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Characterizing cells resistant to treatments is a major issue in research on breast cancer (BC). Tumor plasticity characterized by cancer stem cells (CSCs) existence and processes of epithelial-mesenchymal transition (EMT), leads to tumor heterogeneity and takes part in the genesis of cancer cells harboring specific tumorigenic and cell death resistance properties. In BC, the lack of expression of the membrane protein CD24 is a feature of CSCs and EMT-generated cells. Although being a crucial marker in BC, CD24 precise functions along oncogenesis and its role in treatment resistance remain largely unknown. This thesis work focuses mainly on CD24 role as a player in treatment resistance of BC. In the first part of my work, we have shown that forced extinction of CD24 in mammary epithelial cancer cells is sufficient to increase resistance to radiations and diverse drugs. This resistance is linked to the ROS level modulation. Indeed, the loss of CD24 expression drives a decrease in mitochondrial mass and functions, leading to a disminished intracellular ROS level, which participates in radio- and chemoresistance of BC cells. Moreover, our results show that CD24- cells express mainly epithelial markers, but also show an increase of mesenchymal markers and aldehyde dehydrogenase activity. In the litterature, these features define cells with a hybrid E/M phenotype, and considered, since they exhibit strong stem characteristics, as the most plastic and tumorigenic cells. In the second part of my work, we initiated a transcriptome study to better understand CD24 role in tumor progression and treatment resistance. The first results indicate that the loss of CD24 could be linked to a higher motility of cells. Those results are of utmost importance since the development of such a model of hybrid E/M cells can facilitate the discovery of new targets to fight against treatment failure.; La caractérisation de cellules résistantes aux traitements à l’origine des récidives et rechutes est un enjeu majeur de la recherche contre les cancers du sein. La plasticité tumorale, caractérisée par l’existence des cellules souches cancéreuses (CSC) et des processus de transition épithélio-mésenchymateuse (TEM), est à l’origine de l’hétérogénéité intratumorale et participe à la formation de cellules cancéreuses aux propriétés de tumorogénicité et de résistance à la mort cellulaire singulières. Dans les cancers du sein, l’absence d’expression de la protéine membranaire CD24 caractérise les CSCs et les cellules générées par la TEM. Malgré le fait que CD24 soit un marqueur important des cancers du sein, ses fonctions précises au cours de la cancérogenèse ainsi que son éventuel rôle dans la résistance aux traitements, restent très mal définis.Ce travail de thèse s’intéresse particulièrement au rôle de la protéine CD24 dans les cancers du sein en tant qu’acteur de la résistance thérapeutique. Dans la première partie de mon travail, nous avons montré que la perte artificielle de l’expression de CD24 dans les cellules cancéreuses épithéliales mammaires entraîne à elle seule une augmentation de la résistance à aux radiations et à différentes drogues anticancéreuses. Cette résistance apparait associée à la modulation du niveau d’espèces réactives de l’oxygène (ROS). En effet, la perte d’expression de CD24 entraîne une diminution de la masse et des fonctions mitochondriales à l’origine d’une baisse du niveau de ROS intracellulaire ce qui participe à la radio- et chimiorésistance des cellules. De plus, nos résultats montrent que les cellules CD24- expriment majoritairement des marqueurs épithéliaux (E) tout en présentant une augmentation de l’expression des marqueurs mésenchymateux (M) ainsi que de l’activité aldéhyde déshydrogénase (ALDH). Dans la littérature, ces caractéristiques définissent des cellules de phénotype hybride E/M qui sont considérées comme les cellules les plus plastiques et tumorigènes car fortement enrichies en propriétés souches. Dans la deuxième partie de mon travail, nous avons initié une étude transcriptomique afin de mieux comprendre le rôle de CD24 dans la progression tumorale et la résistance aux traitements. Les premiers résultats obtenus indiquent que la perte de CD24 semble liée à l’acquisition de propriétés migratoires. L’ensemble de ces résultats sont d’autant plus importants que le développement d’un modèle de cellules hybrides E/M permet d’étudier de nouvelles cibles pour lutter contre l’échec thérapeutique.

Background: Given the increased use and diversity of diagnostic procedures, it is important to understand genetic susceptibility to radiation-induced thyroid cancer. Methods: On the basis of self-declared diagnostic radiology examination records in addition to existing literature, we estimated the radiation dose delivered to the thyroid gland from diagnostic procedures during childhood and adulthood in two case–control studies conducted in France. A total of 1,071 differentiated thyroid cancer (DTC) cases and 1,188 controls from the combined studies were genotyped using a custom-made Illumina OncoArray DNA chip. We focused our analysis on variants in genes involved in DNA damage response and repair pathways, representing a total of 5,817 SNPs in 571 genes. We estimated the OR per milli-Gray (OR/mGy) of the radiation dose delivered to the thyroid gland using conditional logistic regression. We then used an unconditional logistic regression model to assess the association between DNA repair gene variants and DTC risk. We performed a meta-analysis of the two studies. Results: The OR/mGy was 1.02 (95% confidence interval, 1.00–1.03). We found significant associations between DTC and rs7164173 in CHD2 (P = 5.79 × 10−5), rs6067822 in NFATc2 (P = 9.26 × 10−5), rs1059394 and rs699517 both in ENOSF1/THYS, rs12702628 in RPA3, and an interaction between rs7068306 in MGMT and thyroid radiation doses (P = 3.40 × 10−4). Conclusions: Our results suggest a role for variants in CDH2, NFATc2, ENOSF1/THYS, RPA3, and MGMT in DTC risk. Impact: CDH2, NFATc2, ENOSF1/THYS, and RPA3 have not previously been shown to be associated with DTC risk.

