HER2 breast cancer is an aggressive disease that occurs in 20 - 30% of the breast cancer population. Treatment for HER2 breast cancer includes use of an anti-HER2 monoclonal antibody, trastuzumab. Testing for HER2 is of critical importance due to the adverse side effects and substantial costs associated with this anti-HER2 treatment. Currently, two kinds of tests, Fluorescence In Situ Hybridization (FISH) and Immunohistochemistry (IHC), are FDA approved for determination of HER2 status in breast cancers. Clinical and non clinical factors that affect the choice HER2 test and the use of anti-HER2 therapy in breast cancer were analyzed using a data set containing information from six outpatient oncology clinics in the United States. The analysis showed that geographic location, cancer stage, and diagnosis date (pre- or post-publication of testing guidelines) have significant effects on choice of test. With regard to trastuzumab prescription, geographic location and HER2 status have significant effects on the prescription of trastuzumab. In addition, there was a non-significant trend for certain Medicare patients not to receive trastuzumab therapy. These findings indicate that disparities are present in breast cancer care based on geography and cancer stage, and highlight the importance of testing guidelines. The cost effectiveness of FISH vs. IHC was determined, by considering the financial and health-related costs associated with testing and subsequent treatment as well as the accuracy of each test. The results show that FISH is the optimal choice for HER2 testing and is more cost-effective than IHC.

Systemic sclerosis (SSc) is immune-mediated fibrotic disease of unknown aetiology. Among the dominant pathogenic manifestations of SSc belong vascular changes, production of autoantibodies, activation of innate and adaptive immune responses and fibrotic processes. Transforming growth factor beta (TGF-β) has been identified as a central profibrotic factor stimulating fibroblasts to produce collagen. There are, however, a number of other mediators involved in the pathogenesis of SSc. Mutual activation and amplification of these molecules and their cascades may be a central mechanism of the SSc pathogenesis. Hedgehog (Hh) canonical signalling pathway plays an important role in the development and progression of fibrotic diseases. Expression of Hh target genes can be regulated through a canonical or non-canonical signalling cascade. The non-canonical activation of GLI transcription factors by TGF-β has not yet been investigated in SSc. The substantial part of this thesis is focused on the study of the mutual interaction of TGF-β and Hh signalling pathway. In vitro analysis confirmed TGF- β/SMAD3 dependent activation of GLI2 in dermal fibroblasts. Fibroblasts specific knockout of GLI2 prevented the development of experimental fibrosis in vivo. Combined targeting of canonical and non-canonical Hh...

Os melanomas malignos em cães são uma das mais frequentes neoplasias diagnosticadas na cavidade oral. Infiltração local, recidiva (15-41%) e o alto potencial para metástases em linfonodos regionais (18-53%) e pulmões (23-27%) nos animais acometidos, conferem uma menor sobrevida (131-818 dias), ressaltando a necessidade e importância do estudo de novas terapias para o tratamento efetivo da doença. As uroquinases (UPA) e metaloproteinases (MMPs) são proteases superexpressas em uma variedade de células tumorais e raramente estão presentes em células fisiologicamente normais. A toxina do Bacillus anthracis é composta por três proteínas chamadas: fator letal (LF), fator de edema (EF) e antígeno protetor (PA). A toxina foi reengenheirada para a formação de dois tipos de PAs chamadas PAU2-R200A e PAL1-I207R, ativadas por UPA e MMPs da superficie das células tumorais, respectivamente, formando um complexo semelhante a um poro celular para permitir a internalização da LF. A citotoxicidade dessa associação reengenheirada PAU2-R200A, PAL1-I207R e LF ocorre quando a LF atinge o meio intracelular e causa a morte celular por interrupção da via de sinalização celular MAPkinase. O objetivo deste estudo é avaliar o potencial terapêutico da toxina reengenheirada do Bacillus anthracis, PAU2-R200A, PAL1-I207R e LF, dependentes de UPA e MMP, em melanomas orais de cães. Três etapas foram propostas para este estudo: o estudo in vitro da citotoxicidade de 5 linhagens de melanomas caninos submetidas à toxina reengenheirada, a avaliação da expressão de UPA e MMP em amostras parafinadas de melanoma oral canino e o tratamento intratumoral com a toxina modificada em cães com melanomas orais espontâneos. A linhagem GMGD2 foi a única que demonstrou sensibilidade à toxina estudada, apesar da concentração inibitória de 50% das células ter sido alta (IC50=4.964,16 mg/dl) em