@phdthesis{Graver2015,
  author    = {Graver, Shannon},
  title     = {Molecular and cellular cross talk between angiogenic, immune and DNA mismatch repair pathways},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-108302},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2015},
  abstract  = {VEGF is a main driver of tumor angiogenesis, playing an important role not only in the formation of new blood vessels, but also acts as a factor for cell migration, proliferation, survival and apoptosis. Angiogenesis is a universal function shared by most solid tumors and its inhibition was thought to have the potential to work across a broad patient population. Clinical evidence has shown that inhibiting pathological angiogenesis only works in a subset of patients and the identification of those patients is an important step towards personalized cancer care. The first approved antiangiogenic therapy was bevacizumab (Avastin®), a monoclonal antibody targeting VEGF in solid tumors including CRC, BC, NSCLC, RCC and others. In addition to endothelial cells, VEGF receptors are present on a number of different cell types including tumor cells, monocytes and macrophages. The work presented in this thesis looked at the in vitro cellular changes in tumor cells and leukocytes in response to the inhibition of VEGF signaling with the use of bevacizumab. In the initial experiments, VEGF was induced by hypoxia in tumor cells to evaluate changes in survival, proliferation, migration and changes in gene or protein expression. There was a minimal direct response of VEGF inhibition in tumor cells that could be attributed to bevacizumab treatment, with minor variations in some of the cell lines screened but no uniform or specific response noted. MMR deficiency often results in microsatellite instability (MSI) in tumors, as opposed to microsatellite stable (MSS) tumors, and accounts for up to 15\% of colorectal carcinomas (CRCs). It has been suggested in clinical data that MMR deficient tumors responded better to bevacizumab regimens, therefore further research used isogenic paired CRC tumor cell lines (MMR deficient and proficient). Furthermore, a DNA damaging agent was added to the treatment regimen, the topoisomerase inhibitor SN-38 (the active metabolite of irinotecan). Inhibiting VEGF using bevacizumab significantly inhibited the ability of MMR deficient tumor cells to form anchor dependent colonies, however conversely, bevacizumab treatment before damaging cells with SN-38, showed a significant increase in colony numbers. Moreover, VEGF inhibition by bevacizumab pretreatment also significantly increased the mutation fraction in MMR deficient cells as measured by transiently transfecting a dinucleotide repeat construct, suggesting VEGF signaling may have an intrinsic role in MMR deficient cells. A number of pathways were analyzed in addition to changes in gene expression profiles resulting in the identification of JNK as a possible VEGF targeted pathway. JUN expression was also reduced in these conditions reinforcing this hypothesis, however the intricate molecular mechanisms remain to be elucidated. In order to remain focused on the clinical application of the findings, it was noted that some cytokines were differentially regulated by bevacizumab between MMR proficient and deficient cells. Treatment regimens employed in vitro attempted to mimic the clinical setting by inducing DNA damage, then allowing cells to recover with or without VEGF using bevacizumab treatment. Inflammatory cytokines, CCL7 and CCL8, were found to have higher expression in the MMR deficient cell line with bevacizumab after DNA damage, therefore the cross talk via tumor derived factors to myeloid cells was analyzed. Gene expression changes in monocytes induced by tumor conditioned media showed CCL18 to be a bevacizumab regulated gene by MMR deficient cells and less so in MMR proficient cells. CCL18 has been described as a prognostic