International audience; Abstract: High‐Z metallic nanoparticles (NPs) are new players in the therapeutic arsenal againstcancer, especially radioresistant cells. Indeed, the presence of these NPs inside malignant cells isbelieved to enhance the effect of ionizing radiation by locally increasing the dose deposition. In thiscontext, the potential of platinum nanoparticles (PtNPs) as radiosensitizers was investigated in twobreast cancer cell lines, T47D and MDA‐MB‐231, showing a different radiation sensitivity. PtNPswere internalized in the two cell lines and localized in lysosomes and multivesicular bodies. Anal‐yses of cell responses in terms of clonogenicity, survival, mortality, cell‐cycle distribution, oxidativestress, and DNA double‐strand breaks did not reveal any significant enhancement effect when cellswere pre‐exposed to PtNPs before being irradiated, as compared to radiation alone. This result isdifferent from that reported in a previous study performed, under the same conditions, on cervicalcancer HeLa cells. This shows that the efficacy of radio‐enhancement is strongly cell‐type‐depend‐ent. Simulation of the early stage ionization processes, taking into account the irradiation character‐istics and realistic physical parameters in the biological sample, indicated that PtNPs could weaklyincrease the dose deposition (by 3%) in the immediate vicinity of the nanoparticles. Some featuresthat are potentially responsible for the biological effect could not be taken into account in the simu‐lation. Thus, chemical and biological effects could explain this discrepancy. Forinstance, we showedthat, in these breast cancer cell lines, PtNPs exhibited ambivalent redox properties, with an antiox‐idant potential which could counteract the radio‐enhancement effect. This work shows that the ef‐ficacy of PtNPs for enhancing radiation effects is strongly cell‐dependent and that no effect is ob‐served in the case of the breast cancer cell lines T47D and MDA‐MB‐231. Thus, more extensive ex‐periments using other relevant biological models are needed in order to evaluate such combinedstrategies, since several clinical trials have already demonstrated the success of combiningnanoagents with radiotherapy in the treatment of a range of tumor types

The use of high-Z nanoparticles to enhance radiotherapy effects has gained momentum over the last decade. Historically, as nanoparticles increase tumor density, they were thought to improve radiation dose by locally increasing the probability of interactions with ionizing radiations. Local dose enhancement is then associated with increased oxidative stress and DNA damage. Therefore, radiosensitization with nanoparticles could impair radioresistance as well as improve therapeutic index. Radiotherapy is a cornerstone of breast cancer treatment. However, mammary tumors are heterogeneous and comprise distinct populations of cancer cells that respond differently to treatments. Cancer stem cells (CSC) and epithelial to mesenchymal transition (EMT) are major factors contributing to cancer cells plasticity, tumor heterogeneity, and escape from programmed cell death (apoptosis). In breast cancer, both CSC and cells undergoing EMT are characterized by the expression of two surface markers CD24 and CD44 (CD24-/low, CD44 high). This work aims to evaluate the efficiency of high-Z nanoparticles of different nature (gold, platinum), different size (from 5 to 35 nm) and different surface charge (positive and negative) as potent radiosensitizer on several breast cancer models of different epithelial or mesenchymal state. As no significant change could initially be observed in vitro following the combination of nanoparticles with radiation compared to radiation alone, I gain insight on the influence of physical, chemical and biological parameters required for characterizing radio-enhancement. Among them, I focused on improving the diffusion of nanoparticles and their internalization in tumor cells. I showed that nanoparticles uptake by breast cancer cells was depending on their mesenchymal state: nanoparticle internalization by cancer cells is dramatically increased in mesenchymal-like cancer cells compared to epithelial-like cells across a panel of several breast cancer cell lines. Importantly this discrepancy was not affected by the charge, size or surface chemistry of the nanoparticles themselves. This strongly suggests a cell-dependent mechanism, in opposition to the current paradigm that nanoparticles uptake is mainly governed by their inherent physical/chemical properties. This study emphasized the importance of membrane and extracellular structures in nanoparticle recognition and preferential interaction with cells. Our results are of peculiar interests as the identification of genes or mechanisms facilitating nanoparticles accumulation into radioresistant cancer cells could further conception of promising therapeutic nanoparticles.; L’utilisation de nanoparticules de haut numéro atomique pour potentialiser les effets de la radiothérapie fait l’objet de nombreux travaux de recherches. Historiquement, l’intérêt porté à ces nanoparticules repose sur un principe d’action physique : en densifiant la matière, les nanoparticules localisées dans une tumeur augmentent localement la probabilité d’interaction des rayonnements ionisants avec celle-ci. L’augmentation de la dose délivrée localement serait alors associée à un stress oxydatif et à une augmentation des lésions de l’ADN. Ainsi la radio-sensibilisation liée aux nanoparticules permettrait d’une part de lutter contre la radio-résistance et d’autre part d’améliorer l’index thérapeutique. La radiothérapie constitue l’un des piliers du traitement du cancer du sein. Néanmoins, les tumeurs mammaires sont hétérogènes et plusieurs sous populations coexistent avec des sensibilités différentes aux traitements. Les cellules souches cancéreuses (CSC) et le processus de transition épithélio-mésenchymateuses (TEM) contribuent principalement à cette hétérogénéité et confèrent aux cellules tumorales des propriétés de plasticité, de tumorogénicité et de résistance à la mort cellulaire. Dans le cas particulier du cancer du sein, les cellules issues de la TEM et les cellules souches cancéreuses partagent un même phénotype surfacique caractérisé par la perte d’expression de la protéine membranaire CD24 et la surexpression de CD44. Ce travail de thèse vise à évaluer l’efficacité de nanoparticules métalliques de nature (or, platine), de taille (5 à 35 nm) et de charges (positives, négatives) différentes comme agents potentialisateurs des effets de l’irradiation sur des modèles de tumeurs mammaires aux statuts épithélio-mésenchymateux différents. Face à la difficulté à mettre en évidence un effet biologique significatif du double traitement in vitro, j’ai cherché à comprendre quels paramètres physiques, chimiques et biologiques sont nécessaires pour observer l’effet radiosensibilisant. L’un des principaux enjeux a été de parvenir à une bonne diffusion des nanoparticules au sein des tumeurs. Pour comprendre les mécanismes, nous avons comparé la réponse transcriptomique de cellules cancéreuses mammaires, au fond génétique commun mais de phénotype épithélial ou mésenchymateux (triées selon leur niveau d’expression CD24/CD44), exposées à un groupe de nanoparticules de composition physico-chimique différente de manière à s’affranchir d’un l’effet qui serait spécifique à une nanoparticule. L’analyse du transcriptome souligne l’importance des structures membranaires et extracellulaires dans la reconnaissance et l’interaction préférentielle des nanoparticules avec les cellules mésenchymateuses. Ces résultats sont d’autant plus importants que l’identification de gènes et de mécanismes clés favorisant l’accumulation de nanoparticules dans les cellules cancéreuses les plus résistantes aux traitements devrait permettre d’améliorer la conception de nouvelles nanoparticules à haut potentiel thérapeutique.

