Дисертації з теми "Nmr hrmas"

A few abnormal cells found in a small piece of prostate tissue are most consequential for a man’s future. The prevalence of prostate cancer (PCa) is increasing globally. The main instigating factor for this cancer is not yet known, but it appears to be the consequence of many variables such as an increasingly older population, more frequent PSA-testing, and factors involving lifestyle. Prostate cancer screening, as an equivalent for breast cancer screening, has been suggested but unfortunately there are no accurate diagnostic tools available for this type of screening. The reason for this is simply that the prostate is one of the most difficult organs to diagnose and, consequently, PCa screening would generate far too many false-positive and false-negative results.  The prostate is not easily accessible as it is deeply-seated in the male pelvic area, wrapped around the urethra and surrounded by sensitive vital organs.  Furthermore, PCa is frequently multi-focal, and the cancer cells have a tendency of assimilating among normal cells and, thus, do not always form solid lumps.  Therefore, prostate tumors are often not felt by digital rectal examination (DRE) or identified by imaging.  The PSA-test is not reliable as it is more prostate-specific than cancer-specific.  Due to increasing prostate awareness, more early-stage and locally confined PCa are being detected. This is saving lives, although there is a high risk of over treatment and unnecessary side-effects.  The increased detection of PCa requires sophisticated diagnostic methods and highly skilled clinicians who can discern between indolent and aggressive cancers.  The current “gold-standard” for PCa diagnosis is biopsy grading by pathologists using the Gleason score system, which is a difficult task.  Therefore, innovative methods to improve the precision of prostate diagnosis, by increased biopsy sensitivity and tumor localization, are of essence. In light of these difficulties, the metabolomic approach using 1D and 2D high-resolution magic angle spinning (HRMAS) NMR spectroscopy combined with histopathology on intact prostatectomy specimens was evaluated in this research project.  The non-destructive nature of HRMAS NMR enables spectroscopic analysis of intact tissue samples with consecutive histological examinations under light microscope. Metabolomics aids in the unraveling and the discovery of organ-specific endogenous metabolites that have the potential to be reliable indicators of organ function and viability, extrinsic and intrinsic perturbations, as well as valuable markers for treatment response. The results may, therefore, be applied clinically to characterize an organ by utilizing biomarkers that have the capacity to distinguish between disease and health. The aim was to characterize the human and the rat prostate in terms of its intermediary metabolism, which I show here to differ between species and anatomical regions.  Furthermore, the aim is to seek the verification of HRMAS NMR derived metabolites which are known to be a part of the prostate metabolome such as, citrate, choline, and the polyamines which were performed, but also the identification of metabolites not previously identified as part of the local prostate metabolism, such as Omega-6, which was detected in tumors.  The extended aim was to elucidate novel bio-markers with clinical potential. In this study, the common phyto-nutrient, inositol, which appears to possess protective properties, was identified as being a potentially important PCa bio-marker for the distinction between the more indolent Gleason score 6 and the more aggressive Gleason score 7 in non-malignant prostate tissues with tumors elsewhere in the organ. Further studies in this area of PCa research are therefore warranted.

Le cancer est la première cause de morbi-mortalité dans le monde. La recherche de biomarqueurs diagnostiques, pronostiques et prédictives de la réponse aux traitements est capitale dans l’amélioration de la prise en charge de ce fléau mondial. Nous avons choisi une technique récente qui est la spectroscopie RMN HRMAS et des méthodes d’analyse statistique robustes (PCA et PLS-DA), afin d’établir les profils métaboliques des cancers épithéliaux de l’ovaire et des cancers mammaires. Nous avons établi, après un rappel théorique de la spectroscopie RMN HRMAS, un état d’art des applications médicales de cette technique, notamment gynécologiques chez la femme et urogénitales chez l’homme. Nous avons décrit les différentes étapes de la démarche établie pour l’analyse spectrale : préparation de l’échantillon tissulaire, acquisition RMN et analyse statistique. Nous avons montré que cette technique, permettant une analyse rapide (20 min) et non destructive d’échantillons tissulaires intacts, est applicable à la prise en charge thérapeutique des patientes atteintes de carcinomes ovariens et mammaires. Elle a permis, dans le cas des cancers de l’ovaire, de caractériser métaboliquement les trois types histologiques (séreux, endométrioïdes et mucineux) et le tissu ovarien sain, de générer des modèles statistiques permettant de classer les tumeurs borderline et de prédire la survie des patientes et la réponse à la chimiothérapie. Dans le cas des cancers du sein, elle a permis de discriminer métaboliquement les carcinomes mammaires, les fibroadénomes et le tissu sain et d’étudier métaboliquement les différents indicateurs histologiques des ces carcinomes. Nous projetons de confirmer ces résultats préliminaires très encourageants sur une plus grande cohorte
Cancer is the leading cause of morbidity and mortality worldwide. The search for diagnostic, prognostic and predictive biomarkers of response to treatment is crucial in improving the management of this global scourge. We chose a new technique that is HRMAS NMR spectroscopy and robust statistical analysis methods (PCA and PLS-DA), to establish the metabolic profiles ofepithelial ovarian and breast cancers. We have determined, after a theoretical reminder of HRMAS NMR spectroscopy, a state of the art including medical applications of this technique, mainly gynecological in woman and uro-genital in man. We describe the different steps of the process established for spectral analysis : preparation of tissue sample, NMR acquisition and statistical analysis. We showed that this technique, allowing a rapid analysis (20 min) and non-destructive of intact tissue samples, is applicable to the therapeutic management of patients with breast and ovarian carcinomas. It has, in the case of ovarian cancer, characterize metabolically the three histological types (serous, endometrioid and mucinous) and healthy ovarian tissue, generate statistical models to classify borderline tumors and predict survival patients and response to chemotherapy. In the case of breast cancer, it could discriminate metabolically breast carcinomas, fibroadenomas and healthy tissue and study metabolically different histological indicators of these carcinomas. We plan to confirm these very encouraging preliminary results in a larger cohort

