Ciclosporina A no eritema nodoso hansênico com manifestações sistêmicas: avaliação clínica, laboratorial e histopatológica

O ENH é séria intercorrência aguda ou subaguda que acomete pacientes das formas dimorfa-virchowiana e virchowiana da classificação de Ridley e Jopling. Neste estudo, foi utilizada uma droga imunorreguladora, a ciclosporina A, com o propósito de avaliar a eficácia nesta reação, cujo tratamento depende de medicamentos como a talidomida, que tem contra-indicações formais e corticóides, que provocam dependência, entre outros danos. Foram selecionados dez doentes de ENH com sintomas sistêmicos; todos haviam passado por vários episódios desta reação e faziam uso contínuo e prolongado de prednisona em doses elevadas e ocasionalmente, de talidomida. Os pacientes tomaram ciclosporina A em doses de 3-5 mg/kg/dia durante um período de 90 dias. Realizaram exames laboratoriais nos dias zero, 150 e 600 de uso da ciclosporina A e também o histopatológico das lesões de ENH (antes do tratamento e com 60 dias). Os exames laboratoriais solicitados foram: hemograma e leucograma; TGO; TGP: uréia e creatinina. Detectou-se leucocitose em graus entre moderado e elevado em 70% dos casos, mas evoluiu para leucocitose leve até o término do acompanhamento na mesma percentagem dos doentes. O exame bioquímico não mostrou alterações significantes, com exceção da elevação da TGO em um caso, da TGP em outro, além de dois pacientes que mostraram aumento da uréia e creatinina, mas que posteriormente, normalizaram sem precisar de medidas adicionais. Os achados histológicos encontrados no primeiro exame foram representados em 40% dos doentes, por dermatite granulomatosa e em 30%, por dermatite nodular. Na segunda análise, houve mudança para dermatite perivascular superficial e profunda em 50% dos casos e para paniculite septal em 20%; isto denota melhora histológica compatível com a melhora dos sintomas verificada nos primeiros quinze dias de terapêutica. A ação da ciclosporina A se revelou benéfica, principalmente na sintomatologia sistêmica, com exceção dos casos que se acompanhavam de neurite; desta forma, a ciclosporina A pode ser uma opção para a melhoria clínica das reações hansênicas tipo 11.

Avaliação do efeito citotóxico da nitensidina A em células de glioblastoma multiforme e células não tumorais

Astrocitomas difusos são o tipo de tumor cerebral primario mais comum em adultos. O glioblastoma multiforme (GBM) é o astrocitoma mais frequente e letal. Pacientes diagnosticados com GBM geralmente morrem em aproximadamente 14 meses apesar do tratamento normalmente adotado. O tratamento consiste em remoção cirúrgica do tumor, radioterapia e quimioterapia com o agente alquilante temozolomida (TMZ). Entretanto, devido a elevada resistência desse tumor à radioterapia e quimioterapia, na maioria dos casos ocorre recidiva do tumor algumas semanas após a cirurgia. Baseado nesse prognóstico pobre e na elevada resistência das células de GBM à quimioterapia, a busca por novos fármacos a fim de aumentar as chances de sobrevivência e a qualidade de vida dos pacientes, é de extrema importância. Nitensidina A é um alcaloide guanidínico isolado da planta típica do cerrado brasileiro Pterogyne nitens, que demonstrou notável efeito citotóxico em células de câncer cervical. A fim de analisar o potencial da nitensidina A como antineoplásico foram realizados ensaios de citotoxicidade desta substância e da TMZ. Os resultados mostraram que a nitensidina A apresenta efeito citotóxico em concentração muito inferior à TMZ. Os resultados também demonstram que dentre as células analisadas, a RO é a célula não tumoral mais resistente a ambas as substâncias e, dentre as células tumorais, a célula mais sensível e a mais resistente são, respectivamente, U87MG e U343MG. Estes resultados indicam que a nitensidina A tem um potencial terapêutico promissor para este tipo tumoral. Experimentos adicionais estão em andamento para investigar esta hipótese

Investigação do papel de HJURP (Holliday Junction Recognizing Protein) na resistência de células de glioblastoma multiforme à radiação ionizante

