeted apoptosis and the other targeted autophagy. / First, we focused on the apoptotic signaling. The Bcl-2 family comprises antiapoptotic members, such as Bcl-2, Mcl-1, and Bcl-XL, and proapoptotic members, such as Bax, Bak, and Bid. The Bcl-2 family controls the integrity of the outer mitochondrial membrane and is critical in determining the susceptibility of cells to apoptosis induced by the intrinsic pathway. The balance between cell survival and cell death is modulated by the ratios and interactions of antiapoptotic and proapoptotic Bcl-2 family proteins. Overexpression of Bcl-2 or Bcl-XL is observed in several cancers, including lung, colorectal, prostate, and breast cancers, and has been shown to confer resistance to various anticancer agents, including radiotherapy. In cancer cells, alterations in the amounts of these antiapoptotic Bcl-2 proteins promote cell survival, among others by contributing to their evasion from treatment-induced apoptosis. We made the observation that lung cancer cells have different radiosensitivity. On the basis of their relative response to radiotherapy, we stratified lung cancer cells into two groups (higher or lower sensitivity), and selected a representative cell line of each group for more in-depth study: A549 (resistant) and HCC2429 (sensitive). We found that the expression levels of Bcl-XL expression, which is antiapoptotic, was dramatically higher in A549, whereas almost not detected in HCC2429. We then hypothesized that AT-101, a pan-Bcl-2 inhibitor, had the potential to radiosensitize lung cancer by restoring radiation-induced apoptosis. When administered alone, AT-101 resulted in increased apoptosis in a concentration-dependent manner in both groups, with enhanced activity in HCC2429 even at lower concentration. Furthermore, AT-101 promoted radiosensitivity of A549 and HCC2429 cells (p < 0.005). A549 cells required increased AT-101 dose to achieve the same level of cytotoxicity than HCC2429 cells. These investigations suggest that the Bcl-2 family members may serve as effective therapeutic targets in lung cancer. However, the potential of AT-101 as an agent that enhances the therapeutic ratio of radiotherapy varies depending on the lung cancer clone. / Next, we turned to a different approach, focusing on the inhibition of apoptosis instead of its promotion. This work hypothesis was based on previous observations looking at the role of radiation-induced apoptosis by knockdown of Bak and Bax. The radiosensitivity of breast and lung cancer in vitro was increased through autophagy, an alternate type of programmed cell death. Consistently, radiation-induced apoptosis accounts for a minor portion of cell death in irradiated solid tumors. The hypothesis of our work was that apoptosis inhibition would increase radiation-induced autophagy and tumor sensitivity to radiation. To block apoptosis, we used Z-VAD, a broad-spectrum caspase inhibitor, and examined its in vitro and in vivo effects on breast and lung cancer models. Z-VAD markedly radiosensitized breast and lung cancer cells in vitro, with a radiation dose enhancement ratio of 1.31 (P < 0.003). The enhanced tumor cytotoxicity was associated with induction of autophagy. In both breast and lung cancer mice xenograft models, the administration of Z-VAD concurrent with radiation produced a significant tumor growth delay compared with radiation alone and was well tolerated. Interestingly, Z-VAD also had a dramatic antiangiogenic effect when combined with radiation both in vitro and in vivo. Thus, Z-VAD represents an attractive anticancer therapeutic strategy. We further explored the potential of apoptosis inhibition as a way to sensitize cancer to radiation using a more selective chemical, M867, which is a reversible caspase-3 inhibitor. In an in vivo mouse hind limb lung cancer model, the administration of M867 with ionizing radiation was well tolerated, and produced a significant tumor growth delay compared with radiation alone. A dramatic decrease in tumor vasculature and tumor cell proliferation was observed with M867 despite the reduced levels of apoptosis. The radiosensitizing effect of M867 through the inhibition of caspases was validated using a caspase-3/-7 double-knockout (DKO) mouse embryonic fibroblasts (MEF) cell model. Consistent with our previous results, autophagy contributed to the mechanism of increased cell death, following inhibition of apoptosis. Finally, we investigated the mechanism by which radiation triggers autophagy in caspase-3/7-deficient cells, and found the involvement of endoplasmic reticulum (ER) stress. The ER activates a survival pathway, the unfolded protein response, which involves ER-localized transmembrane proteins such as protein kinase-like ER kinase (PERK), inositol-requiring enzyme-1, and activating transcription factor-6. In this study, we found that PERK is essential for radiation-induced autophagy and radiosensitivity in caspase-3/7 double-knockout cells. Irradiation of these cells increased expression of phosphorylated-eIF2a. Similar results were seen after administration of tunicamycin (TM), a well-known ER stress inducer. We found that the administration of TM with radiation in MCF-7 breast cancer cells, which are lacking functional caspase-3 and are relatively resistant to many anticancer agents, enhances radiation sensitivity. Our findings revealed ER stress as a novel potential mechanism of radiation-induced autophagy in caspase-3/7-deficient cells and as a potential strategy to maximize efficiency of radiation therapy in breast cancer. Our data suggested that caspase-3 has a critical role in modulating the PERK/eIF2a pathway after radiation. / Many cancers exhibit multiple deregulations in cell death pathways, allowing for the subsequent promotion of tumor cell survival, and contributing to a relatively low response rate to therapies based on the use of pro-apoptotic strategies. As we have showed, there is a potential for novel anticancer strategies to overcome resistant cancer cells with defective apoptosis machinery in order to improve overall therapeutic outcomes. Such novel approach is to drive cancer cells towards autophagy, as demonstrated by our experiments that studied the effect of radiation on the induction of autophagy in caspase-deficient models. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Abstract Cancer is a major global killer and a challenge for the healthcare worldwide. Earlier cancer has been treated with surgery, radiation, chemotherapy and hormonal therapy. Unfortunately the efficiency of these therapies has shown to be limited and this has raised an enthusiasm for development of new, targeted cancer therapies that are based on activated oncogenes. The challenge of the targeted therapies is therapy resistance, de novo, adaptive and acquired. This work investigated targeted therapy sensitivity and resistance in lung cancer, breast cancer, colorectal cancer, and melanoma cell lines. The results of this study indicate that in some non-small cell lung cancer cell lines, dual PI3K and MEK inhibition is a more efficacious treatment than inhibition of either solely. It was also showed that the maximal effect of the dual inhibition can be achieved with alternative dosing schedules that are potentially more tolerable in clinical use. Furthermore, by combining ABT-263, entinostat or dasatinib to the dual PI3K and MEK inhibition, the efficiency of the therapy can be increased. Bcl-xl downregulation is a major determinant of the apoptotic response to the triple inhibitor treatment. The current work showed that cancer stem cells can mediate resistance to targeted therapies. Since these cells follow the stochastic model, concurrent therapy with a targeted agent and a stem cell targeting drug might be needed for maximal therapeutic efficiency. This study also showed that Gö6976 acts as a potent inhibitor of mutant EGFR despite the presence of T790M, the most important mechanism of acquired resistance for EGFR tyrosine kinase inhibitors in lung cancer, both in vitro and in vivo. / Tiivistelmä Syöpä on yksi johtavia kuolemanaiheuttajia ja tauti on maailmanlaajuinen haaste terveydenhuollolle. Perinteiset syöpähoidot käsittävät kirurgian, sädehoidon, kemoterapian ja hormonaalisen hoidon, mutta näiden rinnalle on noussut uusia, aktivoituneiden onkogeenien signaalien estoon perustuvia hoitoja. Tämä työ tutki kohdennettuja syöpähoitoja ja näihin hoitoihin liittyvää resistenssiä