High-pressure intrapleural chemotherapy: feasibility in the pig model.

International audienceABSTRACT: BACKGROUND: The usual treatments for pleural malignancies are mostly palliative. In contrast, peritoneal malignancies are often treated with a curative intent by cytoreductive surgery and intraperitoneal chemotherapy. As pressure has been shown to increase antitumor efficacy, we applied the concept of high-pressure intracavitary chemotherapy to the pleural space in a swine model. METHODS: Cisplatin and gemcitabine were selected because of their antineoplasic efficacy in vitro in a wide spectrum of cancer cell lines. The pleural cavity of 21 pigs was filled with saline solution; haemodynamic and respiratory parameters were monitored. The pressure was increased to 15-25 cm H2O. This treatment was associated with pneumonectomy in 6 pigs. Five pigs were treated with chemotherapy under pressure. RESULTS: The combination of gemcitabine (100 mg/l) and cisplatin (30 mg/l) was highly cytotoxic in vitro. The maximum tolerated pressure was 20 cm H20, due to haemodynamic failure. Pneumonectomy was not tolerated, either before or after pleural infusion. Five pigs survived intrapleural chemotherapy associating gemcitabine and cisplatin with 20 cm H2O pressure for 60 min. CONCLUSIONS: High-pressure intrapleural chemotherapy is feasible in pigs. Further experiments will establish the pharmacokinetics and determine whether the benefit already shown in the peritoneum is also obtained in the pleura

Comparison of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a murin model of peritoneal carcinomatosis

<p>Abstract</p> <p>Background</p> <p>The best method to deliver intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis from ovarian cancer is not well defined. The aim of this study was to assess the ability of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a rat model of peritoneal carcinomatosis.</p> <p>Methods</p> <p>Four groups of 5 BDIX rats with ovarian peritoneal carcinomatosis underwent IPC with 30 mg/l of cisplatin according to the following conditions: normothermia at 37° for 1 or 2 hours, hyperthermia at 42°C for 1 hour or normothermia at 37°C for 2 hours with 2 mg/l adrenaline. Tissue platinum content was measured by atomic absorption spectroscopy. The effect of hyperthermia, adrenaline and the duration of exposure to the drug was measured <it>in vivo </it>(tissue concentration of platinum in tumor, abdominal and extra abdominal tissues) and <it>in vitro </it>(cytotoxicity on human ovarian cancer cells).</p> <p>Results</p> <p><it>In vitro</it>, hyperthermia and longer exposure enhanced the accumulation and the cytotoxic effect of cisplatin on cancer cells. <it>In vivo</it>, only the 2 hours treatment with adrenaline resulted in increased platinum concentrations. The rats treated with adrenaline showed significantly lower concentrations of cisplatin in extra peritoneal tissues than those treated with hyperthermia.</p> <p>Conclusion</p> <p>Adrenaline is more effective than hyperthermia in order to enhance the intratumoral concentration of cisplatin in rats with peritoneal carcinomatosis from ovarian origin. It may also decrease the systemic absorption of the drug.</p

Patterns of Bone Failure in Localized Prostate Cancer Previously Irradiated: The Preventive Role of External Radiotherapy on Pelvic Bone Metastases

Introduction: External beam radiation therapy (EBRT) can cure localized prostate cancer (PCa) by sterilizing cancer cells in the prostate gland and surrounding tissues at risk of microscopic dissemination. We hypothesized that pelvic EBRT for localized PCa might have an unexpected prophylactic impact on the occurrence of pelvic bone metastases.Material and Methods: We reviewed the data of 332 metastatic PCa patients. We examined associations between the number (≤5 vs. &gt;5) and the location of bone metastases (in-field vs. out-of-field), which occurred at first relapse, and a previous history of EBRT for PCa (EBRT vs. No-EBRT).Results: One hundred and ten patients M0 at baseline were eligible. Fifty-six patients (51%) were in the No-EBRT group, and 54 patients (49%) in the EBRT group. The proportion of patients who developed &gt;5 bone metastases in the bony pelvis was higher in the No-EBRT group vs. the EBRT group: 10 patients (18%) vs. 2 patients (4%), respectively (p = 0.02). By multivariate analysis EBRT was associated with a lesser occurrence of patients who had &gt;5 bone metastases in the bony pelvis (OR = 0.17 [95%CI, 0.04–0.87], p = 0.03). Time to occurrence of bone metastases ≥5 years (OR = 0.10 [95%CI, 0.05–0.19], p &lt; 0.01), prior curative prostate treatment (OR = 0.58 [95%CI, 0.36–0.91], p = 0.02), &gt;5 bone metastases in bony pelvis (OR = 2.61 [95%CI, 1.28–5.31], p &lt; 0.01), &gt;5 bone metastases out of bony pelvis (OR = 1.73 [95%CI, 1.09–2.76], p = 0.02) were all predictive of overall survival.Conclusion: Previous pelvic EBRT for PCa is associated with a lower number of pelvic bone metastases, which is associated with better overall survival

Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either gram negative or gram positive bacteria

<p>Abstract</p> <p>Background</p> <p>In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.</p> <p>Methods</p> <p>Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.</p> <p>Results</p> <p>97 episodes of either GN bacteremia (<it>n </it>= 52) or GP bacteremia (<it>n </it>= 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71–0.88).</p> <p>Conclusion</p> <p>In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.</p

Nomogram-based Prediction of Overall Survival in Patients with Metastatic Urothelial Carcinoma Receiving First-line Platinum-based Chemotherapy: Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC)

The available prognostic models for overall survival (OS) in patients with metastatic urothelial carcinoma (UC) have been derived from clinical trial populations of cisplatin-treated patients

Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Blood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.</p> <p>Methods</p> <p>review of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1^stSeptember, 2006 and 31^stJuly, 2007.</p> <p>Results</p> <p>179 episodes of either primary (<it>n </it>= 117) or secondary (<it>n </it>= 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; <it>p </it>< 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; <it>p </it>= 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (<it>n </it>= 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; <it>p </it>< 0.050).</p> <p>Conclusion</p> <p>In a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection.</p

Aspects fonctionnels et pronostiques des cellules myéloïdes suppressives et de Foxp3 dans le cancer

Evasion of immune surveillance by certain tumour cells seems to be a basic requirement for tumour development in preclinical models and in humans. The mechanisms by which the tumour mediates its immune evasion are manifold, and involve the majority of immune system cells. Among these, immunoregulatory cells such as myeloid-derived suppressor cells (MDSCs) or regulatory T lymphocytes (T-regs, which express the transcription factor Foxp3) appear to play a predominant role. The results presented in this work aim to improve our understanding of the functional and prognostic roles of myeloid suppressor cells and T-regs in cancer, focussing particularly on how these cells are modulated by chemotherapy. Regarding MDSCs, our work has made it possible to better understand on the one hand the molecular mechanisms underlying their accumulation, and on the other hand, their acquisition of immunosuppressive properties, through a signaling pathway involving exosomes of tumoral origin. This discovery, combined with the ability of amiloride, a molecule in frequent therapeutic use, to reduce the production of exosomes, even by tumour cells, offers new avenues for pharmacological targeting of MDSCs. Indeed, a study of the cytotoxic effects on MDSCs of several chemotherapy compounds made it possible to show that 5-fluorouracil has a selective capacity to eliminate MDSCs, probably due to the low level of expression of its target, thymidylate synthase, in MDSCs. Our immunohistochemical studies on tumour specimens resected from patients with localised breast cancer treated by neoadjuvant chemotherapy have shown that neoadjuvant chemotherapy is associated with qualitative changes in tumour infiltration by both CD8+ T-lymphocytes and Foxp3+ T-regs. The existence of a favourable immune response ratio after neoadjuvant chemotherapy, as defined by high infiltration by CD8+ and a low level of Foxp3+ infiltration, is associated with a significant increase in markers of cell-mediated cytotoxicity, and is also significantly correlated with complete eradication of tumour cells. This favourable immunological profile is reflected in the long-term by improved disease-free survival and better overall survival, regardless of the type of chemotherapy, the achievement or not of complete pathological response, and the molecular