151
|
Abstract
Great progress has been made in many areas of pediatric oncology. However, tumors of the central nervous system (CNS) remain a significant challenge. A recent explosion of data has led to an opportunity to understand better the molecular basis of these diseases and is already providing a foundation for the pursuit of rationally chosen therapeutics targeting relevant molecular pathways. The molecular biology of pediatric brain tumors is shifting from a singular focus on basic scientific discovery to a platform upon which insights are being translated into therapies.
Collapse
|
152
|
Lee MJ. Overview of CNS Gliomas in Childhood. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mee Jeong Lee
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
153
|
Robison NJ, Kieran MW. Identification of novel biologic targets in the treatment of newly diagnosed diffuse intrinsic pontine glioma. Am Soc Clin Oncol Educ Book 2016:625-8. [PMID: 24451808 DOI: 10.14694/edbook_am.2012.32.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) carry an extremely poor prognosis. Standard practice has been to base the diagnosis on classic imaging and clinical characteristics and to treat with focal radiation therapy, usually accompanied with experimental therapy. As a result of the desire to avoid upfront biopsy, little has been learned regarding the molecular features of this disease. Findings from several autopsy series have included loss of p53 and PTEN, and amplification of PDGFR. Based on these and other findings, murine models have been generated and provide a new tool for preclinical testing. DIPG biopsy at diagnosis has increasingly become incorporated into national protocols at several centers, bringing the prospect of a better understanding of DIPG biology in the future. Initial analyses of pretreatment tumors cast valuable new light and establish the importance of p53 inactivation and the RTK-PI3K pathway in this disease.
Collapse
Affiliation(s)
- Nathan J Robison
- From the Dana-Farber Children's Hospital Cancer Center, Boston, MA
| | - Mark W Kieran
- From the Dana-Farber Children's Hospital Cancer Center, Boston, MA
| |
Collapse
|
154
|
Kambhampati M, Perez JP, Yadavilli S, Saratsis AM, Hill AD, Ho CY, Panditharatna E, Markel M, Packer RJ, Nazarian J. A standardized autopsy procurement allows for the comprehensive study of DIPG biology. Oncotarget 2016; 6:12740-7. [PMID: 25749048 PMCID: PMC4494970 DOI: 10.18632/oncotarget.3374] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/15/2015] [Indexed: 11/25/2022] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is one of the least understood and most deadly childhood cancers. Historically, there has been a paucity of DIPG specimens for molecular analysis. However, due to the generous participation of DIPG families in programs for postmortem specimen donation, there has been a recent surge in molecular analysis of newly available tumor specimens. Collaborative efforts to share data and tumor specimens have resulted in rapid discoveries in other pediatric brain tumors, such as medulloblastoma, and therefore have the potential to shed light on the biology of DIPG. Given the generous gift of postmortem tissue donation from DIPG patients, there is a need for standardized postmortem specimen accrual to facilitate rapid and effective multi-institutional molecular studies. We developed and implemented an autopsy protocol for rapid procurement, documenting and storing these specimens. Sixteen autopsies were performed throughout the United States and Canada and processed using a standard protocol and inventory method, including specimen imaging, fixation, snap freezing, orthotopic injection, or preservation. This allowed for comparative clinical and biological studies of rare postmortem DIPG tissue specimens, generation of in vivo and in vitro models of DIPG, and detailed records to facilitate collaborative analysis.
Collapse
Affiliation(s)
- Madhuri Kambhampati
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Jennifer P Perez
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Sridevi Yadavilli
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Amanda M Saratsis
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA.,Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley D Hill
- Division of Pathology, Children's National Health System, Washington, DC, USA
| | - Cheng-Ying Ho
- Division of Pathology, Children's National Health System, Washington, DC, USA
| | - Eshini Panditharatna
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA.,Institute for Biomedical Sciences, George Washington University, Washington, DC, USA
| | - Melissa Markel
- Department of Neuro Oncology, Riley hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Roger J Packer
- Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Javad Nazarian
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
155
|
Mittapalli RK, Chung AH, Parrish KE, Crabtree D, Halvorson KG, Hu G, Elmquist WF, Becher OJ. ABCG2 and ABCB1 Limit the Efficacy of Dasatinib in a PDGF-B-Driven Brainstem Glioma Model. Mol Cancer Ther 2016; 15:819-29. [PMID: 26883271 DOI: 10.1158/1535-7163.mct-15-0093] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/10/2016] [Indexed: 12/22/2022]
Abstract
Dasatinib is a multikinase inhibitor in clinical trials for glioma, and thus far has failed to demonstrate significant efficacy. We investigated whether the ABC efflux transporters ABCG2 and ABCB1 expressed in the blood-brain barrier (BBB), are limiting the efficacy of dasatinib in the treatment of glioma using genetic and pharmacologic approaches. We utilized a genetic brainstem glioma mouse model driven by platelet-derived growth factor-B and p53 loss using abcg2/abcb1 wild-type (ABC WT) or abcg2/abcb1 knockout mice (ABC KO). First, we observed that brainstem glioma tumor latency is significantly prolonged in ABC KO versus ABC WT mice (median survival of 47 vs. 34 days). Dasatinib treatment nearly doubles the survival of brainstem glioma-bearing ABC KO mice (44 vs. 80 days). Elacridar, an ABCG2 and ABCB1 inhibitor, significantly increases the efficacy of dasatinib in brainstem glioma-bearing ABC WT mice (42 vs. 59 days). Pharmacokinetic analysis demonstrates that dasatinib delivery into the normal brain, but not into the tumor core, is significantly increased in ABC KO mice compared with ABC WT mice. Surprisingly, elacridar did not significantly increase dasatinib delivery into the normal brain or the tumor core of ABC WT mice. Next, we demonstrate that the tight junctions of the BBB of this model are compromised as assessed by tissue permeability to Texas Red dextran. Finally, elacridar increases the cytotoxicity of dasatinib independent of ABCG2 and ABCB1 expression in vitro In conclusion, elacridar improves the efficacy of dasatinib in a brainstem glioma model without significantly increasing its delivery to the tumor core. Mol Cancer Ther; 15(5); 819-29. ©2016 AACR.
Collapse
Affiliation(s)
- Rajendar K Mittapalli
- Department of Pharmaceutics, Brain Barriers Research Center, University of Minnesota, Minneapolis, Minnesota
| | - Alexander H Chung
- Department of Pediatrics, Duke University, Durham, North Carolina. Department of Pathology, Duke University, Durham, North Carolina. Preston Robert Tisch Brain Tumor Center, Durham, North Carolina
| | - Karen E Parrish
- Department of Pharmaceutics, Brain Barriers Research Center, University of Minnesota, Minneapolis, Minnesota
| | - Donna Crabtree
- Department of Pediatrics, Duke University, Durham, North Carolina. Department of Pathology, Duke University, Durham, North Carolina. Preston Robert Tisch Brain Tumor Center, Durham, North Carolina
| | - Kyle G Halvorson
- Department of Pediatrics, Duke University, Durham, North Carolina. Department of Pathology, Duke University, Durham, North Carolina. Preston Robert Tisch Brain Tumor Center, Durham, North Carolina. Department of Surgery, Division of Neurological Surgery, Duke University, Durham, North Carolina
| | - Guo Hu
- Department of Pediatrics, Duke University, Durham, North Carolina. Department of Pathology, Duke University, Durham, North Carolina. Preston Robert Tisch Brain Tumor Center, Durham, North Carolina
| | - William F Elmquist
- Department of Pharmaceutics, Brain Barriers Research Center, University of Minnesota, Minneapolis, Minnesota
| | - Oren J Becher
- Department of Pediatrics, Duke University, Durham, North Carolina. Department of Pathology, Duke University, Durham, North Carolina. Preston Robert Tisch Brain Tumor Center, Durham, North Carolina.
| |
Collapse
|
156
|
Common mutations in ALK2/ACVR1, a multi-faceted receptor, have roles in distinct pediatric musculoskeletal and neural orphan disorders. Cytokine Growth Factor Rev 2015; 27:93-104. [PMID: 26776312 DOI: 10.1016/j.cytogfr.2015.12.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Activin receptor-like kinase-2 (ALK2), the product of ACVR1, is a member of the type I bone morphogenetic protein (BMP) receptor family. ALK2 exerts key and non-redundant roles in numerous developmental processes, including the specification, growth and morphogenesis of endochondral skeletal elements. There is also strong evidence that BMP signaling plays important roles in determination, differentiation and function of neural cells and tissues. Here we focus on the intriguing discovery that common activating mutations in ALK2 occur in Fibrodysplasia Ossificans Progressiva (FOP) and Diffuse Intrinsic Pontine Gliomas (DIPGs), distinct pediatric disorders of significant severity that are associated with premature death. Pathogenesis and treatment remain elusive for both. We consider recent studies on the nature of the ACVR1 mutations, possible modes of action and targets, and plausible therapeutic measures. Comparisons of the diverse - but genetically interrelated - pathologies of FOP and DIPG will continue to be of major mutual benefit with broad biomedical and clinical relevance.