keuhko-, rinta- ja paksusuolen syövän sekä melanooman solulinjoissa. Tulokset osoittavat, että joissakin ei-pienisoluisen keuhkosyövän solulinjoissa yhdistetty PI3K- ja MEK-esto aiheuttaa tehokkaamman vasteen kuin kummankaan signaalireitin esto yksistään. Tässä työssä näytettiin myös, että maksimaalinen vaste yhdistetylle PI3K- ja MEK-estolle voidaan saavuttaa vaihtoehtoisilla annostelutavoilla, jotka ovat voisivat olla paremmin siedettyjä kliinisessä käytössä kuin kahden lääkkeen jatkuva annostelu. Tämä tutkimus osoitti lisäksi, että kaksoiseston tehokkuutta voidaan lisätä yhdistämällä hoitoon kolmas lääkeaine, ABT-263, entinostaatti tai dasatinibi. Bcl-xl proteiinilla on keskeinen rooli apoptoottisen vasteen määrittäjänä näille kolmen lääkkeen käsittelyille. Tämä työ osoitti, että syövän kantasolut voivat välittää resistenssiä kohdennetuille syöpähoidoille. Nämä solut noudattavat niin kutsuttua stokastista mallia, joten parhaan vasteen saaminen saattaa edellyttää että hoito kohdentuu sekä erilaistuneisiin että kantasolutyyppisiin syöpäsoluihin. Tässä tutkimuksessa osoitettin lisäksi, että Gö6976 toimii mutatoituneen EGFR:n estäjänä, huolimatta kehittyvää keuhkosyövissä resistenssiä välittävästä T90M mutaatiosta, sekä in vitro -että in vivo -malleissa.

Les glioblastomes sont les tumeurs primitives cérébrales les plus agressives de l’adulte. Elles sont caractérisées par une importante néo-angiogenèse, conduisant au développement des anti-VEGF chez ces patients. L’objectif de cette thèse était d’identifier de potentiels marqueurs prédictifs de l’activité du bevacizumab et d’analyser le profil évolutif des facteurs de l’angiogenèse. En situation de récidive d’un gliome de haut grade, si aucun facteur clinique ne semble permettre d’identifier un sous-groupe de patients bénéficiant particulièrement du bevacizumab, les taux plasmatiques avant traitement de MMP2 et MMP9, inversement corrélés entre eux suggérant un rôle biologique distinct mais relié, semblent associés à la réponse, la survie sans progression et la survie globale de patients porteurs de gliome de haut grade traités à la récidive par bevacizumab. Le rôle potentiel de ces marqueurs est renforcé par la cinétique de leurs taux plasmatiques observé sous traitement, Nous avons mis en évidence des résultats superposables chez des patientes porteuses de cancers du sein inflammatoires traités par bevacizumab en situation néo-adjuvante, renforçant l’intérêt de ces marqueurs. Par ailleurs, l’analyse de la signature angiogénique tissulaire des glioblastomes nouvellement diagnostiqués et récidivants nous a permis d’observer une modification de l’expression des facteurs de l’angiogenèse avec un possible switch de la voie VEGFR2-HIF1α en faveur de la voie CXCL12-CXCR4 à la récidive. Ces différents résultats permettent d’ouvrir de nouvelles perspectives dans le ciblage de l’angiogenèse et dans l’approche thérapeutique de patients porteurs de gliome de haut grade. / Glioblastomas are the most frequent and aggressive primary brain tumors for adult. They are characterized by a high angiogenesis leading to the evaluation of the bevacizumab. Our aim was to identify potential predictive biomarkers of bevacizumab activity and to analyze the evolutive profile of the angiogenic factors during the disease. If no clinical factor allows the identification of patient subgroup benefiting of bevacizumab, MMP2 and MMP9 plasma level at baseline were correlated to response, progression-free survival and overall survival of patients with recurrent high grade glioma treated by bevacizumab. Moreover, plasma levels of these markers change during treatment and significantly varied at the time of progression. We observed similar results for patients with inflammatory breast cancer treated with neoadjuvant bevacizumab, reinforcing the potential value of these prebiomarkers. In tumor tissue, while we did not observed changes in MMP2/MMP9 expression between the initial diagnosis and the recurrence post radio-chemotherapy, we observed a modification of the expression of angiogenic factors with a potential switch from the VEGFR2-HIF1α to the CXCL12-CXCR4 pathway. These results lead to new perspectives in angiogenic modulation and glioblastoma treatment.

