Parameters and algorithms to evaluate cardiac mechanics by conductance catheter

This work is structured as follows: In Section 1 we discuss the clinical problem of heart failure. In particular, we present the phenomenon known as ventricular mechanical dyssynchrony: its impact on cardiac function, the therapy for its treatment and the methods for its quantification. Specifically, we describe the conductance catheter and its use for the measurement of dyssynchrony. At the end of the Section 1, we propose a new set of indexes to quantify the dyssynchrony that are studied and validated thereafter. In Section 2 we describe the studies carried out in this work: we report the experimental protocols, we present and discuss the results obtained. Finally, we report the overall conclusions drawn from this work and we try to envisage future works and possible clinical applications of our results. Ancillary studies that were carried out during this work mainly to investigate several aspects of cardiac resynchronization therapy (CRT) are mentioned in Appendix. -------- Ventricular mechanical dyssynchrony plays a regulating role already in normal physiology but is especially important in pathological conditions, such as hypertrophy, ischemia, infarction, or heart failure (Chapter 1,2.). Several prospective randomized controlled trials supported the clinical efficacy and safety of cardiac resynchronization therapy (CRT) in patients with moderate or severe heart failure and ventricular dyssynchrony. CRT resynchronizes ventricular contraction by simultaneous pacing of both left and right ventricle (biventricular pacing) (Chapter 1.). Currently, the conductance catheter method has been used extensively to assess global systolic and diastolic ventricular function and, more recently, the ability of this instrument to pick-up multiple segmental volume signals has been used to quantify mechanical ventricular dyssynchrony. Specifically, novel indexes based on volume signals acquired with the conductance catheter were introduced to quantify dyssynchrony (Chapter 3,4.). Present work was aimed to describe the characteristics of the conductancevolume signals, to investigate the performance of the indexes of ventricular dyssynchrony described in literature and to introduce and validate improved dyssynchrony indexes. Morevoer, using the conductance catheter method and the new indexes, the clinical problem of the ventricular pacing site optimization was addressed and the measurement protocol to adopt for hemodynamic tests on cardiac pacing was investigated. In accordance to the aims of the work, in addition to the classical time-domain parameters, a new set of indexes has been extracted, based on coherent averaging procedure and on spectral and cross-spectral analysis (Chapter 4.). Our analyses were carried out on patients with indications for electrophysiologic study or device implantation (Chapter 5.). For the first time, besides patients with heart failure, indexes of mechanical dyssynchrony based on conductance catheter were extracted and studied in a population of patients with preserved ventricular function, providing information on the normal range of such a kind of values. By performing a frequency domain analysis and by applying an optimized coherent averaging procedure (Chapter 6.a.), we were able to describe some characteristics of the conductance-volume signals (Chapter 6.b.). We unmasked the presence of considerable beat-to-beat variations in dyssynchrony that seemed more frequent in patients with ventricular dysfunction and to play a role in discriminating patients. These non-recurrent mechanical ventricular non-uniformities are probably the expression of the substantial beat-to-beat hemodynamic variations, often associated with heart failure and due to cardiopulmonary interaction and conduction disturbances. We investigated how the coherent averaging procedure may affect or refine the conductance based indexes; in addition, we proposed and tested a new set of indexes which quantify the non-periodic components of the volume signals. Using the new set of indexes we studied the acute effects of the CRT and the right ventricular pacing, in patients with heart failure and patients with preserved ventricular function. In the overall population we observed a correlation between the hemodynamic changes induced by the pacing and the indexes of dyssynchrony, and this may have practical implications for hemodynamic-guided device implantation. The optimal ventricular pacing site for patients with conventional indications for pacing remains controversial. The majority of them do not meet current clinical indications for CRT pacing. Thus, we carried out an analysis to compare the impact of several ventricular pacing sites on global and regional ventricular function and dyssynchrony (Chapter 6.c.). We observed that right ventricular pacing worsens cardiac function in patients with and without ventricular dysfunction unless the pacing site is optimized. CRT preserves left ventricular function in patients with normal ejection fraction and improves function in patients with poor ejection fraction despite no clinical indication for CRT. Moreover, the analysis of the results obtained using new indexes of regional dyssynchrony, suggests that pacing site may influence overall global ventricular function depending on its relative effects on regional function and synchrony. Another clinical problem that has been investigated in this work is the optimal right ventricular lead location for CRT (Chapter 6.d.). Similarly to the previous analysis, using novel parameters describing local synchrony and efficiency, we tested the hypothesis and we demonstrated that biventricular pacing with alternative right ventricular pacing sites produces acute improvement of ventricular systolic function and improves mechanical synchrony when compared to standard right ventricular pacing. Although no specific right ventricular location was shown to be superior during CRT, the right ventricular pacing site that produced the optimal acute hemodynamic response varied between patients. Acute hemodynamic effects of cardiac pacing are conventionally evaluated after stabilization episodes. The applied duration of stabilization periods in most cardiac pacing studies varied considerably. With an ad hoc protocol (Chapter 6.e.) and indexes of mechanical dyssynchrony derived by conductance catheter we demonstrated that the usage of stabilization periods during evaluation of cardiac pacing may mask early changes in systolic and diastolic intra-ventricular dyssynchrony. In fact, at the onset of ventricular pacing, the main dyssynchrony and ventricular performance changes occur within a 10s time span, initiated by the changes in ventricular mechanical dyssynchrony induced by aberrant conduction and followed by a partial or even complete recovery. It was already demonstrated in normal animals that ventricular mechanical dyssynchrony may act as a physiologic modulator of cardiac performance together with heart rate, contractile state, preload and afterload. The present observation, which shows the compensatory mechanism of mechanical dyssynchrony, suggests that ventricular dyssynchrony may be regarded as an intrinsic cardiac property, with baseline dyssynchrony at increased level in heart failure patients. To make available an independent system for cardiac output estimation, in order to confirm the results obtained with conductance volume method, we developed and validated a novel technique to apply the Modelflow method (a method that derives an aortic flow waveform from arterial pressure by simulation of a non-linear three-element aortic input impedance model, Wesseling et al. 1993) to the left ventricular pressure signal, instead of the arterial pressure used in the classical approach (Chapter 7.). The results confirmed that in patients without valve abnormalities, undergoing conductance catheter evaluations, the continuous monitoring of cardiac output using the intra-ventricular pressure signal is reliable. Thus, cardiac output can be monitored quantitatively and continuously with a simple and low-cost method. During this work, additional studies were carried out to investigate several areas of uncertainty of CRT. The results of these studies are briefly presented in Appendix: the long-term survival in patients treated with CRT in clinical practice, the effects of CRT in patients with mild symptoms of heart failure and in very old patients, the limited thoracotomy as a second choice alternative to transvenous implant for CRT delivery, the evolution and prognostic significance of diastolic filling pattern in CRT, the selection of candidates to CRT with echocardiographic criteria and the prediction of response to the therapy.

