Regulation of cancer cell phenotype by the tumor microenvironment has motivated further investigation into how microenvironmental factors could contribute to tumor initiation, development, and therapeutic resistance. Analyzing how the microenvironment drives tumor development and cancer cell heterogeneity is particularly important in cancers such as glioblastoma multiforme (GBM) that have no known risk factors and are characterized by a high degree of heterogeneity. GBM patients have a median survival of 15 months and therefore are in great need of more effective therapeutic options. The goal of this research is to generate in vitro models of the heterogeneous brain tumor microenvironment, with a focus on vascular dynamics, to probe the impact of microenvironmental cues on tumor progression and to integrate the tumor models with highly sensitive analytical tools to characterize the epigenome of discrete phenotypic subpopulations that contribute to intratumoral cellular heterogeneity. As GBM tumors are characterized by a dense vasculature, we delved into microenvironmental factors that may be promoting angiogenesis. The correlations emerging between inflammation and cancer led to analysis of the inflammatory molecule lipopolysaccharide (LPS). We utilized 3D micro-tissue models to simulate vascular exposure to ultra-low chronic inflammatory levels of LPS and observed an increase in vascular formation when brain endothelial cells were exposed to ultra-low doses of LPS. We also utilized our micro-tissue models to analyze histone methylation changes across the epigenome in response to microenvironmental cues, namely culture dimensionality and oxygen status. The H3K4me3 modification we analyzed is associated with increased gene transcription, therefore the alterations we observed in H3K4me3 binding across the genome could be a mechanism by which the tumor microenvironment is regulating cancer cell phenotype. Lastly, we developed a microfluidic platform in which vascular dynamics along with microenvironmental heterogeneities can be modeled in a more physiologically relevant context. We believe the studies presented in this dissertation provide insight into how vasculature primed by chronic inflammation and epigenetic alterations in tumor cells could both contribute to enhanced tumor development. Modeling these biological processes in our advanced microfluidic platform further enables us to better understand microenvironmental regulation of tumor progression, uncovering new potential therapeutic targets. / PHD / Regulation of cancer cell behavior by the tumor microenvironment, which includes the surrounding extracellular matrix, native healthy cells, and signaling molecules, has motivated further investigation into how microenvironmental factors could contribute to tumor initiation, development, and therapeutic resistance. Analyzing how the microenvironment drives tumor development and heterogeneity in cancer cell behavior is particularly important in cancers such as glioblastoma multiforme (GBM) that have no known risk factors and are characterized by a high degree of heterogeneity. GBM patients have a median survival of 15 months and therefore are in great need of more effective therapeutic options. The goal of this research is to generate models of the heterogeneous brain tumor microenvironment with a focus on how microenvironmental cues impact blood vessel development, which facilitates tumor progression. We will also use these tumor models, along with sensitive analytical tools, to characterize epigenetic modifications that potentially contribute to tumor cell heterogeneity. As GBM tumors are characterized by a dense vasculature, we delved into microenvironmental factors that may promote blood vessel growth. The correlations emerging between inflammation and cancer led to analysis of the inflammatory molecule lipopolysaccharide (LPS). We utilized 3D tumor models to simulate blood vessel exposure to ultra-low chronic inflammatory levels of LPS and observed an increase in blood vessel formation when brain endothelial cells were exposed to ultra-low doses of LPS. We also utilized our tissue models to analyze histone methylation changes across the epigenome in response to microenvironmental cues, namely culture dimensionality and oxygen status. The histone methylation changes we observed across the genome could be a mechanism by which the tumor microenvironment is regulating cancer cell v behavior. Lastly, we developed a microfluidic platform in which blood vessel development along with microenvironmental heterogeneities can be modeled in a more physiologically relevant context. We believe the studies presented in this dissertation provide insight into how blood vessel exposure to chronic inflammatory factors and epigenetic alterations in tumor cells could both contribute to enhanced tumor development. Modeling these biological processes in our advanced microfluidic platform further enables us to better understand microenvironmental regulation of tumor progression, uncovering new potential therapeutic targets.