Severe traumatic brain injury (sTBI) is a cause of death and disability worldwide and requires treatment at specialized neuro-intensive care units (NICU) with a multimodal monitoring approach. The CT scan imaging supports the monitoring and diagnostics. The level of S100B and neuron specific enolase (NSE) reflects the severity of the injury. The therapy resistant intracranial hypertension requires decompressive craniectomy (DC). After DC, the cranium must be reconstructed to recreate the normal intracranial physiology as well as to address cosmetic issues. The evolution of the pathological intracranial changes was analyzed in accordance with the three CT classifications: Marshall, Rotterdam and Morris-Marshall. The Rotterdam scale was best in describing the dynamics of the pathological evolution. Both the Rotterdam score and Morris- Marshall classification showed strong correlation with the clinical outcome, a finding that suggests that they could be used for prognostication. We demonstrated a clear correlation between the CT classifications and concentrations of S100B and NSE. The results revealed a concomitant correlation between NSE and S100B and clinical outcome. We found that the interaction between the ICP, Rotterdam CT classification, and concentrations of biochemical biomarkers are all associated with DC. We found a high percentage of complications following cranioplasty. Our results call into question whether custom-made allograft should be considered the best material for cranioplasty. It is concluded that both the Rotterdam and Morris-Marshall classification contribute to clinical evaluation of intracranial dynamics after sTBI, and might be used in combination with biochemical biomarkers for better assessment. The decision to perform DC should include a re-assesment of ICP evolution, CT scan images and concentration of the biochemical biomarkers. Furthermore, when determining whether DC treatment should be used, surgeon should also consider the risks of the following cranioplasty.

Orientadores: Wagner Eduardo Matheus, Ubirajara Ferreira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:07:43Z (GMT). No. of bitstreams: 1 Senatore_MarcelaAndreaDuranHaun_D.pdf: 1829482 bytes, checksum: bc20dee71d7524f229d7b76160f9e38b (MD5) Previous issue date: 2014 / Resumo: Atualmente existem diferentes agentes para o tratamento do câncer renal avançado. O objetivo principal desse trabalho foi realizar revisão sistemática com meta-análise dos estudos clínicos randomizados que compararam: sorafenibe, sunitinibe, bevacizumabe, temsirolimus e everolimus ao interferon-?. Para isto foi realizada revisão sistemática da literatura em diferentes bancos de dados: EMBASE, LILACS e PUBMED, identificando estudos clínicos randomizados que compararam as terapias alvo moleculares (TAM) disponíveis versus interferon-alfa para tratamento de pacientes com câncer renal avançado. Para o tratamento de 1a linha foram encontrados 10 estudos que avaliaram as terapias com sunitinibe, sorafenibe, bevacizumabe e temsirolimus; e três estudos que avaliaram o sorafenibe e everolimus como tratamento de 2a linha. O Risco Relativo (RR) da sobrevida livre de progressão (SLP) dos estudos de 1a linha foi de 0.83, intervalo de confiança (IC) [0.78-0.87] com I2= 94% e p<0.00001. Os melhores resultados foram: o estudo do sunitinibe, 0.38, IC [0.25-0.58], do bevacizumabe com RR de 0.62, IC [0.47-0.83] e do temsirolimus, 0.78, IC [0.70-0.87]. A meta-análise não demonstrou benefício quanto à sobrevida global (SG), no tratamento de 1a linha com sunitinibe e temsirolimus. Os tratamentos de 1ª linha com sorafenibe e bevacizumabe não associaram benefícios clínicos significativos. Não foi possível