relação a linhagem controle HT29-RJ (IC50=179,47). As demais linhagens não demostraram redução da viabilidade celular com o aumento da concentração da toxina reengenheirada e não atingiram a IC50. Dentre as amostras de melanomas submetidos a imuno-histoquimica, 76,6% expressavam tanto uroquinases quanto metaloproteinases. Melanomas orais espontâneos de cães variando de 231,8 a 18601,6 mm3 em volume, sem evidências de metástases, foram tratados com as aplicações da toxina modificada por via intratumoral, previamente à excisão, realizada nos dias 07 ou 14 do tratamento. Dentre os animais estudados, todos apresentaram evolução favorável classificada como doença estável e resposta parcial. Somente um animal apresentou reação local. Nenhum dos pacientes apresentou efeito colateral sistêmico importante. Os resultados sugerem que existe potencial terapêutico da toxina reengenheirada do Bacillus anthracis sobre os melanomas bucais caninos e futuros ensaios clínicos são possíveis em cães e de extrema importância para o estudo mais aprofundado da toxina como nova terapia antineoplásica / Malignant melanomas in dogs are one of the most frequent malignancies diagnosed in the oral cavity. Local infiltration, recurrence (15-41%) and the high potential for regional lymph nodes metastases (18-53%) and lungs (23-27%) in the affected animals, confer a lower survival (131-818 days), emphasizing the necessity and importance of the study of new therapies for the effective treatment of the disease. Urokinase (UPA) and metalloproteinases (MMPs) are overexpressed proteases in a variety of tumor cells and are rarely present in normal physiological cells. Bacillus anthracis toxin is composed of three proteins called lethal factor (LF), edema factor (EF) and protective antigen (PA). The toxin was re-engineered for the formation of two types of PAs called PAU2-R200A and PAL1-I207R, activated by UPA and MMPs from the surface of tumor cells, respectively, forming a cell-like complex to allow the internalization of the LF. The cytotoxicity of this association PAU2-R200A, PAL1-I207R and LF occurs when LF reaches the intracellular environment and causes cell death by disruption of the MAPkinase cell signaling pathway. The objective of this study is to evaluate the therapeutic potential of UPA and MMP-dependent Bacillus anthracis toxin (PAU2- R200A, PAL1-I207R and LF) to treat oral melanomas in dogs. Three steps were proposed: cytotoxicity assay of 5 lineages of canine melanomas submitted to the reengineered toxin, immunohistochemistry study for UPA and MMP expression in paraffin samples of canine oral melanoma and intratumoral treatment with toxin in dogs with spontaneous oral melanomas. The lineage GMGD2 was the only one that showed sensitivity to the toxin studied, although 50% inhibitory concentration of the cells was high (IC50 = 4,964.16 mg / dl) in relation to the HT29-RJ control lineage (IC 50 = 179.47). Among the samples of melanomas submitted to immunohistochemistry, 76.6% expressed both urokinase and metalloproteinases. Spontaneous oral melanomas of dogs ranging volume from 231.8 to 18601.6 mm3 with no evidence of distant metastases, were treated with the applications of intratumoral re-engineered toxin prior to surgical excision. All of them has presented favorable evolution classified as stable disease and partial response. Only one animal had a local allergic reaction. None of the patients had a significant systemic side effects. The results suggest that there is a potential therapeutic effect of re-engineered anthrax toxin on canine melanomas and future clinical trials are possible in dogs and extremely important for further studies on the role of the B. anthracis toxin as a new antineoplastic agent

Le cancer de la prostate est le cancer le plus fréquent chez les hommes et la capacité des tumeurs à développer une résistance face aux thérapies anti-androgéniques vient souvent compromettre le pronostic des patients. Le développement de nouvelles approches thérapeutiques afin de circonvenir à la progression de ces tumeurs représente un besoin important la gestion de ce type de cancer. Plusieurs démonstrations récentes établissent l’implication de la famille des proprotéines convertases dans la progression tumorale. Ces enzymes ont pour fonctions biologiques de cliver une variété de précurseurs protéiques jouant des rôles importants dans la tumorigénèse. Dans le cancer de la prostate, la proprotéine convertase PACE4 est fortement surexprimée dans les cellules cancéreuses et joue un rôle dans la prolifération et la capacité à former des tumeurs, ce qui en fait une cible thérapeutique d’intérêt. En ce sens, des inhibiteurs peptidomimétiques ont été développés dans l’optique de la thérapie ciblée contre la PACE4. Toutefois, dans le but de