Background Prostate cancer (PCa) is the most frequently diagnosed malignant disease among adult males in the USA and the second leading cause of cancer deaths in men. Due to the lack of diagnostic tools that are able to differentiate highly malignant and aggressive cases from indolent tumors, overtreatment has become very common in the era of prostate specific antigen (PSA) screening. New diagnostic methods to determine biological status, malignancy, aggressiveness and extent of PCa are urgently needed. 1H High Resolution Magic Angle Spinning Nuclear Magnetic Resonance Spectroscopy (1H HRMAS MRS) can be used to establish PCa metabolomic profiles while preserving tissue architecture for subsequent histopathological analysis. Immunohistochemistry (IHC), as opposed to conventional histopathology methods, has the potential to provide objective, more accurate and quantitative knowledge of tissue pathology. This diagnostic- accuracy study sought to evaluate a novel approach to quantitatively identify metabolomic markers of PCa by exploring the potential of PCa immunomarkers to quantify metabolomic profiles established by 1H HRMAS MRS. Material and Methods 1H HRMAS MRS was performed on tissue samples of 51 prostate cancer patients using a 14.1 Tesla NMR spectrometer (BRUKER Biospin, Billerica, MA) with a rotor synchronized CPMG pulse sequence. Spectral intensities of 36 regions of interest were measured as integrals of curve fittings with Lorentzian-Gaussian line shapes. Immunohistochemistry (IHC) was carried out following the spectroscopy scan, using three prostate immunomarkers to identify cancerous and benign glands: P504S (Alpha-methylacyl-CoA-racemace), CK903 (high-molecular weight cytokeratin) and p63. The immunostaining quality following 1H HRMAS MRS was evaluated and compared to unscanned sections of the same sample, to verify the stability and accessibility of the proposed immunomarkers. IHC images were automatically and quantitatively evaluated, using a quantitative image analysis program (QIAP), to determine the percentage of cancerous and benign epithelia in the tissue cross- sections. The results of the program were validated by a correlation with the results of a quantitative IHC review and quantitative conventional histopathology analysis performed by an experienced pathologist. Ultimately, spectral intensities and the cancer epithelium percentage, obtained from quantitative immunohistochemistry, were correlated in order to validate PCa metabolomic markers identified by 1H HRMAS MRS. Patient outcomes and incidence of recurrence were determined by retrospective review of medical records five years after initial surgery. Categories of recurrence were correlated to spectral intensities to explore potential metabolomic markers of recurrence in the cohort. Results Immunostainings with P504S and CK903 showed excellent staining quality and accessibility following 1H HRMAS MRS, suggesting these markers to be suitable for the presented quantitative approach to determine metabolomics profiles of PCa. In contrast, the quality of p63 IHC was impaired after previously performed spectroscopy. IHC using the immunomarkers P504S and CK903 on adjacent slides was found to present a feasible quantitative diagnostic method to distinguish between benign and cancerous conditions in prostate tissue. The cancer epithelium percentage as determined by QIAP showed a significant correlation to the results of quantitative IHC analysis performed by a pathologist (p < 0.001), as well as to a quantitative conventional histopathology review (p = 0.001). The same was true for the benign epithelium percentage (p < 0.001 and p = 0.0183), validating the presented approach. Two metabolomic regions showed a significant correlation between relative spectral intensities and the cancer epithelium percentage as determined by QIAP: 3.22 ppm (p = 0.015) and 2.68 ppm (p = 0.0144). The metabolites corresponding to these regions, phosphocholine and citrate, could be identified as metabolomic markers of PCa in the present cohort. 45 patients were followed for more than 12 months. Of these, 97.8% were still alive five years after initial surgery. 11 patients (24.4%) experienced a recurrence during the follow- up time. The categories of recurrence showed a correlation to the spectral intensities of two regions, 2.33 – 2.3 ppm (p = 0.0403) and 1.28 ppm (p = 0.0144), corresponding to the metabolites phosphocreatine and lipids. Conclusion This study introduces a method that allows an observer-independent, quantitative analysis of IHC to help establish metabolomic profiles and identify metabolomic markers of PCa from spectral intensities obtained with 1H HRMAS NMR Spectroscopy. The immunomarkers P504S and CK903 have been found suitable IHC analysis following 1H HRMAS MRS. A prospective in vivo application of PCa metabolite profiles and metabolomic markers determined by the presented method could serve as highly sensitive, non- invasive diagnostic tool. This observer- independent, computer- automated, quantitative analysis could help to distinguish highly aggressive tumors from low-malignant conditions, avoid overtreatment and reduce risks and complications for cancer patients in the future. Further studies are needed to verify the identified PCa metabolomic markers and to establish clinical applicability
Einführung Prostatakrebs ist eine häufigsten Krebserkrankungen in den USA und die zweithäufigste malignom- assoziierte Todesursache männlicher Patienten weltweit. Seit der Einführung des Prostata- spezifischen Antigen (PSA)- Screeningtests wird diese Krebsart in früheren Stadien diagnostiziert und therapiert, wodurch die Mortalitätsrate in den letzten Jahren deutlich reduziert werden konnte. Da moderne diagnostische Methoden bislang jedoch nicht ausreichend in der Lage sind, suffizient zwischen hochmalignen und weniger aggressiven Varianten dieses bösartigen Krebsleidens zu unterscheiden, werden häufig auch Patienten aggressiv therapiert, deren niedriggradiges Prostatakarzinom keine klinische Relevanz gehabt hätte. Es besteht daher ein großes wissenschaftliches Interesse an der Entwicklung neuer diagnostischer Methoden zur akkuraten Bestimmung von biologischem Status, Malignität, Aggressivität und Ausmaß einer Prostatakrebserkrankung. \\\\\\\"1H High Resolution Magic Angle Spinning Nuclear Magnetic Resonance Spectroscopy\\\\\\\" (1H HRMAS MRS) ist eine vielversprechende diagnostische Methode, welche es ermöglicht, metabolomische Profile von Prostatakrebs zu erstellen, ohne die Gewebsstruktur der analysierten Proben zu zerstören. Durch anschließende histopathologische Begutachtung lassen sich die erstellten Metabolitprofile validieren und evaluieren. Im Gegensatz zu konventionellen histopathologischen Methoden können durch immunhistochemische Verfahren dabei objektivere, akkuratere und quantifizierbare histopathologische Erkenntnisse gewonnen werden. Die vorliegende Studie präsentiert einen neuentwickelten diagnostischen Ansatz zur quantitativen Bestimmung von metabolomischen Markern von Prostatakrebs, basierend auf der Durchführung von 1H HRMAS NMR Spektroskopie und quantitativer Immunhistochemie. Material und Methoden Einundfünfzig Gewebsproben von Prostatakrebspatienten wurden mittels 1H HRMAS MRS an einem 14.1 T BRUKER NMR Spektrometer unter Einsatz einer CPMG-Pulssequenz untersucht. Spektrale Intensitäten in 36 Metabolitregionen wurden gemessen. Anschließend wurden die analysierten Gewebeproben mit drei Immunfärbemarkern für sowohl malignes (P504S, Alpha-methylacyl-CoA-racemase) als auch benignes (CK903, High-molecular weight cytokeratin, und p63) Prostatagewebe angefärbt und quantitativ mit Hilfe eines Bildanalyseprogramms (QIAP) ausgewertet. Die Anwendbarkeit und Auswertbarkeit der genannten Immunomarker nach Spektroskopie wurde evaluiert und mit der Färbungsqualität von nicht- gescannten Schnitten verglichen. Die Resultate der automatischen Auswertung durch QIAP konnten durch einen erfahrenen Pathologen in einer quantitativen Analyse der Immunfärbungen sowie konventioneller histologischer Färbungen derselben Gewebsproben validiert werden. Die spektralen Intensitäten aus den Messungen mit 1H HRMAS MRS wurden mit den korrespondierenden Ergebnissen der quantitativen Auswertung der Immunfärbungen korreliert, um metabolomische Marker von Prostatakrebs zu identifizieren. Der klinische Verlauf und die Rezidivrate der Patienten wurden 5 Jahre nach der initialen Prostatektomie retrospektiv bestimmt. Rezidivkategorien wurden erstellt und mit den bestimmten spektralen Intensitäten korreliert, um metabolomische Marker für das Auftreten von Prostatakrebsrezidiven zu identifizieren. Ergebnisse Die Immunfärbungen mit P504S und CK903 zeigten exzellente Qualität und Auswertbarkeit nach vorheriger 1H HRMAS MRS. Beide Marker eigneten sich zur Durchführung von quantitativer Immunhistochemie an spektroskopierten Gewebeproben. Im Gegensatz dazu war die Qualität der Immunfärbungen mit p63 nach Spektroskopie vermindert. Quantitative Immunfärbungen unter Einsatz der Immunmarker P504S und CK903 stellten eine praktikable diagnostische Methode dar, um zwischen malignen und benignem Prostatagewebe zu unterscheiden. Der Anteil von bösartig verändertem Prostatagewebe, bestimmt durch QIAP, korrelierte signifikant mit den Ergebnissen der quantitativen Analyse der Immunfärbungen durch den Pathologen (p < 0.001), sowie mit der quantitativen Auswertung der konventionellen histopathologischen Färbung (p = 0.001). Ebenso ließ sich die Bestimmung des Anteils von benignem Gewebe mit QIAP zu den Ergebnissen der pathologischen Analyse korrelieren (p < 0.001 und p = 0.0183). Für zwei metabolomische Regionen konnte ein signifikante Korrelation zwischen relativen spektralen Intensitäten, bestimmt mit 1H HRMAS NMR Spektroskopie, und dem Anteil von malignem Epithelium in derselben Gewebeprobe, ermittelt durch QIAP, festgestellt werden: 3.22 ppm (p = 0.015) und 2.68 ppm (p = 0.0144). Die zu diesen Regionen korrespondierenden Metaboliten, Phosphocholin und Zitrat, konnten als potentielle metabolomische Marker für Prostatakrebs identifiziert werden. Die retrospektiven Analyse der klinischen Daten der Patienten fünf Jahre nach Prostatektomie ergab eine Überlebensrate von 97.8%. Elf dieser Patienten (24.4%) erlitten ein Rezidiv ihrer Erkrankung. Die bestimmten Rezidivkategorien korrelierten signifikant mit zwei metabolomischen Regionen (2.33 – 2.3 ppm, p = 0.0403 und 1.28 ppm, p = 0.0144), welche zu den Metaboliten Phosphokreatin und Lipiden korrespondierten. Schlussfolgerung Die vorliegende Studie präsentiert einen diagnostischen Ansatz zur objektiven und quantitativen Bestimmung metabolomischer Marker von Prostatakrebs unter Verwendung von 1H HRMAS MRS und Immunhistochemie. P504S und CK903 eignen sich als Immunmarker für quantitative Immunfärbungen nach vorheriger Durchführung von 1H HRMAS MRS. Die Metaboliten Phosphocholin und Zitrat konnten in der vorliegenden Patientenkohorte als potentielle metabolomische Marker für Prostatakrebs identifiziert werden. Eine mögliche in vivo Anwendung der gefundenen metabolomischen Marker könnte als hochsensitives, objektives und nicht- invasives diagnostisches Werkzeug der Prostatakrebsdiagnostik dienen. Der vorliegende untersucherunabhängige, automatisierte und quantitative diagnostischer Ansatz hat das Potential, zwischen hochmalignen und weniger aggressiven Krebsfällen zu unterscheiden und somit unnötige Risiken und Komplikationen für Prostatakrebspatienten zu reduzieren. Weitere Untersuchungen sind notwendig, um die identifizierten metabolomischen Marker zu verifizieren und eine klinische Anwendung zu etablieren

Le Cancer, l’une des pathologies les plus fréquentes au sein de la population, possède encore actuellement un taux de morbi-mortalité important tous sexes confondus, et ce malgré les importants progrès diagnostiques et thérapeutiques réalisés. D’un point de vue diagnostique, dans une approche dite de « Biologie de systèmes », en complément de l’étude anatomo- pathologique qui reste la référence, de nouvelles techniques ont été développées pour la caractérisation de profils métaboliques (Métabolomique) d’échantillons tissulaires pathologiques ou non, parmi lesquelles la Spectroscopie RMN HRMAS. Après un bref rappel théorique et avoir dressé le bilan des applications de cette technique en Cancérologie, nous avons exposé les différentes étapes du protocole à mettre en place afin d’envisager son implémentation dans un cadre hospitalier. L’ensemble des résultats présentés permettent d’envisager l’utilisation de cette technique en pratique clinique courante. Il faut néanmoins valider la robustesse des modèles statistiques élaborés et confirmer ces résultats sur de plus grandes cohortes d’échantillons. Des développements technologiques, analytiques et statistiques sont également nécessaires
Cancer, one of the most frequent pathologies among the population, has still an important morbidity-mortality rate all sex confounded, despite the important diagnostical and therapeutical progresses achieved. From a diagnostical point of view, in a so called “Systems Biology approach”, as a complement of the gold standard histopathological study, some new techniques have been developed for the characterization of metabolic profiles (Metabolomics) of tissular samples pathological or not, among which HRMAS NMR Spectroscopy. After some brief theoretical considerations and after reporting the applications of this technique in Cancerology, we exposed the different steps of the protocol to design in order to consider its implementation in a hospital set up. All the results presented allow considering the use of this technique in a clinical routine. Nevertheless, it is necessary to validate the robustness of the statistical models built and to confirm these results on much larger cohorts of samples. Some technical, analytical and statistical developments are also needed

From day to day, the role of HRMAS (High-Resolution Magic Angle Sinning) Nuclear Magnetic Resonance Spectroscopy (NMRS) in medical diagnosis is increasing. This technique enables setting up metabolite profiles of ex vivo pathological and healthy tissue. Automatic spectrum quantitation enables monitoring of diseases. However for several metabolites, the values of chemical shifts of proton groups may slightly differ according to the micro-environment in the tissue or cells, in particular to its pH. This hampers accurate estimation of the metabolite concentrations mainly when using quantitation algorithms based on a metabolite basis-set. The present word is devoted to the optimization of NMR metabolite basis set signals, particularly to the algorithms of chemical shift mismatch correction. Two sighal processing ("warping") methods were developed for simple and fast spectrum optimization : signal stretching/shrinking (resampling) and spectrum splitting. Then, another optimization method, QM-QUEST, coupling Quantrum Mechanical simulation and quantitation algorithms was implemented. The latter provides more robust fitting while limiting user involvement and respects the correct fingerprints of metabolites. Its efficiency is demonstrated by accurately quantitating signals from tissue samples of human brains with oligodendroglioma, obtained at 11.7 Tesla and spectra of cells acquired at 9.4T by HRMAS-NMR. As the necessity of fast NMR signal simulation based on quantum Mechanics is raised in the thesis, a part of the word is dedicated to an approximate method speeding-up the calculations. The algorithm based on spin-system fragmentation could become an important part of the QM-QUEST optimization method and will be implemented as an option of simulation in NMR-SCOPE, module of the jMRUI software package.