The only demonstrated etiologic factor for thyroid cancer is an exposure to ionizing radiation (IR) during childhood. Epidemiological studies can measure a significant risk to develop a cancer following thyroid doses above 50 mGy. This risk is observed after external exposure to high doses/dose rates (radiotherapy) and after contamination of iodine radioisotopes at lower doses.As the risk decreases with the dose, if radiation-induced cancers (R) develop after thyroid doses, Le seul facteur étiologique démontré pour le cancer de la thyroïde est une exposition aux radiations ionisantes (RI) durant l’enfance. Les études épidémiologiques mesurent un risque significatif de développer un cancer suite à l’exposition pour une dose reçue à la thyroïde d’au minimum 50 mGy, le risque étant proportionnel à la dose. Ce risque est observé après une exposition externe à fortes doses/débits de dose (radiothérapie) et après une contamination à de plus faibles doses de radioisotopes de l’iode. Si des cancers radio-induits (R) se développent à des doses

International audience; Chlordecone (Kepone®) and γ-hexachlorocyclohexane (γ-HCH or lindane) have been used for decades in the French West Indies (FWI) resulting in long-term soil and water pollution. In a previous work, we have identified a new Citrobacter species (sp.86) that is able to transform chlordecone into numerous products under anaerobic conditions. No homologs to known reductive dehalogenases or other candidate genes were found in the genome sequence of Citrobacter sp.86. However, a complete anaerobic pathway for cobalamin biosynthesis was identified. In this study, we investigated whether cobalamin or intermediates of cobalamin biosynthesis was required for chlordecone microbiological transformation. For this purpose, we constructed a set of four Citrobacter sp.86 mutant strains defective in several genes belonging to the anaerobic cobalamin biosynthesis pathway. We monitored chlordecone and its transformation products (TPs) during long-term incubation in liquid cultures under anaerobic conditions. Chlordecone TPs were detected in the case of cobalamin-producing Citrobacter sp.86 wild-type strain but also in the case of mutants able to produce corrinoids devoid of lower ligand. In contrast, mutants unable to insert the cobalt atom in precorrin-2 did not induce any transformation of chlordecone. In addition, it was found that lindane, previously shown to be anaerobically transformed by Citrobacter freundii without evidence of a mechanism, was also degraded in the presence of the wild-type strain of Citrobacter sp.86. The lindane degradation abilities of the various Citrobacter sp.86 mutant strains paralleled chlordecone transformation. The present study shows the involvement of cobalt-containing corrinoids in the microbial degradation of chlorinated compounds with different chemical structures. Their increased production in contaminated environments could accelerate the decontamination processes.

International audience; Failure of conventional antitumor therapy is commonly associated with cancer stem cells (CSCs), which are often defined as inherently resistant to radiation and chemotherapeutic agents. However, controversy about the mechanisms involved in the radiation response remains and the inherent intrinsic radioresistance of CSCs has also been questioned. These discrepancies observed in the literature are strongly associated with the cell models used. In order to clarify these contradictory observations, we studied the radiosensitivity of breast CSCs using purified CD24−/low/CD44+ CSCs and their corresponding CD24+/CD44low non-stem cells. These cells were generated after induction of the epithelial-mesenchymal transition (EMT) by transforming growth factor β (TGFβ) in immortalized human mammary epithelial cells (HMLE). Consequently, these 2 cellular subpopulations have an identical genetic background, their differences being related exclusively to TGFβ-induced cell reprogramming. We showed that mesenchymal CD24−/low/CD44+ CSCs are more resistant to radiation compared with CD24+/CD44low parental cells. Cell cycle distribution and free radical scavengers, but not DNA repair efficiency, appeared to be intrinsic determinants of cellular radiosensitivity. Finally, for the first time, we showed that reduced radiation-induced activation of the death receptor pathways (FasL, TRAIL and TNF-α) at the transcriptional level was a key causal event in the radioresistance of CD24−/low/CD44+ cells acquired during EMT.

The first study establishing exposure to ionizing radiations (IRs) as a risk factor for differentiated thyroid cancer (DTC) was published 70 years ago. Given that radiation exposure causes direct DNA damage, genetic alterations in the different DNA repair mechanisms are assumed to play an important role in long-term IR-induced DNA damage prevention. Individual variations in DNA repair capacity may cause different reactions to damage made by IR exposure. The aim of this review is to recapitulate current knowledge about constitutional genetic polymorphisms found to be significantly associated with DTC occurring after IR exposure. Studies were screened online using electronic databases – only fully available articles, and studies performed among irradiated population or taking radiation exposure as adjustment factors and showing significant results are included. Nine articles were identified. Ten variants in/near to genes in six biological pathways, namely thyroid activity regulations, generic transcription, RET signaling, ATM signaling and DNA repair pathways were found to be associated with radiation-related DTC in these studies. Only seven variants were found to be in interaction with IR exposure in DTC risk. Most of these variants are also associated to sporadic DTC and are not specific to IR-related DTC. In the published studies, no data on children treated with radiotherapy is described. In conclusion, more studies carried out on larger cohorts or on case–control studies with well-documented individual radiation dose estimations are needed to get a comprehensive picture of genetic susceptibility factors involved in radiation-related DTC.

International audience; It is generally accepted that carcinogenesis and aging are two biological processes, which are known to be associated. Notably, the frequency of certain cancers (including lung cancer), increases significantly with the age of patients and there is now a wealth of data showing that multiple mechanisms leading to malignant transformation and to aging are interconnected, defining the so-called common biology of aging and cancer. OncoAge, a consortium launched in 2015, brings together the multidisciplinary expertise of leading public hospital services and academic laboratories to foster the transfer of scientific knowledge rapidly acquired in the fields of cancer biology and aging into innovative medical practice and silver economy development. This is achieved through the development of shared technical platforms (for research on genome stability, (epi)genetics, biobanking, immunology, metabolism, and artificial intelligence), clinical research projects, clinical trials, and education. OncoAge focuses mainly on two pilot pathologies, which benefit from the expertise of several members, namely lung and head and neck cancers. This review outlines the broad strategic directions and key advances of OncoAge and summarizes some of the issues faced by this consortium, as well as the short-and long-term perspectives.

a Cardiology Department, European Society of Hypertension Excellence Center, Hopital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France b Cardiology Department, Hopital Nord-Ouest, F-69400 Villefranche-sur-Saone, France c Radiology Department, Hopital de la Croix-Rousse, Hospices Civils de Lyon, F-69004 Lyon, France d Universite de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Universite Claude Bernard Lyon 1; Hospices Civils de Lyon, France

International audience; Gold nanoparticles (AuNPs) are increasingly studied for cancer treatment purposes, as they can potentially improve both control and efficiency of the treatment. Intensive research is conducted in vitro on rodent and human cell lines to objectify the gain of combining AuNPs with cancer treatment and to understand their mechanisms of action. However, using nanoparticles in such studies requires thorough knowledge of their cellular uptake. In this study, we optimized single particle ICPMS (sp-ICPMS) analysis to qualify and quantify intracellular AuNP content after exposure of in vitro human breast cancer cell lines. To this aim, cells were treated with an alkaline digestion method with 5% TMAH, allowing the detection of gold with a yield of 97% on average. Results showed that under our experimental conditions, the AuNP size distribution appeared to be unchanged after internalization and that the uptake of particles depended on the cell line and on the exposure duration. Finally, the comparison of the particle numbers per cell with the estimates based on the gold masses showed excellent agreement, confirming the validity of the sp-ICPMS particle measurements in such complex samples.