Collapse
|
157
|
The Challenge of Cancer Genomics in Rare Nervous System Neoplasms: Malignant Peripheral Nerve Sheath Tumors as a Paradigm for Cross-Species Comparative Oncogenomics. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 186:464-77. [PMID: 26740486 DOI: 10.1016/j.ajpath.2015.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/20/2015] [Indexed: 12/12/2022]
Abstract
Comprehensive genomic analyses of common nervous system cancers provide new insights into their pathogenesis, diagnosis, and treatment. Although analogous studies of rare nervous system tumors are needed, there are major barriers to performing such studies. Cross-species comparative oncogenomics, identifying driver mutations in mouse cancer models and validating them in human tumors, is a promising alternative. Although still in its infancy, this approach is being applied to malignant peripheral nerve sheath tumors (MPNSTs), rare Schwann cell-derived malignancies that occur sporadically, after radiotherapy, and in neurofibromatosis type 1. Studies of human neurofibromatosis type 1-associated tumors suggest that NF1 tumor suppressor loss in Schwann cells triggers cell-autonomous and intercellular changes, resulting in development of benign neurofibromas; subsequent neurofibroma-MPNST progression is caused by aberrant growth factor signaling and mutations affecting the p16(INK4A)-cyclin D1-CDK4-Rb and p19(ARF)-Mdm2-p53 cell cycle pathways. Mice with Nf1, Trp53, and/or Cdkn2a mutations that overexpress the Schwann cell mitogen neuregulin-1 or overexpress the epidermal growth factor receptor validate observations in human tumors and, to various degrees, model human tumorigenesis. Genomic analyses of MPNSTs arising in neuregulin-1 and epidermal growth factor receptor-overexpressing mice and forward genetic screens with Sleeping Beauty transposons implicate additional signaling cascades in MPNST pathogenesis. These studies confirm the utility of mouse models for MPNST driver gene discovery and provide new insights into the complexity of MPNST pathogenesis.
Collapse
|
158
|
Baker SJ, Ellison DW, Gutmann DH. Pediatric gliomas as neurodevelopmental disorders. Glia 2015; 64:879-95. [PMID: 26638183 DOI: 10.1002/glia.22945] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/13/2015] [Indexed: 01/01/2023]
Abstract
Brain tumors represent the most common solid tumor of childhood, with gliomas comprising the largest fraction of these cancers. Several features distinguish them from their adult counterparts, including their natural history, causative genetic mutations, and brain locations. These unique properties suggest that the cellular and molecular etiologies that underlie their development and maintenance might be different from those that govern adult gliomagenesis and growth. In this review, we discuss the genetic basis for pediatric low-grade and high-grade glioma in the context of developmental neurobiology, and highlight the differences between histologically-similar tumors arising in children and adults.
Collapse
Affiliation(s)
- Suzanne J Baker
- Department of Developmental Neurobiology, St. Jude's Children's Research Hospital, Memphis, Tennessee
| | - David W Ellison
- Department of Pathology, St. Jude's Children's Research Hospital, Memphis, Tennessee
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
159
|
Histone H3F3A and HIST1H3B K27M mutations define two subgroups of diffuse intrinsic pontine gliomas with different prognosis and phenotypes. Acta Neuropathol 2015; 130:815-27. [PMID: 26399631 PMCID: PMC4654747 DOI: 10.1007/s00401-015-1478-0] [Citation(s) in RCA: 430] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/15/2023]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is the most severe paediatric solid tumour, with no significant therapeutic progress made in the past 50 years. Recent studies suggest that diffuse midline glioma, H3-K27M mutant, may comprise more than one biological entity. The aim of the study was to determine the clinical and biological variables that most impact their prognosis. Ninety-one patients with classically defined DIPG underwent a systematic stereotactic biopsy and were included in this observational retrospective study. Histone H3 genes mutations were assessed by immunochemistry and direct sequencing, whilst global gene expression profiling and chromosomal imbalances were determined by microarrays. A full description of the MRI findings at diagnosis and at relapse was integrated with the molecular profiling data and clinical outcome. All DIPG but one were found to harbour either a somatic H3-K27M mutation and/or loss of H3K27 trimethylation. We also discovered a novel K27M mutation in HIST2H3C, and a lysine-to-isoleucine substitution (K27I) in H3F3A, also creating a loss of trimethylation. Patients with tumours harbouring a K27M mutation in H3.3 (H3F3A) did not respond clinically to radiotherapy as well, relapsed significantly earlier and exhibited more metastatic recurrences than those in H3.1 (HIST1H3B/C). H3.3-K27M-mutated DIPG have a proneural/oligodendroglial phenotype and a pro-metastatic gene expression signature with PDGFRA activation, while H3.1-K27M-mutated tumours exhibit a mesenchymal/astrocytic phenotype and a pro-angiogenic/hypoxic signature supported by expression profiling and radiological findings. H3K27 alterations appear as the founding event in DIPG and the mutations in the two main histone H3 variants drive two distinct oncogenic programmes with potential specific therapeutic targets.
Collapse
|
160
|
Tumor location, but not H3.3K27M, significantly influences the blood-brain-barrier permeability in a genetic mouse model of pediatric high-grade glioma. J Neurooncol 2015; 126:243-51. [PMID: 26511492 DOI: 10.1007/s11060-015-1969-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
Pediatric high-grade gliomas (pHGGs) occur with strikingly different frequencies in infratentorial and supratentorial regions. Although histologically these malignancies appear similar, they represent distinct diseases. Recent genomic studies have identified histone K27M H3.3/H3.1 mutations in the majority of brainstem pHGGs; these mutations are rarely encountered in pHGGs that arise in the cerebral cortex. Previous research in brainstem pHGGs suggests a restricted permeability of the blood-brain-barrier (BBB). In this work, we use dynamic contrast-enhanced (DCE) MRI to evaluate BBB permeability in a genetic mouse model of pHGG as a function of location (cortex vs. brainstem, n = 8 mice/group) and histone mutation (mutant H3.3K27M vs. wild-type H3.3, n = 8 mice/group). The pHGG models are induced either in the brainstem or the cerebral cortex and are driven by PDGF signaling and p53 loss with either H3.3K27M or wild-type H3.3. T2-weighted MRI was used to determine tumor location/extent followed by 4D DCE-MRI for estimating the rate constant (K (trans) ) for tracer exchange across the barrier. BBB permeability was 67 % higher in cortical pHGGs relative to brainstem pHGGs (t test, p = 0.012) but was not significantly affected by the expression of mutant H3.3K27M versus wild-type H3.3 (t-test, p = 0.78). Although mice became symptomatic at approximately the same time, the mean volume of cortical tumors was 3.6 times higher than the mean volume of brainstem tumors. The difference between the mean volume of gliomas with wild-type and mutant H3.3 was insignificant. Mean K (trans) was significantly correlated to glioma volume. These results present a possible explanation for the poor response of brainstem pHGGs to systemic therapy. Our findings illustrate a potential role played by the microenvironment in shaping tumor growth and BBB permeability.
Collapse
|
161
|
Puget S, Beccaria K, Blauwblomme T, Roujeau T, James S, Grill J, Zerah M, Varlet P, Sainte-Rose C. Biopsy in a series of 130 pediatric diffuse intrinsic Pontine gliomas. Childs Nerv Syst 2015; 31:1773-80. [PMID: 26351229 DOI: 10.1007/s00381-015-2832-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Diffuse intrinsic pontine glioma (DIPG) is the most severe pediatric solid tumor, with no significant improvement in the past 50 years. Possible reasons for failure to make therapeutic progress include poor understanding of the underlying molecular biology due to lack of tumor material. METHODS We performed a prospective analysis of children with typical appearance of DIPG who had a stereotactic biopsy in our unit since 2002. Technical approach, complications, histopathological results, and samples processing are exposed. The literature on this subject is discussed. RESULTS Reviewing our own 130 cases of DIPG biopsies and previous published data, these procedures appear to have a diagnostic yield and morbidity rates similar to those reported for other brain locations (3.9 % of transient morbidity in our series). In addition, the quality and the quantity of the material obtained allow to (1) confirm the diagnosis, (2) reveal that WHO grading was useless to predict outcome, and (3) perform an extended molecular screen, including biomarkers study and the development of preclinical models. Recent studies reveal that DIPG may comprise more than one biological entity and a unique oncogenesis involving mutations never described in other types of cancers, i.e., histones H3 K27M and activin receptor ACVR1. CONCLUSION Stereotactic biopsies of DIPG can be considered as a safe procedure in well-trained neurosurgical teams and could be incorporated in protocols. It is a unique opportunity to integrate DIPG biopsies in clinical practice and use the biology at diagnosis to drive the introduction of innovative targeted therapies, in combination with radiotherapy.