La transplantation pulmonaire est une alternative thérapeutique ultime dans de nombreuses maladies pulmonaires sévères, en particulier chez des patients atteints de mucoviscidose (Cystic Fibrosis) , de fibrose pulmonaire idiopathique (IPF idiopathie pulmonary fibrosis), delymphangioléiomyomatose (LAM) ou d'hypertension pulmonaire. Cependant, les besoins en greffe dépassent largement le nombre de transplantations pratiquées en France. Les causes de ce déséquilibre incluent un trop faible nombre de donneurs potentiels en raison de critères actuels pour l'acceptation du greffon qui sont restreints car les biomarqueurs biologiques de qualité et de viabilité du greffon n'ont pas été décrits à ce jour. L'une des possibilités d'augmenter le nombre de donneurs, est de mettre en évidence des biomarqueurs de la qualité du greffon et d'étendre les critères d'acceptabilité du greffon en permettant les prélèvements à partir de donneurs à coeur arrêté est une possibilité. Les prélèvements pulmonaires après arrêt cardiaque sont effectués, en clinique expérimentale chez l'homme, en Espagne depuis trois ans. Il existe dans ce pays une législation très favorable et surtout une conscience collective qui rend le don d'organes extrêmement facilité. Il est donc essentiel d'optimiser l' utilisation de cette ressource. Pour cela, la mise en place de critères de validation de la qualité du greffon est une donnée clé pour palier à ce manque de transplantation pulmonaire. Les critères d'acceptabilité d'un greffon pulmonaires sont basés sur des données cliniques n'existant pas de biomarqueurs biologiques de qualité et de viabilité du greffon. Nous proposons ici l'utilisation de la métabolomique par spectroscopie en Résonance Magnétique Nucléaire à haute résolution par rotation à angle magique (RMN HRMAS) pour mettre en évidence des biomarqueurs de la qualité du greffon. La métabolomique par la spectroscopie RMN HRMAS, est une technique d'analyse rapide (20 minutes) et originale, caractérisée par l'analyse directe d'un tissu biologique intact sans nécessité d'extraction. Cette technique étudie les profils métaboliques dans le but de mettre en évidence des biomarqueurs métaboliques. La métabolomique a été largement utilisée dans des études en cancérologie pour la détermination de la malignité d'un tissu (Bertini 1. et coll. , Canser Res. 2012/ Griffin JL et coll ., Nat Rev Cancer, 2004/ Li M. et coll. , PLoSOne, 2011/ O'connell TM. Bioanalysis. 2012/ Ma Y. et coll. Mol Biol Rep. 2012). Cependant, très peu de publications dans la littérature s'intéressent au domaine de la transplantation et à la qualité du greffon (Rocha C. et coll. , Journal of Proteome Research, 2011/ RobertR. et coll. J Critical Ca re 2010/ Stenlund H. et coll., Chemometrics and Intelligent Laboratory Systems, 2009/ Du a rte F.L. et coll. , Anal.Chem.2005). Ce projet de thèse avait pour objectifs de :1. Etudier la faisabilité d'utiliser la métabolomique par la spectroscopie RMN HRMAS pour évaluer la qualité du greffon pulmonaire.2. Mettre en évidence de potentiels biomarqueurs de la qualité du greffon pulmonaire.3. Evaluer une éventuelle introduction de cette technique en pratique courante dans un environnement hospitalier. Pour répondre à ces objectifs, il a été entrepris :• Etudier les métabolomes pulmonaires de différentes espèces animales, puis de les comparer au métabolome du poumonhumain afin d'identifier le modèle expérimental le plus adapté à la transplantation pulmonaire.• Evaluer la qualité du greffon chez un modèle animal (porc Large White) pour la transplantation pulmonaire (modèle expérimental de préservation pulmonaire en in situ chez le donneur à coeur arrêté, modèle de perfusion pulmonaire en ex vivo sur machine ocs™).• Evaluer l'effet de la perfusion de deux solutions de conservation sur la qualité du greffon pulmonaire chez le porc
Lung transplantation is a therapeutic alternative in many severe pulmonary diseases, especially in patients suffering from CF (CysticFibrosis), idiopathie pulmonary fibrosis (IPF), lymphangioleiomyomatosis (LAM) or pulmonary hypertension . However, the need fortransplantation far outweighs the number of transplants performed in France. The causes of this imbalance include an insufficient number of potential donors because of the current criteria for the acceptance of the graft that are restricted as biomarkers of quality and viability of the graft have not been described so far.One of the possibilities to increase the donor pool is to identify biomarkers of the quality of the graft and expand the criteria foracceptability of the graft allowing withdrawals from non-heart-beating donors. The lung taking were performed after cardiac arrest inclinical trials carried out on humans for three years in Spain.lt is therefore essential to optimize the use of this resource. For this, the establishment of criteria for validating the quality of the graft isgiven a key to solve this problem of lung transplantation. The criteria for acceptability of a lung transplant are based on clinical data inabsence of biomarkers of quality and viability for the lung graft.We propose the use of the metabolomics by high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (HRMASNMR) to highlight potential biomarkers for the quality of the graft.The Metabolomics by NMR HRMAS spectroscopy is an original analytical technique characterized by a rapid analysis (20 minutes)performed on intact biopsy samples without extraction prior to analysis. This technique studies the metabolic profiles in arder to identifymetabolic biomarkers. Metabolomics has been widely used in studies in oncology for the determination of malignancy of a tissue (Bertini et al. , Canser Res. 2012/ Griffin JL et al., Nat Rev Cancer, 2004/ Li M. et al. , PLoS One, 2011/ O'connel! TM. Bioanalysis. 2012/ Ma Y. et al. Mol Biol Rep. 2012). However, very few papers in the literature combine the use of the metabolomics NMR HRMAS and the assessment of the quality of the graft (Rocha C. et al. , Journal of Proteome Research, 2011/ Robert R. et al. J Critical Care 2010/ Stenlund H. et al, Chemometrics and Intelligent Laboratory Systems, 2009/ Duarte F.L. et al. , Anal. Chem. 2005).The purposes of this research work were:1. Studying the feasibility of using the metabolomics by NMR HRMAS for the assessment of the quality of the lung graft2. Assess the metabolome of the lung in degradation conditions and highlight potential biomarkers of the quality of the graft3. Assess the possible use of the metabolomics by NMR HRMAS as a tool in clinical practice within a hospital environment.To answer to these purposes we made experimental experiences as follows:- Studying the lung metabolome of various animal species, and compare them to the human metabolome to identify the most suitableexperimental model for lung transplantation.- Assessing the quality of the graft in an animal model (pig Large White) for lung transplantation (experimental model of lung preservation in situ in the case of non-heart-beating donor, lung model for an ex vivo perfusion using OCS ™ Machine)- Evaluating the effect of perfusion with two preservation solutions on the quality of lung graft in pig model

La spectroscopie RMN Haute Résolution en Rotation à l’Angle Magique (HRMAS) permet la caractérisation métabolomique tissulaire. Nous avons caractérisé par RMN HRMAS le profil métabolomique des glandes parathyroïdiennes hypersécrétantes. Celui de l’hyperparathyroïdie primaire (HPT1) a été comparé à celui des HPT rénales. Au sein des HPT1, la distinction a pu être faite entre pathologie uni- et multi-glandulaire. Le profil métabolomique du tissu pancréatique sain a été comparé à celui du tissu tumoral. Aussi, les patients longs/courts-survivants ont pu être distingués. La relation entre le phénotype métabolique et la survie des patients a été étudiée. Le profil métabolomique des TIPMP a été caractérisé. Les TIPMP non dégénérées et dégénérées ont été comparées. Le risque de dégénérescence a été corrélé au profil métabolomique. Nos résultats montrent que la spectroscopie RMN HRMAS est une technique prometteuse pour l’étude du profil métabolomique des HPT et des pathologies pancréatiques
High Resolution Magic Angle Spinning (HRMAS) NMR spectroscopy allows metabolomics of intact tissues. Metabolomics profiling of hyperfunctioning parathyroid glands were characterized were characterized by using HRMAS NMR spectroscopy. Primary hyperparathy- roidism (PHPT) was compared to renal HPT. Among PHPT, we distinguished single gland disease from multiple gland disease. Pancreatic parenchyma and adenocarcinoma were compared. Thus, long-term and short-term survival patients were distinguished. The relationship between the survival of patients and their metabolic phenotype was studied. Metabolomics profiling of IPMN was also examined. IPMN with no degeneration and de- generated IPMN were compared. Finally, the risk of degeneration was correlated with the metabolomics profile. Our results show that HRMAS NMR spectroscopy is a promising technique in view of studying metabolomic profiling of HPT and pancreatic diseases