To enhance the efficiency of radiotherapy, a promising strategy consists in tumor exposure simultaneously to ionizing radiation (IR) and gold nanoparticles (GNPs). Indeed, when exposed to the radiation beam, these GNPs exhibit a photoelectric effect that generates reactive oxygen species (ROS) within the tumor and enhances the direct IR related deleterious effects. The measurement of this photoelectric effect thanks to an additional detector could give new insight for in vivo quantification and distribution of the GNPs in the tumor and more importantly for measuring the precise dose deposition. As a first step towards such a challenge, we present here materials and methods designed for detecting and measuring very low concentrations of GNPs in solution and for performing 3D reconstruction of small gold objects whose size is representative with respect to the considered application. A matrix image detector, whose sensitivity is first validated through the detection of few hundreds of micrograms of GNPs, is combined with a pinhole element and moved along a limited circular trajectory to acquire 2D fluorescence images of a motionless object. We implement a direct back-projection algorithm that provides a 3D image of these objects from this sparse set of data.

International audience; Gold nanoparticles (AuNPs) are increasingly studied for cancer treatment purposes, as they can potentially improve both control and efficiency of the treatment. Intensive research is conducted in vitro on rodent and human cell lines to objectify the gain of combining AuNPs with cancer treatment and to understand their mechanisms of action. However, using nanoparticles in such studies requires thorough knowledge of their cellular uptake. In this study, we optimized single particle ICPMS (sp-ICPMS) analysis to qualify and quantify intracellular AuNP content after exposure of in vitro human breast cancer cell lines. To this aim, cells were treated with an alkaline digestion method with 5% TMAH, allowing the detection of gold with a yield of 97% on average. Results showed that under our experimental conditions, the AuNP size distribution appeared to be unchanged after internalization and that the uptake of particles depended on the cell line and on the exposure duration. Finally, the comparison of the particle numbers per cell with the estimates based on the gold masses showed excellent agreement, confirming the validity of the sp-ICPMS particle measurements in such complex samples.

Nanodiamonds (NDs) are promising nanomaterials for biomedical applications. However, a few studies highlighted an in vitro genotoxic activity for detonation NDs, which was not evidenced in one of our previous work quantifying γ-H2Ax after 20 and 100 nm high-pressure high-temperature ND exposures of several cell lines. To confirm these results, in the present work, we investigated the genotoxicity of the same 20 and 100 nm NDs and added intermediate-sized NDs of 50 nm. Conventional in vitro genotoxicity tests were used, i.e., the in vitro micronucleus and comet assays that are recommended by the French National Agency for Medicines and Health Products Safety for the toxicological evaluation of nanomedicines. In vitro micronucleus and in vitro comet assays (standard and hOGG1-modified) were therefore performed in two human cell lines, the bronchial epithelial 16HBE14o- cells and the colon carcinoma T84 cells. Our results did not show any genotoxic activity, whatever the test, the cell line or the size of carboxylated NDs. Even though these in vitro results should be confirmed in vivo, they reinforce the potential interest of carboxylated NDs for biomedical applications or even as a negative reference nanoparticle in nanotoxicology. Copyright © 2017 John WileySons, Ltd.

International audience; Secreted proteins play a key role in cell signaling and communication. We recently showed that ionizing radiations induced a delayed cell death of breast cancer cells, mediated by the death receptor pathways through the expression of soluble forms of death ligands. Using the same cell model, the objective of our work was the identification of diffusible factors, secreted following cell irradiation, potentially involved in cell death signaling. Differential proteomic analysis of conditioned media using 2DE resulted in detection of numerous spots that were significantly modulated following cell irradiation. The corresponding proteins were identified using MALDI-TOF MS and LC-MS/MS approaches. Interestingly, five isoforms of cyclophilin A were observed as increased in conditioned medium of irradiated cells. These isoforms differed in isoelectric points and in accumulation levels. An increase of cyclophilin A secretion was confirmed by Western blotting of conditioned media of irradiated or radiosentive mammary cells. These isoforms displayed an interesting pattern of protein maturation and post-translational modifications, including an alternating removal of N-terminal methionine, associated with a combination of acetylations and methylations. The role of the protein is discussed in relation with its potential involvement in the mechanisms of intercells relationships and radiosensitivity.

The association between ionizing radiation and the subsequent development of osteosarcoma has been well described, but little is known about the cytogenetic and molecular events, which could be involved in the formation of radiation-induced osteosarcomas. Here, we performed comparative genomic hybridization (CGH) to detect chromosomal copy number changes in a series of 16 rat osteosarcomas induced by injection of plutonium-238. Recurrent gains/amplifications were observed at chromosomal regions 3p12-q12, 3q41-qter, 4q41-qter, 6q12-q16, 7q22-q34, 8q11-q23, 9q11-q22, 10q32.1-qter, and 12q, whereas recurrent losses were observed at 1p, 1q, 3q23-q35, 5q21-q33, 8q24-q31, 10q22-q25, 15p, 15q, and 18q. The gained region at 7q22-q34 was homologous to human chromosome bands 12q13-q15/8q24/22q11-q13, including the loci of Mdm2, Cdk4, c-Myc and Pdgf-b genes. The lost regions at 5q21-q33, 10q22-q25 and 15q contained tumor suppressor genes such as p16INK4a/p19ARF, Tp53 and Rb1. To identify potential target gene(s) for the chromosomal aberrations, we compared the expression levels of several candidate genes, located within the regions of frequent chromosomal aberrations, between the tumors and normal osteoblasts by using quantitative RT-PCR analysis. The Cdk4, c-Myc, Pdgf-b and p57KIP2 genes were thought to be possible target genes for the frequent chromosomal gain at 7q22-34 and loss at 1q in the tumors, respectively. In addition, mutations of the Tp53 gene were found in 27% (4 of 15) osteosarcomas. Our data may contribute to further understanding of the molecular mechanisms underlying osteosarcomas induced by ionizing radiation in human.