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Estudo funcional de genes de reparo de DNA superexpressos em glioblastoma multiforme

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Ocorrência de eritema nodoso hansênico

Introdução: A Hanseníase, em pacientes de formas multibacilares, pode apresentar episódios reacionais de Eritema Nodoso Hansênico, que podem ocorrer antes, durante e após o tratamento, causando neurites, iridociclites e orquiepidimites, levando a sequelas importantes, como cegueira e incapacidade motora. Objetivo: observar a freqüência de surtos de ENH de acordo com o tratamento com PQT e o número de vezes em que se repetiu. Métodos: ocorrência de ENH em pacientes com hanseníase multibacilar. Resultados: Foram avaliados 344 pacientes, 59,88% da forma MB; destes, 59,2% apresentaram ENH. A faixa etária variou de 12 a 86 anos, a maioria, 51,63%, entre 40-59 anos; dois (1,63%) eram menores de 15 anos; 52 eram da forma D e 70 da V; 66,39% do sexo masculino e 33,60% do feminino. Os episódios reacionais variaram de 1 a 17 por paciente; 16,39% o apresentaram uma vez e 17,21% acima de 7; 40,77% não o apresentaram. No geral, 68,02% apresentaram mais de três episódios. Quanto ao tratamento, em 8,19% o episódio manifestou-se antes do início, em 64,75% durante e em 30,32%, após. 51,63% apresentaram durante e após. Observou-se que em 63,11% o IB foi considerado alto, maior ou igual a 3 +++. Conclusão: considerou-se elevados o número de pacientes que o apresentaram e o número de repetições acima de 3 vezes, o que aumenta os riscos dos danos e seqüelas. Todas as medidas para evitá-lo devem consideradas.

Sintesi e caratterizzazione di sistemi nanostrutturati per il trattamento del Glioblastoma multiforme

Nanomedicine is a science based on the preparation of nanosystems for biomedical application. The drugs can be entrapped inside the nanocarriers to improve the drug concentration in the diseased issue through a drug delivery approach; polimeric materials as PLGA-b-PEG has been revealed good properties for this purpose. To improve the nanosystem efficiency it is possible to bind a targeting agent on the carrier surface. In this thesis work silver nanoparticles or drugs as Temsirolimus and Alisertib have been entrapped in PLGA-b-PEG carriers. Chlorotoxin has been linked on the carrier surface as a specific targeting agent for brain tumors. Citotoxicity in vitro of the nanosystems on Glioblastoma cells has been studied.

Synthesis and surface modification of silver and gold nanoparticles. Nanomedicine applications against Glioblastoma Multiforme.

In the last decades noble metal nanoparticles (NPs) arose as one of the most powerful tools for applications in nanomedicine field and cancer treatment. Glioblastoma multiforme (GBM), in particular, is one of the most aggressive malignant brain tumors that nowadays still presents a dramatic scenario concerning median survival. Gold nanorods (GNRs) and silver nanoparticles (AgNPs) could find applications such as diagnostic imaging, hyperthermia and glioblastoma therapy. During these three years, both GNRs and AgNPs were synthesized with the “salt reduction” method and, through a novel double phase transfer process, using specifically designed thiol-based ligands, lipophilic GNRs and AgNPs were obtained and separately entrapped into biocompatible and biodegradable PEG-based polymeric nanoparticles (PNPs) suitable for drug delivery within the body. Moreover, a synergistic effect of AgNPs with the Alisertib drug, were investigated thanks to the simultaneous entrapment of these two moieties into PNPs. In addition, Chlorotoxin (Cltx), a peptide that specifically recognize brain cancer cells, was conjugated onto the external surface of PNPs. The so-obtained novel nanosystems were evaluated for in vitro and in vivo applications against glioblastoma multiforme. In particular, for GNRs-PNPs, their safety, their suitability as optoacoustic contrast agents, their selective laser-induced cells death and finally, a high tumor retention were all demonstrated. Concerning AgNPs-PNPs, promising tumor toxicity and a strong synergistic effect with Alisertib was observed (IC50 10 nM), as well as good in vivo biodistribution, high tumor uptake and significative tumor reduction in tumor bearing mice. Finally, the two nanostructures were linked together, through an organic framework, exploiting the click chemistry azido-alkyne Huisgen cycloaddition, between two ligands previously attached to the NPs surface; this multifunctional complex nanosystem was successfully entrapped into PNPs with nanoparticles’ properties maintenance, obtaining in this way a powerful and promising tool for cancer fight and defeat.