Ces travaux de thèse portent sur l'analyse des mélanges réels et synthétiques complexes composés de petites molécules à l'aide de la RMN HRMAS. Dans une première partie, une approche RMN HRMAS basée sur l'analyse métabolomique en combinaison avec des techniques de reconnaissance des formes (PCA et O-PLS-DA) a été appliquée pour le diagnostic des lésions thyroïdiennes indéterminées et étudier également les effets biologiques négatifs des nanoparticules d'aluminium sur pseudomonas brassicacearum. Dans une seconde partie, nous avons étudié la RMN chromatographique en utilisant la silice comme matrice de support qui pourrait fournir une alternative rapide et complète de la LC pour la caractérisation de mélanges complexes. En outre, l'exigence de la suppression du signal dans l'extrait de plantes naturelles et d'hydrocarbures aromatiques conduit à l'élaboration d'une méthode rapide et précise en utilisant des polymères à empreintes moléculaires avec une excellente sélectivité. La sélectivité des polymères à empreintes moléculaires à travers la capture d'une cible moléculaire spécifique est exploitée ici pour éliminer efficacement les signaux RMN
This thesis work deals with the analysis of natural and synthetic complex mixtures composed of small molecules using HRMAS NMR. In a first part, an integrated HRMAS-NMR based metabolomic analysis in combination with pattern recognition techniques (PCA and O-PLS-DA) has been applied for the diagnosis of indeterminate thyroid lesions and also studied the potential adverse biological effects of aluminium nanoparticles on pseudomonas brassicacearum. In a second part we investigated that chromatographic NMR using silica as the matrix support could provide a quick alternative and complement to LC for the characterization of complex mixtures. In addition, requirement for signal suppression in natural plant extract and aromatic hydrocarbons led to the development of a rapid and accurate method using molecularly imprinted polymers with excellent selectivity. The selectivity of Molecularly Imprinted polymers towards capturing a specific molecular target is exploited here to efficiently remove NMR signals

Le dogme relatif à la radiorésistance du Système Nerveux Central (SNC) a vécu. Les progrès en neurosciences permettent aujourd'hui de reconsidérer les dysfonctionnements cognitifs radio-induits observés au décours des radiothérapies ou après un accident d'irradiation, et d'envisager des moyens diagnostiques et thérapeutiques adaptés. Nous avons développé un modèle Rat afin d'étudier les effets d'une irradiation gamma corps entier à dose sublétale (4,5 Gy). Celle-ci induit des troubles de l'apprentissage et de la mémorisation d'une tâche en cours d'acquisition durant le premier mois – lesquels sont prévenus par l'administration d'une molécule radioprotectrice de référence (amifostine) – tandis qu'elle ne semble pas perturber la mémoire rétrograde. Précocement, une vague apoptotique survient 5 à 9 heures après exposition dans la zone sous-ventriculaire avec, en parallèle, une neurogenèse anéantie. Deux jours après irradiation, l'étude métabolique ex vivo réalisée par RMN HRMAS (High Resolution Magic Angle Spinning) suggère la présence d'un œdème cérébral tandis que l'étude des lipides cérébraux en RMN liquide confirme l'atteinte membranaire (élévation du cholestérol et des phospholipides). Le profil lipidique se normalise ensuite tandis qu'une réaction gliale apparait. Enfin, 1 mois post-irradiation, l'élévation du GABA, neurotransmetteur inhibiteur du SNC, dans 2 structures cérébrales distinctes, s'accompagne d'une diminution de la taurine dans l'hippocampe qui persiste 6 mois. Notre modèle intégré permet ainsi de valider des biomarqueurs quantifiables en spectroscopie RMN in vivo – prochaine étape expérimentale – et de tester de nouvelles thérapeutiques radioprotectrices
The radioresistance dogma of Central Nervous System (CNS) is now obsolete. Recent progress in neuroscience allow us to reconsider the radiation-induced cognitive dysfunctions observed after radiation therapy or after a nuclear accident, and to devise appropriate diagnostic and therapeutic means. We have developed a Rat model to study the effects of total body irradiation at a sublethal dose (4. 5 Gy). This leads to impaired learning and memory of a task being acquired during the first month – which is prevented by administration of a radioprotector (amifostine) – while it does not appear to affect retrograde memory. Early, an apoptotic wave occurs in the sub-ventricular zone, 5 to 9 hours after exposure, while neurogenesis is suppressed. Two days after irradiation, the metabolic study conducted by NMR HRMAS (High Resolution Magic Angle Spinning) suggests the presence of cerebral oedema and the study of brain lipids in liquid NMR confirms the membrane damages (elevated cholesterol and phospholipids). The lipid profile is then normalized while a gliosis appears. Finally, 1 month post-irradiation, the elevation of GABA, an inhibitory neurotransmitter, in 2 separate brain structures, occurs simultaneously with a taurine decrease in the hippocampus that lasts 6 months. Our integrated model allows validating biomarkers measurable in vivo NMR spectroscopy – the next experimental stage – and testing new radiation-protective agents

Doutoramento em Química
The main scope of this work was to evaluate the metabolic effects of anticancer agents (three conventional and one new) in osteosarcoma (OS) cells and osteoblasts, by measuring alterations in the metabolic profile of cells by nuclear magnetic resonance (NMR) spectroscopy metabolomics. Chapter 1 gives a theoretical framework of this work, beginning with the main metabolic characteristics that globally describe cancer as well as the families and mechanisms of action of drugs used in chemotherapy. The drugs used nowadays to treat OS are also presented, together with the Palladium(II) complex with spermine, Pd2Spm, potentially active against cancer. Then, the global strategy for cell metabolomics is explained and the state of the art of metabolomic studies that analyze the effect of anticancer agents in cells is presented. In Chapter 2, the fundamentals of the analytical techniques used in this work, namely for biological assays, NMR spectroscopy and multivariate and statistical analysis of the results are described. A detailed description of the experimental procedures adopted throughout this work is given in Chapter 3. The biological and analytical reproducibility of the metabolic profile of MG-63 cells by high resolution magic angle spinning (HRMAS) NMR is evaluated in Chapter 4. The metabolic impact of several factors (cellular integrity, spinning rate, temperature, time and acquisition parameters) on the 1H HRMAS NMR spectral profile and quality is analysed, enabling the definition of the best acquisition parameters for further experiments. The metabolic consequences of increasing number of passages in MG-63 cells as well as the duration of storage are also investigated. Chapter 5 describes the metabolic impact of drugs conventionally used in OS chemotherapy, through NMR metabolomics studies of lysed cells and aqueous extracts analysis. The results show that MG-63 cells treated with cisplatin (cDDP) undergo a strong up-regulation of lipid contents, alterations in phospholipid constituents (choline compounds) and biomarkers of DNA degradation, all associated with cell death by apoptosis. Cells exposed to doxorubicin (DOX) or methotrexate (MTX) showed much slighter metabolic changes, without any relevant alteration in lipid contents. However, metabolic changes associated with altered Krebs cycle, oxidative stress and nucleotides metabolism were detected and were tentatively interpreted at the light of the known mechanisms of action of these drugs. The metabolic impact of the exposure of MG-63 cells and osteoblasts to cDDP and the Pd2Spm complex is described in Chapter 6. Results show that, despite the ability of the two agents to bind DNA, the metabolic consequences that arise from exposure to them are distinct, namely in what concerns to variation in lipid contents (absent for Pd2Spm). Apoptosis detection assays showed that, differently from what was seen for MG-63 cells treated with cDDP, the decreased number of living cells upon exposure to Pd2Spm was not due to cell death by apoptosis or necrosis. Moreover, the latter agent induces more marked alterations in osteoblasts than in cancer cells, while the opposite seemed to occur upon cDDP exposure. Nevertheless, the results from MG-63 cells exposure to combination regimens with cDDP- or Pd2Spm-based cocktails, described in Chapter 7, revealed that, in combination, the two agents induce similar metabolic responses, arising from synergy mechanisms between the tested drugs. Finally, the main conclusions of this thesis are summarized in Chapter 8, and future perspectives in the light of this work are presented.
Este trabalho teve como principal objetivo estudar os efeitos metabólicos de alguns fármacos (três fármacos convencionais e um em desenvolvimento) em células de osteossarcoma (OS) e osteoblastos, através da medição de alterações dos perfis metabólicos celulares por metabolómica usando espectroscopia de Ressonância Magnética Nuclear (RMN). O Capítulo 1 apresenta um enquadramento teórico deste trabalho, começando por identificar as principais características metabólicas que descrevem o cancro em geral, assim como as famílias e mecanismos de ação dos fármacos usados no seu tratamento. São ainda apresentados os fármacos usados atualmente na quimioterapia do OS, bem como o complexo de Paládio (II) com espermina, Pd2Spm, com potencial atividade anticancerígena. Seguidamente, é explicada a estratégia da metabolómica celular e apresentado o estado da arte de estudos metabolómicos do efeito de agentes anticancerígenos em células. No Capítulo 2, apresentam-se os princípios das técnicas analíticas usadas neste trabalho, nomeadamente ensaios biológicos, espectroscopia de RMN e análise multivariada e estatística dos resultados. Os detalhes e procedimentos experimentais relativos aos métodos usados são descritos no Capítulo 3. O estudo da reprodutibilidade analítica e biológica do perfil metabólico de células MG-63 medido por RMN de alta resolução e rotação segundo o ângulo mágico (HRMAS) é apresentado no Capítulo 4. Avalia-se o impacto de vários fatores (integridade celular, velocidade de rotação da amostra, temperatura, duração e parâmetros de aquisição) nas características e qualidade do espectro de RMN HRMAS de 1H, definindo-se então os parâmetros de aquisição dos espectros a adquirir subsequentemente. Avaliam-se também os efeitos do nº de passagens celulares e do tempo de armazenamento no perfil metabólico de células MG-63. O Capítulo 5 descreve o impacto metabólico de fármacos convencionais usados atualmente na quimioterapia do OS, estudado por metabolómica por RMN de células lisadas e análise de extratos celulares aquosos. Os resultados mostram que as células MG-63 tratadas com cisplatina (cDDP) sofrem um aumento dramático do teor de lípidos, alterações dos níveis de constituintes dos fosfolípidos (compostos de colina) e de indicadores de degradação do DNA, associados a fenómenos de apoptose. Nas células expostas a doxorrubicina (DOX) ou a metotrexato (MTX) foram identificadas alterações metabólicas mais ténues, com a quase total ausência de alterações no teor de lípidos. Foram também detetadas alterações em metabolitos relacionados com o ciclo de Krebs, stress oxidativo e metabolismo de nucleótidos, interpretadas tentativamente à luz dos mecanismos de ação de cada um dos fármacos. O impacto metabólico da exposição de células MG-63 e osteoblastos a cDDP e ao complexo de Pd2Spm é apresentado no Capítulo 6. Os resultados mostram que, apesar de ambos os fármacos poderem ligar ao DNA, as alterações metabólicas que decorrem da sua ação são muito distintas, nomeadamente no que respeita às variações nos teores de lípidos (ausentes para Pd2Spm). Ensaios de medição de apoptose mostraram que, contrariamente ao verificado para células MG-63 expostas a cDDP, a redução do número de células por exposição a Pd2Spm não se deve a fenómenos de morte celular por apoptose ou necrose. Além disso, este último complexo exerce um efeito mais marcado em osteoblastos do que nas células cancerígenas, o inverso parecendo acontecer com a exposição a cDDP. Contudo, os resultados da exposição de células MG-63 a regimes de tratamento combinado com base em cocktails de cDDP ou Pd2Spm, descritos no Capítulo 7, mostram que, em combinação, os dois agentes induzem respostas metabólicas semelhantes entre si, decorrentes de mecanismos de sinergia entre fármacos. Finalmente, sumariam-se no Capítulo 8 as conclusões deste trabalho e apontam-se perspetivas de trabalho futuro.