Collapse
Affiliation(s)
- Stephanie Puget
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France. .,Sorbonne Paris Cité, Université Paris Descartes, Paris, France. .,UMR CNRS 8203 "Vectorologie et Thérapeutiques Anticancéreuses", Département de Cancérologie de l'Enfant et de l'Adolescent, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif cedex, France.
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Thomas Roujeau
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Syril James
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology and CNRS UMR 8203 "Vectorology and Anticancer Therapeutics", Gustave Roussy Cancer Institute, Universite Paris Sud, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Michel Zerah
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, 1 rue Cabanis, 75014, Paris, France
| | - Christian Sainte-Rose
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| |
Collapse
|
162
|
van Vuurden DG, Aronica E, Hulleman E, Wedekind LE, Biesmans D, Malekzadeh A, Bugiani M, Geerts D, Noske DP, Vandertop WP, Kaspers GJL, Cloos J, Würdinger T, van der Stoop PPM. Pre-B-cell leukemia homeobox interacting protein 1 is overexpressed in astrocytoma and promotes tumor cell growth and migration. Neuro Oncol 2015; 16:946-59. [PMID: 24470547 DOI: 10.1093/neuonc/not308] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Glial brain tumors cause considerable mortality and morbidity in children and adults. Innovative targets for therapy are needed to improve survival and reduce long-term sequelae. The aim of this study was to find a candidate tumor-promoting protein, abundantly expressed in tumor cells but not in normal brain tissues, as a potential target for therapy. METHODS In silico proteomics and genomics, immunohistochemistry, and immunofluorescence microscopy validation were performed. RNA interference was used to ascertain the functional role of the overexpressed candidate target protein. RESULTS In silico proteomics and genomics revealed pre-B-cell leukemia homeobox (PBX) interacting protein 1 (PBXIP1) overexpression in adult and childhood high-grade glioma and ependymoma compared with normal brain. PBXIP1 is a PBX-family interacting microtubule-binding protein with a putative role in migration and proliferation of cancer cells. Immunohistochemical studies in glial tumors validated PBXIP1 expression in astrocytoma and ependymoma but not in oligodendroglioma. RNAi-mediated PBXIP1-knockdown in glioblastoma cell lines strongly reduced proliferation and migration and induced morphological changes, indicating that PBXIP1 knockdown decreases glioma cell viability and motility through rearrangements of the actin cytoskeleton. Furthermore, expression of PBXIP1 was observed in radial glia and astrocytic progenitor cells in human fetal tissues, suggesting that PBXIP1 is an astroglial progenitor cell marker during human embryonic development. CONCLUSION PBXIP1 is a novel protein overexpressed in astrocytoma and ependymoma, involved in tumor cell proliferation and migration, that warrants further exploration as a novel therapeutic target in these tumors.
Collapse
|
163
|
Pediatric brainstem gliomas: new understanding leads to potential new treatments for two very different tumors. Curr Oncol Rep 2015; 17:436. [PMID: 25702179 DOI: 10.1007/s11912-014-0436-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pediatric brainstem gliomas include low-grade focal brainstem gliomas (FBSG) and high-grade diffuse intrinsic pontine gliomas (DIPG). These tumors share a crucial and eloquent area of the brain as their location, which carries common challenges for treatment. Otherwise, though, these two diseases are very different in terms of presentation, biology, treatment, and prognosis. FBSG usually present with greater than 3 months of symptoms, while DIPG are usually diagnosed within 3 months of symptom onset. Surgery remains the preferred initial treatment for FBSG, with chemotherapy used for persistent, recurrent, or inoperable disease; conversely, radiation is the only known effective treatment for DIPG. Recent developments in biological understanding of both tumors have led to new treatment possibilities. In FBSG, two genetic changes related to BRAF characterize the majority of tumors, and key differences in their biological effects are informing strategies for targeted chemotherapy use. In DIPG, widespread histone H3 and ACVR1 mutations have led to new hope for effective targeted treatments. FBSG has an excellent prognosis, while the long-term survival rate of DIPG tragically remains near zero. In this review, we cover the epidemiology, biology, presentation, imaging characteristics, multimodality treatment, and prognosis of FBSG and DIPG, with a focus on recent biological discoveries.
Collapse
|
164
|
Molecular Biology in Pediatric High-Grade Glioma: Impact on Prognosis and Treatment. BIOMED RESEARCH INTERNATIONAL 2015; 2015:215135. [PMID: 26448930 PMCID: PMC4584033 DOI: 10.1155/2015/215135] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/04/2014] [Indexed: 12/17/2022]
Abstract
High-grade gliomas are the main cause of death in children with brain tumours. Despite recent advances in cancer therapy, their prognosis remains poor and the treatment is still challenging. To date, surgery followed by radiotherapy and temozolomide is the standard therapy. However, increasing knowledge of glioma biology is starting to impact drug development towards targeted therapies. The identification of agents directed against molecular targets aims at going beyond the traditional therapeutic approach in order to develop a personalized therapy and improve the outcome of pediatric high-grade gliomas. In this paper, we critically review the literature regarding the genetic abnormalities implicated in the pathogenesis of pediatric malignant gliomas and the current development of molecularly targeted therapies. In particular, we analyse the impact of molecular biology on the prognosis and treatment of pediatric high-grade glioma, comparing it to that of adult gliomas.
Collapse
|
165
|
Coutinho de Souza P, Mallory S, Smith N, Saunders D, Li XN, McNall-Knapp RY, Fung KM, Towner RA. Inhibition of Pediatric Glioblastoma Tumor Growth by the Anti-Cancer Agent OKN-007 in Orthotopic Mouse Xenografts. PLoS One 2015; 10:e0134276. [PMID: 26248280 PMCID: PMC4527837 DOI: 10.1371/journal.pone.0134276] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022] Open
Abstract
Pediatric glioblastomas (pGBM), although rare, are one of the leading causes of cancer-related deaths in children, with tumors essentially refractory to existing treatments. Here, we describe the use of conventional and advanced in vivo magnetic resonance imaging (MRI) techniques to assess a novel orthotopic xenograft pGBM mouse (IC-3752GBM patient-derived culture) model, and to monitor the effects of the anti-cancer agent OKN-007 as an inhibitor of pGBM tumor growth. Immunohistochemistry support data is also presented for cell proliferation and tumor growth signaling. OKN-007 was found to significantly decrease tumor volumes (p<0.05) and increase animal survival (p<0.05) in all OKN-007-treated mice compared to untreated animals. In a responsive cohort of treated animals, OKN-007 was able to significantly decrease tumor volumes (p<0.0001), increase survival (p<0.001), and increase diffusion (p<0.01) and perfusion rates (p<0.05). OKN-007 also significantly reduced lipid tumor metabolism in responsive animals [(Lip1.3 and Lip0.9)-to-creatine ratio (p<0.05)], as well as significantly decrease tumor cell proliferation (p<0.05) and microvessel density (p<0.05). Furthermore, in relationship to the PDGFRα pathway, OKN-007 was able to significantly decrease SULF2 (p<0.05) and PDGFR-α (platelet-derived growth factor receptor-α) (p<0.05) immunoexpression, and significantly increase decorin expression (p<0.05) in responsive mice. This study indicates that OKN-007 may be an effective anti-cancer agent for some patients with pGBMs by inhibiting cell proliferation and angiogenesis, possibly via the PDGFRα pathway, and could be considered as an additional therapy for pediatric brain tumor patients.
Collapse
Affiliation(s)
- Patricia Coutinho de Souza
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States of America
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, United States of America
| | - Samantha Mallory
- University of Oklahoma Children's Hospital, Oklahoma City, OK, United States of America
| | - Nataliya Smith
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States of America
| | - Debra Saunders
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States of America
| | - Xiao-Nan Li
- Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX, United States of America
| | - Rene Y. McNall-Knapp
- University of Oklahoma Children's Hospital, Oklahoma City, OK, United States of America
| | - Kar-Ming Fung
- Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK, United States of America
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Department of Pathology, Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, United States of America
| | - Rheal A. Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States of America
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, United States of America
- Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK, United States of America
- * E-mail:
| |
Collapse
|
166
|
Kaye EC, Baker JN, Broniscer A. Management of diffuse intrinsic pontine glioma in children: current and future strategies for improving prognosis. CNS Oncol 2015; 3:421-31. [PMID: 25438813 DOI: 10.2217/cns.14.47] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is one of the deadliest pediatric central nervous system cancers in spite of treatment with radiation therapy, the current standard of care. The outcome of affected children remains dismal despite multiple clinical trials that investigated radiation therapy combined with chemotherapy. Recently, multiple genome-wide studies unveiled the distinct molecular characteristics of DIPGs and preclinical models of DIPG were developed to mimic the human disease. Both of these accomplishments have generated tremendous progress in the research of new therapies for children with DIPG. Here we review some of these promising new strategies.