sub-type of breast cancer. Combining this immunological information with the data about the extent of tumour residue after treatment makes it possible to considerably refine prognosis in these patients. Finally, our preliminary work suggests that expression of Foxp3 in cancerous cells in HER2+++ breast tumours is a favourable prognostic factor. Overall, these results illustrate the importance not only of the tumour characteristics, but also of the host characteristics, in particular, the type of immune response that it is capable of eliciting, and the effect of chemotherapy on this immune response.L’échappement des cellules tumorales au processus d’immunosurveillance semble être une condition nécessaire au développement tumoral dans les modèles précliniques, comme chez l’homme. Les mécanismes par lesquels la tumeur parvient à médier une immunosubvertion sont multiples et font intervenir la plupart des cellules du système immunitaire, au sein desquelles, les cellules immunorégulatrices telles les cellules myéloides suppressives (MDSCs) ou les lymphocytes T régulateurs (Tregs, exprimant le facteur de transcription Foxp3), semblent jouer un rôle prépondérant. Les résultats présentés dans ce travail visent à mieux comprendre les rôles fonctionnels et pronostics des cellules myéloïdes suppressives et des Tregs dans le cancer, avec une attention plus particulière sur la façon dont ces cellules peuvent être modulées par la chimiothérapie. Concernant les MDSCs, nos travaux ont permis de mieux comprendre les mécanismes moléculaires présidant à leur accumulation d’une part, et d’autre part à l’acquisition de leur propriétés immunosuppressives, à travers une voie de signalisation impliquant les exosomes d’origine tumorale. Cette découverte, et la propriété d’une molécule d’usage thérapeutique courant, l’amiloride, de diminuer la production d’exosomes, y compris par les cellules tumorales, offrent une nouvelle possibilité de ciblage pharmacologique des MDSCs. Par ailleurs, l’étude des effets cytotoxiques sur les MDSCs de plusieurs molécules de chimiothérapie nous a permis de montrer que le 5-fluorouracile, probablement en raison d’un faible niveau d’expression de sa cible, la thymidilate synthase, dans les MDSCs, possédait une capacité sélective à éliminer ces cellules. Nos travaux d’immunohistochimie conduits sur des prélèvements tumoraux issus de patientes porteuses de cancers du sein localisés traitées par chimiothérapie néoadjuvante ont quand à eux permis de démontrer que la chimiothérapie néoadjuvante s’accompagne de modifications qualitatives de l’infiltration tumorale à la fois en lymphocytes T CD8+ et en lymphocytes T régulateurs Foxp3+. L’existence, après chimiothérapie néoadjuvante, d’une balance favorable de la réponse immunitaire, associant forte infiltration en CD8+ et faible infiltration en Foxp3+ s’accompagne d’une augmentation significative des marqueurs de cytotoxicité à médiation cellulaire, et est significativement corrélée à une éradication complète des cellules tumorales. Cette signature immunologique favorable se traduit également à long terme par une meilleure survie sans récidive et une meilleure survie globale, indépendamment du type de chimiothérapie reçue, de l’obtention ou non d’une réponse complète histologique, et du sous type moléculaire de cancer du sein. La combinaison de cette information immunologique avec la connaissance de la taille du résidu tumoral après traitement permet de considérablement affiner le pronostic des patientes. Enfin, nos travaux préliminaires semblent montrer que l’expression de Foxp3 dans les cellules cancéreuses de tumeurs du sein HER2+++ constitue un facteur de bon pronostic. Ces résultats illustrent donc l’importance non pas seulement des caractéristiques tumorales, mais aussi des caractéristiques de l’hôte, en particulier de la réponse immunitaire qu’il est capable de susciter, et de l’influence de la chimiothérapie sur cette dernière

Aspects fonctionnels et pronostiques des cellules myéloïdes suppressives et de Foxp3 dans le cancer