Le long des côtes de l’Atlantique Nord-Est, le genre Cystoseira (algues brunes, famille des Sargassacceae) se décline principalement en cinq espèces établies dans les cuvettes de l’étage médiolittoral. Au-delà de l’intérêt écologique de ces organismes, leur valorisation potentielle en tant que sources naturelles de composés bioactifs peut aujourd’hui être envisagée. Cependant, une telle démarche peut se voir freinée par des questions taxinomiques restées sans réponse depuis le début du XXème siècle. Le premier volet de ce projet de thèse consiste à résoudre ces difficultés, en combinant des approches aujourd’hui classiques (analyses phylogénétiques issues de données moléculaires) à des études chimiques exploitant de nouvelles techniques analytiques (RM7N et LC-MS), pour proposer un cadre taxinomique à chaque espèce. En s’appuyant sur les données phylogénétiques les plus récentes, nos résultats ont permis de mettre en évidence la pertinence de critères chimiques pour illustrer les relations de parenté existant au sein du genre, et nous avons également pu obtenir des « cartes d’identité chimique» de chaque taxon. Un chimiomarqueur de type méroditerpène a été identifié et isolé chez Cystoseira nodicaulis. La deuxième partie du travail consiste en une étude écologique des populations du genre Cystoseira du littoral breton. Contrairement au phénomène d’étagement des macroalgues sur l’étage médiollttoral, bien connu dans les zones tempérées, peu de données existent sur la répartition des macroalgues peuplant les cuvettes de l’estran. Nous avons pu mettre en évidence une répartition précise des espèces dans les cuvettes de l’estran, sous la dépendance de gradients de facteurs environnementaux. Nous avons également caractérisé l’évolution spatio-temporelle de certaines variables des populations. Grâce à une étude complémentaire sur les pigments principaux de ces algues par HPLC, nous avons pu montrer l’existence d’une photo- adaptation aux niveaux intra- et inter-populationnels. Enfin, ce projet propose d’étudier les phlorotannins des cinq espèces bretonnes. Ces molécules sont connues pour leur activité antioxydante et la variété de leurs rôles in vivo. Aussi, le but de cette dernière étude est de mettre au point des protocoles d’extraction et de purification adaptés à ces composés, d’en caractériser la structure chimique, et d’en déterminer des activités au moyen de test in vitro. Une première démarche de quantification nous a permis d’appréhender les variations interspécifiques et saisonnières des teneurs en composés phénoliques chez les cinq espèces étudiées. Dans un deuxième temps, nous avons purifié et caractérisé partiellement les composés phénoliques extraits des algues, et enfin, nous avons pu déterminer les variations saisonnières du phloroglucinol, que nous avons pu identifier comme étant le composé phénolique majoritaire de C. Tamariscifolia
Along the North-East Atlantic, the genus Cystoseira (brown algae, family Sargassaceae) is composed of five main species and their populations settle in rock pools from the intertidal zone Beyond the ecological value of these organisms they are now more and more studied as a source of natural products However, taxonomical issues within this genus must be solved first So we investigated the taxonomy of the five species occurring m Brittany using two strategies phylogenetic analyses (thanks to molecular markers) and chemical analyses (using NMR and LC-MS) Using recent phylogenetic data, our results highlighted the relevancy of the use of chemical criteria to illustrate the phylogenetic relationships This way we were able to associate a "chemical ID card" to each species We also isolated a meroditerpene from Cystoseira nodicaulis. The second part of our work was an ecological study of several populations settled in Brittany Concerning the emerged substrata of the intertidal zone, the available data about zonation patterns are plethoric, conversely, few authors have investigated the distribution of macroalgae in tide pools. We highlighted a singular distribution pattern for the Cystoseira species that must be under the dependency of environmental factors. We also demonstrated the spatio-temporal variability several variables of the populations. Additionally, we showed through the quantification of the main pigments by HPLC that different photo-adaptive behaviors exist within and between populations. Finally, we investigated the phlorotannins of the Cystoseira species. These molecules are known to exhibit se biological activities and many ecological roles have been demonstrated in the literature. We developed a new protocol for the purification and quantification of the compounds and we also determined their radical-scavenging activity. This way, we revealed specific differences and seasonal patterns in phlorotannin production. We also purified phenolics and identified the main kind of compounds in the extracts. We identified phloroglucinol in Cystoseira tamariscifolia, and revealed a seasonal evolution of its production, in relation with its phenology