realizar meta-análise nos estudos do tratamento de 2a linha, pois, as populações eram diferentes. Logo, para o tratamento de 1a linha, sunitinibe e temsirolimus foram a terapias mais efetivas, quanto a SLP. No tratamento de 2a linha, o sorafenibe e everolimus foram relacionados à melhora da SLP. Em todos os estudos de 1a linha os pacientes não apresentaram melhora de SG e a qualidade metodológica não foram adequadas, portanto esses resultados devem ser analisados com cautela / Abstract: Currently, there are different agents for the treatment of advanced kidney cancer. The main aim of this study was to perform a systematic review and meta-analysis of randomized clinical trials that compared: sorafenib, sunitinib, bevacizumab, temsirolimus and everolimus. It was performed a systematic review of the literature in different databases: EMBASE, LILACS and PubMed, identifying randomized clinical trials that compared the available therapies target cells versus alpha-interferon for the patient treatments with advanced kidney cancer. For the treatment of first-line were found 10 studies that evaluated the therapy with sunitinib, sorafenib, bevacizumab and temsirolimus and three studies evaluating sorafenib and everolimus as a treatment second-line. The relative risk of progression free survival of first line studies was 0.83, confidence interval (CI) [0.78-0.87] with I2 = 94% and p <0.00001. The best results were: the study of sunitinib, 0.38, CI [0:25 to 0:58], bevacizumab with RR of 0.62, CI [0.47-0.83] and temsirolimus, 0.78, CI [0.70-0.87]. The meta-analysis showed no benefit on overall survival in first-line treatment with sunitinib and temsirolimus. The first-line treatment with sorafenib and bevacizumab not associated significant clinical benefits. Unable to perform meta-analysis on studies of second-line treatment, because the cohorts were different between them. For the treatment of first-line, sunitinib and temsirolimus were more effective therapies, as the progression free survival (PFS). In the second line treatment, sorafenib and everolimus was associated with improved PFS. In these studies, patients showed no improvement in overall survival (OS) and methodological quality were not adequate, so these results should be analyzed with caution / Doutorado / Fisiopatologia Cirúrgica / Doutora em Ciências

Multiple Myeloma (MM) is the second most common hematological malignancy, and although patient outcomes have significantly improved since the introduction of autologous stem cell transplantation (ASCT) and novel pharmacological agents such as immunomodulators (IMID), proteasome inhibitors (PI), and monoclonal antibodies (mAb), the disease remains incurable. The pathological complexity of MM results from accumulating mutations in clonal populations of malignant B-cells, which are cytogenetically heterogenous and selectively sensitive to different therapeutic agents. Drug regimens therefore include a diverse combination of therapeutics designed to target specific pathways to inhibit cell proliferation. Recent advances in genomic analytics and novel pharmacological agents potentially allow for more targeted treatments which improve patient outcomes and frequency of remission with minimal adverse effects. Only recently have studies began to correlate an increased understanding of the many subtypes of MM with optimal treatment regimens, and practices such as “Direct to Drug” screening can give clinicians a look at a patient’s likely response to a combination of drugs. By incorporating emerging pharmaceutical agents into studies based on patient characteristics, the management of MM is making incremental strides towards a more targeted treatment paradigm.