International audience; Malignant mesothelioma (MM) is one of the worst cancers in terms of clinical outcome, urging the need to establish and characterize new preclinical tools for investigation of the tumorigenic process, improvement of early diagnosis and evaluation of new therapeutic strategies. For these purposes, we characterized a collection of 27 cell lines established from F344 rats, after 136 to 415 days of induction with crocidolite asbestos administered intraperitoneally. Four mesotheliomas were distinguished from 23 preneoplastic mesothelial cell lines (PN) according to their propensity to generate tumors after orthotopic transplantation into syngeneic rats, their growth pattern, and the expression profile of three genes. PN cell lines were further discriminated into groups / subgroups according to morphology in culture and the expression profiles of 14 additional genes. This approach was completed by analysis of positive and negative immunohistochemical MM markers in the four tumors, of karyotype alterations in the most aggressive MM cell line in comparison with a PN epithelioid cell line, and of human normal mesothelial and mesothelioma cells and a tissue array. Our results showed that both the rat and human MM cell lines shared in common a dramatic decrease in the relative expression of Cdkn2a and of epigenetic regulators, in comparison with PN and normal human mesothelial cells, respectively. In particular, we identified the involvement of the relative expression of the Ten-Eleven Translocation (TET) family of dioxygenases and Dnmt3a in relation to the 5-hydroxymethylcytosine level in malignant transformation and the acquisition of metastatic potential. INTRODUCTION Malignant mesothelioma (MM) is a rare, aggressive cancer mainly related to asbestos exposure [1], the long latency time between exposure and occurrence of clinical symptoms limiting the efficacy of therapeutic interventions. Given its chemoresistance, current therapies have a negligible impact on overall survival due to a lack of understanding of the complex biology of MM [2]. Thus, a better understanding of the different steps in the development of this disease should be of great interest for the identification of early markers of MM AU 1

The present work focuses on nanoparticles and their great skills for oncology therapies. Two kinds of nanoparticles have been studied in order to biologically validate and characterize their features. The use of hydrogenated Nanodiamonds (H-NDs) as radio sensitizer is based on a physic-chemical postulate where they act as oxidative stress generator through interaction with irradiation. Thus we validated this hypothesis in radio resistant kidney and breast cancer cell lines and identify senescence as the main pathway after co-treatment with H-NDs and irradiation. Metal organic frameworks are also of particular interest for drug delivery because of their very important loading capacities. Here we demonstrate the biocompatibility of the empty compounds in four lung and hepatic cancer cell lines, a main point before their involvement in drug delivery strategies. Finally, following international guidelines encouraging to make animal testing more ethic, we developed a new 3D cell culture mimicking mucinous lung adenocarcinoma. This well characterized model will be used for the study of cancer development and drug screening.; Ce travail de thèse s’inscrit dans un contexte d’explosion des nanoparticules et de leur très grand potentiel pour des applications en cancérologie. Ainsi, deux classes de nanoparticules ont été étudiées afin de valider et de caractériser biologiquement ce potentiel. Premièrement les Nanodiamants hydrogénés (H-NDs) dont l’interaction avec les photons de l’irradiation comme générateur de stress oxidatif était au cœur du postulat physico-chimique. Nous avons non seulement validé cette hypothèse dans plusieurs lignées cellulaires de cancer du rein et du sein notamment, insensibles aux doses d’irradiation étudiées ; mais également identifié la sénescence comme étant la voie activée par le double traitement H-NDs et irradiation. Les Solides hybrides poreux sont également des matériaux prometteurs grâce à leur haut pouvoir d’encapsulation de molécules actives. Nous avons ainsi démontré l’absence de toxicité de ces composés seuls dans quatre lignées de cancer du poumon et du foie, élément essentiel avant d’envisager leur utilisation, chargés avec des principes actifs. Enfin, à l’heure où la réglementation internationale encourage le développement et l’utilisation de modèles alternatifs à l’expérimentation animale, nous avons mis au point un modèle de culture tridimensionnelle d’adénocarcinome mucosécrétant de poumon. Il est utilisé pour l’étude de la progression tumorale ainsi que pour la découverte de nouvelles molécules de chimiothérapie.

International audience; Ku70-dependent canonical nonhomologous end-joining (c-NHEJ) DNA repair system is fundamental to the genome maintenance and B-cell lineage. c-NHEJ is upregulated and error-prone in incurable forms of chronic lymphocytic leukemia which also displays telomere dysfunction, multiple chromosomal aberrations and the resistance to DNA damage-induced apoptosis. We identify in these cells a novel DNA damage inducible form of phospho-Ku70. In vitro in different cancer cell lines, Ku70 phosphorylation occurs in a heterodimer Ku70/Ku80 complex within minutes of genotoxic stress, necessitating its interaction with DNA damage-induced kinase pS2056-DNA-PKcs and/or pS1981-ATM. The mutagenic effects of phospho-Ku70 are documented by a defective S/G2 checkpoint, accelerated disappearance of gamma-H2AX foci and kinetics of DNA repair resulting in an increased level of genotoxic stress-induced chromosomal aberrations. Together, these data unveil an involvement of phospho-Ku70 in fast but inaccurate DNA repair; a new paradigm linked to both the deregulation of c-NHEJ and the resistance of malignant cells.

International audience; This article highlights our recent application of functional nanodiamonds (NDs) with peptide nucleic acids (PNA) to develop tools for DNA detection. NDs appear as an ideal nanocarrier due to their versatile surface chemistry, their non-cytotoxicity and since they could benefit from intrinsic luminescent properties. In this work, we report for the first time the possibility to prepare a covalent, stable and functional conjugate of PNA with 20 nm HPHT (High Pressure High Temperature) nanodiamonds. Peptide nucleic acid is a DNA mimic related to both peptides via its backbone and to nucleic acid via its bases. It binds more specifically and more strongly than DNA itself to either DNA or RNA. We have initiated a novel functionalization route based on an optimized amidation of ND carboxylic acid groups, to produce ND–PNA conjugates via an efficient, simple and reproducible method. We describe the synthesis and characterization of those conjugates. The covalent binding of the ND–PNA and the loading of nucleic acid grafted onto the NDs were performed using various characterization methods including FTIR, Kaiser tests and thermogravimetry. Then, ND–PNA conjugates were validated through a successful recognition of complementary DNA in a mixture, showing their efficiency toward nucleic acid detection. Moreover, the impact of ND–PNA on A 549 cells’ viability was analysed with flow cytometry and showed an absence of ND–PNA conjugates cytotoxicity. Such nucleic acid-functionalized nanodiamonds offer a wide range of applications and namely the possibility to target and to recognize DNA.

