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Access Type

WSU Access

Date of Award

January 2025

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Physiology

First Advisor

Gil Mor

Second Advisor

Sorin Drăghici

Abstract

The 5-year survival rate for high grade serous ovarian cancer (HGSOC) is barely 30% because most patients are diagnosed late, and the cancer typically recurs even after initial successful treatment. Therefore, early detection and effective therapies to prevent (or at least, significantly delay) cancer recurrence are the two major unmet needs in HGSOC management. Although emerging evidence has now confirmed the Fallopian tubes as the site of origin of HGSOC, the exact mechanisms which underlie the early transformation of normal Fallopian tube into precursors of HGSOC, and their eventual progression to invasive and recurrent carcinoma are not fully understood. In this dissertation, we sought to understand the molecular mechanisms underlying ovarian cancer initiation and progression to help us identify novel early detection biomarkers and therapeutic targets for HGSOC. By performing spatial transcriptomic studies on normal and malignantly transformed Fallopian tube epithelium, we identified loss of Connective Tissue Growth Factor (CTGF) as a critical event during early malignant transformation of the Fallopian tube epithelium. Additionally, we observed the enrichment of inflammatory processes in the stroma of transformed Fallopian tube, underscoring the importance of dysregulated immune processes during ovarian cancer initiation and progression. Subsequently, we showed that successful chemotherapy reverses immunologic tolerance to cancer cells, re-establishing immune surveillance and anti-tumoral immune response in long-term responders compared to early recurrence patients. Overall, this dissertation lays important foundation for future work to facilitate development of effective early detection tests, improved patient stratification, and novel therapies to someday improve patient outcomes from this lethal malignancy.

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