Doutoramento em Química
This thesis reports the application of metabolomics to human tissues and biofluids (blood plasma and urine) to unveil the metabolic signature of primary lung cancer. In Chapter 1, a brief introduction on lung cancer epidemiology and pathogenesis, together with a review of the main metabolic dysregulations known to be associated with cancer, is presented. The metabolomics approach is also described, addressing the analytical and statistical methods employed, as well as the current state of the art on its application to clinical lung cancer studies. Chapter 2 provides the experimental details of this work, in regard to the subjects enrolled, sample collection and analysis, and data processing. In Chapter 3, the metabolic characterization of intact lung tissues (from 56 patients) by proton High Resolution Magic Angle Spinning (HRMAS) Nuclear Magnetic Resonance (NMR) spectroscopy is described. After careful assessment of acquisition conditions and thorough spectral assignment (over 50 metabolites identified), the metabolic profiles of tumour and adjacent control tissues were compared through multivariate analysis. The two tissue classes could be discriminated with 97% accuracy, with 13 metabolites significantly accounting for this discrimination: glucose and acetate (depleted in tumours), together with lactate, alanine, glutamate, GSH, taurine, creatine, phosphocholine, glycerophosphocholine, phosphoethanolamine, uracil nucleotides and peptides (increased in tumours). Some of these variations corroborated typical features of cancer metabolism (e.g., upregulated glycolysis and glutaminolysis), while others suggested less known pathways (e.g., antioxidant protection, protein degradation) to play important roles. Another major and novel finding described in this chapter was the dependence of this metabolic signature on tumour histological subtype. While main alterations in adenocarcinomas (AdC) related to phospholipid and protein metabolisms, squamous cell carcinomas (SqCC) were found to have stronger glycolytic and glutaminolytic profiles, making it possible to build a valid classification model to discriminate these two subtypes. Chapter 4 reports the NMR metabolomic study of blood plasma from over 100 patients and near 100 healthy controls, the multivariate model built having afforded a classification rate of 87%. The two groups were found to differ significantly in the levels of lactate, pyruvate, acetoacetate, LDL+VLDL lipoproteins and glycoproteins (increased in patients), together with glutamine, histidine, valine, methanol, HDL lipoproteins and two unassigned compounds (decreased in patients). Interestingly, these variations were detected from initial disease stages and the magnitude of some of them depended on the histological type, although not allowing AdC vs. SqCC discrimination. Moreover, it is shown in this chapter that age mismatch between control and cancer groups could not be ruled out as a possible confounding factor, and exploratory external validation afforded a classification rate of 85%. The NMR profiling of urine from lung cancer patients and healthy controls is presented in Chapter 5. Compared to plasma, the classification model built with urinary profiles resulted in a superior classification rate (97%). After careful assessment of possible bias from gender, age and smoking habits, a set of 19 metabolites was proposed to be cancer-related (out of which 3 were unknowns and 6 were partially identified as N-acetylated metabolites). As for plasma, these variations were detected regardless of disease stage and showed some dependency on histological subtype, the AdC vs. SqCC model built showing modest predictive power. In addition, preliminary external validation of the urine-based classification model afforded 100% sensitivity and 90% specificity, which are exciting results in terms of potential for future clinical application. Chapter 6 describes the analysis of urine from a subset of patients by a different profiling technique, namely, Ultra-Performance Liquid Chromatography coupled to Mass Spectrometry (UPLC-MS). Although the identification of discriminant metabolites was very limited, multivariate models showed high classification rate and predictive power, thus reinforcing the value of urine in the context of lung cancer diagnosis. Finally, the main conclusions of this thesis are presented in Chapter 7, highlighting the potential of integrated metabolomics of tissues and biofluids to improve current understanding of lung cancer altered metabolism and to reveal new marker profiles with diagnostic value.
A presente tese reporta a aplicação da metabolómica ao estudo de tecidos e biofluidos humanos (plasma sanguíneo e urina), com o intuito de caracterizar a assinatura metabólica do cancro pulmonar primário. No Capítulo 1, apresenta-se uma breve introdução sobre a epidemiologia e a patogénese deste tipo de cancro, bem como um sumário das principais alterações metabólicas tipicamente associadas ao cancro em geral. Descreve-se ainda a abordagem metabolómica, nomeadamente os métodos analíticos e estatísticos utilizados, assim como o estado da arte da sua aplicação em estudos clínicos do cancro do pulmão. No Capítulo 2, apresentam-se os detalhes experimentais deste trabalho, no que diz respeito ao grupo de indivíduos envolvidos, à colheita e análise das amostras e ao posterior tratamento dos dados. O Capítulo 3 descreve a caracterização metabólica de tecidos do pulmão (de 56 doentes) por espetroscopia de Ressonância Magnética Nuclear (RMN) de alta resolução com rotação no ângulo mágico. Após a otimização cuidada das condições de aquisição e a identificação detalhada dos sinais espetrais (mais de 50 metabolitos identificados), os perfis metabólicos dos tumores e dos tecidos adjacentes não envolvidos (controlos) foram comparados por análise multivariada, tendo sido discriminados com uma exatidão de 97%. Os metabolitos que mais significativamente contribuíram para esta diferenciação foram: glucose e acetato (diminuídos nos tumores), lactato, alanina, glutamato, GSH, taurina, creatina, fosfocolina, glicerofosfocolina, fosfoetanolamina, nucleótidos de uracilo e péptidos (aumentados nos tumores). Algumas destas variações corroboraram alterações típicas do metabolismo do cancro (e.g., glicólise e glutaminólise aumentadas), enquanto outras sugeriram novas pistas sobre a possível relevância de processos como a proteção antioxidante e a degradação proteica. Um outro resultado novo e importante descrito neste capítulo foi a dependência da assinatura metabólica em relação ao tipo histológico do tumor. Enquanto as principais alterações observadas nos adenocarcinomas (AdC) se relacionaram com o metabolismo fosfolipídico e proteico, os carcinomas de células escamosas (SqCC) apresentaram perfis glicolíticos e glutaminolíticos mais pronunciados, sendo possível construir um modelo válido para a discriminação destes subtipos. No Capítulo 4, apresenta-se o estudo metabolómico por RMN de plasma sanguíneo de mais de 100 doentes e quase 100 controlos saudáveis, do qual resultou um modelo multivariado com uma taxa de classificação de 87%. A distinção entre os grupos foi feita essencialmente com base nos níveis de lactato, piruvato, acetoacetato, lipoproteínas LDL+VLDL e glicoproteínas (aumentados nos doentes), juntamente com os níveis de glutamina, histidina, valina, metanol, lipoproteínas HDL e dois compostos não identificados (diminuídos nos doentes). Estas variações foram detetadas desde os estádios iniciais da doença e a magnitude de algumas delas dependeu do tipo histológico, embora não permitindo discriminar AdC de SqCC. Para além disso, mostra-se neste capítulo que o desequilíbrio dos grupos controlo e cancro em termos da idade dos indivíduos poderá ter alguma influência nos resultados, e apresenta-se uma tentativa exploratória de validação externa, que resultou numa taxa de classificação de 85%. O estudo por RMN do perfil metabólico da urina dos doentes com cancro do pulmão e dos controlos é apresentado no Capítulo 5. Comparativamente ao plasma, o modelo construído com os perfis urinários apresentou uma taxa de classificação superior (97%). Após uma avaliação cuidada da possível influência do género, idade e hábitos tabágicos, um conjunto de 19 metabolitos foi proposto como estando relacionado com a doença (incluindo 3 compostos desconhecidos e 6 parcialmente identificados como metabolitos N-acetilados). Tal como no caso do plasma, estas variações foram detetadas em doentes no estádio inicial e mostraram alguma dependência em relação ao tipo histológico, obtendo-se um modelo válido para a discriminação AdC vs. SqCC, ainda que com um poder preditivo modesto. Para além disso, o teste preliminar de validação externa revelou 100% de sensibilidade e 90% de especificidade, o que é um resultado bastante promissor em termos da potencial utilização dos perfis urinários em aplicações clínicas futuras. No Capitulo 6, descreve-se a caracterização dos perfis metabólicos da urina (de um subgrupo de indivíduos) por cromatografia líquida de ultra-eficiência acoplada a espetrometria de massa (UPLC-MS). Embora não avançando muito na identificação estrutural de possíveis marcadores, este estudo reforçou o valor diagnóstico da urina, já que os modelos multivariados resultantes apresentaram taxa de classificação e poder preditivo elevados. Finalmente, no Capítulo 7, apresentam-se as principais conclusões deste trabalho, realçando o contributo da metabolómica integrada de tecidos e biofluidos para a compreensão do metabolismo alterado do cancro do pulmão e para a deteção de novos perfis marcadores com valor diagnóstico.

Les plantes médicinales constituent une source inexhaustible de composés (des produits naturels - PN) utilisé en médecine pour la prévention et le traitement de diverses maladies. L'introduction de nouvelles technologies et méthodes dans le domaine de la chimie des produits naturels a permis le développement de méthodes ‘high throughput’ pour la détermination de la composition chimique des extraits de plantes, l'évaluation de leurs propriétés et l'exploration de leur potentiel en tant que candidats médicaments. Dernièrement, la métabolomique, une approche intégrée incorporant les avantages des technologies d'analyse moderne et la puissance de la bioinformatique s’est révélé un outil efficace dans la biologie des systèmes. En particulier, l'application de la métabolomique pour la découverte de nouveaux composés bioactifs constitue un domaine émergent dans la chimie des produits naturels. Dans ce contexte, le genre Acronychia de la famille des Rutaceae a été choisi sur la base de son usage en médecine traditionnelle pour ses propriétés antimicrobienne, antipyrétique, antispasmodique et anti-inflammatoire. Nombre de méthodes chromatographiques modernes, spectrométriques et spectroscopiques sont utilisées pour l'exploration de leur contenu en métabolites suivant trois axes principaux constituant les trois chapitres de cette thèse. En bref, le premier chapitre décrit l’étude phytochimique d’Acronychia pedunculata, l’identification des métabolites secondaires contenus dans cette espèce et l'évaluation de leurs propriétés biologiques. Le deuxième chapitre vise au développement de méthodes analytiques pour l'identification des dimères d’acétophénones (marqueurs chimiotaxonomiques du genre) et aux stratégies utilisées pour la déréplication de ces différents extraits et la caractérisation chimique des composés par UHPLC-HRMSn. Le troisième chapitre se concentre sur l'application de méthodologies métabolomique (RMN et LC-MS) pour l'analyse comparative (entre les différentes espèces, origines, organes), pour des études chimiotaxonomiques (entre les espèces) et pour la corrélation des composés contenus avec une activité pharmacologique
Medicinal plants constitute an unfailing source of compounds (natural products – NPs) utilised in medicine for the prevention and treatment of various deceases. The introduction of new technologies and methods in the field of natural products chemistry enabled the development of high throughput methodologies for the chemical composition determination of plant extracts, evaluation of their properties and the exploration of their potentials as drug candidates. Lately, metabolomics, an integrated approach incorporating the advantages of modern analytical technologies and the power of bioinformatics has been proven an efficient tool in systems biology. In particular, the application of metabolomics for the discovery of new bioactive compounds constitutes an emerging field in natural products chemistry. In this context, Acronychia genus of Rutaceae family was selected based on its well-known traditional use as antimicrobial, antipyretic, antispasmodic and anti-inflammatory therapeutic agent. Modern chromatographic, spectrometric and spectroscopic methods were utilised for the exploration of their metabolite content following three basic axes constituting the three chapters of this thesis. Briefly, the first chapter describes the phytochemical investigation of Acronychia pedunculata, the identification of secondary metabolites contained in this species and evaluation of their biological properties. The second chapter refers to the development of analytical methods for the identification of acetophenones (chemotaxonomic markers of the genus) and to the dereplication strategies for the chemical characterisation of extracts by UHPLC-HRMSn. The third chapter focuses on the application of metabolomic methodologies (LC-MS & NMR) for comparative analysis (between different species, origins, organs), chemotaxonomic studies (between species) and compound-activity correlations