International audience; Although nanodiamonds (NDs) appear as one of the most promising nanocarbon materials available so far for biomedical applications, their risk for human health remains unknown. Our work was aimed at defining the cytotoxicity and genotoxicity of two sets of commercial carboxylated NDs with diameters below 20 and 100 nm, on six human cell lines chosen as representative of potential target organs: HepG2 and Hep3B (liver), Caki-1 and Hek-293 (kidney), HT29 (intestine) and A549 (lung). Cytotoxicity of NDs was assessed by measuring cell impedance (xCELLigence® system) and cell survival/death by flow cytometry while genotoxicity was assessed by γ-H2Ax foci detection, which is considered the most sensitive technique for studying DNA double-strand breaks. To validate and check the sensitivity of the techniques, aminated polystyrene nanobeads were used as positive control in all assays. Cell incorporation of NDs was also studied by flow cytometry and luminescent N–V center photoluminescence (confirmed by Raman microscopy), to ensure that nanoparticles entered the cells. Overall, we show that NDs effectively entered the cells but NDs do not induce any significant cytotoxic or genotoxic effects on the six cell lines up to an exposure dose of 250 µg/mL. Taken together these results strongly support the huge potential of NDs for human nanomedicine but also their potential as negative control in nanotoxicology studies.

International audience; Nanodiamonds (NDs) are often considered as inert platforms with high interests for biomedical applications. They are well adapted for drug delivery, and may display embedded fluorescence. We report here on a new way to consider these nanocarbon particles, by revealing therapeutic capacities coming from electronic properties of NDs. With an optimized surface chemistry, the generation of Reactive Oxygen Species (ROS) occurs when those hydrogen-terminated NDs are exposed to photon irradiation, thus opening up the field towards the radiosensitization of tumor cells.

This work focuses on the characterization of radiation-resistant breast cancer cells, responsible for relapse after radiotherapy. The “Cancer Stem Cells” (CSC) theory describes a radiation-resistant cellular sub-population, with enhanced capacity to induce tumors and proliferate. In this work, we show that only the CSC marker CD24-/low defines a radiation resistant cell population, able to transmit the “memory” of irradiation, expressed as long term genomic instability in the progeny of irradiated cells. We show that CD24 is not only a marker, but is an actor of radiation-response. So, CD24 expression controls cell proliferation in vitro and in vivo, and ROS level before and after irradiation. As a result, CD24-/low cells display enhanced radiation-resistance and genomic stability. For the first time, our results attribute a role to CD24-/low CSCs in the transmission of genomic instability. Moreover, by providing informations on tumor intrinsic radiation-sensitivity, CD24- marker could help to design new radiotherapy protocols.; Ce travail de thèse s’inscrit dans la caractérisation des cellules radiorésistantes des cancers du sein, à l’origine des rechutes après traitement par radiothérapie. La théorie des « Cellules Souches Cancéreuses » (CSC) place une sous-population cellulaire présentant une capacité accrue à induire des tumeurs et à proliférer au centre de la résistance à l’irradiation. Au cours de ce travail, nous avons montré que seul le marqueur de CSC CD24-/low permettait de définir une sous population radiorésistante, capable de transmettre une « mémoire » de l’irradiation se traduisant par une instabilité génétique persistante dans la descendance des cellules irradiées. En outre, nous avons montré que CD24 n’est pas uniquement un marqueur, mais bien un acteur de la réponse à l’irradiation. Ainsi, CD24 contrôle la prolifération cellulaire in vitro et in vivo, ainsi que les niveaux de ROS avant et après irradiation. L’ensemble de ces propriétés aboutit à une sensibilité réduite des cellules CD24-/low à l’irradiation γ, ainsi qu’à une baisse de l’instabilité génétique. Ces résultats permettent pour la première fois d’attribuer un rôle aux CSC CD24-/low dans la transmission de l’instabilité chromosomique. De plus, en apportant des informations pour évaluer la radiorésistance intrinsèque des tumeurs mammaires, le marquage CD24 pourrait contribuer à l’amélioration des protocoles de radiothérapie.

Background The sensitivity of chronic lymphocytic leukemia (CLL) cells to current treatments, both in vitro and in vivo, relies on their ability to activate apoptotic death. CLL cells resistant to DNA damage-induced apoptosis display deregulation of a specific set of genes. Methods Microarray hybridization (Human GeneChip, Affymetrix), immunofluorescent in situ labeling coupled with video-microscopy recording/analyses, chromatin-immunoprecipitation (ChIP), polymerase chain reactions (PCR), real-time quantitative PCR (RT-QPCR) and bisulfite genome sequencing were the main methods applied. Statistical analyses were performed by applying GCRMA and SAM analysis (microarray data) and Student's t-test or Mann & Whitney's U-test. Results Herein we show that, remarkably, in a resistant male CLL cells the vast majority of genes were down-regulated compared with sensitive cells, whereas this was not the case in cells derived from females. This gene down-regulation was found to be associated with an overall gain of heterochromatin as evidenced by immunofluorescent labeling of heterochromatin protein 1α (HP-1), trimethylated histone 3 lysine 9 (3metH3K9), and 5-methylcytidine (5metC). Notably, 17 genes were found to be commonly deregulated in resistant male and female cell samples. Among these, RELB was identified as a discriminatory candidate gene repressed in the male and upregulated in the female resistant cells. Conclusion The molecular defects in the silencing of RELB involve an increase in H3K9- but not CpG-island methylation in the promoter regions. Increase in acetyl-H3 in resistant female but not male CLL samples as well as a decrease of total cellular level of RelB after an inhibition of histone deacetylase (HDAC) by trichostatin A (TSA), further emphasize the role of epigenetic modifications which could discriminate two CLL subsets. Together, these results highlighted the epigenetic RELB silencing as a new marker of the progressive disease in males.