Evasion of immune surveillance by certain tumour cells seems to be a basic requirement for tumour development in preclinical models and in humans. The mechanisms by which the tumour mediates its immune evasion are manifold, and involve the majority of immune system cells. Among these, immunoregulatory cells such as myeloid-derived suppressor cells (MDSCs) or regulatory T lymphocytes (T-regs, which express the transcription factor Foxp3) appear to play a predominant role. The results presented in this work aim to improve our understanding of the functional and prognostic roles of myeloid suppressor cells and T-regs in cancer, focussing particularly on how these cells are modulated by chemotherapy. Regarding MDSCs, our work has made it possible to better understand on the one hand the molecular mechanisms underlying their accumulation, and on the other hand, their acquisition of immunosuppressive properties, through a signaling pathway involving exosomes of tumoral origin. This discovery, combined with the ability of amiloride, a molecule in frequent therapeutic use, to reduce the production of exosomes, even by tumour cells, offers new avenues for pharmacological targeting of MDSCs. Indeed, a study of the cytotoxic effects on MDSCs of several chemotherapy compounds made it possible to show that 5-fluorouracil has a selective capacity to eliminate MDSCs, probably due to the low level of expression of its target, thymidylate synthase, in MDSCs. Our immunohistochemical studies on tumour specimens resected from patients with localised breast cancer treated by neoadjuvant chemotherapy have shown that neoadjuvant chemotherapy is associated with qualitative changes in tumour infiltration by both CD8+ T-lymphocytes and Foxp3+ T-regs. The existence of a favourable immune response ratio after neoadjuvant chemotherapy, as defined by high infiltration by CD8+ and a low level of Foxp3+ infiltration, is associated with a significant increase in markers of cell-mediated cytotoxicity, and is also significantly correlated with complete eradication of tumour cells. This favourable immunological profile is reflected in the long-term by improved disease-free survival and better overall survival, regardless of the type of chemotherapy, the achievement or not of complete pathological response, and the molecular sub-type of breast cancer. Combining this immunological information with the data about the extent of tumour residue after treatment makes it possible to considerably refine prognosis in these patients. Finally, our preliminary work suggests that expression of Foxp3 in cancerous cells in HER2+++ breast tumours is a favourable prognostic factor. Overall, these results illustrate the importance not only of the tumour characteristics, but also of the host characteristics, in particular, the type of immune response that it is capable of eliciting, and the effect of chemotherapy on this immune response.L’échappement des cellules tumorales au processus d’immunosurveillance semble être une condition nécessaire au développement tumoral dans les modèles précliniques, comme chez l’homme. Les mécanismes par lesquels la tumeur parvient à médier une immunosubvertion sont multiples et font intervenir la plupart des cellules du système immunitaire, au sein desquelles, les cellules immunorégulatrices telles les cellules myéloides suppressives (MDSCs) ou les lymphocytes T régulateurs (Tregs, exprimant le facteur de transcription Foxp3), semblent jouer un rôle prépondérant. Les résultats présentés dans ce travail visent à mieux comprendre les rôles fonctionnels et pronostics des cellules myéloïdes suppressives et des Tregs dans le cancer, avec une attention plus particulière sur la façon dont ces cellules peuvent être modulées par la chimiothérapie. Concernant les MDSCs, nos travaux ont permis de mieux comprendre les mécanismes moléculaires présidant à leur accumulation d’une part, et d’autre part à l’acquisition de leur propriétés immunosuppressives, à travers une voie de signalisation impliquant les exosomes d’origine tumorale. Cette découverte, et la propriété d’une molécule d’usage thérapeutique courant, l’amiloride, de diminuer la production d’exosomes, y compris par les cellules tumorales, offrent une nouvelle possibilité de ciblage pharmacologique des MDSCs. Par ailleurs, l’étude des effets cytotoxiques sur les MDSCs de plusieurs molécules de chimiothérapie nous a permis de montrer que le 5-fluorouracile, probablement en raison d’un faible niveau d’expression de sa cible, la thymidilate synthase, dans les MDSCs, possédait une capacité sélective à éliminer ces cellules. Nos travaux d’immunohistochimie conduits sur des prélèvements tumoraux issus de patientes porteuses de cancers du sein localisés traitées par chimiothérapie néoadjuvante ont quand à eux permis de démontrer que la chimiothérapie néoadjuvante s’accompagne de modifications qualitatives de l’infiltration tumorale à la fois en lymphocytes T CD8+ et en lymphocytes T régulateurs Foxp3+. L’existence, après chimiothérapie néoadjuvante, d’une balance favorable de la réponse immunitaire, associant forte infiltration en CD8+ et faible infiltration en Foxp3+ s’accompagne d’une augmentation significative des marqueurs de cytotoxicité à médiation cellulaire, et est significativement corrélée à une éradication complète des cellules tumorales. Cette signature immunologique favorable se traduit également à long terme par une meilleure survie sans récidive et une meilleure survie globale, indépendamment du type de chimiothérapie reçue, de l’obtention ou non d’une réponse complète histologique, et du sous type moléculaire de cancer du sein. La combinaison de cette information immunologique avec la connaissance de la taille du résidu tumoral après traitement permet de considérablement affiner le pronostic des patientes. Enfin, nos travaux préliminaires semblent montrer que l’expression de Foxp3 dans les cellules cancéreuses de tumeurs du sein HER2+++ constitue un facteur de bon pronostic. Ces résultats illustrent donc l’importance non pas seulement des caractéristiques tumorales, mais aussi des caractéristiques de l’hôte, en particulier de la réponse immunitaire qu’il est capable de susciter, et de l’influence de la chimiothérapie sur cette dernière