Dans le but de valoriser la biodiversité végétale des Alpes-Maritimes, une plante commune dans cette région, Solidago virgaurea, a été sélectionnée pour son potentiel inhibiteur de la conversion levure-hyphe de Candida albicans, micro-organisme responsable d’infections bucco-dentaires de type candidose. Le fractionnement bioguidé de l’extrait aqueux a conduit à l’identification d’une famille de saponines particulièrement active. Parmi les onze saponines majoritaires caractérisées par RMN et HRMS, cinq se sont révélées être de nouvelles structures. Les tests biologiques ont néanmoins montré qu’elles n’étaient pas toutes actives contre la forme filamenteuse de C. albicans. Ces résultats ont conduit à une étude de la variabilité de la composition en saponines de plusieurs populations alpines de S. virgaurea. Trois méthodes de dosage des saponines ont été développées par HPLC et HPTLC. Les résultats ont démontré l'influence de différents facteurs sur la composition en saponines. Enfin, la composition globale de différents extraits de S. virgaurea a été étudiée dans le but d'identifier des activités biologiques complémentaires. Parmi les composés identifiés, trois nouveaux acides octulosoniques ont été caractérisés, aux côtés de trois composés phénoliques identifiés pour la première fois chez S. virgaurea. Les tests biologiques sur les extraits et fractions ont par ailleurs mis en évidence des activités antioxydante, anti-tyrosinase et inhibitrice de cellules cancéreuses in vitro. Ces tests devront être approfondis ultérieurement
Toward the promotion of plant diversity of Maritime Alps, a common plant of the alpine area, Solidago virgaurea, was chosen to its inhibiting activity of Candida albicans yeast-hyphal conversion, a causal agent of opportunistic oral infections named candidiasis. In a first step, an aqueous extract of S. virgaurea was submitted to bioassay guided fractionation. This led to an active saponin-containing fraction from which eleven saponins were characterized by carrying out NMR experiments along with HRMS analyses. Five out of these were identified for the first time and bioassays showed that saponins activity varied according to the molecular structure of the compound. In a second step, the saponins composition of various S. virgaurea populations was studied qualitatively and quantitatively, using HPLC and HPTLC. Results demonstrated that saponins composition depends on various factors. Finally, the overall chemical composition of different S. virgaurea extracts was investigated searching for additional bioactivities. Among all the identified compounds, three new octulosonic acids were characterized and three phenolic compounds were found for the first time in S. virgaurea. Moreover, bioassays on extracts and fractions showed antioxidant, anti-tyrosinase activity and inhibition of cancer cell lines in vitro. Further bioassays have now to be completed. As a conclusion, this work was the starting point of an oral care product development and the setting-up of an innovative sector