DNA repair mechanisms constitute major defences against agents that cause cancer, degenerative disease and aging. Different repair systems cooperate to maintain the integrity of genetic information. Investigations of DNA repair involvement in human pathology require an efficient tool that takes into account the variety and complexity of repair systems. We have developed a highly sensitive damaged plasmid microarray to quantify cell lysate excision/synthesis (ES) capacities using small amounts of proteins. This microsystem is based on efficient immobilization and conservation on hydrogel coated glass slides of plasmid DNA damaged with a panel of genotoxic agents. Fluorescent signals are generated from incorporation of labelled dNTPs by DNA excision-repair synthesis mechanisms at plasmid sites. Highly precise DNA repair phenotypes i.e. simultaneous quantitative measures of ES capacities toward seven lesions repaired by distinct repair pathways, are obtained. Applied to the characterization of xeroderma pigmentosum (XP) cells at basal level and in response to a low dose of UVB irradiation, the assay showed the multifunctional role of different XP proteins in cell protection against all types of damage. On the other hand, measurement of the ES of peripheral blood mononuclear cells from six donors revealed significant diversity between individuals. Our results illustrate the power of such a parallelized approach with high potential for several applications including the discovery of new cancer biomarkers and the screening of chemical agents modulating DNA repair systems.

International audience; Inhalation of radon is closely associated with an increased risk of lung cancers. While the involvement of Ink4a in lung tumor development has been widely described, the tumor suppressor gene has not been studied in radon-induced lung tumors. In this study, loss of heterozygosity (LOH) analysis of the Cdkn2a locus, common to the Ink4a and Arf genes, was performed on 33 radon-induced rat lung tumors and showed a DNA loss in 50% of cases. The analysis of p16(Ink4a) protein expression by immunohistochemistry revealed that 50% of the tumors were negative for this protein. Looking for the origin of this lack of expression, we observed a low frequency of homozygous deletion (6%), a lack of mutation, an absence of correlation between promoter methylation and Ink4a mRNA expression and no correlation between LOH and protein expression. However, a tendency for an inverse correlation between p16(Ink4a) and pRb protein expression was observed. The expressions of p19Arf, Mmd2 and Mdm4 were not deregulated and only 14% of the tumors were mutated for Tp53. These results indicated that Ink4a/Cdk4/Rb1 pathway deregulation, more than Arf/Mdm2/Tp53 pathway, has a major role in the development of these tumors through p16(Ink4a) deregulation. However, all known mechanisms of inactivation of the pathway do not play a recurrent role in these tumors and the actual origin of the lack of p16(Ink4a) protein expression remains to be established.

The radon gas is a well known lung carcinogenic factor in human at high doses but the cancer risk at low doses is not established. Indeed, epidemiological studies at low doses are difficult to conduct because of the human exposure to other lung carcinogenic factors. These data underlined the necessity to conduct experiments on lung tumors developed on animal model.The aim of this work was to characterize rat lung tumors by working on a series of radon-induced tumors that included adenocarcinomas (AC), squamous cell carcinomas (SCC) and adenosquamous carcinomas (ASC), that are mixed tumors with both AC and SCC cellular components. A CGH analysis of the three types of tumors allowed us to define chromosomal recurrent unbalances and to target candidate genes potentially implicated in lung carcinogenesis, as p16Ink4a, p19Arf, Rb1, K-Ras or c-Myc. A more precise analysis of the p16Ink4a/Cdk4/Rb1 and p19Arf/Mdm2/Tp53 pathways was performed and indicated that the Rb1 pathway was frequently inactivated through an absence of p16Ink4a protein expression, indicating that it has a major role in rat lung carcinogenesis. Finally, a comparative transcriptomic analysis of the three types of tumors allowed us to show for the first time that the complex tumors ASC have a transcriptomic profile in accordance with their mixed nature but that they also display their own expression profiles specificities.This work allowed us to find molecular characteristics common to murin and human lung tumors, indicating that the model of lung tumors in rat is pertinent to search for radiation-induced lung tumors specificities and to help for a better molecular identification of this type of tumors in human., Le radon est un carcinogène pulmonaire avéré chez l'homme à fortes doses mais l'existence d'un risque de cancer à faibles doses n'est pas établie car les approches épidémiologiques se heurtent, à ce niveau de doses, à de nombreux facteurs confondants. Ces données soulignent la nécessité de disposer d'un modèle d'étude des tumeurs pulmonaires chez l'animal. Le but de ce travail de thèse est de caractériser, sur le plan moléculaire, une série de tumeurs pulmonaires radon-induites chez le rat qui comprend des adénocarcinomes (AC), des carcinomes épidermoïdes (Sq) et des carcinomes adénosquameux (ASq) formés des composantes cellulaires AC et Sq. Une analyse cytogénétique globale de ces tumeurs par la technique de CGH a permis de définir des déséquilibres récurrents de régions chromosomiques, sur lesquelles ont été ciblés des gènes candidats potentiellement impliqués dans le développement des tumeurs, comme p16Ink4a, p19Arf, Rb1, K-Ras ou c-Myc. Une analyse plus précise des voies p16Ink4a/Cdk4/Rb1 et p19Arf/Mdm2/Tp53 a été menée et a permis de mettre en évidence une inactivation fréquente de la voie Rb1, par la perte d'expression de la protéine p16Ink4a, indiquant que cette voie joue un rôle majeur dans le développement de ces tumeurs pulmonaires. Enfin, une analyse transcriptomique comparative des trois types de tumeurs induites a révélé que les tumeurs complexes ASq ont un profil d'expression génique qui reflète leur nature composite mais qu'elles présentent également des spécificités. L'ensemble de ce travail à mis à jour des caractéristiques moléculaires communes aux tumeurs pulmonaires murines et humaines qui encouragent à poursuivre l'étude des spécificités des tumeurs pulmonaires radio-induites chez le rat pour aider à une meilleure caractérisation de ces tumeurs chez l'homme.

Data on rats exposed to cigarette smoke before or after exposure to radon are used to estimate smoke-dependent parameters of the biologically based two-stage clonal expansion model. The baseline parameters and the action of radon acting on initiation and promotion were fixed based on earlier work. Cigarette smoke acting on transformation and inducing a reduction of the radon dose to the target cells after a smoking period gives an acceptable description of the data. © Springer-Verlag 2005.