RNA Interference and cyclooxygenase-2 (COX-2) regulation in colon cancer cells

Despite new methods and combined strategies, conventional cancer chemotherapy still lacks specificity and induces drug resistance. Gene therapy can offer the potential to obtain the success in the clinical treatment of cancer and this can be achieved by replacing mutated tumour suppressor genes, inhibiting gene transcription, introducing new genes encoding for therapeutic products, or specifically silencing any given target gene. Concerning gene silencing, attention has recently shifted onto the RNA interference (RNAi) phenomenon. Gene silencing mediated by RNAi machinery is based on short RNA molecules, small interfering RNAs (siRNAs) and microRNAs (miRNAs), that are fully o partially homologous to the mRNA of the genes being silenced, respectively. On one hand, synthetic siRNAs appear as an important research tool to understand the function of a gene and the prospect of using siRNAs as potent and specific inhibitors of any target gene provides a new therapeutical approach for many untreatable diseases, particularly cancer. On the other hand, the discovery of the gene regulatory pathways mediated by miRNAs, offered to the research community new important perspectives for the comprehension of the physiological and, above all, the pathological mechanisms underlying the gene regulation. Indeed, changes in miRNAs expression have been identified in several types of neoplasia and it has also been proposed that the overexpression of genes in cancer cells may be due to the disruption of a control network in which relevant miRNA are implicated. For these reasons, I focused my research on a possible link between RNAi and the enzyme cyclooxygenase-2 (COX-2) in the field of colorectal cancer (CRC), since it has been established that the transition adenoma-adenocarcinoma and the progression of CRC depend on aberrant constitutive expression of COX-2 gene. In fact, overexpressed COX-2 is involved in the block of apoptosis, the stimulation of tumor-angiogenesis and promotes cell invasion, tumour growth and metastatization. On the basis of data reported in the literature, the first aim of my research was to develop an innovative and effective tool, based on the RNAi mechanism, able to silence strongly and specifically COX-2 expression in human colorectal cancer cell lines. In this study, I firstly show that an siRNA sequence directed against COX-2 mRNA (siCOX-2), potently downregulated COX-2 gene expression in human umbilical vein endothelial cells (HUVEC) and inhibited PMA-induced angiogenesis in vitro in a specific, non-toxic manner. Moreover, I found that the insertion of a specific cassette carrying anti-COX-2 shRNA sequence (shCOX-2, the precursor of siCOX-2 previously tested) into a viral vector (pSUPER.retro) greatly increased silencing potency in a colon cancer cell line (HT-29) without activating any interferon response. Phenotypically, COX-2 deficient HT-29 cells showed a significant impairment of their in vitro malignant behaviour. Thus, results reported here indicate an easy-to-use, powerful and high selective virus-based method to knockdown COX-2 gene in a stable and long-lasting manner, in colon cancer cells. Furthermore, they open up the possibility of an in vivo application of this anti-COX-2 retroviral vector, as therapeutic agent for human cancers overexpressing COX-2. In order to improve the tumour selectivity, pSUPER.retro vector was modified for the shCOX-2 expression cassette. The aim was to obtain a strong, specific transcription of shCOX-2 followed by COX-2 silencing mediated by siCOX-2 only in cancer cells. For this reason, H1 promoter in basic pSUPER.retro vector [pS(H1)] was substituted with the human Cox-2 promoter [pS(COX2)] and with a promoter containing repeated copies of the TCF binding element (TBE) [pS(TBE)]. These promoters were choosen because they are partculary activated in colon cancer cells. COX-2 was effectively silenced in HT-29 and HCA-7 colon cancer cells by using enhanced pS(COX2) and pS(TBE) vectors. In particular, an higher siCOX-2 production followed by a stronger inhibition of Cox-2 gene were achieved by using pS(TBE) vector, that represents not only the most effective, but also the most specific system to downregulate COX-2 in colon cancer cells. Because of the many limits that a retroviral therapy could have in a possible in vivo treatment of CRC, the next goal was to render the enhanced RNAi-mediate COX-2 silencing more suitable for this kind of application. Xiang and et al. (2006) demonstrated that it is possible to induce RNAi in mammalian cells after infection with engineered E. Coli strains expressing Inv and HlyA genes, which encode for two bacterial factors needed for successful transfer of shRNA in mammalian cells. This system, called “trans-kingdom” RNAi (tkRNAi) could represent an optimal approach for the treatment of colorectal cancer, since E. Coli in normally resident in human intestinal flora and could easily vehicled to the tumor tissue. For this reason, I tested the improved COX-2 silencing mediated by pS(COX2) and pS(TBE) vectors by using tkRNAi system. Results obtained in HT-29 and HCA-7 cell lines were in high agreement with data previously collected after the transfection of pS(COX2) and pS(TBE) vectors in the same cell lines. These findings suggest that tkRNAi system for COX-2 silencing, in particular mediated by pS(TBE) vector, could represent a promising tool for the treatment of colorectal cancer. Flanking the studies addressed to the setting-up of a RNAi-mediated therapeutical strategy, I proposed to get ahead with the comprehension of new molecular basis of human colorectal cancer. In particular, it is known that components of the miRNA/RNAi pathway may be altered during the progressive development of colorectal cancer (CRC), and it has been already demonstrated that some miRNAs work as tumor suppressors or oncomiRs in colon cancer. Thus, my hypothesis was that overexpressed COX-2 protein in colon cancer could be the result of decreased levels of one or more tumor suppressor miRNAs. In this thesis, I clearly show an inverse correlation between COX-2 expression and the human miR- 101(1) levels in colon cancer cell lines, tissues and metastases. I also demonstrate that the in vitro modulating of miR-101(1) expression in colon cancer cell lines leads to significant variations in COX-2 expression, and this phenomenon is based on a direct interaction between miR-101(1) and COX-2 mRNA. Moreover, I started to investigate miR-101(1) regulation in the hypoxic environment since adaptation to hypoxia is critical for tumor cell growth and survival and it is known that COX-2 can be induced directly by hypoxia-inducible factor 1 (HIF-1). Surprisingly, I observed that COX-2 overexpression induced by hypoxia is always coupled to a significant decrease of miR-101(1) levels in colon cancer cell lines, suggesting that miR-101(1) regulation could be involved in the adaption of cancer cells to the hypoxic environment that strongly characterize CRC tissues.

