Discovery of Novel Molecular and Biochemical Predictors of Response and Outcome in Diffuse Large B-Cell Lymphoma Last, Kim William
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Discovery of novel molecular and biochemical predictors of response and outcome in diffuse large B-cell lymphoma Last, Kim William The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author For additional information about this publication click this link. https://qmro.qmul.ac.uk/jspui/handle/123456789/563 Information about this research object was correct at the time of download; we occasionally make corrections to records, please therefore check the published record when citing. For more information contact [email protected] Discovery of Novel Molecular and Biochemical Predictors of Response and Outcome in Diffuse Large B-cell Lymphoma Kim William Last A thesis submitted for the degree of Doctor of Philosophy At the University of London Cancer Research UK Centre of Medical Oncology St Bartholomew’s Hospital Queen Mary University of London, London UK 2008 1 Abstract ABSTRACT Discovery of Novel Molecular and Biochemical Predictors of Response and Outcome in Diffuse Large B-cell Lymphoma Diffuse large B-cell lymphoma (DLBCL) is the commonest form of non-Hodgkin lymphoma and responds to treatment with a 5-year overall survival (OS) of 40-50%. Predicting outcome using the best available method, the International Prognostic Index (IPI), is inaccurate and unsatisfactory. This thesis describes research undertaken to discover, explore and validate new molecular and biochemical predictors of response and long-term outcome with the aims of improving on the inaccurate IPI and of suggesting novel therapeutic approaches. Two strategies were adopted: a rational and an empirical approach. The rational strategy used gene expression profiling to identify transcriptional signatures that correlated with outcome to treatment and from which a model of 13-genes accurately predict long-term OS. Two components of the 13-gene model, PKC and PDE4B, were studied using inhibitors in lymphoma cell-lines and primary cell cultures. PKC inhibition using SC-236 proved to be cytostatic and cytotoxic in the cell-lines examined and to a lesser extent in primary tumours. PDE4 inhibition using piclamilast and rolipram had no effect either alone or in combination with chemotherapy. The empirical approach investigated the trace element selenium in presentation serum and found that it was a biochemical predictor of response and outcome to treatment. In an attempt to provide evidence of a causal relationship as an explanation for the associations between presentation serum selenium, response and outcome, two selenium compounds, methylseleninic acid (MSA) and selenodiglutathione (SDG) were studied in vitro in the same lymphoma cell-lines and primary cell cultures. Both MSA and SDG exhibited cytostatic and cytotoxic activity and caspase-8 and caspase-9 driven apoptosis. For SDG reactive oxygen species generation was important for its activity in three of the four cell-lines. In conclusion, molecular and biochemical predictors of response and survival were discovered in DLBCL that led to viable targets for drug intervention being validated in vitro. 2 Declaration I Dr Kim William Last hereby declare that this document is the work of my own hand. 3 Dedication I dedicate this thesis to my wife, Marie-Christine and my son, Raphael and to my late mum, without who’s unfailing love and support the completion of this work would have been impossible. I give heartfelt thanks to my brother and my ‘Aunty’ Ann for steadfast encouragement and belief in my abilities. 4 Acknowledgements ACKNOWLEDGEMENTS The work described in this thesis was carried out whilst I was a clinical research fellow at the Cancer Research UK Medical Oncology Unit at St Bartholomew’s Hospital. I am indebted to numerous of my scientific, medical and nursing colleagues for their support and encouragement throughout my time within the Unit and to the patients that donated material for research. In particular I wish to thank Dr Jude Fitzgibbon and Dr Simon Joel for scientific supervision, Dr’s Margaret Shipp and Todd Golub and their teams at the Dana Farber Cancer Centre and the Whitehead Institute for the opportunity to participate in their micro-array project and Professor T Andrew Lister and Professor Ama Rohatiner for supervision of the translational and clinical aspects of the research undertaken. I will always be grateful to CR-UK for their generous funding of the clinical research fellowship I held and the charity’s enlightened and enabling ethos towards my time in research. Of the many others who have helped me I would like to mention Dr Lindsey Goff, Ms Suzanne Jordan, Dr Andrew Norton, Dr Abigail Lee for assistance with immunohistochemistry; Dr