développer une approche thérapeutique optimale, il convient néanmoins de comprendre le niveau de redondance fonctionnelle entre les différents membres de la famille des convertases, qui sont connus pour partager plusieurs de leurs substrats, ainsi que les mécanismes moléculaires régissant l’activité de la PACE4 et de ses substrats sous-jacents. L’utilisation d’une approche de répression génique stable envers les différentes convertases a permis de mettre en lumière les fonctions uniques de la PACE4 dans la progression tumorale. De plus, grâce à une approche de protéomique comparative, le premier substrat de la PACE4 dans le cancer de la prostate; le growth differenciation factor 15, a été découvert. Ce substrat permet de commencer à dresser l’implication de PACE4 dans le paysage moléculaire du cancer de la prostate. Grâce à des modalités d’imagerie moléculaire, l’emploi de versions radiomarquées des inhibiteurs peptidiques a également permis de démontrer que les composés s’accumulent dans les cellules cancéreuses en fonction des niveaux de PACE4 présents, et ce, tant in cellulo qu’in vivo. Ces données suggèrent un potentiel pour le développement d’un examen théranostique pour prédire la réponse tumorale à la pharmacothérapie anti-PACE4. Finalement, l’analyse de l’épissage alternatif de l’ARNm de PACE4 a permis l’élucidation des caractéristiques biochimiques et des fonctions spécifiques d’une nouvelle isoforme; la PACE4-altCT, qui est exprimée chez les cellules cancéreuses de la prostate, mais aussi d’autres types de cancer. Cette découverte a permis de redéfinir le modèle de travail en intégrant le concept de la rétention intracellulaire de cette isoforme qui semble médier la plupart de l’activité pro-proliférative reliée à l’activité PACE4, ce qui en fait la cible pharmacologique principale des inhibiteurs peptidiques dans le cancer de la prostate, mais aussi un biomarqueur potentiel. / Abstract: Prostate cancer is the most common cancer among men. The capabilities of tumors to adapt and overcome antiandrogenic therapy is persistently worsening patient’s prognostic and the development of novel therapeutic approaches to circumvent tumor progression therefore represents an unmet need. Many reports now demonstrate the implication of the enzymes from the proprotein convertase family in the progression of tumor from many cancer types. These enzymes are responsible for the processing of various protein precursors playing important roles in tumorigenesis. In prostate cancer, the proprotein convertase PACE4 is strongly overexpressed in cancer cells and plays a role in cell proliferation and tumor formation thus making a strong case for its use as a pharmacological target. For this reason, PACE4 peptidomimetic inhibitors were generated to develop PACE4-targeted therapies. However, to develop an optimal therapeutic approach regarding the inhibition of this enzyme, a complete understanding of the level of functional redundancy between the different convertases in prostate cancer is needed. Moreover, understanding the molecular mechanisms both upstream and downstream of PACE4 in prostate cancer cells would allow a better understanding of the considerations underneath such a therapeutic strategy. Using a stable gene silencing approach to knockdown all co-expressed member of the convertase family in prostate cancer cells, the roles of PACE4 in tumor progression were found to be unique and non-redundant among the other family member. Through a comparative proteomic approach, the first PACE4-specific substrate in prostate cancer; growth and differentiation factor 15, was identified. With this substrate growth factor, it is now possible to initiate the dissection of PACE4 biochemical functions in the prostate cancer molecular landscape. Using a radiolabelled version of the PACE4 peptide inhibitors, it was possible to demonstrate using molecular imaging that when applied in cellulo and in vivo, the compound is uptaken by cancer cells as well as by tissues according to their PACE4 expression levels. These data suggest that such PACE4 molecular imaging with pharmacological inhibitor could be developed as a theranostic assay to predict which tumor could be treated by PACE4-targetted therapy. Lastly, PACE4 mRNA alternative splicing analysis permitted the discovery of a new PACE4 isoform; named PACE4-altCT, which is strongly overexpressed by prostate cancer cells as well as other cancer types. As this isoform displays specific biochemical features and functions, notably being intracellularly retained and mediating most of the PACE4-associated cell growth capabilities, this discovery further redefined our working model, pointing to PACE4-altCT as the pharmacological target of inhibitory peptides in prostate cancer as well as a potential biomarker.