Mechanism of resistance to tyrosine kinase inhibitors in philadelphia-positive acute lymphblastic leukaemia (all): from genetic alterations to impaired RNA editing

The Ph chromosome is the most frequent cytogenetic aberration associated with adult ALL and it represents the single most significant adverse prognostic marker. Despite imatinib has led to significant improvements in the treatment of patients with Ph+ ALL, in the majority of cases resistance developed quickly and disease progressed. Some mechanisms of resistance have been widely described but the full knowledge of contributing factors, driving both the disease and resistance, remains to be defined. The observation of rapid development of lymphoblastic leukemia in mice expressing altered Ikaros (Ik) isoforms represented the background of this study. Ikaros is a zinc finger transcription factor required for normal hemopoietic differentiation and proliferation, particularly in the lymphoid lineages. By means of alternative splicing, Ikaros encodes several proteins that differ in their abilities to bind to a consensus DNA-binding site. Shorter, DNA nonbinding isoforms exert a dominant negative effect, inhibiting the ability of longer heterodimer partners to bind DNA. The differential expression pattern of Ik isoforms in Ph+ ALL patients was analyzed in order to determine if molecular abnormalities involving the Ik gene could associate with resistance to imatinib and dasatinib. Bone marrow and peripheral blood samples from 46 adult patients (median age 55 yrs, 18-76) with Ph+ ALL at diagnosis and during treatment with imatinib (16 pts) or dasatinib (30 pts) were collected. We set up a fast, high-throughput method based on capillary electrophoresis technology to detect and quantify splice variants. 41% Ph+ ALL patients expressed high levels of the non DNA-binding dominant negative Ik6 isoform lacking critical N-terminal zinc-fingers which display abnormal subcellular compartmentalization pattern. Nuclear extracts from patients expressed Ik6 failed to bind DNA in mobility shift assay using a DNA probe containing an Ikaros-specific DNA binding sequence. In 59% Ph+ ALL patients there was the coexistence in the same PCR sample and at the same time of many splice variants corresponded to Ik1, Ik2, Ik4, Ik4A, Ik5A, Ik6, Ik6 and Ik8 isoforms. In these patients aberrant full-length Ikaros isoforms in Ph+ ALL characterized by a 60-bp insertion immediately downstream of exon 3 and a recurring 30-bp in-frame deletion at the end of exon 7 involving most frequently the Ik2, Ik4 isoforms were also identified. Both the insertion and deletion were due to the selection of alternative splice donor and acceptor sites. The molecular monitoring of minimal residual disease showed for the first time in vivo that the Ik6 expression strongly correlated with the BCR-ABL transcript levels suggesting that this alteration could depend on the Bcr-Abl activity. Patient-derived leukaemia cells expressed dominant-negative Ik6 at diagnosis and at the time of relapse, but never during remission. In order to mechanistically demonstrated whether in vitro the overexpression of Ik6 impairs the response to tyrosine kinase inhibitors (TKIs) and contributes to resistance, an imatinib-sensitive Ik6-negative Ph+ ALL cell line (SUP-B15) was transfected with the complete Ik6 DNA coding sequence. The expression of Ik6 strongly increased proliferation and inhibited apoptosis in TKI sensitive cells establishing a previously unknown link between specific molecular defects that involve the Ikaros gene and the resistance to TKIs in Ph+ ALL patients. Amplification and genomic sequence analysis of the exon splice junction regions showed the presence of 2 single nucleotide polymorphisms (SNPs): rs10251980 [A/G] in the exon2/3 splice junction and of rs10262731 [A/G] in the exon 7/8 splice junction in 50% and 36% of patients, respectively. A variant of the rs11329346 [-/C], in 16% of patients was also found. Other two different single nucleotide substitutions not recognized as SNP were observed. Some mutations were predicted by computational analyses (RESCUE approach) to alter cis-splicing elements. In conclusion, these findings demonstrated that the post-transcriptional regulation of alternative splicing of Ikaros gene is defective in the majority of Ph+ ALL patients treated with TKIs. The overexpression of Ik6 blocking B-cell differentiation could contribute to resistance opening a time frame, during which leukaemia cells acquire secondary transforming events that confer definitive resistance to imatinib and dasatinib.