Made available in DSpace on 2014-07-29T15:29:11Z (GMT). No. of bitstreams: 1 Dissertacao Alex Caetano dos Santos.pdf: 982242 bytes, checksum: f685e405b1e872acdf53a2790d29d70b (MD5) Previous issue date: 2011-04-25 / Context In 85% of the cases, colorectal cancer is diagnosed at an advanced stage during investigation of symptomatic patients. Currently, 10% to 33% of the cases may present emergency situations (obstruction or perforation), requiring immediate surgical treatment, and may result in higher mortality compared with elective surgical procedures. Objective Analyze clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery at the Hospital de Urgências de Goiânia. Methods We studied 107 patients operated on between January 2006 and June 2010 presenting with histologically confirmed colorectal malignancy. Results This series consisted of 58 women and 49 men with mean age of 59.81 ± 17.08 years. The most frequent symptoms were: abdominal pain (97.2%), no bowel movements (81.3%), vomiting (76.6%), and anorexia (40.2%). Clinical preoperative diagnosis was divided into five groups: obstructive acute abdomen (n = 68), obstructive acute perforation (n = 21), obstructive acute inflammation (n = 13), abdominal sepsis (n = 3), and severe gastrointestinal bleeding (n = 2). Tumors were located in the rectosigmoid (51.4%), transverse colon (19.6%), ascending colon (12.1%), descending colon (11.2%), and 5.6% of the cases presented association of two colon tumors (synchronic tumors). Histopathological examination revealed the presence of adenocarcinoma in 98.1% of the cases. The surgical treatments were: tumor resection with colostomy (85%), tumor resection with primary anastomosis (10.3%), and colostomy without tumor resection (4.7%). Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p > 0.05%). Conclusions Colorectal cancer in patients who underwent emergency surgery due to acute abdominal complication was more prevalent in females and elderly individuals with nonspecific colonic complaints. Adenocarcinoma of the rectosigmoid was the most frequent condition. Despite the high mortality rate, surgical treatment of colorectal cancer was indicated due to intestinal occlusion. / Contexto Em 85% dos casos, o câncer colorretal é diagnosticado em estádio avançado durante a investigação de pacientes sintomáticos. Atualmente, 10% a 33% dos casos podem apresentar situações emergenciais (obstrução ou perfuração), necessitando de intervenção cirúrgica imediata, podendo resultar em mortalidade operatória maior do que a cirurgia eletiva. Objetivo Analisar os aspectos clínicos e patológicos de pacientes com câncer colorretal operados em urgência, no Hospital de Urgência de Goiânia. Métodos Foram estudados 107 pacientes operados entre janeiro de 2006 e junho de 2010 com diagnóstico histológico de neoplasia maligna colorretal. Resultados A amostra foi constituída de 58 mulheres e 49 homens com idade média de 59,81 ± 17,08 anos. Os sintomas mais frequentes foram: dor abdominal (97,2%), parada de eliminação de gases e fezes (81,3%), vômitos (76,6%) e anorexia (40,2%). Na avaliação pré-operatória foram diagnosticados: abdome agudo obstrutivo (n = 68), abdome agudo perfurativo (n = 21), abdome agudo inflamatório (n = 13), sepse abdominal (n = 3) e hemorragia digestiva grave (n = 2). Os tumores estavam localizados no retossigmoide (51,4%), cólon transverso (19,6%), cólon ascendente (12,1%), cólon descendente (11,2%) e em 5,6% dos casos houve associação de dois tumores no intestino (tumores sincrônicos). Os exames histopatológicos revelaram a presença de adenocarcinoma em 98,1% dos casos. Os tratamentos cirúrgicos adotados foram: ressecção tumoral com colostomia (85%), ressecção tumoral com anastomose primária (10,3%) e colostomia sem ressecção tumoral (4,7%). Houve mortalidade imediata em 33,4% dos casos. Na análise bivariada, as variáveis sexo, localização e estádio tumoral apresentaram p > 0,05% em relação ao óbito. Conclusão O câncer colorretal operado em urgência teve maior prevalência no sexo feminino e nos idosos com queixas inespecíficas. O diagnóstico histopatológico na quase totalidade foi adenocarcinoma localizado no retossigmoide. Embora a mortalidade seja elevada, o tratamento cirúrgico do câncer colorretal deve ser realizado.