Collapse
Affiliation(s)
- Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital; 262 Danny Thomas Place, Mail Stop 260, Memphis, TN 38105, USA
| | | | | |
Collapse
|
167
|
Misuraca KL, Cordero FJ, Becher OJ. Pre-Clinical Models of Diffuse Intrinsic Pontine Glioma. Front Oncol 2015; 5:172. [PMID: 26258075 PMCID: PMC4513210 DOI: 10.3389/fonc.2015.00172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/09/2015] [Indexed: 01/03/2023] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a rare and incurable brain tumor that arises in the brainstem of children predominantly between the ages of 6 and 8. Its intricate morphology and involvement of normal pons tissue precludes surgical resection, and the standard of care today remains fractionated radiation alone. In the past 30 years, there have been no significant advances made in the treatment of DIPG. This is largely because we lack good models of DIPG and therefore have little biological basis for treatment. In recent years, however, due to increased biopsy and acquisition of autopsy specimens, research is beginning to unravel the genetic and epigenetic drivers of DIPG. Insight gleaned from these studies has led to improvements in approaches to both model these tumors in the lab and to potentially treat them in the clinic. This review will detail the initial strides toward modeling DIPG in animals, which included allograft and xenograft rodent models using non-DIPG glioma cells. Important advances in the field came with the development of in vitro cell and in vivo xenograft models derived directly from autopsy material of DIPG patients or from human embryonic stem cells. Finally, we will summarize the progress made in the development of genetically engineered mouse models of DIPG. Cooperation of studies incorporating all of these modeling systems to both investigate the unique mechanisms of gliomagenesis in the brainstem and to test potential novel therapeutic agents in a preclinical setting will result in improvement in treatments for DIPG patients.
Collapse
Affiliation(s)
- Katherine L Misuraca
- Department of Pediatrics, Division of Hematology-Oncology, Duke University Medical Center , Durham, NC , USA
| | | | - Oren J Becher
- Department of Pediatrics, Division of Hematology-Oncology, Duke University Medical Center , Durham, NC , USA ; Department of Pathology, Duke University Medical Center , Durham, NC , USA
| |
Collapse
|
168
|
Abstract
Diffuse intrinsic pontine glioma (DIPG) is an aggressive tumor that is universally fatal, and to-date we are at a virtual standstill in improving its grim prognosis. Dearth of tissue due to rarity of biopsy has precluded understanding the elusive biology and frustration continues in reproducing faithful animal models for translational research. Furthermore the intricate anatomy of the pons has forestalled locoregional therapy and drug penetration. Over the last few years, biopsy-driven targeted therapy, development of vitro and xenograft animal models for therapeutic testing, profiling immunotherapeutic strategies and locoregional infusion of drugs in brain stem tumors, now provide a sense of hope in the years ahead. This review aims to discuss current status and advances in the management of these tumors.
Collapse
Affiliation(s)
- Soumen Khatua
- Pediatric Neuro-Oncology, Department of Pediatrics, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 87, Houston, TX 77030, USA
| | | |
Collapse
|
169
|
de Gooijer MC, Zhang P, Thota N, Mayayo-Peralta I, Buil LCM, Beijnen JH, van Tellingen O. P-glycoprotein and breast cancer resistance protein restrict the brain penetration of the CDK4/6 inhibitor palbociclib. Invest New Drugs 2015; 33:1012-9. [PMID: 26123925 DOI: 10.1007/s10637-015-0266-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Palbociclib is a cyclin dependent kinase (CDK) 4/6 inhibitor with nanomolar potency and was recently approved for treatment of breast cancer. The drug may also be useful in glioblastoma (GBM) and diffuse intrinsic pontine gliomas (DIPG), which often have an activated CDK4/6-retinoblastoma signaling pathway. However, GBM and DIPG spread widely into the surrounding brain, which calls for a CDK4/6 inhibitor with sufficient blood-brain barrier penetration. METHODS We first performed in vitro transwell assays and demonstrate that palbociclib is a substrate of both P-gp and BCRP. Next, we conducted pharmacokinetic studies using wildtype, Abcg2(-/-), Abcb1a/b(-/-) and Abcg2; Abcb1a/b(-/-) mice. RESULTS The plasma levels were about 3000 and 500 nM and similar in all genotypes at 1 and 4 h after i.v. administration of 10 mg/kg. At 4 h the brain-to-plasma ratios were 0.3 in WT and Abcg2(-/-) mice versus 5.5 and 15 in Abcb1a/b(-/-) and Abcg2; Abcb1a/b(-/-) mice, respectively. The oral bioavailability of palbociclib was high (63 %) in WT mice and increased only modestly and non-significantly in Abcg2; Abcb1a/b(-/-) mice. The plasma level after oral dosing of 150 mg/kg was already much higher than observed in patients (200-400 nM) and exceeded 2500 nM for up to 24 h. This latter dose is commonly used in preclinical studies, which calls into question their predictive value as they were conducted at dose levels causing a clinically non-relevant systemic drug exposure. CONCLUSION Thus, the brain penetration of palbociclib is restricted by P-gp and BCRP, which may restrict the efficacy against GBM and DIPG. Moreover, preclinical studies with this agent should be conducted at a more clinically relevant dose level.
Collapse
Affiliation(s)
- Mark C de Gooijer
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ping Zhang
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Neurosurgery, Qilu Hospital, Shandong University, Wenhua Xi Road 107, 250012, Jinan, People's Republic China
| | - Nishita Thota
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Isabel Mayayo-Peralta
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Levi C M Buil
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute /Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.,Division of Drug Toxicology, Faculty of Pharmacy, Division of Biomedical Analysis, Faculty of Science, Utrecht University, Sorbonnelaan 16, 3584 CA, Utrecht, The Netherlands
| | - Olaf van Tellingen
- Department of Bio-Pharmacology/ Mouse Cancer Clinic, The Netherlands Cancer Institute, AKL room C1.005, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
170
|
Buczkowicz P, Hawkins C. Pathology, Molecular Genetics, and Epigenetics of Diffuse Intrinsic Pontine Glioma. Front Oncol 2015; 5:147. [PMID: 26175967 PMCID: PMC4485076 DOI: 10.3389/fonc.2015.00147] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/16/2015] [Indexed: 11/13/2022] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a devastating pediatric brain cancer with no effective therapy. Histological similarity of DIPG to supratentorial high-grade astrocytomas of adults has led to assumptions that these entities possess similar underlying molecular properties and therefore similar therapeutic responses to standard therapies. The failure of all clinical trials in the last 30 years to improve DIPG patient outcome has suggested otherwise. Recent studies employing next-generation sequencing and microarray technologies have provided a breadth of evidence highlighting the unique molecular genetics and epigenetics of this cancer, distinguishing it from both adult and pediatric cerebral high-grade astrocytomas. This review describes the most common molecular genetic and epigenetic signatures of DIPG in the context of molecular subgroups and histopathological diagnosis, including this tumor entity's unique mutational landscape, copy number alterations, and structural variants, as well as epigenetic changes on the global DNA and histone levels. The increased knowledge of DIPG biology and histopathology has opened doors to new diagnostic and therapeutic avenues.