Functional and prognostic aspects of myeloid suppressor cells and Foxp3 in cancer

L’échappement des cellules tumorales au processus d’immunosurveillance semble être une condition nécessaire au développement tumoral dans les modèles précliniques, comme chez l’homme. Les mécanismes par lesquels la tumeur parvient à médier une immunosubvertion sont multiples et font intervenir la plupart des cellules du système immunitaire, au sein desquelles, les cellules immunorégulatrices telles les cellules myéloides suppressives (MDSCs) ou les lymphocytes T régulateurs (Tregs, exprimant le facteur de transcription Foxp3), semblent jouer un rôle prépondérant. Les résultats présentés dans ce travail visent à mieux comprendre les rôles fonctionnels et pronostics des cellules myéloïdes suppressives et des Tregs dans le cancer, avec une attention plus particulière sur la façon dont ces cellules peuvent être modulées par la chimiothérapie. Concernant les MDSCs, nos travaux ont permis de mieux comprendre les mécanismes moléculaires présidant à leur accumulation d’une part, et d’autre part à l’acquisition de leur propriétés immunosuppressives, à travers une voie de signalisation impliquant les exosomes d’origine tumorale. Cette découverte, et la propriété d’une molécule d’usage thérapeutique courant, l’amiloride, de diminuer la production d’exosomes, y compris par les cellules tumorales, offrent une nouvelle possibilité de ciblage pharmacologique des MDSCs. Par ailleurs, l’étude des effets cytotoxiques sur les MDSCs de plusieurs molécules de chimiothérapie nous a permis de montrer que le 5-fluorouracile, probablement en raison d’un faible niveau d’expression de sa cible, la thymidilate synthase, dans les MDSCs, possédait une capacité sélective à éliminer ces cellules. Nos travaux d’immunohistochimie conduits sur des prélèvements tumoraux issus de patientes porteuses de cancers du sein localisés traitées par chimiothérapie néoadjuvante ont quand à eux permis de démontrer que la chimiothérapie néoadjuvante s’accompagne de modifications qualitatives de l’infiltration tumorale à la fois en lymphocytes T CD8+ et en lymphocytes T régulateurs Foxp3+. L’existence, après chimiothérapie néoadjuvante, d’une balance favorable de la réponse immunitaire, associant forte infiltration en CD8+ et faible infiltration en Foxp3+ s’accompagne d’une augmentation significative des marqueurs de cytotoxicité à médiation cellulaire, et est significativement corrélée à une éradication complète des cellules tumorales. Cette signature immunologique favorable se traduit également à long terme par une meilleure survie sans récidive et une meilleure survie globale, indépendamment du type de chimiothérapie reçue, de l’obtention ou non d’une réponse complète histologique, et du sous type moléculaire de cancer du sein. La combinaison de cette information immunologique avec la connaissance de la taille du résidu tumoral après traitement permet de considérablement affiner le pronostic des patientes. Enfin, nos travaux préliminaires semblent montrer que l’expression de Foxp3 dans les cellules cancéreuses de tumeurs du sein HER2+++ constitue un facteur de bon pronostic. Ces résultats illustrent donc l’importance non pas seulement des caractéristiques tumorales, mais aussi des caractéristiques de l’hôte, en particulier de la réponse immunitaire qu’il est capable de susciter, et de l’influence de la chimiothérapie sur cette dernière.Evasion of immune surveillance by certain tumour cells seems to be a basic requirement for tumour development in preclinical models and in humans. The mechanisms by which the tumour mediates its immune evasion are manifold, and involve the majority of immune system cells. Among these, immunoregulatory cells such as myeloid-derived suppressor cells (MDSCs) or regulatory T lymphocytes (T-regs, which express the transcription factor Foxp3) appear to play a predominant role. The results presented in this work aim to improve our understanding of the functional and prognostic roles of myeloid suppressor cells and T-regs in cancer, focussing particularly on how these cells are modulated by chemotherapy. Regarding MDSCs, our work has made it possible to better understand on the one hand the molecular mechanisms underlying their accumulation, and on the other hand, their acquisition of immunosuppressive properties, through a signaling pathway involving exosomes of tumoral origin. This discovery, combined with the ability of amiloride, a molecule in frequent therapeutic use, to reduce the production of exosomes, even by tumour cells, offers new avenues for pharmacological targeting of MDSCs. Indeed, a study of the cytotoxic effects on MDSCs of several chemotherapy compounds made it possible to show that 5-fluorouracil has a selective capacity to eliminate MDSCs, probably due to the low level of expression of its target, thymidylate synthase, in MDSCs. Our immunohistochemical studies on tumour specimens resected from patients with localised breast cancer treated by neoadjuvant chemotherapy have shown that neoadjuvant chemotherapy is associated with qualitative changes in tumour infiltration by both CD8+ T-lymphocytes and Foxp3+ T-regs. The existence of a favourable immune response ratio after neoadjuvant chemotherapy, as defined by high infiltration by CD8+ and a low level of Foxp3+ infiltration, is associated with a significant increase in markers of cell-mediated cytotoxicity, and is also significantly correlated with complete eradication of tumour cells. This favourable immunological profile is reflected in the long-term by improved disease-free survival and better overall survival, regardless of the type of chemotherapy, the achievement or not of complete pathological response, and the molecular sub-type of breast cancer. Combining this immunological information with the data about the extent of tumour residue after treatment makes it possible to considerably refine prognosis in these patients. Finally, our preliminary work suggests that expression of Foxp3 in cancerous cells in HER2+++ breast tumours is a favourable prognostic factor. Overall, these results illustrate the importance not only of the tumour characteristics, but also of the host characteristics, in particular, the type of immune response that it is capable of eliciting, and the effect of chemotherapy on this immune response

