ABSTRACT Renal cell carcinoma (RCC), the most common type of kidney cancer, is a highly metastatic disease. Late stage metastatic RCC is essentially incurable and lethal. The average survival of patients, following metastatic RCC, is about 4 months and only 10% of patients survive for one year. None of the currently available chemotherapy, radiotherapy, hormonal or biological therapies have a significant impact on the progression of the disease. Novel chemotherapeutics are urgently required for the treatment of this deadly disease. The mechanisms that pose the greatest challenges to chemotherapeutics are resistance of tumour cells to apoptosis, tumour angiogenesis and multi-drug resistance. Resistance to apoptosis may be mediated by the up-regulation of anti-apoptotic proteins, especially Bcl-2 and Bcl-XL, and/or by the down- regulation of pro-apoptotic proteins, particularly Bax. Angiogenesis is pivotal for tumour growth and metastasis. Of all identified pro-angiogenic molecules, vascular endothelial growth factor (VEGF) is considered to be a key molecule. Drug resistance is thought to be mediated by the up-regulation of multi-drug resistance molecules such as MDR-1 and MRP-1. Up-regulation of Bcl-2 also confers drug resistance to cancer cells. The main hypothesis of this thesis was that treatment targets of metastatic RCCs are likely to multifactorial and that inhibition of molecules that regulate the processes of apoptosis, angiogenesis and multidrug resistance are likely to be better targets than those that regulate only one of these processes. In this regard, the transcription factor nuclear factor kappaB (NF-kB) meets the criterion, regulating the apoptotic, angiogenic and multi-drug resistance pathways of cancer cells. Its inhibition appeared to be an attractive strategy for the treatment of metastatic RCC. Many studies have demonstrated an association between the over-expression NF-kB and RCC. Thus, the major aim of this thesis was to explore the anti-cancer effect of pyrrolidine dithiocarbamate (PDTC), a potent NF-kB inhibitor on human metastatic RCC cell lines. The thesis is divided into seven Chapters. In Chapter 1, the literature on RCC, NF-B and the role of NF-kB in RCC development and progression are reviewed. The rationale for the inhibition of NF-kB as a potential anti-RCC strategy using PDTC is established. During the course of this research, the use of PDTC as an anti-cancer agent has risen to prominence. Chapter 2 describes the materials and methods used in the project. In Chapter 3, the expression of NF-kB in human kidney and the RCC cell lines, ACHN and SN12K1, was established. The proof of hypothesis that NF-kB inhibition using PDTC is an effective anti-cancer strategy was demonstrated. PDTC was selectively toxic to the RCC cell lines, but not to normal human kidney cells. PDTC induced apoptosis and inhibited proliferation of the RCC cells. PDTC also inhibited NF-kB, its upstream regulatory molecules such as the inhibitory protein family of the IkBs, and the kinase IKK complex. PDTC also inhibited anti-apoptotic Bcl-2 and Bcl-XL, but not pro-apoptotic Bax. Chapter 4 demonstrated the in vitro and ex vivo anti-angiogenic and anti-metastatic effects of PDTC. Protein microarrays for angiogenic factors produced controversial results. PDTC inhibited epidermal growth factor (EGF) produced in endothelial cells. VEGF had neutral effect on angiogenesis under the experimental conditions used. In the RCC cell lines, several pro-angiogenic molecules were modulated. Interestingly, the pro-angiogenic molecule interleukin (IL)-8 was up-regulated in both RCC cell lines. The monocyte chemoattractant protein-1 (MCP-1) was decreased in ACHN cells, but increased in SN12K1 cells. The implications of these controversial findings are discussed. Chapter 5 demonstrated the ability of PDTC to overcome drug resistance in a synergism with cisplatin. Individual non-toxic concentrations of PDTC and cisplatin, when combined, induced significant toxicity of RCC cell lines. The synergistic effect was not mediated by the inhibition of NF-kB, but rather through the inhibition of transcriptional activation of NF-kB. Bcl-2 rather than MDR-1 or the regulatory protein MRP-1 may be important in overcoming drug resistance in RCC. Chapter 6 showed the anti-cancer effect of PDTC in an animal model of RCC. PDTC significantly decreased the growth of RCC implanted in the kidney of severe combined immunodeficiency (SCID) mice. PDTC inhibited NF-kB and was not toxic to normal cells. The expression of Bcl-2, Bcl-XL and Bax were contradictory to the in vitro findings and a theory about the spread of RCC based on these findings is discussed. In Chapter 7, the findings are summarised. A case for PDTC as a potential therapeutic agent for RCC is established. Under the experimental conditions used, PDTC was demonstrated to be an effective anti-RCC agent by targeting the three most important characteristics of RCC that pose the greatest challenges to chemotherapeutics: resistance of tumour cells to apoptosis, tumour angiogenesis and multi-drug resistance. PDTC was selectively toxic to RCC, but not to normal renal cells. Thus PDTC appears to be a promising anti-cancer agent. This is supported by the current increase in interest, and in the number of publications, on the use of PDTC in several cancers. Some future directions are also discussed in this Chapter. These include, but are not limited to, an investigation of what is protecting normal cells from the toxicity of PDTC, the creation of an Australian database on RCC, and the characterisation of RCC based on NF-kB expression.
| Identifer | oai:union.ndltd.org:ADTP/279238 |
| Creators | Christudas Morais |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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