Development and in vitro testing of liposomal gadolinium-formulations for neutron capture therapy of glioblastoma multiforme

For the improvement of current neutron capture therapy, several liposomal formulations of neutron capture agent gadolinium were developed and tested in a glioma cell model. Formulations were analyzed regarding physicochemical and biological parameters, such as size, zeta potential, uptake into cancer cells and performance under neutron irradiation. The neutron and photon dose derived from intracellular as well as extracellular Gd was calculated via Monte Carlo simulations and set in correlation with the reduction of cell survival after irradiation. To investigate the suitability of Gd as a radiosensitizer for photon radiation, cells were also irradiated with synchrotron radiation in addition to clinically used photons generated by linear accelerator.rnIrradiation with neutrons led to significantly lower survival for Gd-liposome-treated F98 and LN229 cells, compared to irradiated control cells and cells treated with non-liposomal Gd-DTPA. Correlation between Gd-content and -dose and respective cell survival displayed proportional relationship for most of the applied formulations. Photon irradiation experiments showed the proof-of-principle for the radiosensitizer approach, although the photon spectra currently used have to be optimized for higher efficiency of the radiosensitizer. In conclusion, the newly developed Gd-liposomes show great potential for the improvement of radiation treatment options for highly malignant glioblastoma.rn

Applicazione di tecniche di analisi statistica e texture analysis all'imaging di risonanza magnetica di pazienti affetti da glioblastoma multiforme

Il seguente lavoro di tesi si è concentrato sull'analisi statistica dei dati prodotti dall'imaging di risonanza magnetica di pazienti affetti da tumori di alto grado, in particolare glioblastoma multiforme. Le tipologie di acquisizione d'immagine utilizzate sono state l'imaging pesato in T1 e il Diffusion-Weighted Imaging (DWI). Lo studio è stato suddiviso in due fasi: nella prima è stato considerato un campione di pazienti affetti da glioblastoma multiforme che, dopo il trattamento, avessero manifestato una ricaduta della malattia; per questi pazienti è stato quantificato in che modo la dose erogata durante la terapia si sia distribuita sul target del trattamento, in particolare nella porzione di tessuto in cui andrà a svilupparsi la recidiva. Nella seconda fase, è stato selezionato un campione più ristretto che disponesse, per entrambe le modalità di imaging, di un'acquisizione pre-terapia e di un numero sufficiente di esami di follow up; questo al fine di seguire retrospettivamente l'evoluzione della patologia e analizzare tramite metodi statistici provenienti anche dalla texture analysis, i dati estratti dalle regioni tumorali. Entrambe le operazioni sono state svolte tramite la realizzazione di software dedicati, scritti in linguaggio Matlab. Nel primo capitolo vengono fornite le informazioni di base relative ai tumori cerebrali, con un'attenzione particolare al glioblastoma multiforme e alle sue modalità di trattamento. Nel secondo capitolo viene fatta una panoramica della fisica dell'imaging di risonanza magnetica e delle tecniche di formazione delle immagini, con un'ampia sezione è dedicata all'approfondimento dell'imaging in diffusione. Nel terzo capitolo viene descritto il progetto, i campioni e gli strumenti statistici e di texture analysis utilizzati in questo studio. Il quarto capitolo è dedicato alla descrizione puntuale dei software realizzati durante questo lavoro e nel quinto vengono mostrati i risultati ottenuti dall'applicazione di questi ultimi ai campioni di pazienti esaminati.