Le rhabdomyosarcome de l'adulte est une tumeur rare au pronostic. Le présent travail propose d'étudier les caractéristiques cliniques et moléculaires et la prise en charge des adolescents et adultes atteints de rhabdomyosarcome ainsi que la possibilité de combinaison de thérapie ciblées sur lignées cellulaires in vitro. Nous avons anamysé rétrospectivement 239 patients âgés de 10 ans ou plus, atteints de rhabdomyosarcome au MD Anderson Cancer Center entre 1957 et 2003 et leur statut fusionnel pour PAX-FOXO1 par hybridation in situ en fluorescence. Trois lignées cellulaire de sarcome à petites cellules ont été soumises à des combinaisons de thérapies ciblées avec analyse de la viabilité. Les patients de plus de 50 ans avaient une survie globale à 5 ans de 13 % (médiane de survi à 1.7 ans) en dépit d'une maladie localisée. Approximativement 13 % des patients métastasiques de moins de 50 ans ont eu une survie prolongée de plus de 15 ans. L'utilisation d'une stratégie thérapeutique triple, intégrant chirurgie, chimiothérapie et radiothérapie était signifcativement associée à une survie prolongée. Auniveau molécualire, la présence du transcrit de fusio PAX3/7-FOXO1 était significativement liée à un risque accru de maladie métastatique. L'étude in vitro de thérapies ciblées a permis d'identifier la combinaison du vorinostat plus le 17DMAG associée à la doxorubicine comme ayant une meilleure efficacité. La prise en charge du rhabdomyosarcome de l'adolescent et de l'adulte semble souffrir d'une approche moins agressive comparée au rhabdomyosarcome pédiatrique. De plus, des combianaisons de thérapies ciblées peuvent être intégrées aux protocoles de chimiothérapies standards. / Rhabdomyosarcoma is a rare entity adult patient with unfavourable outcome. This work describes the clinical and molecular specificities of adolescent and adult type of rhabdomyosarcoma and investigates the optimal integration of targetd therapy combinations on small cell sarcoma cell lines in vitro. We retrospectively analyzed 239 patients, 10 years of age and greater, diagonsed withrhabdomyosarcoma at MD Anderson Cancer Center from 1957 trough 2003 and their PAX-FOXO1 fusion gene status by fluorescence in situ hybridization on tissues microarray. Three samll cell sarcoma cell lines were exposed to targetd agent combinations. PAtient with metastatic rhabdomyosarcoma were found to have a 18 % survival rate at 5 years from diagnosis with an 12 %survival past 15 years. This outcome was even poorer for patients over 50 of age, even with localized disease. Younger patients were more likely to receive multidisciplinary therapy than their older counterparts. The presence of PAX-FOXO1 tranlocation was significantly associated with a higher frequency of metastatic disease. The four agents with the exception of abacavir synergized two by two with each other in vitro but the triple combinations did not perform beter than the bitherapies. The dual therapies vorinostat 5HDAC inhibitor) plus 17-DMAG (Hsp90 inhibitor) added with doxorubicin achvied better results than dual or triple therapies. Adult patient with rhabdomyosarcoma present similar molecular and clinical characteristics compared pediatric patients but outcome decrease with age partly du to a less multimodal management. Moreover targeted combinations should be integrated to chemotherapy backbone.