marker in gastric, colorectal and ovarian cancers, however the significance is dependent on tumor type. CCL18 primarily exerts its function on the adaptive immune system to trigger a TH2 response in T cells, but is also described to increase non-specific phagocytosis. The results of this study did show an increase in the phagocytic activity of macrophages in the presence of bevacizumab that was significantly more apparent in MMR deficient cells. Furthermore, after DNA damage MMR deficient cells treated with bevacizumab released a cytokine mix that induced monocyte migration in a bevacizumab dependent manner, showing a functional response with the combination of MMR deficiency and bevacizumab. In summary, the work in this thesis has shown evidence of immune cell modulation that is specific to MMR deficient tumor cells that may translate into a marker for the administration of bevacizumab in a clinical setting. VEGF ist ein zentraler Regulator der Tumor-Angiogenese, und spielt eine wichtige Rolle nicht nur in der Bildung von neuen Blutgef{\"a}ßen, sondern ist auch f{\"u}r die Migration, Proliferation, das {\"U}berleben und Apoptose von Tumorzellen essentiell. Angiogenese ist eine der universellen Funktionen, welche das Wachstum der meisten soliden Tumoren charakterisiert. Eine der klassischen therapeutischen Ideen wurde auf der Basis entwickelt, dass die spezifische Hemmung der Angiogenese das Potenzial hat in einer breiten Patientenpopulation einen klinischen Effekt zu zeigen. Die klinische Erfahrung und Anwendung hat jedoch gezeigt, dass die Hemmung der pathologischen Angiogenese nur in einem Teil der Patienten einen therapeutischen Nutzen aufweist. Somit stellt die Identifikation derjenigen Patienten, welche von der anti-angiogenen Therapie profitieren, einen wichtiger Schritt zur personalisierten Krebsbehandlung dar. Die erste zugelassene antiangiogene Therapie war Bevacizumab (Avastin®), ein monoklonaler Antik{\"o}rper gegen VEGF, welcher unter anderem in soliden Tumoren wie CRC, BC, nicht-kleinzelligem Lungenkrebs (NSCLC) und dem Nierenzellkarzinom angewandt wird. VEGF-Rezeptoren befinden sich nicht nur auf Endothelzellen, sondern sind auch auf einer Anzahl von verschiedenen Zelltypen, einschließlich Tumorzellen, Monozyten und Makrophagen nachweisbar. Die in dieser Arbeit vorgestellten Ergebnisse befassen sich mit den zellul{\"a}ren Ver{\"a}nderungen an Tumorzellen und Leukozyten als Reaktion auf die Hemmung der VEGF-Signalkaskade durch Bevacizumab in-vitro. In den Initialen Experimenten wurde VEGF durch Hypoxie in Tumorzellen induziert und Ver{\"a}nderungen der {\"U}berlebensrate, der Proliferation, Migration als auch in der Gen- oder Protein-Expression gemessen. Es konnte eine minimale direkte Reaktion der VEGF-Hemmung auf Tumorzellen beobachtet werden, welche auf die Bevacizumab Behandlung zur{\"u}ckgef{\"u}hrt werden k{\"o}nnte. Es zeigten sich aber auch geringf{\"u}gige Abweichungen in einigen der verwendeten Zellinien, die keine einheitliche Interpretation erlauben oder auf eine uniformelle Reaktion hinweisen w{\"u}rden. Das ph{\"a}notypische Korrelat einer „Mismatch" Reparatur (MMR)-Defizienz ist die Mikrosatelliteninstabilit{\"a}t im Gegensatz zu mikrosatellitenstabilen Tumoren und findet sich bei bis zu 15\% der kolorektalen Karzinomen (CRC) wieder. Klinischen Daten deuten daraufhin, dass Bevacizumab besser in MMR-defizienten Tumoren wirkt. Daher wurden die weiteren Untersuchungen in gepaarten MMR stabilen und MMR instabilen CRC-Tumorzelllinien (MMR defizient und kompetent) durchgef{\"u}hrt. Weiterhin wurde ein DNA-sch{\"a}digendes Agens, SN-38, ein Topoisomerase-Inhibitor (der aktive Metabolit von Irinotecan) dem Behandlungsschema zugef{\"u}gt. Es zeigte sich, dass die Hemmung von VEGF mittels Bevacizumab die F{\"a}higkeit der MMR defizienten Tumorzellen Kolonien zu bilden signifikant inhibiert. Im Gegensatz dazu, hatte die Behandlung von Bevacizumab vor der Zugabe des DNA