Optimisation de l'immunothérapie non spécifique du cancer superficiel de la vessie
|Advisor:||Fradet, Yves; Larue, Hélène|
|Abstract:||Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence (60%). Ten to fiftheen % of the recurrences will progress toward muscle-invasive tumors, which are more dangerous. Transurethral resection (TUR) of non-muscle invasive tumors is frequently followed by intravesical immunotherapy using BCG (bacillus Calmette-Guérin) to prevent recurrence and progression but this treatment fails in 40% of cases. Moreover, the severity of the side effects prevents many patients to comply with the whole treatment. Tools to predict the response to BCG and the development of alternative treatments are therefore required. We first evaluated the clinical significance of the presence of tumor infiltrating mature dendritic cells (TIDCs) and of tumor-associated macrophages (TAMs) in low-risk NMIBCs treated only by TUR. The presence of TIDCs allowed the identification of patients that were at high risk of progression. In patients with NMIBCs at high risk of recurrence and progression treated with BCG, we observed that those with a high level of MAT or TIDC infiltration did not respond efficiently to BCG. In the second part of my work, I have explored the possibility to use other immunomodulatory agents to replace or complement BCG immunotherapy. I therefore selected toll-like receptors (TLRs) agonists for this purpose. TLRs, which are mainly expressed in immune cells but also epithelial cells, play an important role in the innate immunity by recognizing molecular patterns that are conserved between pathogens. I have first showed that TLRs are expressed and functional in normal and tumor urothelial cells. Then, I showed that poly(I:C), a TLR3 agonsist, has direct cytotoxic and antiproliferative effects on bladder cancer cell lines. In MGH-U3 cells, it induces the secretion of proinflammatory cytokines and expression of major histocompatibility class I molecules whereas BCG has little effect on the immunogenicity of these cells. A growth inhibition assay using the MBT-2 murine bladder cancer model showed that the combination of poly(I:C) and BCG inhibited very significantly the growth of bladder cancer cells whereas each product alone had no significant effect. Our study suggests that poly(I:C), due to its anti-tumoral effects, could improve the therapeutic efficacy of BCG for the immunotherapy of NMIBCs.|
|Document Type:||Thèse de doctorat|
|Open Access Date:||18 April 2018|
|Collection:||Thèses et mémoires|
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