Aspects fonctionnels et pronostiques des cellules myéloïdes suppressives et de Foxp3 dans le cancer

L échappement des cellules tumorales au processus d immunosurveillance semble être une condition nécessaire au développement tumoral dans les modèles précliniques, comme chez l homme. Les mécanismes par lesquels la tumeur parvient à médier une immunosubvertion sont multiples et font intervenir la plupart des cellules du système immunitaire, au sein desquelles, les cellules immunorégulatrices telles les cellules myéloides suppressives (MDSCs) ou les lymphocytes T régulateurs (Tregs, exprimant le facteur de transcription Foxp3), semblent jouer un rôle prépondérant. Les résultats présentés dans ce travail visent à mieux comprendre les rôles fonctionnels et pronostics des cellules myéloïdes suppressives et des Tregs dans le cancer, avec une attention plus particulière sur la façon dont ces cellules peuvent être modulées par la chimiothérapie. Concernant les MDSCs, nos travaux ont permis de mieux comprendre les mécanismes moléculaires présidant à leur accumulation d une part, et d autre part à l acquisition de leur propriétés immunosuppressives, à travers une voie de signalisation impliquant les exosomes d origine tumorale. Cette découverte, et la propriété d une molécule d usage thérapeutique courant, l amiloride, de diminuer la production d exosomes, y compris par les cellules tumorales, offrent une nouvelle possibilité de ciblage pharmacologique des MDSCs. Par ailleurs, l étude des effets cytotoxiques sur les MDSCs de plusieurs molécules de chimiothérapie nous a permis de montrer que le 5-fluorouracile, probablement en raison d un faible niveau d expression de sa cible, la thymidilate synthase, dans les MDSCs, possédait une capacité sélective à éliminer ces cellules. Nos travaux d immunohistochimie conduits sur des prélèvements tumoraux issus de patientes porteuses de cancers du sein localisés traitées par chimiothérapie néoadjuvante ont quand à eux permis de démontrer que la chimiothérapie néoadjuvante s accompagne de modifications qualitatives de l infiltration tumorale à la fois en lymphocytes T CD8+ et en lymphocytes T régulateurs Foxp3+. L existence, après chimiothérapie néoadjuvante, d une balance favorable de la réponse immunitaire, associant forte infiltration en CD8+ et faible infiltration en Foxp3+ s accompagne d une augmentation significative des marqueurs de cytotoxicité à médiation cellulaire, et est significativement corrélée à une éradication complète des cellules tumorales. Cette signature immunologique favorable se traduit également à long terme par une meilleure survie sans récidive et une meilleure survie globale, indépendamment du type de chimiothérapie reçue, de l obtention ou non d une réponse complète histologique, et du sous type moléculaire de cancer du sein. La combinaison de cette information immunologique avec la connaissance de la taille du résidu tumoral après traitement permet de considérablement affiner le pronostic des patientes. Enfin, nos travaux préliminaires semblent montrer que l expression de Foxp3 dans les cellules cancéreuses de tumeurs du sein HER2+++ constitue un facteur de bon pronostic. Ces résultats illustrent donc l