<p>Triple Negative Breast Cancer (TNBC) is the most aggressive type of breast cancer. TNBC patients are resistant to virtually all target therapies and suffer a higher post-chemotherapy relapse with a worse overall survival compared with other types of breast cancers. Therefore, the development of an effective therapy is urgently needed. PKM2 plays a prominent role in mediating<b> </b>tumor glycolysis and PKM2 is often overexpressed in human cancers. However, whether PKM2 mediated glycolysis is necessary for cancer cell growth is questionable. Here, I have found that inhibition of PKM2 does not affect TNBC cell growth due to a metabolic switch from glycolysis to fatty acid oxidation (FAO). We show that PKM2 directly interacts with EZH2 to coordinately mediate epigenetic silencing of SLC16A9, transporter of a key player in FAO, Carnitine. Inhibition of either PKM2 or EZH2 increases levels of SLC16A9 and intracellular Carnitine to promote FAO and thereby sustains cancer cell growth. Direct inhibition of EZH2 using a clinically tested EZH2 inhibitor, GSK126, is able to elicit a previously unidentified vulnerability to a clinically tested FAO inhibitor, Etomoxir. As a result, combined GSK126-Etomoxir treatment synergistically abolishes TNBC xenograft tumor growth in vivo. Together, this study uncovers PKM2-EZH2 mediated metabolic reprogramming that leads to a new drug combination therapy by dual targeting of EZH2 and FAO for effective treatment of TNBC.<b> </b></p> <p> </p> <p>Furthermore, Dendritic Cell (DC) vaccination has shown promise in treating cancer patients. However, the <i>in vitro</i> generation of a fully functional DC remains a big challenge in this field. EZH2 inhibition has shown to be able to create an immunologically ‘hot’ tumors. Nonetheless, the role of EZH2 in regulation of DC function is still unclear. I found that the expression levels of EZH2 and its functional maker, H3K27Me3, are enhanced following maturation from immature DC (iDC) into two functional DCs, α-type 1-polarized-DC (αDC) and gold standard DC (sDC). Moreover, inhibition of EZH2 by GSK126 treatment elicits a dependency of sDC on FAO. These results suggest that EZH2 plays a role in maturation of DC through metabolic reprogramming, which may also provide new DC based immunotherapy of TNBC. </p>

Autophagy is a critical cellular maintenance machinery in cells, and prevents the accumulation of toxic protein aggregates, organelles or lipid droplets through degradation via the lysosome. In macro-autophagy, autophagosome first engulfs around aggregates or cellular debris and subsequently fuses with a lysosome that is sufficiently acidic (pH 4.5–5.5), where the contents are then degraded via lysosomal enzymes. Autophagy inhibition as a result of lysosomal acidification dysfunction (pH > 5.5) have been reported to play a major role in various diseases pathogenesis. Hence, there is a pressing need to target lysosomal pH to rescue autophagy. Nanoparticles are attractive materials which has been shown to be efficiently uptaken into cellular organelles and can serve as an agent to specifically localize into lysosomes and modulate its pH. Lipotoxicity, induced by chronic exposure to free fatty acids, and exposure to neurotoxins (e.g. MPP+), elevates lysosomal pH in pancreatic beta cells (Type II Diabetes, T2D) and hepatocytes (Non-alcoholic fatty liver disease, NAFLD), and PC-12 cells (Parkinson’s Disease), respectively. We first tested the lysosome acidification capability of photo-activable nanoparticles (paNPs) and poly (lactic-co-glycolic) acid nanoparticles (PLGA NPs) in a T2D model. Both NPs lowered lysosomal pH in pancreatic beta cells under lipotoxicity and improved insulin secretion function. However, paNPs only release acids upon UV trigger, limiting its applicability in vivo, while PLGA NPs degrade upon lysosome localization. We further showed that PLGA NPs are able to rescue MPP+ induced cell death in a PD model, though it has a slow degradation rate. To attain the most efficacious nanoparticle with a fast degradation and acidification rate, we synthesized acidic nanoparticles (acNPs) based on tetrafluorosuccinic and succinic acids to form optimized nanoparticles. The acNPs showed faster rescue of cellular function compared to PLGA NPs in the PD model. Finally, we tested the acNPs in NAFLD model, and where lysosomal pH reduction by acNPs restored autophagy, reduced lipid accumulation, and improved mitochondria function in high-fat diet mice. In sum, nanoparticles are of potential therapeutic interest for pathologies associated with lysosomal acidity impairment. Future studies include testing the acNPs in NASH disease model and clinical studies. / 2022-05-18T00:00:00Z