Collapse
Affiliation(s)
- Pawel Buczkowicz
- Division of Pathology, The Hospital for Sick Children , Toronto, ON , Canada ; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children , Toronto, ON , Canada
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children , Toronto, ON , Canada ; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children , Toronto, ON , Canada ; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto , Toronto, ON , Canada
| |
Collapse
|
171
|
Abstract
Advances in understanding pediatric high-grade glioma (pHGG) genetics have revealed key differences between pHGG and adult HGG and have uncovered unique molecular drivers among subgroups within pHGG. The 3 core adult HGG pathways, the receptor tyrosine kinase-Ras-phosphatidylinositide 3-kinase, p53, and retinoblastoma networks, are also disrupted in pHGG, but they exhibit a different spectrum of effectors targeted by mutation. There are also similarities and differences in the genomic landscape of diffuse intrinsic pontine glioma (DIPG) and pediatric nonbrainstem (pNBS)-HGG. In 2012, histone H3 mutations were identified in nearly 80% of DIPGs and ~35% of pNBS-HGG. These were the first reports of histone mutations in human cancer, implicating novel biology in pediatric gliomagenesis. Additionally, DIPG and midline pNBS-HGG vary in the frequency and specific histone H3 amino acid substitution compared with pNBS-HGGs arising in the cerebral hemispheres, demonstrating a molecular difference among pHGG subgroups. The gene expression signatures as well as DNA methylation signatures of these tumors are also distinctive, reflecting a combination of the driving mutations and the developmental context from which they arise. These data collectively highlight unique selective pressures within the developing brainstem and solidify DIPG as a specific molecular and biological entity among pHGGs. Emerging studies continue to identify novel mutations that distinguish subgroups of pHGG. The molecular heterogeneity among pHGGs will undoubtedly have clinical implications moving forward. The discovery of unique oncogenic drivers is a critical first step in providing patients with appropriate, targeted therapies. Despite these insights, our vantage point has been largely limited to an in-depth analysis of protein coding sequences. Given the clear importance of histone mutations in pHGG, it will be interesting to see how aberrant epigenetic regulation contributes to tumorigenesis in the pediatric context. New mechanistic insights may allow for the identification of distinct vulnerabilities in this devastating spectrum of childhood tumors.
Collapse
Affiliation(s)
- Alexander K Diaz
- Developmental Neurobiology, St. Jude Children׳s Research Hospital, Memphis, TN; Integrated Biomedical Sciences Program, University of Tennessee Health Science Center, Memphis, TN
| | - Suzanne J Baker
- Developmental Neurobiology, St. Jude Children׳s Research Hospital, Memphis, TN; Integrated Biomedical Sciences Program, University of Tennessee Health Science Center, Memphis, TN.
| |
Collapse
|
172
|
Aldape K, Zadeh G, Mansouri S, Reifenberger G, von Deimling A. Glioblastoma: pathology, molecular mechanisms and markers. Acta Neuropathol 2015; 129:829-48. [PMID: 25943888 DOI: 10.1007/s00401-015-1432-1] [Citation(s) in RCA: 441] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/14/2015] [Accepted: 04/22/2015] [Indexed: 12/30/2022]
Abstract
Recent advances in genomic technology have led to a better understanding of key molecular alterations that underlie glioblastoma (GBM). The current WHO-based classification of GBM is mainly based on histologic features of the tumor, which frequently do not reflect the molecular differences that describe the diversity in the biology of these lesions. The current WHO definition of GBM relies on the presence of high-grade astrocytic neoplasm with the presence of either microvascular proliferation and/or tumor necrosis. High-throughput analyses have identified molecular subtypes and have led to progress in more accurate classification of GBM. These findings, in turn, would result in development of more effective patient stratification, targeted therapeutics, and prediction of patient outcome. While consensus has not been reached on the precise nature and means to sub-classify GBM, it is clear that IDH-mutant GBMs are clearly distinct from GBMs without IDH1/2 mutation with respect to molecular and clinical features, including prognosis. In addition, recent findings in pediatric GBMs regarding mutations in the histone H3F3A gene suggest that these tumors may represent a 3rd major category of GBM, separate from adult primary (IDH1/2 wt), and secondary (IDH1/2 mut) GBMs. In this review, we describe major clinically relevant genetic and epigenetic abnormalities in GBM-such as mutations in IDH1/2, EGFR, PDGFRA, and NF1 genes-altered methylation of MGMT gene promoter, and mutations in hTERT promoter. These markers may be incorporated into a more refined classification system and applied in more accurate clinical decision-making process. In addition, we focus on current understanding of the biologic heterogeneity and classification of GBM and highlight some of the molecular signatures and alterations that characterize GBMs as histologically defined. We raise the question whether IDH-wild type high grade astrocytomas without microvascular proliferation or necrosis might best be classified as GBM, even if they lack the histologic hallmarks as required in the current WHO classification. Alternatively, an astrocytic tumor that fits the current histologic definition of GBM, but which shows an IDH mutation may in fact be better classified as a distinct entity, given that IDH-mutant GBM are quite distinct from a biological and clinical perspective.
Collapse
Affiliation(s)
- Kenneth Aldape
- Princess Margaret Cancer Centre and MacFeeters-Hamilton Centre for Neuro-Oncology Research, 101 College St., Toronto, ON, M5G 1L7, Canada,
| | | | | | | | | |
Collapse
|
173
|
Panditharatna E, Yaeger K, Kilburn LB, Packer RJ, Nazarian J. Clinicopathology of diffuse intrinsic pontine glioma and its redefined genomic and epigenomic landscape. Cancer Genet 2015. [PMID: 26206682 DOI: 10.1016/j.cancergen.2015.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is one of the most lethal pediatric central nervous system (CNS) cancers. Recently, a surge in molecular studies of DIPG has occurred, in large part due to the increased availability of tumor tissue through donation of post-mortem specimens. These new discoveries have established DIPGs as biologically distinct from adult gliomas, harboring unique genomic aberrations. Mutations in histone encoding genes are shown to be associated with >70% of DIPG cases. However, the exact molecular mechanisms of the tumorigenicity of these mutations remain elusive. Understanding the driving mutations and genomic landscape of DIPGs can now guide the development of targeted therapies for this incurable childhood cancer.
Collapse
Affiliation(s)
- Eshini Panditharatna
- Institute for Biomedical Sciences, George Washington University School of Medicine, Washington, DC, USA; Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA
| | - Kurt Yaeger
- Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Lindsay B Kilburn
- Division of Oncology, Center for Cancer and Immunology Research, Children's National Health System, Washington, DC, USA
| | - Roger J Packer
- Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Javad Nazarian
- Research Center for Genetic Medicine, Children's National Health System, Washington, DC, USA; Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| |
Collapse
|
174
|
Korshunov A, Ryzhova M, Hovestadt V, Bender S, Sturm D, Capper D, Meyer J, Schrimpf D, Kool M, Northcott PA, Zheludkova O, Milde T, Witt O, Kulozik AE, Reifenberger G, Jabado N, Perry A, Lichter P, von Deimling A, Pfister SM, Jones DTW. Integrated analysis of pediatric glioblastoma reveals a subset of biologically favorable tumors with associated molecular prognostic markers. Acta Neuropathol 2015; 129:669-78. [PMID: 25752754 DOI: 10.1007/s00401-015-1405-4] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 12/29/2022]
Abstract
Pediatric glioblastoma (pedGBM) is amongst the most common malignant brain tumors of childhood and carries a dismal prognosis. In contrast to adult GBM, few molecular prognostic markers for the pediatric counterpart have been established. We, therefore, investigated the prognostic significance of genomic and epigenetic alterations through molecular analysis of 202 pedGBM (1-18 years) with comprehensive clinical annotation. Routinely prepared formalin-fixed paraffin-embedded tumor samples were assessed for genome-wide DNA methylation profiles, with known candidate genes screened for alterations via direct sequencing or FISH. Unexpectedly, a subset of histologically diagnosed GBM (n = 40, 20 %) displayed methylation profiles similar to those of either low-grade gliomas or pleomorphic xanthoastrocytomas (PXA). These tumors showed a markedly better prognosis, with molecularly PXA-like tumors frequently harboring BRAF V600E mutations and 9p21 (CDKN2A) homozygous deletion. The remaining 162 tumors with pedGBM molecular signatures comprised four subgroups: H3.3 G34-mutant (15 %), H3.3/H3.1 K27-mutant (43 %), IDH1-mutant (6 %), and H3/IDH wild-type (wt) GBM (36 %). These subgroups were associated with specific cytogenetic aberrations, MGMT methylation patterns and clinical outcomes. Analysis of follow-up data identified a set of biomarkers feasible for use in risk stratification: pedGBM with any oncogene amplification and/or K27M mutation (n = 124) represents a particularly unfavorable group, with 3-year overall survival (OS) of 5 %, whereas tumors without these markers (n = 38) define a more favorable group (3-year OS ~70 %).Combined with the lower grade-like lesions, almost 40 % of pedGBM cases had distinct molecular features associated with a more favorable outcome. This refined prognostication method for pedGBM using a molecular risk algorithm may allow for improved therapeutic choices and better planning of clinical trial stratification for this otherwise devastating disease.
Collapse
Affiliation(s)
- Andrey Korshunov
- Clinical Cooperation Unit Neuropathology (G380), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
175
|
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) are a fairly common pediatric brain tumor, and children with these tumors have a dismal prognosis. They generally are diagnosed within the first decade of life, and due to their location within the pons, these tumors are not surgically resectable. The median survival for children with DIPGs is less than 1 year, in spite of decades of clinical trial development of unique approaches to radiation therapy and chemotherapy. Novel therapies are under investigation for these deadly tumors. As clinicians and researchers make a concerted effort to obtain tumor tissue, the molecular signals of these tumors are being investigated in an attempt to uncover targetable therapies for DIPGs. In addition, direct application of chemotherapies into the tumor (convection-enhanced delivery) is being investigated as a novel delivery system for treatment of DIPGs. Overall, DIPGs require creative thinking and a disciplined approach for development of a therapy that can improve the prognosis for these unfortunate children.