Our knowledge of the molecular mechanisms that regulate hematopoiesis in physiologic and pathologic conditions is limited. Using a molecular approach based on cDNA microarrays, we demonstrated the emergence of an alternative pathway for mature bone marrow cell recovery after the programmed and reversible eradication of CD41+ cells in transgenic mice expressing a conditional toxigene targeted by the platelet αIIb promoter. The expression profile of the newly produced CD41+ cells showed high levels of transcripts encoding Ezh2, TdT, Rag2, and various immunoglobulin (Ig) heavy chains. In this context, we identified and characterized a novel population of Lin-Sca-1hic-Kit- cells, with a lymphoid-like expression pattern, potentially involved in the reconstitution process. Our study revealed novel transcriptional cross talk between myeloid and lymphoid lineages and identified gene expression modifications that occur in vivo under these particular stress conditions, opening important prospects for therapeutic applications.

Data sets of radon-exposed male rats from Wistar and Sprague-Dawley strains have been investigated with two different versions of the two-step clonal expansion (TSCE) model of carcinogenesis. These so-called initiation-promotion (IP) and initiation-transformation (IT) models are named after the cell-based processes that are assumed to be induced by radiation. The analysis was done with all malignant lung tumours taken to be incidental and with fatal tumours alone. For all tumours treated as incidental, both models could explain the tumour incidence data equally well. Owing to its better fit, only the IP model was applied in the analysis of fatal tumours that carry additional information on the time when they cause death. A statistical test rejected the hypothesis that a joint cohort of Wistar and Sprague-Dawley rats can be described with the same set of model parameters. Thus, the risk analysis has been carried out for the Wistar rats and the Sprague-Dawley rats separately and has been restricted to fatal tumours alone because of their similar effect in humans. Using a refined technique of age-adjustment, the lifetime excess absolute risk has been standardised with the survival function from competing risks in the control population. The age-adjusted excess risks for both strains of rats were of similar size, for animals with first exposure later in life they decreased markedly. For high cumulative exposure the excess risk increased with longer exposure duration, for low cumulative exposure it showed the opposite trend. In addition, high cumulative exposure exerted lethal effects other than lung cancer on the rats. © Springer 2004.

Procedures for age-adjustment of cancer fractions are proposed which do not require fixed age intervals. The full available information on survival times can then be used, which is especially important in small treatment groups. For incidental cancers a non-decreasing prevalence function and for fatal cancers the Kaplan-Meier estimator is used. In the latter case, the estimated competing risk of the control population is standardized, not its true survival. This makes the technique also applicable to treatment groups with high incidence, which otherwise may give adjusted rates above 100%. In the application part these age-adjustment techniques are used here to study lung cancer in radon-exposed Wistar and Sprague-Dawley rats. The data include a classification in fatal and incidental lung cancers. For fatal lung cancer, the lifetime excess absolute risk (LEAR) at 1 WLM averaged over all exposed groups is 0.67x10 -4 for the Wistar rats, while for the Sprague-Dawley rats it is 0.40x10-4. For the Sprague-Dawley rats, there are several groups exposed later in life. When the averaging is restricted to animals with start of exposure prior to 150 days of age, the weighted average risk among the Sprague-Dawley rats is 0.79x10-4. Compared to groups with similar exposures as young adults (up to about 150 days), animals exposed later in life have substantially lower lifetime risks. The Wistar rats include groups with roughly equal exposure rates and ages at start of exposure, but with increasing exposure duration. Within these groupings the LEAR at 1 WLM does not decrease with additional exposure at higher age, as would be expected if the risk from exposures at different ages would be additive. © Springer 2004.

A comparison of incidence of lung tumours in rats after inhalation exposure to aerosols containing alpha emitters which have different physico-chemical properties has been performed. Aerosols of radon and progeny, uranium ore dust, NpO 2 , PuO 2 or Cm 2 O 3 were considered for intercomparison with similar or different particle sizes. Dose-effect relationships for the frequency of malignant lung tumours appear linear up to a few Gy and then become infralinear at higher doses delivered to the lungs. The initial slope of the curves reflects the risk of induction of a lung tumour. The highest slopes of incidence were observed for radon and uranium ore dust (about 70 and 20% Gy -1 respectively) for which the most homogeneous alpha dose distribution to the lungs is expected. In a general trend, increasing the alpha-activity of deposited particles (higher specific activity of constituent radioisotopes or larger particle size) decreases the risk. The comparison of the reported data shows that the risk per Gy at 'low' doses' could vary over more than one order of magnitude depending on the physico-chemical properties of the aerosols.

Lamins are major proteins of the nuclear envelope that are members of the intermediate filament protein family. In vertebrates, nuclei from differentiated tissues usually contain both lamins of the A and B subtypes, while embryonic tissues contain the B-type lamin only. We have examined the composition of the nuclear lamina in human B and T lymphocytes representative of distinct stages of lymphoid differentiation. We show here that, in both cell lineages, while lamin B is constitutively expressed at all stages of differentiation, A-type lamin expression is restricted to later developmental stages.

[DOI:\hrefhttps://dx.doi.org/10.1093/ajh/hpu26810.1093/ajh/hpu268] [PubMed:\hrefhttps://www.ncbi.nlm.nih.gov/pubmed/2558870025588700]; International audience; In patients free from overt cardiac disease, R wave in aVL lead (RaVL) is strongly correlated with left ventricular mass index (LVMI) assessed by transthoracic echocardiography. The aim of the present study was to extend this finding to other settings (cardiomyopathy or conduction disorders), by comparing ECG criteria of left ventricular hypertrophy (LVH) to cardiac MRI (CMR).\ In 501 patients, CMR and ECG were performed within a median-period of 5 days. CMR LVH cut-offs used were 83 g/m2 in men and 67 g/m2 in women.\ RaVL was independently correlated with LVMI in patients with or without myocardial infarction (MI) (N = 300 and N = 201, respectively). SV3 was independently correlated with LVMI and LV enlargement only in patients without MI. In the whole cohort, RaVL had area under receiver-operating characteristic curve of 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV). The performance of RaVL was remarkable in women, in Caucasians, and in the presence of right bundle branch block. It decreased in case of MI. Overall, it is proposed that below 0.5 mV and above 1.0 mV, RaVL is sufficient to exclude or establish LVH. Between 0.5 and 1 mV, composite indices (Cornell voltage or product) should be used. Using this algorithm allowed classifying appropriately 85% of the patients.\ Our results showed that RaVL is a good index of LVH with a univocal threshold of 1.0 mV in various clinical conditions. SV3 may be combined to RaVL in some conditions, namely LV enlargement to increase its performance.