Exossomos (Exo) originados de células dendríticas (DCs) carregam moléculas associadas à apresentação antigênica. Neste trabalho procurou-se estabelecer se Exo de DCs seriam capazes de conferir imunogenicidade às células tumorais. Os Exo isolados de culturas de DCs expressavam as moléculas HLA-ABC, HLA-DR, CD86, CD11c, CD81, CD54 e CD18. Estes foram então adicionados às células da linhagem humana de adenocarcinoma mamário, SK-BR-3, as quais passaram a expressar as moléculas HLA-DR, CD86 e CD11c. As células tumorais modificadas pelos Exo induziram a produção de IL-6 e IL-10, detectados no sobrenadante das co-culturas destas com linfócitos T. Estas células tumorais também induziram aumento do número de linfócitos produtores de IFN-<font face=\"Symbol\">g, pré-sensibilizados contra antígenos tumorais, e aumento da expressão de SOCS3 nestes. Em conclusão, nossos resultados mostram que, Exo de DCs alteram o fenótipo de células tumorais, modificando sua interação com linfócitos T, sem induzir nas mesmas capacidade de ativar respostas proliferativas ou citotóxicas de linfócitos T in vitro. / Exosomes (Exo) originated from dendritic cells (DCs) contain molecules involved in antigen presentation. The present work sought to determine if Exo from DCs would be able to transfer immunogenicity to tumor cells. Exo isolated from DCs cultures carried HLA-ABC, HLA-DR, CD86, CD11c, CD81, CD54 and CD18. These Exo were added to cultures of the human breast adenocarcinoma cell line, SK-BR-3, which gained expression of HLA-DR, CD86 and CD11c. Tumor cells modified by Exo induced IL-6 and IL-10 production, detected in the supernatant of their co-cultures with T lymphocytes. These tumor cells also induced an increase in the frequency of IFN-<font face=\"Symbol\">g-producing T lymphocytes, pre-sensitized against tumor antigens, and an increased expression of SOCS3. In conclusion, our results show that, Exo from DCs affect the phenotype of tumor cells, modifying their interaction with T lymphocytes, without inducing the ability to activate cytotoxic or T cell proliferative responses in vitro.

Introdução: Indivíduos sobreviventes à sepse apresentam maior mortalidade à longo prazo e maior risco de apresentar infecções oportunistas. Existem evidências clínicas e experimentais de desregulação imune no estado pós-sepse. Essas alterações apresentam semelhança com aquelas encontradas no microambiente tumoral, estando relacionadas à imunossupressão. O presente trabalho avaliou o papel de macrófagos associados ao tumor (TAM) em modelo de progressão tumoral em camundongos sobreviventes à sepse. Materiais e Métodos: Camundongos C57/BL6 foram submetidos a ligadura e punção cecal (CLP) e tratados com ertapenem (20 mg/kg, i.p., 6 horas após CLP e 12/12 h por 3 dias). Os animais sobreviventes de sepse eram inoculados com células de melanoma B16-F10 (30 mil, s.c., 15 dias após a CLP). Animais naïve foram usados como controle. Foram avaliadas a progressão tumoral, sobrevida e formação de metástases espontâneas à distância. No D+14, animais foram sacrificados para mensuração do acúmulo de TAM por citometria de fluxo (CD45+F4/80+CD206+) e de citocinas no soro e no tumor por ELISA (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12). Macrófagos derivados de medula óssea de animais pós-CLP ou naïve foram coinoculados com células B16 para avaliação de progressão tumoral e sobrevida. TAM de animais naïve ou pós-CLP foram isolados através de gradiente de Percoll seguido de adesão seletiva e o RNA foi isolado para análise diferencial de expressão gênica por microarray. Para avaliação da participação da via CXCL12/CXCR4 foi realizada sua inibição com o AMD3100, antagonista de CXCR4 (5 mg/kg, i.p., D+10 e D+14). Foi avaliada a progressão tumoral, sobrevida, acúmulo de TAM e proliferação extramedular de TAM no D+14. Resultados: Animais sobreviventes de sepse apresentaram aumento de progressão tumoral (após 15, 30 e 60 dias da CLP), aumento da carga de metástases (após 15 dias da CLP) e redução de sobrevida. Foi detectado o aumento de TAM nos animais pós-CLP, associado a maior marcação de Ki67, em comparação com animais naïve no D+14. Verificamos aumento das concentrações séricas de TGF-?, CXCL12, CCL2 e TNF-?. Camundongos naïve que coinoculados com macrófagos derivados de medula óssea de animais pós-CLP apresentaram aumento de progressão tumoral e redução de sobrevida em comparação com o grupo controle. TAM de animais pós-CLP apresentaram menor expressão de genes relacionados ao MHC-II e genes relacionados à ativação leucocitária. A inibição de CXCL12/CXCR4 preveniu a progressão tumoral induzida por sepse, com menor acúmulo de TAM e menor presença de TAM Ki67+. Conclusões: O estado pós-sepse promove a progressão tumoral de