Les possibilités de combinaison thérapeutiques offertes par les nanoparticules ont ouvert un nouveau champ d’investigation pour la recherche sur le cancer. Dans ce projet de recherche, des nanoparticules dérivées de la protéine de capside du virus de la mosaïque du tabac (TMV) ont été utilisées afin de transporter différents peptides thérapeutiques ciblant le récepteur neuropiline-1. Cette stratégie a permis de solubiliser un peptide fortement hydrophobe ayant préalablement démontré son efficacité anticancéreuse sur des lignées de cancer du sein humain et de glioblastome. Les résultats obtenus ont également permis de démontrer la possibilité de combiner différents peptides thérapeutiques via l’auto-assemblage de la protéine de capside du TMV. / Nanoparticles play an ever increase role in carrying therapeutic compounds in the cancer field. In this research project, the coat protein of Tobacco mosaic virus (TMV) was used as nanocarrier to solubilize a hydrophobic peptide interfering with the transmembrane domain of neuropilin-1. The nanoparticles created have conserved the antiangiogenic and antimigratory effect of the therapeutic peptide. This strategy was also used to create nanoparticles carrying a peptide targeting the ectodomain of neuropilin-1. The two types of nanoparticles were then assembled through auto-assembling ability of the coat protein. These nanoparticles also exhibit antiangiogenic ability thus, confirming the validity of this approach to combine therapeutic peptides.

La lutte contre le cancer est certainement l’un des défis majeurs de ce 21ème siècle. Les résistances qui émergent contre les agents de thérapie ciblée présentent un aspect particulièrement épineux de cette problématique. La thèse présentée ici s’inscrit dans ce cadre. Elle vise à développer des molécules bioactives pouvant circonvenir les résistances apparues contre les traitements de certaines hémopathies malignes : la leucémie myéloïde chronique (LMC) et le syndrome myélodysplasique (SMD). Après avoir mis au point une méthodologie de synthèse monotope permettant de transformer un azoture en un 5-alcynyl-1,2,3-triazole, nous avons synthétisé deux séries de produits : nucléosidique et non nucléosidique. Pour chacune de ces séries, des relations structure-activité ont été établies. Après plusieurs cycles d’optimisation, trois composés lead très efficaces contre des lignées cellulaires résistantes de LMC et SMD, ont été sélectionnés. De surcroît, leur mode d’action s’est révélé très intéressant : il repose (partiellement ou entièrement, suivant le composé) sur un processus cellulaire qui connaît un véritable regain d’intérêt, à savoir l’autophagie. Une évaluation in vivo a été réalisée et a permis de valider l’activité prometteuse de notre composé lead nucléosidique. Par ailleurs, des études visant à déterminer la localisation intracellulaire et les cibles moléculaires de nos produits sont actuellement en cours / The fight against cancer is certainly one of the biggest challenges of the 21st century. Resistance that comes up against targeted therapy agents presents a particularly important aspect of this issue. The thesis presented here takes part within that framework. It aims at developing bioactive molecules able to circumvent resistance that have emerged against the treatment of certain hematological malignancies: chronic myeloid leukemia (CML) and myelodysplastic syndrome (MDS). Having developed a one-pot synthesis methodology that converts azides into 5-alkynyl-1,2,3-triazole, we synthesized two series of products: nucleosidic and non-nucleosidic. For each of these series, structure-activity relationships have been established. After running several cycles of optimization, three lead compounds particularly active on resistant cell lines of CML and MDS were selected. Further, their mode of action proved to be very interesting. It is based (partially or fully, depending on the compound) on a cellular process, which is experiencing a real renewed interest, the autophagy. An in vivo evaluation confirmed the promising activity of our nucleosidic lead compound. Moreover, studies aiming at determining the intracellular localization and molecular targets of our products are currently in progress