Detrimental effects of exuberant and restrained immune responses against the central nervous system in the context of multiple sclerosis and glioblastoma multiforme

Glioblastoma multiforme (GBM) is the most common and most aggressive astrocytic tumor of the central nervous system (CNS) in adults. The standard treatment consisting of surgery, followed by a combinatorial radio- and chemotherapy, is only palliative and prolongs patient median survival to 12 to 15 months. The tumor subpopulation of stem cell-like glioma-initiating cells (GICs) shows resistance against radiation as well as chemotherapy, and has been suggested to be responsible for relapses of more aggressive tumors after therapy. The efficacy of immunotherapies, which exploit the immune system to specifically recognize and eliminate malignant cells, is limited due to strong immunosuppressive activities of the GICs and the generation of a specialized protective microenvironment. The molecular mechanisms underlying the therapy resistance of GICs are largely unknown. rnThe first aim of this study was to identify immune evasion mechanisms in GICs triggered by radiation. A model was used in which patient-derived GICs were treated in vitro with fractionated ionizing radiation (2.5 Gy in 7 consecutive passages) to select for a more radio-resistant phenotype. In the model cell line 1080, this selection process resulted in increased proliferative but diminished migratory capacities in comparison to untreated control GICs. Furthermore, radio-selected GICs downregulated various proteins involved in antigen processing and presentation, resulting in decreased expression of MHC class I molecules on the cellular surface and diminished recognition potential by cytotoxic CD8+ T cells. Thus, sub-lethal fractionated radiation can promote immune evasion and hamper the success of adjuvant immunotherapy. Among several immune-associated proteins, interferon-induced transmembrane protein 3 (IFITM3) was found to be upregulated in radio-selected GICs. While high expression of IFITM3 was associated with a worse overall survival of GBM patients (TCGA database) and increased proliferation and migration of differentiated glioma cell lines, a strong contribution of IFITM3 to proliferation in vitro as well as tumor growth and invasiveness in a xenograft model could not be observed. rnMultiple sclerosis (MS) is the most common autoimmune disease of the CNS in young adults of the Western World, which leads to progressive disability in genetically susceptible individuals, possibly triggered by environmental factors. It is assumed that self-reactive, myelin-specific T helper cell 1 (Th1) and Th17 cells, which have escaped the control mechanisms of the immune system, are critical in the pathogenesis of the human disease and its animal model experimental autoimmune encephalomyelitis (EAE). It was observed that in vitro differentiated interleukin 17 (IL-17) producing Th17 cells co-expressed the Th1-phenotypic cytokine Interferon-gamma (IFN-γ) in combination with the two respective lineage-associated transcription factors RORγt and T-bet after re-isolation from the CNS of diseased mice. Pathogenic molecular mechanisms that render a CD4+ T cell encephalitogenic have scarcely been investigated up to date. rnIn the second part of the thesis, whole transcriptional changes occurring in in vitro differentiated Th17 cells in the course of EAE were analyzed. Evaluation of signaling networks revealed an overrepresentation of genes involved in communication between the innate and adaptive immune system and metabolic alterations including cholesterol biosynthesis. The transcription factors Cebpa, Fos, Klf4, Nfatc1 and Spi1, associated with thymocyte development and naïve T cells were upregulated in encephalitogenic CNS-isolated CD4+ T cells, proposing a contribution to T cell plasticity. Correlation of the murine T-cell gene expression dataset to putative MS risk genes, which were selected based on their proximity (± 500 kb; ensembl database, release 75) to the MS risk single nucleotide polymorphisms (SNPs) proposed by the most recent multiple sclerosis GWAS in 2011, revealed that 67.3% of the MS risk genes were differentially expressed in EAE. Expression patterns of Bach2, Il2ra, Irf8, Mertk, Odf3b, Plek, Rgs1, Slc30a7, and Thada were confirmed in independent experiments, suggesting a contribution to T cell pathogenicity. Functional analysis of Nfatc1 revealed that Nfatc1-deficient CD4+ T cells were restrained in their ability to induce clinical signs of EAE. Nfatc1-deficiency allowed proper T cell activation, but diminished their potential to fully differentiate into Th17 cells and to express high amounts of lineage cytokines. As the inducible Nfatc1/αA transcript is distinct from the other family members, it could represent an interesting target for therapeutic intervention in MS.rn