melanoma B16 em camundongos, o qual foi associado a aumento de 12 TAM. A via CXCL12/CXCR4 participa do processo de acúmulo de TAM nesse modelo experimental. / Background: Survivors from sepsis present higher long-term mortality and increased risk of opportunistic infections. There is clinical and experimental evidence for an immunosuppressive immune dysregulation in post-sepsis. These alterations are similar to those found in tumor microenvironment. The present work assessed the role of tumorassociated macrophage (TAM) in a model of tumor progression in sepsis-surviving mice. Materials and Methods: C57/BL6 mice were submitted to cecal ligation and puncture (CLP) and treated with ertapenem (20 mg/kg, ip. - 6 h after CLP and then each 12 h for 3 days). Sepsis surviving mice were inoculated with B16-F10 melanoma cells (30,000, sc., 15 days after CLP). Naïve mice were used as controls. Tumor progression, survival and distant spontaneous metastasis were evaluated. Mice were killed at D+14 for TAM measurement through flow cytometry (CD45+F4/80+CD206+) and for cytokines (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12) quantification by ELISA. Bone marrow-derived macrophage (BMDM) were isolated and co-inoculated together with B16 melanoma cells for tumor progression and survival evaluation. TAM from naïve or post-sepsis mice were isolated through Percoll gradient (70/30) followed by selective adhesion. The RNA was isolated for gene expression analysis using microarray assay. To evaluate the role of CXCL12/CXCR4, we used the specific antagonist AMD3100 (5 mg/kg, ip., at D+10 and D+14) and assessed tumor progression, survival and TAM accumulation at D+14. Results: Sepsis-surviving mice showed increased tumor progression (15, 30 or 60 days after CLP), higher metastatic burden (15 days after CLP), and less overall survival. TAM were increased in post-sepsis mice at D+14. We found increased serum levels of TGF-?, CXCL12, CCL2 e TNF-?. Naïve mice inoculated with BMDM from post-sepsis and B16 cells showed higher tumoral progression and less survival, when compared to the control group. TAM from post-sepsis showed decreased expression of MHC-II related genes and genes related to leukocyte activation. The inhibition of CXCL12/CXCR4 prevented the post-sepsis-induced tumor progression, with less TAM accumulation and reduced expression of Ki67 in TAM. Conclusions: The post-sepsis state promotes the progression of B16 melanoma in mice, which was associated with an increase in TAM accumulation. CXCL12/CXCR4 mediates TAM accumulation in this experimental model.

Brain and central nervous cancer presents a significant clinical burden, accounting for 2.4% of all cancer deaths. High grade glioma is particularly deadly, with 5 year survival times of 35% or less. Traditional treatment includes tumor resection followed by radiation therapy or chemotherapy. Aggressive resection is essential in order to prolong patient life. In fact, several studies have shown that life expectancy increases with increased extent of resection. Extent of resection is burdened by the fact that surgeons must be careful not to remove functional brain tissue. Resection is incomplete more often than not due to lack of visual cues for the surgeon. He must rely on tactile sensation to distinguish tumor from healthy tissue. Methods such as intraoperative MRI and CT exist, but these require expensive equipment and special training that is not available in all surgical environments. Some laboratories have proposed small molecule dyes to solve this problem, but these are insufficient when used in an invasive tumor model. It was the goal of this research to provide an objective cue in the form of a nanoencapsulated visible dye without the need for additional equipment of changes to the surgery process itself other than injection of the dye. We hypothesized that the nanocarrier would allow staining of the tumor through passive targeting by taking advantage of the enhanced permeability and retention effect. Once the nanocarriers have reached the desired target, they would not diffuse out into healthy tissue due to their large size compared to small molecule dyes, which readily diffuse out and stain healthy tissue. To test this hypothesis, we prepared and characterized a liposomal nanocarrier encapsulating Evans blue dye. The nanocarrier was tested for safety in vitro and in vivo, then used to delineate tumor margins in an invasive rat glioma model in vivo. Microscopic analysis was then conducted to ensure only tumor tissue was stained by the nanocarrier. This thesis presents a successful method of tumor border delineation to provide surgeons with positive visual cues without the need for changes in surgical environment or techniques.