Silvana Debarnardi, Dr Spouros Sgouros for assistance with gene expression profiling; Dr Wai Liu, Dr Sandra Strauss, Dr Theresa Davis, Ms Lenushka Maharaj, Ms Jackie Perrie and Mr Patrick Grimshaw for assistance with cell culture and FACS analysis; Dr Sandra Strauss with assistance with western blotting and Ms Jackie Perrie for assistance with annexin V and propidium iodide staining and FACS analysis and for performing the reactive oxygen species experiments; Mr Keith Adams, Ms Fauzia Khan and Mr Dave Wilkinson for assistance with patient material identification, reagent and equipment requirements; Mr Andrew Wilson and Dr Victoria Cornelius for clinical data collation and statistical analysis, Mr Linden and Mrs Ann Emery for proofreading and Mrs Margaret Cresswell and Ms Susan Chandler for tracking me down to ensure the thesis was submitted. 5 Individual Contributions INDIVIDUAL CONTRIBUTIONS Archived sample identification and retrieval: Kim Last Cell cycle FACS analysis: Kim Last Clinical data extraction and analysis: Kim Last and Andy Wilson Ethics approval: Jude Fitzgibbon, Simon Joel and Andrew Lister Histopathology review: Andrew Norton John Amess and Jon C. Aster In vitro proliferation, cell count and viability experiments: Kim Last Microarray project leadership Margaret A. Shipp & Todd R. Golub Microarray sample preparation: Michelle Gaasenbeek Microarray data analysis (US): Ken N. Ross, Pablo Tamayo, Michael Angelo, Michael Reich, Tane S. Ray, Jill Mesirov Microarray data analysis (UK): Spouros Sgouros N-acetyl cysteine in vitro experiments: Lenushka Maharaj Novel drug identification for in vitro studies: Kim Last and Jude Fitzgibbon Primary cell culture in vitro experiments: Kim Last and Lenushka Maharaj Propidium iodide and annexin V FACS analysis: Jackie Perrie Reactive Oxygen Species Measurement: Jackie Perrie Serum selenium measurement: Trevor Delves, Christine Sieniawska Statistics for serum selenium associations: Victoria Cornelius Western blotting: Sandra Strauss 6 Contents TABLE OF CONTENTS ACKNOWLEDGEMENTS 5 INDIVIDUAL CONTRIBUTIONS 6 TABLE OF CONTENTS 7 LIST OF TABLES 11 LIST OF FIGURES 12 LIST OF APPENDIX TABLES 16 ABBREVIATIONS 19 THESIS AIMS 26 CHAPTER 1: INTRODUCTION 27 1.1 PATHOGENESIS OF LYMPHOMA AND CANCER 27 1.1.1 The Process of Carcinogenesis 27 1.1.2 Impaired Apoptosis in NHL and Cancer 29 1.1.3 Impairment of the Intrinsic Apoptotic Pathway: Alterations in The Bcl-2 Family of Proteins 31 1.1.4 Impairment of the Extrinsic Apoptotic Pathway: Fas and TRAIL Death Receptor Signalling in NHL 32 1.1.5 Cell Cycle Deregulation in Cancer and Lymphoma 35 1.1.6 Resistance to Cell Cycle Arrest 36 1.2 DIFFUSE LARGE B-CELL LYMPHOMA 39 1.2.1 Pathology 39 1.2.2 Clinical Presentation and Natural History 42 1.2.3 Treatment 43 1.2.4 Epidemiology of DLBCL and NHL 51 1.2.5 Clinical Aetiolology of DLBCL 51 1.2.6 Prognostic Factors in DLBCL and other Lymphomas 56 1.3 GENETIC EVENTS IN LYMPHOMA AND DLBCL 67 1.3.1 Genetic Instability: an Integral Part of Tumourigenesis 67 1.3.2 Chromosomal Instability: Gains and Losses 68 1.3.3 Chromosomal Instability: Translocations in the NHLs 70 1.3.4 Epigenetic Changes in Lymphoma 76 1.4 APPLICATION OF EMPIRICAL AND RATIONAL RESEARCH STRATEGIES TO DISCOVER AND VALIDATE NOVEL FACTORS PREDICTIVE OF RESPONSE AND OUTCOME IN DLBCL 77 1.4.1 The Empirical Research Strategy: To Investigate Serum Selenium for Associations with Response and Outcome in DLBCL 79 1.4.2 The Physiological Role of Selenium 79 7 Contents 1.4.3 Dietary Sources of Selenium 81 1.4.4 Normal Daily Intake of Selenium 81 1.4.5 Selenium Deficiency 82 1.4.6 Selenosis: Selenium Toxicity 83 1.4.7 Selenium Metabolites And Chemoprevention 83 1.4.8 Selenium Intake and Cancer Risk 86 1.4.9 The Selenoproteome and Cancer 93 1.4.10 Molecular Mechanisms of Selenium Chemoprevention 94 1.4.11 The Rational Research Strategy: Identification of Gene Expression Signatures Predictive of Outcome in DLBCL 95 1.4.12 An Introduction to Microarray Technology 97 1.4.13 The Different Types of Microarray Platform 98 1.4.14 Expression Profiling in Cancer and DLBCL 100 1.4.15 Exploration and Validation of The Empirical and Rational Research Strategy Results 102 CHAPTER 2. MATERIALS AND METHODS 105 2.1 MICROARRAY AND EXPRESSION VALIDATION MATERIALS AND METHODS 105 2.1.1 Patients and their Samples 105 2.1.2 ‘Target’ preparation for Microarray 107 2.1.3 Data processing and analysis 108 2.1.4 Immunohistochemical Staining 109 2.2 PRESENTATION SERUM SELENIUM MATERIALS AND METHODS 110 2.2.1 Patient Samples, Histology and Clinical Variables Investigated 110 2.2.2 Treatment 112 2.2.3 Selenium Concentration Measurement 112 2.2.4 Statistical Methods 113 2.3 IN VITRO TARGET VALIDATION MATERIALS AND METHODS 117 2.3.1 Established Tumour Cell-lines 117 2.3.2 3-day Cell-line