Background Prostate cancer (PCa) is the most frequently diagnosed malignant disease among adult males in the USA and the second leading cause of cancer deaths in men. Due to the lack of diagnostic tools that are able to differentiate highly malignant and aggressive cases from indolent tumors, overtreatment has become very common in the era of prostate specific antigen (PSA) screening. New diagnostic methods to determine biological status, malignancy, aggressiveness and extent of PCa are urgently needed. 1H High Resolution Magic Angle Spinning Nuclear Magnetic Resonance Spectroscopy (1H HRMAS MRS) can be used to establish PCa metabolomic profiles while preserving tissue architecture for subsequent histopathological analysis. Immunohistochemistry (IHC), as opposed to conventional histopathology methods, has the potential to provide objective, more accurate and quantitative knowledge of tissue pathology. This diagnostic- accuracy study sought to evaluate a novel approach to quantitatively identify metabolomic markers of PCa by exploring the potential of PCa immunomarkers to quantify metabolomic profiles established by 1H HRMAS MRS. Material and Methods 1H HRMAS MRS was performed on tissue samples of 51 prostate cancer patients using a 14.1 Tesla NMR spectrometer (BRUKER Biospin, Billerica, MA) with a rotor synchronized CPMG pulse sequence. Spectral intensities of 36 regions of interest were measured as integrals of curve fittings with Lorentzian-Gaussian line shapes. Immunohistochemistry (IHC) was carried out following the spectroscopy scan, using three prostate immunomarkers to identify cancerous and benign glands: P504S (Alpha-methylacyl-CoA-racemace), CK903 (high-molecular weight cytokeratin) and p63. The immunostaining quality following 1H HRMAS MRS was evaluated and compared to unscanned sections of the same sample, to verify the stability and accessibility of the proposed immunomarkers. IHC images were automatically and quantitatively evaluated, using a quantitative image analysis program (QIAP), to determine the percentage of cancerous and benign epithelia in the tissue cross- sections. The results of the program were validated by a correlation with the results of a quantitative IHC review and quantitative conventional histopathology analysis performed by an experienced pathologist. Ultimately, spectral intensities and the cancer epithelium percentage, obtained from quantitative immunohistochemistry, were correlated in order to validate PCa metabolomic markers identified by 1H HRMAS MRS. Patient outcomes and incidence of recurrence were determined by retrospective review of medical records five years after initial surgery. Categories of recurrence were correlated to spectral intensities to explore potential metabolomic markers of recurrence in the cohort. Results Immunostainings with P504S and CK903 showed excellent staining quality and accessibility following 1H HRMAS MRS, suggesting these markers to be suitable for the presented quantitative approach to determine metabolomics profiles of PCa. In contrast, the quality of p63 IHC was impaired after previously performed spectroscopy. IHC using the immunomarkers P504S and CK903 on adjacent slides was found to present a feasible quantitative diagnostic method to distinguish between benign and cancerous conditions in prostate tissue. The cancer epithelium percentage as determined by QIAP showed a significant correlation to the results of quantitative IHC analysis performed by a pathologist (p < 0.001), as well as to a quantitative conventional histopathology review (p = 0.001). The same was true for the benign epithelium percentage (p < 0.001 and p = 0.0183), validating the presented approach. Two metabolomic regions showed a significant correlation between relative spectral intensities and the cancer epithelium percentage as determined by QIAP: 3.22 ppm (p = 0.015) and 2.68 ppm (p = 0.0144). The metabolites corresponding to these regions, phosphocholine and citrate, could be identified as metabolomic markers of PCa in the present cohort. 45 patients were followed for more than 12 months. Of these, 97.8% were still alive five years after initial surgery. 11 patients (24.4%) experienced a recurrence during the follow- up time. The categories of recurrence showed a correlation to the spectral intensities of two regions, 2.33 – 2.3 ppm (p = 0.0403) and 1.28 ppm (p = 0.0144), corresponding to the metabolites phosphocreatine and lipids. Conclusion This study introduces a method that allows an observer-independent, quantitative analysis of IHC to help establish metabolomic profiles and identify metabolomic markers of PCa from spectral intensities obtained with 1H HRMAS NMR Spectroscopy. The immunomarkers P504S and CK903 have been found suitable IHC analysis following 1H HRMAS MRS. A prospective in vivo application of PCa metabolite profiles and metabolomic markers determined by the presented method could serve as highly sensitive, non- invasive diagnostic tool. This observer- independent, computer- automated, quantitative analysis could help to distinguish highly aggressive tumors from low-malignant conditions, avoid overtreatment and reduce risks and complications for cancer patients in the future. Further studies are needed to verify the identified PCa metabolomic markers and to establish clinical applicability.:Table of Contents Glossary 1 Introduction 1. 1 Prostate Cancer 1. 2 Detection of Prostate Cancer – State of the Art 1. 2. 1 Prostate- Specific Antigen Test and Digital Rectal Examination 1.2.2 Radiographic Methods in PCa Detection 1.2.3 Transrectal Core Biopsies and Histopathological Analysis 1.2.4 Histopathological Grading of Prostate Cancer: GLEASON Score 1.3 Challenges and Need for New Approaches in PCa Diagnostic Management 2 Scientific Background I: Nuclear Magnetic Resonance,1H HRMAS NMR Spectroscopy and Metabolomic Profiles 2.1 Nuclear Magnetic Resonance 2.1.1 Spin Precession 2.1.2 Magnetic Resonance 2.1.3 Chemical Shift and J- coupling 2.2 Nuclear Magnetic Resonance 2.2.1 Magic Angle Spinning and 1H HRMAS NMR Spectroscopy 2.2.2 MAS Spinning Rates and Spinning Side Bands 2. 3 Metabolomics, Metabolite Profiles and Clinical Utility 3 Scientific Background II: Immunohistochemistry of Prostate Cancer 4 Aims of the Study 5 Material and Methods 5.1 Prostate Tissue Samples and Patient Demographics 5.2 1H HRMAS NMR Spectroscopy 5.2.1 Sample Preparation 5.2.2 Spectroscopy Scan 5.2.3 Data Processing 5.3 Immunohistochemistry 5.3.1 Immunohistochemistry Material and Equipment 5.3.2. Immunohistochemistry Protocol 5. 3. 3 Prostate Immunomarker Stability after 1H HRMAS NMR Spectroscopy 5.3.4 Qualitative IHC Analysis 5. 3.5 Quantitative IHC Analysis 5.3.5.1 Quantitative IHC Slide Review 5.3.5.2 Computer-Automated Quantitative IHC Analysis 5.3 Quantitative Histopathology 5. 4 Identification of Prostate Cancer Metabolomic Markers 5. 5 Patient Outcomes and Recurrence Categories 5.6 Statistical Analysis 6 Results 6. 1 Patient demographics 6. 2 Spectroscopy Results 6. 3 Immunohistochemistry 6. 3. 1 Evaluation of Prostate Immunomarker Stability after 1H HRMAS MRS 6. 3. 2 Qualitative Immunohistochemistry 6. 4 Quantitative Immunohistochemistry 6. 4. 1 Quantitative IHC Slide Review 6. 4. 2 Computer-Automated Quantitative IHC Evaluation using QIAP 6. 5 Quantitative Histopathology 6. 6 Identification of Prostate Cancer Metabolomic Markers using QIAP 6. 7 Patient Outcomes and Recurrence 7 Discussion 8 Summary / Abstract 9 Zusammenfassung 10 References 11 Erklärung über die eigenständige Abfassung der Arbeit 12 Danksagung 13 Lebenslauf und Publikationsverzeichnis Appendix A.1 Immunostaining protocols A.2 Spectral Intensities Measured by 1H HRMAS MRS in 51 Samples A.3 Graphs for Correlations of Spectral Intensities and CaE% determined by QIAP in 34 Additional Regions of Interest
Einführung Prostatakrebs ist eine häufigsten Krebserkrankungen in den USA und die zweithäufigste malignom- assoziierte Todesursache männlicher Patienten weltweit. Seit der Einführung des Prostata- spezifischen Antigen (PSA)- Screeningtests wird diese Krebsart in früheren Stadien diagnostiziert und therapiert, wodurch die Mortalitätsrate in den letzten Jahren deutlich reduziert werden konnte. Da moderne diagnostische Methoden bislang jedoch nicht ausreichend in der Lage sind, suffizient zwischen hochmalignen und weniger aggressiven Varianten dieses bösartigen Krebsleidens zu unterscheiden, werden häufig auch Patienten aggressiv therapiert, deren niedriggradiges Prostatakarzinom keine klinische Relevanz gehabt hätte. Es besteht daher ein großes wissenschaftliches Interesse an der Entwicklung neuer diagnostischer Methoden zur akkuraten Bestimmung von biologischem Status, Malignität, Aggressivität und Ausmaß einer Prostatakrebserkrankung. \\\\\\\"1H High Resolution Magic Angle Spinning Nuclear Magnetic Resonance Spectroscopy\\\\\\\" (1H HRMAS MRS) ist eine vielversprechende diagnostische Methode, welche es ermöglicht, metabolomische Profile von Prostatakrebs zu erstellen, ohne die Gewebsstruktur der analysierten Proben zu zerstören. Durch anschließende histopathologische Begutachtung lassen sich die erstellten Metabolitprofile validieren und evaluieren. Im Gegensatz zu konventionellen histopathologischen Methoden können durch immunhistochemische Verfahren dabei objektivere, akkuratere und quantifizierbare histopathologische Erkenntnisse gewonnen werden. Die vorliegende Studie präsentiert einen neuentwickelten diagnostischen Ansatz zur quantitativen Bestimmung von metabolomischen Markern von Prostatakrebs, basierend auf der Durchführung von 1H HRMAS NMR Spektroskopie und quantitativer Immunhistochemie. Material und Methoden Einundfünfzig Gewebsproben von Prostatakrebspatienten wurden mittels 1H HRMAS MRS an einem 14.1 T BRUKER NMR Spektrometer unter Einsatz einer CPMG-Pulssequenz untersucht. Spektrale Intensitäten in 36 Metabolitregionen wurden gemessen. Anschließend wurden die analysierten Gewebeproben mit drei Immunfärbemarkern für sowohl malignes (P504S, Alpha-methylacyl-CoA-racemase) als auch benignes (CK903, High-molecular weight cytokeratin, und p63) Prostatagewebe angefärbt und quantitativ mit Hilfe eines Bildanalyseprogramms (QIAP) ausgewertet. Die Anwendbarkeit und Auswertbarkeit der genannten Immunomarker nach Spektroskopie wurde evaluiert und mit der Färbungsqualität von nicht- gescannten Schnitten verglichen. Die Resultate der automatischen Auswertung durch QIAP konnten durch einen erfahrenen Pathologen in einer quantitativen Analyse der Immunfärbungen sowie konventioneller histologischer Färbungen derselben Gewebsproben validiert werden. Die spektralen Intensitäten aus den Messungen mit 1H HRMAS MRS wurden mit den korrespondierenden Ergebnissen der quantitativen Auswertung der Immunfärbungen korreliert, um metabolomische Marker von Prostatakrebs zu identifizieren. Der klinische Verlauf und die Rezidivrate der Patienten wurden 5 Jahre nach der initialen Prostatektomie retrospektiv bestimmt. Rezidivkategorien wurden erstellt und mit den bestimmten spektralen Intensitäten korreliert, um metabolomische Marker für das Auftreten von Prostatakrebsrezidiven zu identifizieren. Ergebnisse Die Immunfärbungen mit P504S und CK903 zeigten exzellente Qualität und Auswertbarkeit nach vorheriger 1H HRMAS MRS. Beide Marker eigneten sich zur Durchführung von quantitativer Immunhistochemie an spektroskopierten Gewebeproben. Im Gegensatz dazu war die Qualität der Immunfärbungen mit p63 nach Spektroskopie vermindert. Quantitative Immunfärbungen unter Einsatz der Immunmarker P504S und CK903 stellten eine praktikable diagnostische Methode dar, um zwischen malignen und benignem Prostatagewebe zu unterscheiden. Der Anteil von bösartig verändertem Prostatagewebe, bestimmt durch QIAP, korrelierte signifikant mit den Ergebnissen der quantitativen Analyse der Immunfärbungen durch den Pathologen (p < 0.001), sowie mit der quantitativen Auswertung der konventionellen histopathologischen Färbung (p = 0.001). Ebenso ließ sich die Bestimmung des Anteils von benignem Gewebe mit QIAP zu den Ergebnissen der pathologischen Analyse korrelieren (p < 0.001 und p = 0.0183). Für zwei metabolomische Regionen konnte ein signifikante Korrelation zwischen relativen spektralen Intensitäten, bestimmt mit 1H HRMAS NMR Spektroskopie, und dem Anteil von malignem Epithelium in derselben Gewebeprobe, ermittelt durch QIAP, festgestellt werden: 3.22 ppm (p = 0.015) und 2.68 ppm (p = 0.0144). Die zu diesen Regionen korrespondierenden Metaboliten, Phosphocholin und Zitrat, konnten als potentielle metabolomische Marker für Prostatakrebs identifiziert werden. Die retrospektiven Analyse der klinischen Daten der Patienten fünf Jahre nach Prostatektomie ergab eine Überlebensrate von 97.8%. Elf dieser Patienten (24.4%) erlitten ein Rezidiv ihrer Erkrankung. Die bestimmten Rezidivkategorien korrelierten signifikant mit zwei metabolomischen Regionen (2.33 – 2.3 ppm, p = 0.0403 und 1.28 ppm, p = 0.0144), welche zu den Metaboliten Phosphokreatin und Lipiden korrespondierten. Schlussfolgerung Die vorliegende Studie präsentiert einen diagnostischen Ansatz zur objektiven und quantitativen Bestimmung metabolomischer Marker von Prostatakrebs unter Verwendung von 1H HRMAS MRS und Immunhistochemie. P504S und CK903 eignen sich als Immunmarker für quantitative Immunfärbungen nach vorheriger Durchführung von 1H HRMAS MRS. Die Metaboliten Phosphocholin und Zitrat konnten in der vorliegenden Patientenkohorte als potentielle metabolomische Marker für Prostatakrebs identifiziert werden. Eine mögliche in vivo Anwendung der gefundenen metabolomischen Marker könnte als hochsensitives, objektives und nicht- invasives diagnostisches Werkzeug der Prostatakrebsdiagnostik dienen. Der vorliegende untersucherunabhängige, automatisierte und quantitative diagnostischer Ansatz hat das Potential, zwischen hochmalignen und weniger aggressiven Krebsfällen zu unterscheiden und somit unnötige Risiken und Komplikationen für Prostatakrebspatienten zu reduzieren. Weitere Untersuchungen sind notwendig, um die identifizierten metabolomischen Marker zu verifizieren und eine klinische Anwendung zu etablieren.:Table of Contents Glossary 1 Introduction 1. 1 Prostate Cancer 1. 2 Detection of Prostate Cancer – State of the Art 1. 2. 1 Prostate- Specific Antigen Test and Digital Rectal Examination 1.2.2 Radiographic Methods in PCa Detection 1.2.3 Transrectal Core Biopsies and Histopathological Analysis 1.2.4 Histopathological Grading of Prostate Cancer: GLEASON Score 1.3 Challenges and Need for New Approaches in PCa Diagnostic Management 2 Scientific Background I: Nuclear Magnetic Resonance,1H HRMAS NMR Spectroscopy and Metabolomic Profiles 2.1 Nuclear Magnetic Resonance 2.1.1 Spin Precession 2.1.2 Magnetic Resonance 2.1.3 Chemical Shift and J- coupling 2.2 Nuclear Magnetic Resonance 2.2.1 Magic Angle Spinning and 1H HRMAS NMR Spectroscopy 2.2.2 MAS Spinning Rates and Spinning Side Bands 2. 3 Metabolomics, Metabolite Profiles and Clinical Utility 3 Scientific Background II: Immunohistochemistry of Prostate Cancer 4 Aims of the Study 5 Material and Methods 5.1 Prostate Tissue Samples and Patient Demographics 5.2 1H HRMAS NMR Spectroscopy 5.2.1 Sample Preparation 5.2.2 Spectroscopy Scan 5.2.3 Data Processing 5.3 Immunohistochemistry 5.3.1 Immunohistochemistry Material and Equipment 5.3.2. Immunohistochemistry Protocol 5. 3. 3 Prostate Immunomarker Stability after 1H HRMAS NMR Spectroscopy 5.3.4 Qualitative IHC Analysis 5. 3.5 Quantitative IHC Analysis 5.3.5.1 Quantitative IHC Slide Review 5.3.5.2 Computer-Automated Quantitative IHC Analysis 5.3 Quantitative Histopathology 5. 4 Identification of Prostate Cancer Metabolomic Markers 5. 5 Patient Outcomes and Recurrence Categories 5.6 Statistical Analysis 6 Results 6. 1 Patient demographics 6. 2 Spectroscopy Results 6. 3 Immunohistochemistry 6. 3. 1 Evaluation of Prostate Immunomarker Stability after 1H HRMAS MRS 6. 3. 2 Qualitative Immunohistochemistry 6. 4 Quantitative Immunohistochemistry 6. 4. 1 Quantitative IHC Slide Review 6. 4. 2 Computer-Automated Quantitative IHC Evaluation using QIAP 6. 5 Quantitative Histopathology 6. 6 Identification of Prostate Cancer Metabolomic Markers using QIAP 6. 7 Patient Outcomes and Recurrence 7 Discussion 8 Summary / Abstract 9 Zusammenfassung 10 References 11 Erklärung über die eigenständige Abfassung der Arbeit 12 Danksagung 13 Lebenslauf und Publikationsverzeichnis Appendix A.1 Immunostaining protocols A.2 Spectral Intensities Measured by 1H HRMAS MRS in 51 Samples A.3 Graphs for Correlations of Spectral Intensities and CaE% determined by QIAP in 34 Additional Regions of Interest