Collapse
Affiliation(s)
- Amy Lee Bredlau
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - David N Korones
- Department of Pediatrics, University of Rochester, Rochester, New York, USA; Department of Palliative Care, University of Rochester, Rochester, New York, USA
| |
Collapse
|
176
|
Zhou Z, Ho SL, Singh R, Pisapia DJ, Souweidane MM. Toxicity evaluation of convection-enhanced delivery of small-molecule kinase inhibitors in naïve mouse brainstem. Childs Nerv Syst 2015; 31:557-62. [PMID: 25712742 DOI: 10.1007/s00381-015-2640-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Diffuse intrinsic pontine gliomas (DIPGs) are inoperable and lethal high-grade gliomas lacking definitive therapy. Platelet-derived growth factor receptor (PDGFR) and its downstream signaling molecules are the most commonly overexpressed oncogenes in DIPG. This study tested the effective concentration of PDGFR pathway inhibitors in cell culture and then toxicity of these small-molecule kinase inhibitors delivered to the mouse brainstem via convection-enhanced delivery (CED) for potential clinical application. METHODS Effective concentrations of small-molecule kinase inhibitors were first established in cell culture from a mouse brainstem glioma model. Sixteen mice underwent CED, a local drug delivery technique, of saline or of single and multidrug combinations of dasatinib (2 M), everolimus (20 M), and perifosine (0.63 mM) in the pons. Animals were kept alive for 3 days following the completion of infusion. RESULTS No animals displayed any immediate or delayed neurological deficits postoperatively. Histological analysis revealed edema, microgliosis, acute inflammation, and/or axonal injury in the experimental animals consistent with mild acute drug toxicity. CONCLUSIONS Brainstem CED of small-molecule kinase inhibitors in the mouse did not cause serious acute toxicities. Future studies will be necessary to evaluate longer-term safety to prepare for potential clinical application.
Collapse
Affiliation(s)
- Zhiping Zhou
- Department of Neurological Surgery, Weill Medical College of Cornell University, 1300 York Ave, Box 99, New York, NY, 10065, USA,
| | | | | | | | | |
Collapse
|
177
|
Xavier-Magalhães A, Nandhabalan M, Jones C, Costa BM. Molecular prognostic factors in glioblastoma: state of the art and future challenges. CNS Oncol 2015; 2:495-510. [PMID: 25054820 DOI: 10.2217/cns.13.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Gliomas account for the majority of primary tumors of the CNS, of which glioblastoma (GBM) is the most common and malignant, and for which survival is very poor. Despite significant inter- and intra-tumor heterogeneity, all patients are treated with a standardized therapeutic approach. While some clinical features of GBM patients have already been established as classic prognostic factors (e.g., patient age at diagnosis and Karnofsky performance status), one of the most important research fields in neuro-oncology today is the identification of novel molecular determinants of patient survival and tumor response to therapy. Here, we aim to review and discuss some of the most relevant and novel prognostic biomarkers in adult and pediatric GBM patients that may aid in stratifying subgroups of GBMs and rationalizing treatment decisions.
Collapse
Affiliation(s)
- Ana Xavier-Magalhães
- Life & Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | | | | | | |
Collapse
|
178
|
McEachron TA, Tomboc P, Tran NL. An integrated approach to identifying clinically relevant targets in pediatric gliomas. CNS Oncol 2015; 2:303-6. [PMID: 25054574 DOI: 10.2217/cns.13.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Troy A McEachron
- Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, AZ 85004, USA
| | | | | |
Collapse
|
179
|
Hargrave D. Pediatric diffuse intrinsic pontine glioma: can optimism replace pessimism? CNS Oncol 2015; 1:137-48. [PMID: 25057864 DOI: 10.2217/cns.12.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pediatric diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis that has not seen a change in outcome despite multiple clinical trials. Possible reasons for failure to make progress in this aggressive childhood brain tumor include: poor understanding of the underlying molecular biology due to lack of access to tumor material; absence of accurate and relevant DIPG preclinical models for drug development; ill-defined therapeutic targets for novel agents; and inadequate drug delivery to the brainstem. This review will demonstrate that systematic studies to identify solutions for each of these barriers is starting to deliver progress that can turn pessimism to optimism in DIPG.
Collapse
Affiliation(s)
- Darren Hargrave
- Department of Pediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| |
Collapse
|
180
|
A high-throughput in vitro drug screen in a genetically engineered mouse model of diffuse intrinsic pontine glioma identifies BMS-754807 as a promising therapeutic agent. PLoS One 2015; 10:e0118926. [PMID: 25748921 PMCID: PMC4352073 DOI: 10.1371/journal.pone.0118926] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 01/20/2015] [Indexed: 11/24/2022] Open
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) represent a particularly lethal type of pediatric brain cancer with no effective therapeutic options. Our laboratory has previously reported the development of genetically engineered DIPG mouse models using the RCAS/tv-a system, including a model driven by PDGF-B, H3.3K27M, and p53 loss. These models can serve as a platform in which to test novel therapeutics prior to the initiation of human clinical trials. In this study, an in vitro high-throughput drug screen as part of the DIPG preclinical consortium using cell-lines derived from our DIPG models identified BMS-754807 as a drug of interest in DIPG. BMS-754807 is a potent and reversible small molecule multi-kinase inhibitor with many targets including IGF-1R, IR, MET, TRKA, TRKB, AURKA, AURKB. In vitro evaluation showed significant cytotoxic effects with an IC50 of 0.13 μM, significant inhibition of proliferation at a concentration of 1.5 μM, as well as inhibition of AKT activation. Interestingly, IGF-1R signaling was absent in serum-free cultures from the PDGF-B; H3.3K27M; p53 deficient model suggesting that the antitumor activity of BMS-754807 in this model is independent of IGF-1R. In vivo, systemic administration of BMS-754807 to DIPG-bearing mice did not prolong survival. Pharmacokinetic analysis demonstrated that tumor tissue drug concentrations of BMS-754807 were well below the identified IC50, suggesting that inadequate drug delivery may limit in vivo efficacy. In summary, an unbiased in vitro drug screen identified BMS-754807 as a potential therapeutic agent in DIPG, but BMS-754807 treatment in vivo by systemic delivery did not significantly prolong survival of DIPG-bearing mice.
Collapse
|
181
|
Au K, Singh SK, Burrell K, Sabha N, Hawkins C, Huang A, Zadeh G. A preclinical study demonstrating the efficacy of nilotinib in inhibiting the growth of pediatric high-grade glioma. J Neurooncol 2015; 122:471-80. [PMID: 25732621 PMCID: PMC4436849 DOI: 10.1007/s11060-015-1744-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/16/2015] [Indexed: 12/28/2022]
Abstract
Solid tumors arising from malignant transformation of glial cells are one of the leading causes of central nervous system tumor-related death in children. Recurrence in spite of rigorous surgical and chemoradiation therapies remains a major hurdle in management of these tumors. Here, we investigate the efficacy of the second-generation receptor tyrosine kinase inhibitor nilotinib as a therapeutic option for the management of pediatric gliomas. We have utilized two independent pediatric high-grade glioma cell lines with either high platelet-derived growth factor receptor alpha (PDGFRα) or high PDGFRβ expression in in vitro assays to investigate the specific downstream effects of nilotinib treatment. Using in vitro cell-based assays we show that nilotinib inhibits PDGF-BB-dependent activation of PDGFRα. We further show that nilotinib is able to decrease cell proliferation and anchorage-independent growth via suppression of AKT and ERK1/2 signaling pathways. Our results suggest that nilotinib may be effective for management of a PDGFRα-dependent group of pediatric gliomas.