Presa di decisione in situazioni rischiose: effetto della rabbia

The current studies assessed the role of trait anger and anger expression styles on risk decision-making in adulthood, adolescence and childhood. In the first experiment 158 adults completed the STAXI-2 and an inventory consisting of a battery of hypothetical everyday decision-making scenarios. Participants were also asked to evaluate the perception of risk for each chosen option and some contextual characteristics, that are familiarity and salience for each scenario. The study provides evidence for a relationship between individual differences in the tendency to feel and express anger and risky decisions and for mediation effects of familiarity and salience appraisals. Moreover, results indicated that trait anger was predictive of risk perception and they provide evidence for a positive relationship between risk decision-making and risk perception. In the second study, we examined the relationship between specific components of anger (i.e., cognitive, affective and behavioural) and risk decision-making in adolescents. 101 subjects completed specific tasks, measuring risk decision-making, assessed using hypothetical choice scenarios, and anger, evaluated through the STAXI-CA and the MSAI-R. Results showed that adolescents higher on hostility, anger experience and destructive expression, make more risky decisions in everyday life situations. Moreover, regression analyses indicated that destructive expression of anger and hostility were predictive of adolescents’ risky decisions. In the third experiment, 104 children completed three tasks: the STAXI-CA, the MSAI-R and a task measuring risk decision-making in everyday situations. Subjects were also asked to evaluate the degree of danger, benefit, fun and fear perceived for each risky choice. Analyses indicated that: (a) risk decision-making was predicted by both trait anger and outward expression of anger; (b) destructive expression o anger was predictive of children’s risky decisions; (c) appraisal of danger fully mediated the relation between trait anger and risk; (d) perceptions of benefit, scare and fun partially mediated the relationship between trait anger and risk; and (e) appraisal of danger partially mediated the relationship between outward expression of anger and risk decision-making. The results provide evidence for a relationship between dispositional anger and risk decision-making during childhood, suggesting a possible explanation of the mechanisms below. In particular, risk decision-making can be viewed as the output of cognitive and emotive processes, linked to dispositional anger that leads children to be amused, optimistic and fearless in potentially risky situations. These findings substantiate the importance of incorporating cognitive and emotive factors in theories that seek to explain the relationship between personality traits and risk decision making across a broad range of age.

Analisi genetico-molecolare dei linfomi a cellule T periferiche

Molecular profiling of Peripheral T-cell lymphomas not otherwise specified Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of tumors that the WHO classification basically subdivides into specified and not otherwise specified (NOS). In Western countries, they represent around 12% of all non-Hodgkin's lymphomas. In particular, PTCL/NOS is the commonest subtype, corresponding to about 60-70% of all T-cell lymphomas. However, it remains a complex entity showing great variety regarding either morphology, immunophenotype or clinical behavior. Specially, the molecular pathology of these tumors is still poorly known. In fact, many alteration were found, but no single genes were demonstrated to have a pathogenetic role. Recently, gene expression profiling (GEP) allowed the identification of PTCL/NOS-associated molecular signatures, leading to better understanding of their histogenesis, pathogenesis and prognostication. Interestingly, proliferation pathways are commonly altered in PTCLs, being highly proliferative cases characterized by poorer prognosis. In this study, we aimed to investigate the possible role in PTCL/NOS pathogenesis of selected molecules, known to be relevant for proliferation control. In particular, we analyzed the cell cycle regulators PTEN and CDKN1B/p27, the NF-kB pathway, and the tyrosin kinase PDGFR. First, we found that PTEN and p27 seem to be regulated in PTCL/NOS as in normal T-lymphocytes, as to what expression and cellular localization are concerned, and do not present structural abnormalities in the vast majority of PTCL/NOS. Secondly, NF-kB pathway appeared to be variably activated in PTCL/NOS. In particular, according to NF-kB gene expression levels, the tumors could be divided into two clusters (C1 and C2). Specially, C1 corresponded to cases presenting with a global down-regulation of the entire pathway, while C2 showed over-expression of genes involved in TNF signaling. Notably, by immunohistochemistry, we showed that either the canonical or the alternative NK-kB pathway were activated in around 40% of cases. Finally, we found PGDFRA to be consistently over-expressed (at mRNA and protein level) and activated in almost all PTCLs/NOS. Noteworthy, when investigating possible causes for PDGFRA deregulation, we had evidences that PDGFR over-expression is due to the absence of miR-152, which appeared to be responsible for PDGFRA silencing in normal T-cells. Furthermore, we could demonstrate that its aberrant activation is sustained by an autocrine loop. Importantly, this is the first case, to the best of our knowledge, of hematological tumor in which tyrosin kinase aberrant activity is determined by deregulated miRNA expression and autocrine loop activation. Taken together, our results provide novel insight in PTCL/NOS pathogenesis by opening new intriguing scenarios for innovative therapeutic interventions.