importance non pas seulement des caractéristiques tumorales, mais aussi des caractéristiques de l hôte, en particulier de la réponse immunitaire qu il est capable de susciter, et de l influence de la chimiothérapie sur cette dernière.Evasion of immune surveillance by certain tumour cells seems to be a basic requirement for tumour development in preclinical models and in humans. The mechanisms by which the tumour mediates its immune evasion are manifold, and involve the majority of immune system cells. Among these, immunoregulatory cells such as myeloid-derived suppressor cells (MDSCs) or regulatory T lymphocytes (T-regs, which express the transcription factor Foxp3) appear to play a predominant role. The results presented in this work aim to improve our understanding of the functional and prognostic roles of myeloid suppressor cells and T-regs in cancer, focussing particularly on how these cells are modulated by chemotherapy. Regarding MDSCs, our work has made it possible to better understand on the one hand the molecular mechanisms underlying their accumulation, and on the other hand, their acquisition of immunosuppressive properties, through a signaling pathway involving exosomes of tumoral origin. This discovery, combined with the ability of amiloride, a molecule in frequent therapeutic use, to reduce the production of exosomes, even by tumour cells, offers new avenues for pharmacological targeting of MDSCs. Indeed, a study of the cytotoxic effects on MDSCs of several chemotherapy compounds made it possible to show that 5-fluorouracil has a selective capacity to eliminate MDSCs, probably due to the low level of expression of its target, thymidylate synthase, in MDSCs. Our immunohistochemical studies on tumour specimens resected from patients with localised breast cancer treated by neoadjuvant chemotherapy have shown that neoadjuvant chemotherapy is associated with qualitative changes in tumour infiltration by both CD8+ T-lymphocytes and Foxp3+ T-regs. The existence of a favourable immune response ratio after neoadjuvant chemotherapy, as defined by high infiltration by CD8+ and a low level of Foxp3+ infiltration, is associated with a significant increase in markers of cell-mediated cytotoxicity, and is also significantly correlated with complete eradication of tumour cells. This favourable immunological profile is reflected in the long-term by improved disease-free survival and better overall survival, regardless of the type of chemotherapy, the achievement or not of complete pathological response, and the molecular sub-type of breast cancer. Combining this immunological information with the data about the extent of tumour residue after treatment makes it possible to considerably refine prognosis in these patients. Finally, our preliminary work suggests that expression of Foxp3 in cancerous cells in HER2+++ breast tumours is a favourable prognostic factor. Overall, these results illustrate the importance not only of the tumour characteristics, but also of the host characteristics, in particular, the type of immune response that it is capable of eliciting, and the effect of chemotherapy on this immune response.DIJON-BU Doc.électronique (212319901) / SudocSudocFranceF