Recent advancements in pharmaceutical technology based on principles of nanotechnology, polymer chemistry, and biomedical engineering have resulted in the creation of novel drug delivery systems with the potential to revolutionize current strategies in cancer chemotherapy. In oncology, realization of significant improvements in therapeutic efficacy requires minimization of drug exposure to healthy tissues and concentration of the drug within the tumor. As such, encapsulation of chemotherapeutic agents inside nanoparticles capable of enhancing tumor-targeted drug delivery is a particularly promising innovation. Yet, initial investigations into the intratumoral fate of nanomedicines have suggested that they may be heterogeneously distributed and achieve limited access to cancer cells located distant from the tumor vasculature. As such, uncovering the determinants of nanoparticle transport at the intratumoral level is critical to the development of optimized delivery vehicles capable of fully exploiting the therapeutic potential of nanomedicines. In this work, the chemotherapeutic agent, docetaxel (DTX), was incorporated into nano-sized, biocompatible PEG-b-PCL block copolymer micelles (BCMs). Encapsulation of DTX in micelles via chemical conjugation or physical entrapment resulted in a dramatic increase in drug solubility and customizable drug release rate. The use of multicellular tumor spheroids (MCTS) was established as a viable platform for assessing the efficacy and tumor tissue penetration of nanomedicines in vitro. A series of complementary assays was validated for analysis of DTX-loaded micelle (BCM+DTX) toxicity in monolayer and spheroid cultures relative to Taxotere®. Cells cultured as spheroids were less responsive to treatment relative to monolayer cultures due to mechanisms of drug resistance associated with structural and microenvironmental properties of the 3-D tissue. Computational, image-based methodologies were used to assess the spatial and temporal penetration of BCMs in spheroids and corresponding human tumor xenografts. Using this approach, the tumor penetration of micelles was found to be nanoparticle-size-, tumor tissue type- and time- dependent. Furthermore, spheroids were found to be a valuable platform for the prediction of trends in nanoparticle transport in vivo. Overall, the results reported herein serve to demonstrate important determinants of nanoparticle intratumoral transport and to establish computational in vitro and in vivo methodologies for the rational design and optimization of nanomedicines.

Recent advancements in pharmaceutical technology based on principles of nanotechnology, polymer chemistry, and biomedical engineering have resulted in the creation of novel drug delivery systems with the potential to revolutionize current strategies in cancer chemotherapy. In oncology, realization of significant improvements in therapeutic efficacy requires minimization of drug exposure to healthy tissues and concentration of the drug within the tumor. As such, encapsulation of chemotherapeutic agents inside nanoparticles capable of enhancing tumor-targeted drug delivery is a particularly promising innovation. Yet, initial investigations into the intratumoral fate of nanomedicines have suggested that they may be heterogeneously distributed and achieve limited access to cancer cells located distant from the tumor vasculature. As such, uncovering the determinants of nanoparticle transport at the intratumoral level is critical to the development of optimized delivery vehicles capable of fully exploiting the therapeutic potential of nanomedicines. In this work, the chemotherapeutic agent, docetaxel (DTX), was incorporated into nano-sized, biocompatible PEG-b-PCL block copolymer micelles (BCMs). Encapsulation of DTX in micelles via chemical conjugation or physical entrapment resulted in a dramatic increase in drug solubility and customizable drug release rate. The use of multicellular tumor spheroids (MCTS) was established as a viable platform for assessing the efficacy and tumor tissue penetration of nanomedicines in vitro. A series of complementary assays was validated for analysis of DTX-loaded micelle (BCM+DTX) toxicity in monolayer and spheroid cultures relative to Taxotere®. Cells cultured as spheroids were less responsive to treatment relative to monolayer cultures due to mechanisms of drug resistance associated with structural and microenvironmental properties of the 3-D tissue. Computational, image-based methodologies were used to assess the spatial and temporal penetration of BCMs in spheroids and corresponding human tumor xenografts. Using this approach, the tumor penetration of micelles was found to be nanoparticle-size-, tumor tissue type- and time- dependent. Furthermore, spheroids were found to be a valuable platform for the prediction of trends in nanoparticle transport in vivo. Overall, the results reported herein serve to demonstrate important determinants of nanoparticle intratumoral transport and to establish computational in vitro and in vivo methodologies for the rational design and optimization of nanomedicines.