Mitochondrial Genomics: structure, inheritance and phylogenetic utility of the Mitochondrial genome in Bivalvia and Insecta

This PhD Thesis is the result of my research activity in the last three years. My main research interest was centered on the evolution of mitochondrial genome (mtDNA), and on its usefulness as a phylogeographic and phylogenetic marker at different taxonomic levels in different taxa of Metazoa. From a methodological standpoint, my main effort was dedicated to the sequencing of complete mitochondrial genomes, and the approach to whole-genome sequencing was based on the application of Long-PCR and shotgun sequences. Moreover, this research project is a part of a bigger sequencing project of mtDNAs in many different Metazoans’ taxa, and I mostly dedicated myself to sequence and analyze mtDNAs in selected taxa of bivalves and hexapods (Insecta). Sequences of bivalve mtDNAs are particularly limited, and my study contributed to extend the sampling. Moreover, I used the bivalve Musculista senhousia as model taxon to investigate the molecular mechanisms and the evolutionary significance of their aberrant mode of mitochondrial inheritance (Doubly Uniparental Inheritance, see below). In Insects, I focused my attention on the Genus Bacillus (Insecta Phasmida). A detailed phylogenetic analysis was performed in order to assess phylogenetic relationships within the genus, and to investigate the placement of Phasmida in the phylogenetic tree of Insecta. The main goal of this part of my study was to add to the taxonomic coverage of sequenced mtDNAs in basal insects, which were only partially analyzed.

Identifikation transkriptioneller Alterationen menschlicher Tumoren und Entwicklung eines neuen auf RNA-Transfer basierenden Verfahrens zur Bestimmung der Genfunktion

Zielvorgaben der vorliegenden Arbeit war die Identifikation neuer selektiv in Tumoren aktivierter Gene sowie die Entwicklung eines methodischen Prozesses, um die molekularen Effekte der fehlerhaften Aktivierung solcher Gene zu untersuchen. Für die erste Fragestellung haben wir zwei komplementäre Methoden entwickelt. Zum einen haben wir nach neuen Mitglieder der Cancer/Germline (CG) Familie von Genen gesucht, die bereits attraktive Zielstrukturen laufender Phase I/IIa Studien sind. Zu diesem Zweck wurde ein bioinformatischer Data Mining Ansatz generiert. Dieser führte zur erfolgreichen in silico Klonierung neuer CG Gene. Zur Identifikation von in Tumorzellen überexprimierten Genen nutzten wir einen cDNA Mikroarray mit 1152 ausgewählten Genen mit direkter oder indirekter tumorimmunologischer oder tumorbiologischer Relevanz. Die komparative transkriptionelle Untersuchung von humanen Tumor- und Normalgeweben mit diesem Array führte zur Wiederentdeckung bereits bekannter, aber auch zur Aufdeckung bisher nicht beschriebener tumor-assoziierter Transkriptionsveränderungen. Der zweite große Schwerpunkt dieser Arbeit war die Technologieentwicklung eines versatilen Prozesses zur Untersuchung von molekularen Effekten eines aberrant in Zellen exprimierten Gens. Zur Simulation dieser Situation stellten wir in vitro transkribierte RNA dieses Gens her und elektroporierten diese in Zielzellen. Transkriptionsanalysen solcher Transfektanden mit Affymetrix Oligonukleotid Mikroarray deckten auf gesamt-genomischer Ebene ganze Kaskaden konsekutiver, transkriptioneller Alterationen auf.

Modulation of apoptosis by endogenously produced nitric oxide

Untersuchungen zur Expression der induzierbaren NO-Synthetase (NOS2) belegen eine häufige Expression dieses Enzyms in Tumoren unterschiedlicher Gewebe. Bislang ist jedoch ungeklärt, ob die Expression der NOS2 in Tumorzellen die apoptotische Eliminierung durch zytotoxische T-Zellen beeinflussen kann. In der vorliegenden Arbeit wurden die Folgen einer endogenen NO-Synthese auf die Apoptosesensitivität von HEK293-Zellen untersucht. Um primäre NO-Wirkungen von NO-induzierten, sekundären (kompensatorischen) Veränderungen zu trennen, wurde mit einem induzierbaren Vektorsystem gearbeitet. Die NOS2 wurde zunächst unter der Kontrolle eines Ecdyson-sensitiven Promoters in HEK293-Zellen kloniert. Es konnten regulierbare NOS2-Klone selektiert werden, die nach Ponasteronbehandlung dosisabhängig die NOS2 exprimieren und NO synthetisieren. Die NOS2-Expression wurde durch Western Blot Analyse und Immunfluoreszenzfärbung dargestellt und die NO-Produktion mit Hilfe der Griess-Reaktion gemessen. An den NOS2-induzierten Zellen wurde dann der Einfluss von NO auf die CD95-vermittelte Apoptose analysiert. Es zeigte sich nach Stimulation des CD95-Rezeptors eine deutliche Korrelation der Apoptoserate mit der NOS2-Expression. In Kokulturexperimenten mit Peptid-spezifischen zytotoxischen T-Zellen zeigte sich, dass NO-produzierende Zielzellen effektiver eliminiert werden konnten. Auch nach Behandlung der Zellen mit TRAIL ergab sich eine höhere Apoptoserate in NO-produzierenden Zellen. Die weitere Analyse der durch NO beeinflussten Signalwege ergab eine Beteiligung von ER-Stress-vermittelten Apoptosewegen. Dies zeigte sich an der Hochregulation des ER-Stress-Proteins Grp78 (BiP) nach NOS2-Expression und der Spaltung der am ER-lokalisierten Caspase-4. Darüber hinaus konnte der schnellere Verlust des mitochondrialen Membranpotentials in Abhängigkeit von der NOS2-Expression nachgewiesen werden. Weiterhin wurde die Wirkung einer dauerhaften NO-Exposition auf die Apoptosesensitivität der Zellen untersucht. Auch ohne zusätzliche CD95-Stimulation induzierte eine kontinuierliche NOS2-Expression nach wenigen Tagen in den EcR293-NOS2-Zellen Apoptose. Diese Dauerbehandlung führte zum nahezu vollständigen Absterben der Kulturen. Einige Zellen überlebten jedoch diese Behandlung und wuchsen zu Zellklonen. Diese NO-resistenten Klone konnten isoliert werden. Sie zeigten eine zusätzliche Resistenz für CD95-vermittelte Apoptosesignale und waren besser vor dem Angriff Peptid-spezifischer CTLs geschützt. Die Apoptoseresistenz blieb auch nach längerer Kultur erhalten und scheint auf NO-induzierter Genotoxizität zu beruhen. Anhand dieser Arbeit konnte gezeigt werden, dass allein durch chronische NO-Behandlung eine Selektion apoptoseresistenter Zellen stattfinden kann.