Contribution of Ectodomain Mutations in Epidermal Growth Factor Receptor to Signaling in Glioblastoma Multiforme

CONTRIBUTION OF ECTODOMAIN MUTATIONS IN EPIDERMAL GROWTH FACTOR RECEPTOR TO SIGNALING IN GLIOBLASTOMA MULTIFORME Publication No._________ Marta Rojas, M.S. Supervisory Professor: Oliver Bögler, Ph.D. The Cancer Genome Atlas (TCGA) has conducted a comprehensive analysis of a large tumor cohort and has cataloged genetic alterations involving primary sequence variations and copy number aberrations of genes involved in key signaling pathways in glioblastoma (GBM). This dataset revealed missense ectodomain point mutations in epidermal growth factor receptor (EGFR), but the biological and clinical significance of these mutations is not well defined in the context of gliomas. In our study, we focused on understanding and defining the molecular mechanisms underlying the functions of EGFR ectodomain mutants. Using proteomic approaches to broadly analyze cell signaling, including antibody array and mass spectrometry-based methods, we found a differential spectrum of tyrosine phosphorylation across the EGFR ectodomain mutations that enabled us to stratify them into three main groups that correlate with either wild type EGFR (EGFR) or the long-studied mutant, EGFRvIII. Interestingly, one mutant shared characteristics of both groups suggesting a continuum of behaviors along which different mutants fall. Surprisingly, no substantial differences were seen in activation of classical downstream signaling pathways such as Akt and S6 pathways between these classes of mutants. Importantly, we demonstrated that ectodomain mutations lead to differential tumor growth capabilities in both in vitro (anchorage independent colony formation) and in vivo conditions (xenografts). Our data from the biological characterization allowed us to categorize the mutants into three main groups: the first group typified by EGFRvIII are mutations with a more aggressive phenotype including R108K and A289T; a second group characterized by a less aggressive phenotype exemplified by EGFR and the T263P mutation; and a third group which shared characteristics from both groups and is exemplified by the mutation A289D. In addition, we treated cells overexpressing the mutants with various agents employed in the clinic including temozolomide, cisplatin and tarceva. We found that cells overexpressing the mutants in general displayed resistance to the treatments. Our findings yield insights that help with the molecular characterization of these mutants. In addition, our results from the drug studies might be valuable in explaining differential responses to specific treatments in GBM patients.

Biologic and molecular analysis of tumor suppressor loci in human glioblastoma multiforme

Molecular and cytogenetic analyses of human glioblastomas have revealed frequent genetic alterations, including major deletions in chromosomes 9, 10, and 17, suggesting the presence of glioma-associated tumor suppressor genes on these chromosomes. To examine this hypothesis, copies of chromosomes 2, 4, and 10 derived from a human fibroblast cell line were independently introduced into a human glioma cell line, U251, by microcell-mediated chromosomal transfer. Successful transfer of chromosomes in each case was confirmed by resistance to the drug G418, indicating the presence of the neomycin-resistance gene previously integrated into each transferred chromosome. The presence of novel chromosomes and or chromosomal fragments was also demonstrated by molecular and karyotypic analyses. The hybrid clones containing either a novel chromosome 4 or chromosome 10 displayed suppression of the tumorigenic phenotype in vivo and suppression of the transformed phenotype in vitro, while cells containing a transferred chromosome 2 failed to alter their tumorigenic phenotype. The hybrid cells containing chromosome 4 or 10 exhibited a significant decrease in their saturation density, altered cellular morphology at high cell density, but only a slight decrease in their exponential growth rate. A dramatic decrease was observed in growth of cells with chromosome 4 or 10 in soft agarose, with the number and size of the colonies being greatly reduced, compared to the parental or chromosome 2 containing cells. The introduction of chromosome 4 or 10 also completely suppressed tumor formation in nude mice. These studies indicate that chromosome 10, as hypothesized, and chromosome 4, a novel finding for gliomas, harbor tumor suppressor loci that may be directly involved in the initiation or progression of normal glial precursors to human glioblastoma multiforme. ^

