Organoid Profiling Identifies Common Responders to Chemotherapy in Pancreatic Cancer

Pancreatic cancer is the most lethal common solid malignancy. Systemic therapies are often ineffective, and predictive biomarkers to guide treatment are urgently needed. We generated a pancreatic cancer patient-derived organoid (PDO) library that recapitulates the mutational spectrum and transcriptional subtypes of primary pancreatic cancer. New driver onco-genes were nominated and transcriptomic analyses revealed unique clusters. PDOs exhibited heterogeneous responses to standard-of-care chemotherapeutics and investigational agents. In a case study manner, we found that PDO therapeutic profiles paralleled patient outcomes and that PDOs enabled longitudinal assessment of chemosensitivity and evaluation of synchronous metastases. We derived organoid-based gene expression signatures of chemosensitivity that predicted improved responses for many patients to chemotherapy in both the adjuvant and advanced disease settings. Finally, we nominated alternative treatment strategies for chemorefractory PDOs using targeted agent therapeutic profiling. We propose that combined molecular and therapeutic profiling of PDOs may predict clinical response and enable prospective therapeutic selection. SIGNIFICANCE: New approaches to prioritize treatment strategies are urgently needed to improve survival and quality of life for patients with pancreatic cancer. Combined genomic, transcriptomic, and therapeutic profiling of PDOs can identify molecular and functional subtypes of pancreatic cancer, predict therapeutic responses, and facilitate precision medicine for patients with pancreatic cancer. (C) 2018 AACR.

Roles of Epigenetic Dysregulation in Cancer Progression and Metastasis

Mohammad Sadegh Saghafinia

Nearly all the cells of an organism share the same DNA sequence or genome, and yet they show different phenotypes and carry out different functions. This diversity is made possible by a verity of molecular modifications acting on the DNA sequence that collectively define the cell's epigenome. Failure in the proper regulation of epigenome can lead to abnormal activation or inhibition of vital signaling pathways, which contributes to the initiation and progression of multiple diseases, including cancer. In this thesis, I used a combination of in silico, in vitro, and in vivo techniques to explore the roles of epigenetic dysregulation in tumor progression and metastasis. In the first part, I performed a systematic and unbiased investigation of cancer-associated DNA methylation and gene expression changes across human cancers. I designed a novel algorithmic approach (RESET) to identify aberrant DNA methylation and associated gene expression changes across >6,000 human tumors. We identified a DNA Methylation Instability (DMI) phenotype in tumors acquiring numerous hyper and hypomethylated transcription start sites, which is associated with mutations of chromatin remodeling factors and Wnt-signaling. We showed that silenced genes coalesced in specific pathways including apoptosis, transcriptional regulation, and cell metabolism. The majority of the enhanced genes belonged to cancer-germline antigens (CG), whose expression correlated with response to anti-PD-1 in melanoma patients. Finally, we demonstrated the potential of RESET to explore aberrant DNA methylation in pediatric tumors; pediatric Wilms tumors with diffuse anaplasia exhibit DMI, and specific silencing events predict a worse outcome in cases with favorable histology. These results established a new approach to explore pan-cancer epigenetic modifications and provided a resource of candidate oncogenic events for future functional and therapeutic studies. In the second part, I studied the dynamics of cancer progression and metastasis in Pancreatic Neuroendocrine Tumors (PanNET). This rare tumor is the second most common form of pancreatic cancer. Two principal subtypes of PanNET has been identified: insulinomas (IT) and metastasis-like primaries (MLP), corresponding to the low and high grade of human PanNETs, respectively. From the mouse model of PanNET (RT2), we profiled the single-cell, bulk mRNA and miRNA transcriptomes, and the proteomes of primary and metastasis specimens. We demonstrated that the tumor progression from IT to MLP follows the reverse embryonic and postnatal developmental path. Transcriptomic data from human patients showed that aggressive human PanNETs also follow the same reverse developmental trajectory of dedifferentiation. We established one possible mechanism underlying IT-to-MLP transition. Over-expression of the miR-181cd cluster in IT-like cancer cell-lines resulted in acquisition of the MLP phenotypes. miR-181cd mediated its effect through suppressing the expression of Meis2 and, indirectly, inducing the expression of Hmgb3 and Mycn transcription factors. Inhibiting the expression of Hmgb3 in MLP-like cancer cell-lines resulted in a significant growth decrease both in vitro and in vivo, demonstrating the importance of Hmgb3 in the maintenance of MLP-like cell state. These data presented dedifferentiation as a mechanism by which malignant neuroendocrine cancer cells acquire progenitor-like features, enabling them to become more aggressive and metastatic.

EPFL2020

The interplay between human genetic variation, chronic inflammation and persistent infection: relevance for cardiovascular morbidity

Flavia Aurelia Shoko Hodel

Contemporary genomic approaches allow us to seek answers to biological questions that were previously out of reach. Genome-wide association studies (GWAS) have identified numerous genetic polymorphisms associated with human diseases, providing new insight into the genes and pathways involved in pathogenesis. The work presented in this thesis aimed to harness the power of large-scale genomics, statistical methods and bioinformatic tools to explore the interactions between persistent infections, chronic low-grade inflammation, and coronary heart disease (CHD). To achieve this, we used data collected from large population-based studies of individuals of European ancestry.To identify human genetic determinants of the humoral immune response against persistent or frequently recurring infections, with a special focus on human polyomaviruses, we performed GWAS and meta-analyses of serostatus and quantitative immunoglobulin G responses. We identified NFKB1 as a common locus associated with antibody response to multiple pathogens. For polyomaviruses, we found strong associations of HLA class II, FUT2, STING1, and MUC1 genetic variants with the intensity of the humoral response. Together, these results demonstrate the modulating contribution of host genetic variation to the individual response against some of the most prevalent human viruses.Even when they are latent, chronic infections can trigger some degree of local or systemic immune response, resulting in low-grade inflammation. In an effort to better understand the variability of humoral immune response and inflammation patterns in response to pathogen exposure, we found evidence for an association between Chlamydia trachomatis and Helicobacter pylori seropositivity, and higher plasma levels of C-reactive protein (CRP), a sensitive indicator of inflammation. High polygenic risk was also significantly associated with CRP levels, confirming that human genetic variation plays a modulating role in systemic inflammation. These results improve our understanding of the relationship between persistent infections and chronic inflammation, an important determinant of long-term morbidity in humans.Finally, we developed statistical models to explore the influences of genetic variation, persistent infections and low-grade inflammation on incident CHD. We identified high polygenic risk and Fusobacterium nucleatum infection as associated with an increased risk of developing CHD, in addition to conventional risk factors. These results confirm that CHD is a multicomponent disease that is caused by demographic, genetic and environmental factors. Moreover, they might allow for better identification of individuals at high risk for CHD and provide a rationale for future anti-infective prevention trials.Together, this research demonstrates that current genomic and serological technology, bioinformatic analysis and functional follow-up studies have the potential to provide new insight into the molecular basis of host-pathogen interactions, and their role in chronic diseases. From a translational perspective, the results of this project include new targets for diagnosis and therapeutic development, new disease biomarkers, and better predictive models. Every advance in the understanding of complex disease has the potential to improve genomic and clinical medicine, and I am pleased to have had the opportunity to act at different levels to participate in this much needed transition to precision medicine.

EPFL2022

Roles of Epigenetic Dysregulation in Cancer Progression and Metastasis

Mohammad Sadegh Saghafinia

EPFL2020

The interplay between human genetic variation, chronic inflammation and persistent infection: relevance for cardiovascular morbidity

Flavia Aurelia Shoko Hodel

EPFL2022