Analyse der konditionell-induzierten Überexpression von Smad7 in epithelialen Geweben der adulten Maus

Smad7 ist eine inhibitorische Komponente der TGF-β- bzw. Activin-Signalweiterleitung und erfüllt eine wichtige Aufgabe bei deren Regulation. So führt eine konstitutive Überexpression von Smad7 in epithelialen Geweben zum Auftreten verschiedener Phänotypen, wie embryonaler bzw. perinataler Letalität, Hyperproliferation der Epidermis und Thymusatrophie. Auch die Entwicklung der T-Zellen im Thymus und epithelialer Anhangsgebilde wie z.B. von Haaren und Zähnen wird dadurch beeinträchtigt. In dieser Arbeit sollte nun in der adulten Maus der Effekt einer Überexpression von Smad7 in epithelialen Geweben untersucht werden. Zu diesem Zweck wurde ein, auf dem Cre/loxP-Prinzip beruhendes Transgensystem verwendet (K5-Smad7-tg und K14-creERT2), welches eine konditionell-induzierte Überexpression von Smad7 in epithelialen Zellen der adulten Maus erlaubte. Die so gezüchteten doppeltransgenen Tiere wiesen keine signifikanten Veränderungen gegenüber ihren wildtyp bzw. einfachtransgenen Geschwistertieren auf. Die Überexpression von Smad7 in epithelialen Geweben der adulten Maus zu einem Auftreten verschiedenster veränderter Phänotypen der Haut und deren Anhänge, sowie der Schneidezähne. Bei diesen Tieren konnte auch ein signifikanter Körpergewichtsverlust und eine Erhöhung der Mortalitätsrate beobachtet werden, welche sich im Verlauf nach erfolgter Rekombination einstellte. Weitere Analysen zeigten signifikante Veränderungen in der Haut und im Thymus. So konnte in der Haut eine Erhöhung der Proliferationsrate epidermaler Zellen, eine reduzierte Expression von Smad3 und im Thymus Veränderungen in der Gesamtzahl der lebenden T-Zellen und deren Differenzierung beobachtete werden. Mit dieser Arbeit konnte gezeigt werden, daß die Hemmung der Signalweiterleitung der TGF-β-Superfamilie, speziell von TGF-β und Activin, zu verschiedenen morphogenetischen Defekten der Haut und deren Anhänge, der Zähne und der T-Zellentwicklung im Thymus führt.

Die Synthese von Glycopeptiden und Glycopeptid-Protein-Konjugaten mit einer Partialstruktur des tumorassoziierten Mucins MUC1 zur Entwicklung von Tumorvakzinen

„Synthese von Glycopeptiden und Glycopeptid-Protein-Konjugaten mit einer Partialstruktur des tumorassoziierten Mucins MUC1 zur Entwicklung von Tumorvakzinen“ Das Glycoprotein MUC1 ist in Tumorepithelzellen sonderlich stark überexprimiert und wegen der vorzeitig einsetzenden Sialylierung sind die Saccharid-Epitope der O-Glycanketten stark verkürzt (sog. tumorassoziierte Antigene). Dadurch werden auch bisher verborgene Peptidepitope des Glycoprotein-Rückgrates auf der Zelloberfläche der Epithelzellen zugänglich, die als fremd von den Zellen des Immunsystems erkannt werden können. Dies macht das MUC1-Zelloberfächenmolekül zu einem Zielmolekül in der Entwicklung von Tumorvakzinen. Diese beiden strukturellen Besonderheiten wurden in der Synthese von Glycohexadecapeptiden verbunden, indem die veränderten tumorassoziierten Saccharidstrukturen TN-, STN- und T-Antigen als Glycosylaminosäure-Festphasenbausteine synthetisiert wurden und in das Peptidepitop der Wiederholungseinheit des MUC1 durch Glycopeptid-Festphasensynthese eingebaut wurden. Wegen der inhärenten schwachen Immunogenität der kurzen Glycopeptide müssen die synthetisierten Glycopeptidstrukturen an ein Trägerprotein, welches das Immunsystem stimuliert, gebunden werden. Zur Anbindung der Glycopeptide ist ein selektives Kupplungsverfahren nötig, um definierte und strukturell einheitliche Glycopeptid-Protein-Konjugate zu erhalten. Es konnte eine neue Methode entwickelt werden, bei der die Konjugation durch eine radikalische Additionsreaktion von als Allylamide funktionalisierten Glycopeptiden an ein Thiol-modifiziertes Trägerprotein erfolgte. Dazu wurde anhand von synthetisierten, als Allylamide modifizierten Modellaminosäuren untersucht, ob diese Reaktion generell für eine Biokonjugation geeignet ist und etwaige Nebenreaktionen auftreten können. Mit dieser Methode konnten verschiedene MUC1-Glycopeptid-Trägerprotein-Konjugate hergestellt werden, deren immunologische Untersuchung noch bevorsteht. Das tumorassoziierte MUC1 nimmt in der immundominanten Region seiner Wiederholungseinheit eine knaufartige Struktur ein. Für die Entwicklung von selektiven Tumorvakzinen ist es von großer Bedeutung möglichst genau die Struktur der veränderten Zelloberflächenmoleküle nachzubilden. Durch die Synthese von cyclischen (Glyco)Peptiden wurde dieses Strukturelement fixiert. Dazu wurden olefinische Aminosäure Festphasenbausteine hergestellt, die zusammen mit den oben genannten Glycosylaminosäuren mittels einer Glycopeptid-Festphasensynthese in acyclische Glycopeptide eingebaut wurden. Diese wurden dann durch Ringschlussmetathese zyklisiert und im Anschluss reduziert und vollständig deblockiert. In einem dritten Projekt wurde der Syntheseweg zur Herstellung einer C-Glycosylaminosäure mit einer N-Acetylgalactosamin-Einheit entwickelt. Wichtige Schritte bei der von Glucosamin ausgehenden Synthese sind die Keck-Allylierung, eine Epimerisierung, die Herstellung eines Brom-Dehydroalanin-Derivates und eine B-Alkyl-Suzuki-Miyaura-Kreuzkupplung sowie Schutzgruppenoperationen. Der racemische Baustein konnte dann in der Peptid-Festphasensynthese eines komplexen MUC1-Tetanustoxin-Konjugates eingesetzt werden.