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Made available in DSpace on 2015-07-22T20:50:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-29 / Objetivo: Determinar a epidemiologia dos tumores primários do sistema nervoso central em pacientes pediátricos numa instituição oncológica brasileira. Métodos: Analisamos retrospectivamente 741 prontuários (415 homens e 326 mulheres) de pacientes com idade inferior a 21 anos, com diagnóstico de tumor do SNC de acordo com os critérios da OMS (Organização Mundial da Saúde) no período entre 1989 - 2009. Distribuição por idade e sexo, topografia, sinais e sintomas clínicos, intervalo dos sintomas e classificação dos tumores foram avaliados. Pacientes com diagnóstico clínico/radiológico foram incluídos. Pacientes com idade superior a 22 anos ou que na triagem oncológica foram descartados neoplasia do SNC foram excluídos. Resultados: Setecentos e quarenta e um pacientes portadores de tumor do sistema nervoso central (SNC) foram revisados, sendo que 75% apresentavam diagnóstico histológico. O sexo masculino foi o mais prevalente (56%). Em crianças abaixo dos três anos de idade, o compartimento supratentorial predominou (51,3%). O astrocitoma foi o tumor mais freqüente (39,9%) seguido do meduloblastoma (14,0%), craniofaringioma (10,4%) e ependimoma (6,9%). A cefaléia foi o sintoma mais comum e o intervalo dos sintomas variou de 1 a 5010 dias. Aproximadamente 4% dos pacientes tinham síndromes genéticas associadas. Conclusões: Os autores analisaram uma série de pacientes pediátricos com tumores do sistema nervoso central em um hospital brasileiro de referência. Embora não seja um estudo populacional e possa ter viés seletivo, nossos dados podem ser representativos da nossa população. / Purpose: Central nervous system (CNS) tumors comprise the most frequent group of solid malignant tumors in pediatric patients, representing approximately 20% of all tumors in children under the age of 15. The objective of this study was to determine the epidemiology of primary tumors of the CNS in pediatric patients from a Brazilian oncology institute. Methods: We retrospectively analyzed 741 charts (415 males and 326 females) from patients under 21 years of age who were diagnosed with a CNS tumor. The analysis included patients from 1989 to 2009 and was completed using the World Health Organization criteria. We evaluated the distribution of age, gender, topography, clinical symptoms, symptom intervals and classification of the tumors. Patients with clinical/radiological diagnoses were included. Results: Seven hundred and forty-one patients with tumors in the CNS were reviewed, and 75% of the patients presented a histological diagnosis. Males (56%) were more prevalent than females. In children under the age of three, the supratentorial compartment was the predominant region involved (51,3%). Astrocytoma was the most frequent tumor type (39,9%), followed by medulloblastoma (14,0%), craniopharyngioma (10,4%) and ependymoma (6,9%). Headaches were the most common symptom, and the symptom intervals varied from 1 to 5.010 days. Approximately 4% of the patients had associated genetic syndromes. Conclusions: The authors analyzed a group of pediatric patients with CNS tumors in a Brazilian referral hospital. Although this was not a population study and selection bias may have occurred, our data may be representative of the Brazilian population. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: Indivíduos sobreviventes à sepse apresentam maior mortalidade à longo prazo e maior risco de apresentar infecções oportunistas. Existem evidências clínicas e experimentais de desregulação imune no estado pós-sepse. Essas alterações apresentam semelhança com aquelas encontradas no microambiente tumoral, estando relacionadas à imunossupressão. O presente trabalho avaliou o papel de macrófagos associados ao tumor (TAM) em modelo de progressão tumoral em camundongos sobreviventes à sepse. Materiais e Métodos: Camundongos C57/BL6 foram submetidos a ligadura e punção cecal (CLP) e tratados com ertapenem (20 mg/kg, i.p., 6 horas após CLP e 12/12 h por 3 dias). Os animais sobreviventes de sepse eram inoculados com células de melanoma B16-F10 (30 mil, s.c., 15 dias após a CLP). Animais naïve foram usados como controle. Foram avaliadas a progressão tumoral, sobrevida e formação de metástases espontâneas à distância. No D+14, animais foram sacrificados para mensuração do acúmulo de TAM por citometria de fluxo (CD45+F4/80+CD206+) e de citocinas no soro e no tumor por ELISA (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12). Macrófagos derivados de medula óssea de animais pós-CLP ou naïve foram coinoculados com células B16 para avaliação de progressão tumoral e sobrevida. TAM de animais naïve ou pós-CLP foram isolados através de gradiente de Percoll seguido de adesão seletiva e o RNA foi isolado para análise diferencial de expressão gênica por microarray. Para avaliação da participação da via CXCL12/CXCR4 foi realizada sua inibição com o AMD3100, antagonista de CXCR4 (5 mg/kg, i.p., D+10 e D+14). Foi avaliada a progressão tumoral, sobrevida, acúmulo de TAM e proliferação extramedular de TAM no D+14. Resultados: Animais sobreviventes de sepse apresentaram aumento de progressão tumoral (após 15, 30 e 60 dias da CLP), aumento da carga de metástases (após 15 dias da CLP) e redução de sobrevida. Foi detectado o aumento de TAM nos animais pós-CLP, associado a maior marcação de Ki67, em comparação com animais naïve no D+14. Verificamos aumento das concentrações séricas de TGF-?, CXCL12, CCL2 e TNF-?. Camundongos naïve que coinoculados com macrófagos derivados de medula óssea de animais pós-CLP apresentaram aumento de progressão tumoral e redução de sobrevida em comparação com o grupo controle. TAM de animais pós-CLP apresentaram menor expressão de genes relacionados ao MHC-II e genes relacionados à ativação leucocitária. A inibição de CXCL12/CXCR4 preveniu a progressão tumoral induzida por sepse, com menor acúmulo de TAM e menor presença de TAM Ki67+. Conclusões: O estado pós-sepse promove a progressão tumoral de melanoma B16 em camundongos, o qual foi associado a aumento de 12 TAM. A via CXCL12/CXCR4 participa do processo de acúmulo de TAM nesse modelo experimental. / Background: Survivors from sepsis present higher long-term mortality and increased risk of opportunistic infections. There is clinical and experimental evidence for an immunosuppressive immune dysregulation in post-sepsis. These alterations are similar to those found in tumor microenvironment. The present work assessed the role of tumorassociated macrophage (TAM) in a model of tumor progression in sepsis-surviving mice. Materials and Methods: C57/BL6 mice were submitted to cecal ligation and puncture (CLP) and treated with ertapenem (20 mg/kg, ip. - 6 h after CLP and then each 12 h for 3 days). Sepsis surviving mice were inoculated with B16-F10 melanoma cells (30,000, sc., 15 days after CLP). Naïve mice were used as controls. Tumor progression, survival and distant spontaneous metastasis were evaluated. Mice were killed at D+14 for TAM measurement through flow cytometry (CD45+F4/80+CD206+) and for cytokines (IFN-?, IL-10, TNF-?, TGF-?, CCL2, CXCL12) quantification by ELISA. Bone marrow-derived macrophage (BMDM) were isolated and co-inoculated together with B16 melanoma cells for tumor progression and survival evaluation. TAM from naïve or post-sepsis mice were isolated through Percoll gradient (70/30) followed by selective adhesion. The RNA was isolated for gene expression analysis using microarray assay. To evaluate the role of CXCL12/CXCR4, we used the specific antagonist AMD3100 (5 mg/kg, ip., at D+10 and D+14) and assessed tumor progression, survival and TAM accumulation at D+14. Results: Sepsis-surviving mice showed increased tumor progression (15, 30 or 60 days after CLP), higher metastatic burden (15 days after CLP), and less overall survival. TAM were increased in post-sepsis mice at D+14. We found increased serum levels of TGF-?, CXCL12, CCL2 e TNF-?. Naïve mice inoculated with BMDM from post-sepsis and B16 cells showed higher tumoral progression and less survival, when compared to the control group. TAM from post-sepsis showed decreased expression of MHC-II related genes and genes related to leukocyte activation. The inhibition of CXCL12/CXCR4 prevented the post-sepsis-induced tumor progression, with less TAM accumulation and reduced expression of Ki67 in TAM. Conclusions: The post-sepsis state promotes the progression of B16 melanoma in mice, which was associated with an increase in TAM accumulation. CXCL12/CXCR4 mediates TAM accumulation in this experimental model.