Analysis of differential gene expression in nontumorigenic glioblastoma multiforme

Loss of chromosome 10 represents the most common cytogenetic abnormality in high grade gliomas (glioblastoma multiforme). To identify genes involved in the malignant progression of human gliomas, a subtractive hybridization was performed between a tumorigenic glioblastoma cell line (LG11) and a nontumorgenic hybrid cell (LG11.3) containing an introduced chromosome 10. LG11 mRNA was subtracted from LG11.3 cDNA to produce cDNA probes enriched for sequences whose expression differs quantitatively from the parental tumorigenic cells. Both known and novel sequences were identified as a result of the subtraction. Northern blot analysis was then used to confirm differential expression of several subtracted clones. One novel clone, clone 17, identified a 2.6 kb message that showed a consistent two to four fold increase in expression in the LG11.3 nontumorigenic cells. Clone 17 (340 bp) was used successfully to screen for a near full-length version, RIG (regulated in glioma), which was 2,569 bp in size. The RIG cDNA sequence showed homology to clone 17 and to an anonymous EST (IB666), but to no previously identified genes. This screening effort also identified several independent clones representing novel sequences, most of which failed to show increased expression in the nontumorigenic GBM cells. Tissue distribution studies of RIG indicated highest levels of expression in human brain with appreciably lower levels in heart and lung. In vitro transcription and translation experiments demonstrated the ability of RIG to direct the synthesis of a 13 kD protein product. However, open reading frame analysis revealed no identify with previously described motifs or any known proteins. Using a combination of somatic cell hybrid panels and in situ hybridization, the RIG gene was mapped to chromosome 11p14-11p15. Further study of RIG and related gene products may provide insight into the negative regulation of glial oncogenesis. ^

The functional role of the tumor suppressor MMAC /PTEN in glioblastoma multiforme and prostate cancer

Investigations into the molecular basis of glioblastoma multiforme led to the identification of a putative tumor suppressor gene, MMAC/ PTEN. Initial studies implicated MMAC/PTEN in many different tumor types, and identified a protein phosphatase motif in its sequence. This project aimed to identify the biological and biochemical functions of MMAC/PTEN by transiently expressing the gene in cancer cells that lack a functional gene product. ^ Expression of MMAC/PTEN mildly suppressed the growth of U251 human glioma cells and abrogated the growth advantage mediated by overexpression of the epidermal growth factor receptor (EGFR). Immunoblotting demonstrated that MMAC/PTEN expression did not affect the phosphorylation of the EGFR itself, or the intermediates of several downstream signaling pathways. However, MMAC/PTEN expression significantly reduced the phosphorylation and catalytic activity of the proto-oncogene Akt/PKB. While Akt/PKB regulates the survival of many cell types, expression of MMAC/PTEN did not induce apoptosis in adherent U251 cells. Instead, MMAC/PTEN expression sensitized the cells to apoptosis when maintained in suspension (anoikis). As the survival of suspended cells is one of the hallmarks leading to metastasis, MMAC/PTEN expression was examined in a system in which metastasis is more clinically relevant, prostate cancer. ^ Expression of MMAC/PTEN in both LNCaP and PC3-P human prostate cancer cells specifically inhibited Akt/PKB phosphorylation. MMAC/PTEN expression in LNCaP cells resulted in a profound inhibition of growth that was significantly greater than that achieved with expression of p53. Expression of MMAC/PTEN in PC3-P cells resulted in greater growth inhibition than was observed in U251 glioma cells, but less than was observed in LNCaP cells, or upon p53 expression. To determine if MMAC/PTEN could function as a tumor suppressor in vivo, the effects of MMAC/PTEN expression on PC3-P cells implanted orthotopically in nude mice were examined. The ex-vivo expression of MMAC/PTEN did not decrease tumor incidence, but it did significantly decrease tumor size and metastasis. In-vivo expression of MMAC/PTEN in pre-established PC3-P tumors did not significantly inhibit tumor incidence or size, but did inhibit metastasis formation. ^ These studies demonstrate that MMAC/PTEN is a novel and important tumor suppressor gene, which functions to downregulate an important cell survival signaling pathway. ^