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Caractérisation de marqueurs moléculaires associés à un haut risque de développement de métastases chez des patients atteints du mélanome de la choroïde

Abstract : The choroid is a layer of highly vascularised tissue surrounding the eye. Choroidal blood nourishes the retinal pigment epithelium and the photoreceptors on the outer layer of the retina. Uveal melanoma occurs to the detriment of uveal melanocytes (located in the iris, ciliary body and choroid) and is the most common intraocular malignancy in adults. The etiological factors involved in the process of malignant transformation are poorly understood. There is a doubtful role of environmental factors such exposure to sunlight, age or sexe in the emergence of uveal melanoma.The management of uveal melanomas has greatly evolved, moving towards more focused and conservative treatments (such as observation, photocoagulation, thermotherapy, radiotherapy). According to literature, there is no significant difference in survival between patients treated with enucleation and those treated with conservative methods. To date, no adjuvant therapy has proven effective following the initial treatment of ocular melanoma. The metastatic pattern for uveal melanoma differs from that of skin melanoma and is usually located in the liver. About 50\% of patients will develop metastases after a median time of three years, and will ultimately die of their disease. Once the disease becomes metastatic, median survival ranges from two to six months, and only 15\% of the patients survive more than one year. Surgical resection of metastases is feasible only if occurring in limited areas. Genetic differences may be the origin of the various types of melanoma and their different features. Multivariate analyses of genomic imbalances, showed that cutaneous and uveal melanomas presnted different copy number changes. The most frequently detected imbalances in uveal melanoma is the loss of chromosome 3 and gain of 8q. Further studies revealed that most cases show non-random chromosomal aberrations of chromosomes 1, 3, 6 and 8 and that the loss of chromosome 3 and gain of 8q were significantly associated with overall survival and the development of metastases. Some reports suggested two distinct entities of uveal melanoma (with or without chromosome 3 monosomy) previously unrecognized because of their similar clinicopathological features. In order to improve diagnosis and treatment of uveal melanoma, we propose to perform transcriptome and DNA copy number analysis with following objectives : identify genes linked to metastasis behaviour to identify high risk patients who could take advantage of specific adjuvant therapy ; characterize these genes at molecular level ; study if these genes could be powerful therapeutic target.In this thesis, I will describe the melanocyte lineage in order to understand differences observed between cutaneous and uveal melanoma, then I will discuss the importance of high-throughput approaches in the study of cancer and bioinformatics analysis techniques used. I will finally present the different results as the significance of a phosphatase, PTP4A3, which seems to be relevant in metastatic behaviour in uveal melanoma.
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Cecile Laurent. Caractérisation de marqueurs moléculaires associés à un haut risque de développement de métastases chez des patients atteints du mélanome de la choroïde. Sciences agricoles. Université Paris Sud - Paris XI, 2011. Français. ⟨NNT : 2011PA112155⟩. ⟨tel-00769924⟩

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