Influenza is a severe disease in humans and animals, causing upwards of 40,000 deaths every year in America alone. Influenza A virus (IAV) also causes periodic pandemics every 10 to 50 years, killing millions of people. Despite this, very few effective therapies are available. All strains of IAV are prone to developing resistance to antibodies due to the high mutation rate in the viral genome. Because of this mutation rate, a yearly vaccine must be generated before every flu season, and efficacy varies year to year. IAV has also mutated to escape several of the clinically-approved small molecule inhibitors. A therapeutic agent that targets a highly conserved region of the virus could bypass resistance and also be effective against multiple strains of IAV. IAV attachment is mediated by many individually weak hemagglutinin–sialic acid interactions that all together make a strong attachment to a host cell. Polymerized sialic acid analogs can recreate these interactions and block infection. However, they are not ideal therapeutics due to solubility issues and in vivo toxicity. We used liposomes as a novel means for delivery of the sialic acid-containing glycan, sialylneolacto-N-tetraose c (LSTc). LSTcbearing decoy liposomes form multivalent, polymer-like interactions with IAV. Decoy liposomes competitively bind IAV in hemagglutination inhibition assays and inhibit infection of target cells in a dose-dependent manner. LSTc decoy liposomes co-localize with IAV, while control liposomes do not. Inhibition is specific, as inhibition of Sendai virus and respiratory syncytial virus is not observed. In contrast, monovalent LSTc does not bind IAV or inhibit infectivity. LSTc decoy liposomes prevent the spread of IAV during multiple rounds of replication in vitro and extend survival of mice challenged with a lethal dose of virus. Considering the conservation of the hemagglutinin binding pocket and the ability of decoy liposomes to form high-avidity interactions with IAV hemagglutinin, our decoy liposomes have potential as a new therapeutic agent against emerging strains.

Medulloblastoma (MB) is a malignant embryonal tumor of the posterior fossa belonging to the family of primitive neuro-ectodermic tumors (PNET). MB generally occurs in pediatric age, but in 14–30% of cases, it affects the adults, mostly below the age of 40, with an incidence of 0.6 per million per year, representing about 0.4–1% of tumors of the nervous system in adults. Unlike pediatric MB, robust prospective trials are scarce for the post-puberal population, due to the low incidence of MB in adolescent and young adults. Thus, current MB treatments for older patients are largely extrapolated from the pediatric experience, but the transferability and applicability of these paradigms to adults remain an open question. Adult MB is distinct from MB in children from a molecular and clinical perspective. Here, we review the management of adult MB, reporting the recent published literature focusing on the effectiveness of upfront chemotherapy, the development of targeted therapies, and the potential role of a reduced dose of radiotherapy in treating this disease.

This thesis project serves to fill experimental gaps needed to advance the goal of performing pre-clinical trials using an orthotopic rat glioblastoma model to evaluate the efficacy of high-frequency electroporation (H-FIRE) and QUAD-CTX tumor receptor-targeted cytotoxic conjugate therapies, individually and in combination, in selectively and thoroughly treating glioblastoma multiforme. In order to achieve this, an appropriate model must be developed and characterized. I have transduced F98 rat glioma cells to express red-shifted firefly luciferase, which will facilitate longitudinal tumor monitoring in vivo through bioluminescent imaging. I have characterized their response to H-FIRE relative to DI TNC1 rat astrocytes. I have demonstrated the presence of the molecular targets of QUAD in F98 cells. The in vitro characterization of this model has enabled preclinical studies of this promising glioblastoma therapy in an immunocompetent rat model, an important step before advancing ultimately to clinical human trials. / Master of Science / Treating glioblastoma multiforme (GBM), a form of cancer found in the brain, has not been very successful; patients rarely live two years following diagnosis, and there have been no major breakthrough advances in treatment to improve this outlook for decades. We have been working on two treatments which we hope to combine. The first is high-frequency electroporation (H-FIRE), which uses electrical pulses to kill GBM cells while leaving healthy cells alive and blood vessels intact. The second is QUAD-CTX, which combines a toxin with two types of protein that attach to other proteins that are more common on the surface of GBM cells than healthy cells. We have shown these to be effective at disproportionately killing human GBM cells growing in a lab setting. Before H-FIRE and QUAD-CTX may be tested on humans, we need to show them to be effective in an animal model, specifically rats. I have chosen rat glioma cells that will behave similarly to human GBM and a rat species that will not have an immune response to them. I have made these cells bioluminescent so that we may monitor the tumors as they grow and respond to our treatments. I have also shown that QUAD-CTX kills these rat glioma cells, as does H-FIRE. Because of this work, we are ready to begin testing these two treatments in rats.