Collapse
Affiliation(s)
- Karolyn Au
- The Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1L7, Canada
| | | | | | | | | | | | | |
Collapse
|
182
|
Toxicity evaluation of prolonged convection-enhanced delivery of small-molecule kinase inhibitors in naïve rat brainstem. Childs Nerv Syst 2015; 31:221-6. [PMID: 25269544 DOI: 10.1007/s00381-014-2568-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Convection-enhanced delivery (CED), a local drug delivery technique, is typically performed as a single session and drug concentrations therefore decline quickly post CED. Prolonged CED (pCED) overcomes this problem by performing a long-term infusion to maintain effective drug concentrations for an extended period. The purpose of the current study was to assess the toxicity of using pCED to deliver single and multi-drug therapy in naïve rat brainstem. METHODS Sixteen rats underwent pCED of three small-molecule kinase inhibitors in the pons. Single and multi-drug combinations were delivered continuously for 7 days using ALZET mini-osmotic pumps (model 2001, rate of 1 μl/h). Rats were monitored daily for neurological signs of toxicity. Rats were sacrificed 10 days post completion of infusion, and appropriate tissue sections were analyzed for histological signs of toxicity. RESULTS Two rats exhibited signs of neurological deficits, which corresponded with diffuse inflammation, necrosis, and parenchymal damage on histological analysis. The remaining rats showed no neurological or histological signs of toxicity. CONCLUSION The neurological deficits in the two rats were likely due to injury from physical force, such as cannula movement post insertion and subsequent encephalitis. The remaining rats showed no toxicity and therefore brainstem targeting using pCED to infuse single and multi-drug therapy was well tolerated in these rats.
Collapse
|
183
|
Hiddingh L, Tannous BA, Teng J, Tops B, Jeuken J, Hulleman E, Boots-Sprenger SH, Vandertop WP, Noske DP, Kaspers GJL, Wesseling P, Wurdinger T. EFEMP1 induces γ-secretase/Notch-mediated temozolomide resistance in glioblastoma. Oncotarget 2015; 5:363-74. [PMID: 24495907 PMCID: PMC3964213 DOI: 10.18632/oncotarget.1620] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor. Temozolomide (TMZ) is the standard chemotherapeutic agent for this disease. However, intrinsic and acquired TMZ-resistance represents a major obstacle for this therapy. In order to identify factors involved in TMZ-resistance, we engineered different TMZ-resistant glioblastoma cell lines. Gene expression analysis demonstrated that EFEMP1, an extracellular matrix protein, is associated with TMZ-resistant phenotype. Silencing of EFEMP1 in glioblastoma cells resulted in decreased cell survival following TMZ treatment, whereas overexpression caused TMZ-resistance. EFEMP1 acts via multiple signaling pathways, including γ-secretase-mediated activation of the Notch pathway. We show that inhibition of γ-secretase by RO4929097 causes at least partial sensitization of glioblastoma cells to temozolomide in vitro and in vivo. In addition, we show that EFEMP1 expression levels correlate with survival in TMZ-treated glioblastoma patients. Altogether our results suggest EFEMP1 as a potential therapeutic target to overcome TMZ-resistance in glioblastoma.
Collapse
Affiliation(s)
- Lotte Hiddingh
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
184
|
Truffaux N, Philippe C, Paulsson J, Andreiuolo F, Guerrini-Rousseau L, Cornilleau G, Le Dret L, Richon C, Lacroix L, Puget S, Geoerger B, Vassal G, Östman A, Grill J. Preclinical evaluation of dasatinib alone and in combination with cabozantinib for the treatment of diffuse intrinsic pontine glioma. Neuro Oncol 2014; 17:953-64. [PMID: 25534822 DOI: 10.1093/neuonc/nou330] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/12/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Platelet-derived growth factor receptor A is altered by amplification and/or mutation in diffuse intrinsic pontine glioma (DIPG). We explored in vitro on new DIPG models the efficacy of dasatinib, a multi-tyrosine kinase inhibitor targeting this receptor. METHODS Gene expression profiles were generated from 41 DIPGs biopsied at diagnosis and compared with the signature associated with sensitivity/resistance to dasatinib. A panel of 12 new DIPG cell lines were established from biopsy at diagnosis, serially passaged, and characterized by gene expression analyses. Effects of dasatinib (1-10 μM) on proliferation, invasion, and cytotoxicity were determined on 4 of these cell lines using live-cell imaging and flow cytometry assays. Downstream signaling and receptor tyrosine kinases (RTKs) were assessed by western blot and phospho-RTK array. The effect of the combination with the c-Met inhibitor cabozantinib was studied on cellular growth and invasion analyzed by the Chou-Talaly method. RESULTS DIPG primary tumors and cell lines exhibited the gene expression signature of sensitivity to dasatinib. Dasatinib reduced proliferation (half-maximal inhibitory concentration = 10-100 nM) and invasion (30%-60% reduction) at 100 nM in 4/4 cultures and induced apoptosis in 1 of 4 DIPG cell lines. Activity of downstream effectors of dasatinib targets including activin receptor 1 was strongly reduced. Since multiple RTKs were activated simultaneously in DIPG cell lines, including c-Met, which can be also amplified in DIPG, the benefit of the combination of dasatinib with cabozantinib was explored for its synergistic effects on proliferation and migration/invasion in these cell lines. CONCLUSION Dasatinib exhibits antitumor effects in vitro that could be increased by the combination with another RTK inhibitor targeting c-Met.
Collapse
Affiliation(s)
- Nathalène Truffaux
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Cathy Philippe
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Janna Paulsson
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Felipe Andreiuolo
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Léa Guerrini-Rousseau
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Gaétan Cornilleau
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Ludivine Le Dret
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Catherine Richon
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Ludovic Lacroix
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Stéphanie Puget
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Birgit Geoerger
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Gilles Vassal
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Arne Östman
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| | - Jacques Grill
- CNRS UMR 8203 Vectorology and Anticancer Therapeutics, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (N.T., C.P., F.A., L.G.-R., G.C., L.L.-D., B.G., G.V., J.G.); Functional Genomics Unit, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (C.R.); Translational Research Laboratory and Biobank, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Inserm U981, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Medical Biology and Pathology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (L.L.); Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Paris XI University, Villejuif, France (B.G., J.G.); Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden (J.P., A.Ö.); Department of Neurosurgery, Necker-Sick Children Hospital, Paris Descartes University, Paris, France (S.P.)
| |
Collapse
|
185
|
Tate MC, Lindquist RA, Nguyen T, Sanai N, Barkovich AJ, Huang EJ, Rowitch DH, Alvarez-Buylla A. Postnatal growth of the human pons: a morphometric and immunohistochemical analysis. J Comp Neurol 2014; 523:449-62. [PMID: 25307966 DOI: 10.1002/cne.23690] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/30/2014] [Accepted: 10/06/2014] [Indexed: 01/13/2023]
Abstract
Despite its critical importance to global brain function, the postnatal development of the human pons remains poorly understood. In the present study, we first performed magnetic resonance imaging (MRI)-based morphometric analyses of the postnatal human pons (0-18 years; n = 6-14/timepoint). Pons volume increased 6-fold from birth to 5 years, followed by continued slower growth throughout childhood. The observed growth was primarily due to expansion of the basis pontis. T2-based MRI analysis suggests that this growth is linked to increased myelination, and histological analysis of myelin basic protein in human postmortem specimens confirmed a dramatic increase in myelination during infancy. Analysis of cellular proliferation revealed many Ki67(+) cells during the first 7 months of life, particularly during the first month, where proliferation was increased in the basis relative to tegmentum. The majority of proliferative cells in the postnatal pons expressed the transcription factor Olig2, suggesting an oligodendrocyte lineage. The proportion of proliferating cells that were Olig2(+) was similar through the first 7 months of life and between basis and tegmentum. The number of Ki67(+) cells declined dramatically from birth to 7 months and further decreased by 3 years, with a small number of Ki67(+) cells observed throughout childhood. In addition, two populations of vimentin/nestin-expressing cells were identified: a dorsal group near the ventricular surface, which persists throughout childhood, and a parenchymal population that diminishes by 7 months and was not evident later in childhood. Together, our data reveal remarkable postnatal growth in the ventral pons, particularly during infancy when cells are most proliferative and myelination increases.