Ruolo dei recettori tirosinchinasici in oncologia animale

Disregolazioni dei recettori tirosinchinasici (RTK) sono di frequente riscontro nei tumori dell’uomo e in molti casi sono indicatori biologici che permettono di definire in maniera più accurata la prognosi dei pazienti. Possono rappresentare inoltre marker predittivi per la risposta a terapie antitumorali con farmaci a bersaglio molecolare. Numerosi inibitori tirosinchinasici (TKI) sono attualmente in corso di studio o già disponibili per l’utilizzo in oncologia umana, e molti di questi hanno dimostrato una significativa efficacia utilizzati singolarmente o in combinazione a terapie convenzionali. Studi recenti indicano che un quadro analogo di disregolazione dei recettori tirosinchinasici è presente anche nelle neoplasie dei piccoli animali, e ne suggeriscono in molti casi un’implicazione prognostica. Gli inibitori tirosinchinasi sono da poco entrati nell’arena dell’oncologia veterinaria, ma i primi risultati lasciano supporre che siano destinati ad essere integrati definitivamente nei protocolli terapeutici standard. La tesi consiste in una parte introduttiva in cui sono trattate le principali funzioni biologiche dei recettori tirosinchinasici, la loro struttura e il loro ruolo nell’oncogenesi e nella progressione tumorale in medicina umana e veterinaria. Si affrontano inoltre le principali metodiche di laboratorio per l’analisi molecolare in oncologia e i meccanismi d’azione dei farmaci inibitori tirosinchinasici, con un cenno ai prodotti maggiormente utilizzati e alle loro indicazioni. Segue la presentazione e la discussione dei risultati di quattro studi relativi alla valutazione delle disregolazioni del recettore tirosinchinasico Kit (espressione aberrante e mutazioni genomiche) nel mastocitoma cutaneo del gatto e del recettore del fattore di crescita epidermico (EGFR) nel carcinoma squamocellulare cutaneo del gatto e nei tumori polmonari primitivi del cane, con particolare attenzione al loro ruolo prognostico.

Transgenic mice as a tool for depression research: examples from the endocannabinoid and the corticotropin-releasing hormone system

Major depression belongs to the most serious and widespread psychiatric disorders in today’s society. There is a great need for the delineation of the underlying molecular mechanisms as well as for the identification of novel targets for its treatment. In this thesis, transgenic mice of the endocannabinoid and the corticotropin-releasing hormone (CRH) system were investigated to determine the putative role of these systems for depression-like phenotypes in mice. In the first part of the thesis, we found that the endocannabinoid system was prominently involved in a brain region-specific and temporally controlled manner in acute as well as in chronic stress processing. Genetic deletion in combination with pharmacological intervention revealed the importance of a fully functional endocannabinoid system for efficient neuroendocrine and behavioral stress coping. Accordingly, cannabinoid type 1 (CB1) receptor-deficient mice displayed several depression-like symptoms and molecular alterations, including “behavioral despair”, stress hormone hypersecretion and decreased glucocorticoid receptor and brain-derived neurotrophic factor expression in the hippocampus. However, the endocannabinoid system was dispensable for the efficacy of currently used antidepressant drugs. To facilitate future endocannabinoid research, a transgenic mouse was generated, which overexpressed the CB1 receptor protein fused to a fluorescent protein. In the second part of the thesis, conditional brain region-specific CRH overexpressing mice were evaluated as a model for pathological chronic CRH hyperactivation. Mutant mice showed aberrant neuroendocrine and behavioral stress coping and hyperarousal due to CRH-induced activation of the noradrenergic system in the brain. Mutant mice appeared to share similarities with naturally occurring endogenous CRH activation in wild-type mice and were sensitive to acute pharmacological blockade of CRH receptor type 1 (CRH-R1). Thus, CRH overexpressing mice serve as an ideal in vivo tool to evaluate the efficacy of novel CRH-R1 antagonists. Together, these findings highlight the potential of transgenic mice for the understanding of certain endo-phenotypes (isolated symptoms) of depression and their molecular correlates.