sch{\"a}digenden Agens zu einer vermehrten Kolonienzahl gef{\"u}hrt. Außerdem erh{\"o}hte die Vorbehandlung mit Bevacizumab deutlich die Mutationsrate in MMR-defizienten Zellen, was durch die transiente Transfektion eines Dinukleotid-Repeat-Konstrukts nachgewiesen werden konnte. Dies deutete darauf hin, dass VEGF eine intrinsische Rolle in der Signalkaskade des MMR-Systems haben k{\"o}nnte. Deshalb wurde eine Anzahl von Signalalkaskaden zus{\"a}tzlich zu Ver{\"a}nderungen von Genexpressionsprofilen untersucht und JNK als m{\"o}gliche Verbindungsstelle der beiden Signalkaskaden, VEGF und MMR, identifiziert. Diese Hypothese wurde zus{\"a}tzlich unterst{\"u}tzt durch die Tatsache, dass die JUN Expression unter diesen experimentellen Bedingungen reduziert war. Die Aufkl{\"a}rung der komplexen molekularen Mechanismen der potentiellen Interaktion bleibt zuk{\"u}nftigen Untersuchungen vorbehalten. In Hinblick auf die klinische Konsequenz der erhaltenen Ergebnisse war es auff{\"a}llig, dass einige Zytokine durch Bevacizumab in den MMR defizienten Zellen im Gegensatz zu den MMR kompetenten Zellen unterschiedlich reguliert wurden. Die in-vitro verwendeten Behandlungsschemata waren den klinisch zur Anwendung kommenden Protokollen nachempfunden. Zuerst wurde ein DNA-Schaden gesetzt, und den Zellen erm{\"o}glicht, sich mit oder ohne Bevacizumab zu erholen. Es konnte gezeigt werden, dass die inflammatorischen Zytokine CCL7 und CCL8 eine h{\"o}here Expression in der MMR-defiziente Zelllinie in Kombination mit Bevacizumab aufweisen. Daher wurde ein m{\"o}glicher Crosstalk zwischen von Tumorzellen sezernierten Faktoren und myeloischen Zellen weiter verfolgt. Ver{\"a}nderungen der Genexpression in Monozyten durch Tumorzell- konditionierte Medien zeigte CCL18 als ein Bevacizumab reguliertes Gen in MMR-defizienten Zellen, aber nicht in MMR kompetenten Zellen. CCL18 {\"u}bt seine Funktion prim{\"a}r im adaptiven Immunsystems aus um eine TH2-Antwort in T-Zellen auszul{\"o}sen Ausserdem wird eine Erh{\"o}hung der nicht-spezifische Phagozytose als weitere Funktion beschrieben. CCL18 wurde bereits als prognostischer Marker in Magen-, Dickdarm- und Eierstockkrebsarten beschrieben; die klinische Bedeutung ist jedoch abh{\"a}ngig von Tumortyp. Die Ergebnisse dieser Arbeit zeigen, dass eine Erh{\"o}hung der phagozytischen Aktivit{\"a}t von Makrophagen in Gegenwart von Bevacizumab wesentlich deutlicher in MMR-defizienten Zellen ausgepr{\"a}gt war. Weiterhin wurde gefunden, dass nach DNA-Sch{\"a}digung in Bevacizumab behandelten MMR-defizienten Zellen Zytokine freigesetzt werden, welche eine Monozytenmigration in einer Bevacizumab-abh{\"a}ngigen Weise induzieren. Dies weist auf eine funktionelle Interaktion von MMR-Defizienz und Bevacizumab hin. Zus{\"a}tzlich zeigen die Ergebnisse dieser Arbeit eine Immunzellmodulation, die spezifisch f{\"u}r Mismatch-Reparatur defiziente Tumorzellen ist und in der klinischen Praxis als Marker f{\"u}r die Verabreichung von Bevacizumab verwendet werden k{\"o}nnte.},
  subject      = {Vascular endothelial Growth Factor},
  language  = {en}
}
@phdthesis{Hein2014,
  author    = {Hein, Melanie},
  title     = {Functional analysis of angiogenic factors in tumor cells and endothelia},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-93863},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Tumor angiogenesis is essential for the growth of solid tumors as their proliferation and survival is dependent on consistent oxygen and nutrient supply. Anti-angiogenic treatments represent a therapeutic strategy to inhibit tumor growth by preventing the formation of new blood vessels leading to starvation of the tumor. One of the best characterized anti angiogenic therapeutics is the monoclonal antibody bevacizumab (Avastin), which targets and neutralizes VEGF leading to disruption of the VEGF signaling pathway. Until today, bevacizumab has found its way into clinical practice and has gained approval