Gamma-secretase modulators and inhibitors in Alzheimer's disease: influence of genetic background on efficacy and mechanism of action

According to the amyloid hypothesis, Alzheimer’s disease (AD) is caused by aberrant production or clearance of the amyloid-β (Aβ) peptides, and in particular of the longer more aggregation-prone Aβ42. The Aβ peptides are generated through successive proteolytic cleavage of the amyloid precursor protein (APP) by the β-site APP cleaving enzyme (BACE) and γ-secretase. γ-secretase produces Aβ peptides with variable C-termini ranging from Aβ34 to Aβ48, presumably by sequential trimming of longer into shorter peptides. γ-secretase is a multiprotein complex consisting of at least four different proteins and the presenilin proteins (PS1 or PS2) contain the catalytic center of the complex. In 2001 several non-steroidal anti-inflammatory drugs were identified as the founding members of a new class of γ-secretase modulators (GSMs) that can selectively reduce production of Aβ42. Concomitantly, these GSMs increase Aβ38 production indicating closely coordinated generation of Aβ42 and Aβ38 and a potential precursor-product relationship between these peptides. GSMs seem to exert their activity by direct modulation of γ-secretase. Support for this hypothesis is drawn from the finding that some PS mutations associated with early-onset familial AD (FAD) can modulate the cellular response to GSMs and to γ-secretase inhibitors (GSIs), which inhibit production of all Aβ peptides and are known to directly interact with PS. A particularly interesting FAD PS mutation is PS1-ΔExon9, a complex deletion mutant that blocks endoproteolysis of PS1 and renders cells completely non-responsive to GSMs. Studies presented in this thesis show that the diminished response of PS1-ΔExon9 to GSMs is mainly caused by its lack of endoproteolytic cleavage. Furthermore, we were able to demonstrate that a reduced response to GSMs and GSIs is not limited to PS1-ΔExon9 but is a common effect of aggressive FAD-associated PS1 mutations. Surprisingly, we also found that while the Aβ42 response to GSMs is almost completely abolished by these PS1 mutations, the accompanying Aβ38 increase was indistinguishable to wild-type PS1. Finally, the reduced response to GSIs was confirmed in a mouse model with transgenic expression of an aggressive FAD-associated PS1 mutation as a highly potent GSI failed to reduce Aβ42 levels in brain of these mice. Taken together, our findings provide clear evidence for independent generation of Aβ42 and Aβ38 peptides, and argue that the sequential cleavage model might be an oversimplification of the molecular mechanism of γ-secretase. Most importantly, our results highlight the significance of genetic background in drug discovery efforts aimed at γ-secretase, and indicate that the use of cellular models with transgenic expression of FAD-associated PS mutations might confound studies of the potency and efficacy of GSMs and GSIs. Therefore, such models should be strictly avoided in the ongoing preclinical development of these promising and potentially disease-modifying therapeutics for AD.

adaptive capabilities of the pi3k/akt/mtor pathway in acute myeloid leukemia revealed by the use of selective inhibitors

Because of its aberrant activation, the PI3K/AKT/mTOR signaling pathway represents a pharmacological target in blast cells from patients with acute myelogenous leukemia (AML). Using Reverse Phase Protein Microarrays (RPMA), we have analyzed 20 phosphorylated epitopes of the PI3K/Akt/mTor signal pathway of peripheral blood and bone marrow specimens of 84 patients with newly diagnosed AML. Fresh blast cells were grown for 2 h, 4 h or 20 h untreated or treated with a panel of phase I or phase II Akt allosteric inhibitors, either alone or in combination with the mTOR kinase inhibitor Torin1 or the broad RTK inhibitor Sunitinib. By unsupervised hierarchical clustering a strong phosphorylation/activity of most of the sampled members of the PI3K/Akt/mTOR pathway was observed in 70% of samples from AML patients. Remarkably, however, we observed that inhibition of Akt phosphorylation, as well as of its substrates, was transient, and recovered or even increased far above basal level after 20 h in 60% samples. We demonstrated that inhibition of Akt induces FOXO-dependent insulin receptor expression and IRS-1 activation, attenuating the effect of drug treatment by reactivation of PI3K/Akt. Consistent with this model we found that combined inhibition of Akt and RTKs is much more effective than either alone, revealing the adaptive capabilities of signaling networks in blast cells and highliting the limations of these drugs if used as monotherapy.

Spezifische Inhibition des Wnt-Signalwegs und die Analyse der Konsequenzen auf zellbiologischer Ebene

Der kanonische Wnt Signalweg ist durch Regulation einer Vielzahl von Zielgenen in unterschiedliche Prozesse wie Entwicklung, Wachstum und Differenzierung involviert. Fehlregulation des Signalwegs kann zur Tumorentstehung führen. Die exakte Rolle des Wnt Signalwegs und seiner Zielgene in der karzinogenen Kaskade ist noch nicht genau bekannt. In dieser Arbeit sollte die Beteiligung der Wnt Zielgene c-MYC, CCND1 (kodiert Cyclin D1) und VEGF an der Karzinogenese untersucht werden. Um die Funktionen der Wnt Zielgene und ihre zellulären Effekte unabhängig voneinander untersuchen zu können, wurden die Mengen der entsprechenden Transkriptionsprodukte durch siRNA (short interfering RNA) gezielt verringert. Die Konsequenzen der Inaktivierung wurden in Kolon- und Zervixkarzinomzelllinien untersucht, wobei die zellulären Parameter Proliferation, Apoptose, Metabolismus sowie Migration und Adhäsion untersucht wurden. Dabei konnte beobachtet werden, dass der Wnt Signalweg mit seinen Zielgenen Cyclin D1 und c-MYC die Proliferation mit dem Energiemetabolismus von Tumorzellen verknüpft. Darüber hinaus konnte gezeigt werden, dass Cyclin D1 an der Regulation der zelluläre Migration und Adhäsion beteiligt ist, während VEGF die Apoptose abhängig vom zellulären Kontext inhibiert. Diese Ergebnisse liefern erste Hinweise auf die funktionelle Rolle der verschiedenen Zielgene im Prozess der Karzinogenese in Tumoren mit aktiviertem Wnt Signalweg. Damit ist diese Arbeit ein möglicher Ausgangspunkt für Studien mit dem Ziel der gezielten therapeutischen Beeinflussung des Wnt Signalwegs auf Ebene der Zielgene.