for treatment of different types of cancer including colorectal cancer, non-small cell lung cancer, breast cancer and renal cell carcinoma. Signaling of VEGF is mediated through VEGF receptors, mainly VEGFR2, which are primarily located on the cell surface of endothelial cells. However, there has been evidence that expression of VEGF receptors can also be found on tumor cells themselves raising the possibility of autocrine and/or paracrine signaling loops. Thus, tumor cells could also benefit from VEGF signaling, which would promote tumor growth. The aim of this study was to investigate if bevacizumab has a direct effect on tumor cells in vitro. To this end, tumor cell lines from the NCI-60 panel derived from four different tumor types were treated with bevacizumab and angiogenic gene and protein expression as well as biological outputs including proliferation, migration and apoptosis were investigated. Most of the experiments were performed under hypoxia to mimic the in vivo state of tumors. Overall, there was a limited measurable effect of bevacizumab on treated tumor cell lines according to gene and protein expression changes as well as biological functions when compared to endothelial controls. Minor changes in terms of proliferation or gene regulation were evident in a single tumor cell line after VEGF-A blockade by bevacizumab, which partially demonstrated a direct effect on tumor cells. However, the overall analysis revealed that tumor cell lines are not intrinsically affected in an adverse manner by bevacizumab treatment. Besides the functional analysis of tumor cells, embryonic stem cell derived endothelial cells were characterized to delineate vascular Hey gene functions. Hey and Hes proteins are the best characterized downstream effectors of the evolutionary conserved Notch signaling pathway, which mainly act as transcriptional repressors regulating downstream target genes. Hey proteins play a crucial role in embryonic development as loss of Hey1 and Hey2 in mice in vivo leads to a severe vascular phenotype resulting in early embryonic lethality. The major aim of this part of the thesis was to identify vascular Hey target genes using embryonic stem cell derived endothelial cells utilizing a directed endothelial differentiation approach, as ES cells and their differentiation ability provide a powerful in vitro system to study developmental processes. To this end, Hey deficient and Hey wildtype embryonic stem cells were stably transfected with an antibiotic selection marker driven by an endothelial specific promoter, which allows selection for endothelial cells. ESC-derived endothelial cells exhibited typical endothelial characteristics as shown by marker gene expression, immunofluorescent staining and tube formation ability. In a second step, Hey deficient ES cells were stably transfected with doxycycline inducible Flag-tagged Hey1 and Hey2 transgenes to re-express Hey proteins in the respective cell line. RNA-Sequencing of Hey deficient and Hey overexpressing ES cells as well as ESC-derived endothelial cells revealed many Hey downstream target genes in ES cells and fewer target genes in endothelial cells. Hey1 and Hey2 more or less redundantly regulate target genes in ES cells, but some genes were regulated by Hey2 alone. According to Gene Ontology term analysis, Hey target genes are mainly involved in embryonic development and transcriptional regulation. However, the response of ESC-derived endothelial cells in regulating Hey downstream target genes was rather limited when compared to ES cells, which could be due to lower transgene expression in endothelial cells. The limited response also raises the possibility that target gene regulation in endothelial cells is not only dependent on Hey gene functions alone and thus loss or overexpression of Hey genes in this in vitro setting does not influence target gene regulation.},
  subject      = {Krebs <Medizin>},
  language  = {en}
}