Collapse
Affiliation(s)
- Matthew C Tate
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California - San Francisco, San Francisco, CA, 94143; Department of Neurological Surgery, University of California - San Francisco, San Francisco, CA, 94143
| | | | | | | | | | | | | | | |
Collapse
|
186
|
Burzynski SR, Janicki TJ, Burzynski GS, Marszalek A. The response and survival of children with recurrent diffuse intrinsic pontine glioma based on phase II study of antineoplastons A10 and AS2-1 in patients with brainstem glioma. Childs Nerv Syst 2014; 30:2051-61. [PMID: 24718705 PMCID: PMC4223571 DOI: 10.1007/s00381-014-2401-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Brainstem gliomas (BSG) are relatively rare tumors of which recurrent pediatric diffuse intrinsic pontine gliomas (RPDIPG) comprise a distinct group. Numerous trials have been conducted on RPDIPG, none of which have resulted in identifying any proven pharmacological treatment benefit. This study included 40 patients diagnosed with different types of BSG, but it was decided to describe first the encouraging results in the most challenging group of RPDIPG. MATERIALS AND METHODS This single-arm phase II study evaluated the efficacy and safety of the combination of antineoplastons A10 and AS2-1 (ANP) in patients with RPDIPG. Seventeen patients (median age 8.8 years) were enrolled, and all were diagnosed with RPDIPG. ANP was administered intravenously daily. Efficacy analyses were conducted in this group of patients. RESULTS In this group, complete responses were observed in 6 % of patients, partial responses in 23.5 %, and stable disease in 11.8 %. Six-month progression-free survival was 35.3 %. One-year overall survival was 29.4 %, 2 years 11.8 %, and 5, 10, and 15 years 5.9 %. One patient with DIPG is alive over 15 years post-treatment. Grade 3 and higher toxicities including hypokalemia and fatigue occurred in 6 %, hypernatremia in 18 %, fatigue and urinary incontinence in 6 %, and somnolence in 12 %. In a single patient, grade 4 hypernatremia occurred when he was on mechanical ventilation. He was disconnected from the ventilator and died from brain tumor according to the attending physician. Responding patients experienced improved quality of life. CONCLUSION The results suggest that ANP shows efficacy and acceptable tolerability profile in patients with RPDIPG.
Collapse
Affiliation(s)
| | | | | | - Ania Marszalek
- Burzynski Clinic, 9432 Katy Freeway, Houston, TX 77055 USA
| |
Collapse
|
187
|
Huse JT, Aldape KD. The Evolving Role of Molecular Markers in the Diagnosis and Management of Diffuse Glioma. Clin Cancer Res 2014; 20:5601-11. [DOI: 10.1158/1078-0432.ccr-14-0831] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
188
|
Epigenetic dysregulation: a novel pathway of oncogenesis in pediatric brain tumors. Acta Neuropathol 2014; 128:615-27. [PMID: 25077668 PMCID: PMC4201756 DOI: 10.1007/s00401-014-1325-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/07/2014] [Accepted: 07/19/2014] [Indexed: 12/21/2022]
Abstract
A remarkably large number of "epigenetic regulators" have been recently identified to be altered in cancers and a rapidly expanding body of literature points to "epigenetic addiction" (an aberrant epigenetic state to which a tumor is addicted) as a new previously unsuspected mechanism of oncogenesis. Although mutations are also found in canonical signaling pathway genes, we and others identified chromatin-associated proteins to be more commonly altered by somatic alterations than any other class of oncoprotein in several subgroups of childhood high-grade brain tumors. Furthermore, as these childhood malignancies carry fewer non-synonymous somatic mutations per case in contrast to most adult cancers, these mutations are likely drivers in these tumors. Herein, we will use as examples of this novel hallmark of oncogenesis high-grade astrocytomas, including glioblastoma, and a subgroup of embryonal tumors, embryonal tumor with multilayered rosettes (ETMR) to describe the novel molecular defects uncovered in these deadly tumors. We will further discuss evidence for their profound effects on the epigenome. The relative genetic simplicity of these tumors promises general insights into how mutations in the chromatin machinery modify downstream epigenetic signatures to drive transformation, and how to target this plastic genetic/epigenetic interface.
Collapse
|
189
|
Misuraca KL, Barton KL, Chung A, Diaz AK, Conway SJ, Corcoran DL, Baker SJ, Becher OJ. Pax3 expression enhances PDGF-B-induced brainstem gliomagenesis and characterizes a subset of brainstem glioma. Acta Neuropathol Commun 2014; 2:134. [PMID: 25330836 PMCID: PMC4210596 DOI: 10.1186/s40478-014-0134-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 02/07/2023] Open
Abstract
High-grade Brainstem Glioma (BSG), also known as Diffuse Intrinsic Pontine Glioma (DIPG), is an incurable pediatric brain cancer. Increasing evidence supports the existence of regional differences in gliomagenesis such that BSG is considered a distinct disease from glioma of the cerebral cortex (CG). In an effort to elucidate unique characteristics of BSG, we conducted expression analysis of mouse PDGF-B-driven BSG and CG initiated in Nestin progenitor cells and identified a short list of expression changes specific to the brainstem gliomagenesis process, including abnormal upregulation of paired box 3 (Pax3). In the neonatal mouse brain, Pax3 expression marks a subset of brainstem progenitor cells, while it is absent from the cerebral cortex, mirroring its regional expression in glioma. Ectopic expression of Pax3 in normal brainstem progenitors in vitro shows that Pax3 inhibits apoptosis. Pax3-induced inhibition of apoptosis is p53-dependent, however, and in the absence of p53, Pax3 promotes proliferation of brainstem progenitors. In vivo, Pax3 enhances PDGF-B-driven gliomagenesis by shortening tumor latency and increasing tumor penetrance and grade, in a region-specific manner, while loss of Pax3 function extends survival of PDGF-B-driven;p53-deficient BSG-bearing mice by 33%. Importantly, Pax3 is regionally expressed in human glioma as well, with high PAX3 mRNA characterizing 40% of human BSG, revealing a subset of tumors that significantly associates with PDGFRA alterations, amplifications of cell cycle regulatory genes, and is exclusive of ACVR1 mutations. Collectively, these data suggest that regional Pax3 expression not only marks a novel subset of BSG but also contributes to PDGF-B-induced brainstem gliomagenesis.
Collapse
|
190
|
Abstract
Diffuse high-grade gliomas (HGGs) of childhood are a devastating spectrum of disease with no effective cures. The two-year survival for paediatric HGG ranges from 30%, for tumours arising in the cerebral cortex, to less than 10% for diffuse intrinsic pontine gliomas (DIPGs), which arise in the brainstem. Recent genome-wide studies provided abundant evidence that unique selective pressures drive HGG in children compared to adults, identifying novel oncogenic mutations connecting tumorigenesis and chromatin regulation, as well as developmental signalling pathways. These new genetic findings give insights into disease pathogenesis and the challenges and opportunities for improving patient survival in these mostly incurable childhood brain tumours.
Collapse
|
191
|
Histopathological spectrum of paediatric diffuse intrinsic pontine glioma: diagnostic and therapeutic implications. Acta Neuropathol 2014; 128:573-81. [PMID: 25047029 PMCID: PMC4159563 DOI: 10.1007/s00401-014-1319-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/24/2014] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is the main cause of brain tumour-related death in children. In the majority of cases diagnosis is based on clinical and MRI findings, resulting in the scarcity of pre-treatment specimens available to study. Our group has developed an autopsy-based protocol to investigate the histologic and biologic spectrum of DIPG. This has also allowed us to investigate the terminal pattern of disease and gain a better understanding of what challenges we are facing in treating DIPG. Here, we review 72 DIPG cases with well documented clinical history and molecular data and describe the pathological features of this disease in relation to clinical and genetic features. Fifty-three of the samples were autopsy material (7 pre-treatment) and 19 were pre-treatment biopsy/surgical specimens. Upon histological review, 62 patients had high-grade astrocytomas (18 WHO grade III and 44 WHO grade IV patients), 8 had WHO grade II astrocytomas, and 2 had features of primitive neuroectodermal tumour (PNET). K27M-H3 mutations were exclusively found in tumours with WHO grade II–IV astrocytoma histology. K27M-H3.1 and ACVR1 mutations as well as ALT phenotype were only found in WHO grade III–IV astrocytomas, while PIK3CA mutations and PDGFRA gains/amplifications were found in WHO grade II–IV astrocytomas. Approximately 1/3 of DIPG patients had leptomeningeal spread of their tumour. Further, diffuse invasion of the brainstem, spinal cord and thalamus was common with some cases showing spread as distant as the frontal lobes. These findings suggest that focal radiation may be inadequate for some of these patients. Importantly, we show that clinically classic DIPGs represent a diverse histologic spectrum, including multiple cases which would fit WHO criteria of grade II astrocytoma which nevertheless behave clinically as high-grade astrocytomas and harbour the histone K27M-H3.3 mutation. This suggests that the current WHO astrocytoma grading scheme may not appropriately predict outcome for paediatric brainstem gliomas.
Collapse
|
192
|
Vanan MI, Eisenstat DD. Management of high-grade gliomas in the pediatric patient: Past, present, and future. Neurooncol Pract 2014; 1:145-157. [PMID: 26034626 DOI: 10.1093/nop/npu022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 11/12/2022] Open
Abstract
High-grade gliomas (HGGs) constitute ∼15% of all primary brain tumors in children and adolescents. Routine histopathological diagnosis is based on tissue obtained from biopsy or, preferably, from the resected tumor itself. The majority of pediatric HGGs are clinically and biologically distinct from histologically similar adult malignant gliomas; these differences may explain the disparate responses to therapy and clinical outcomes when comparing children and adults with HGG. The recently proposed integrated genomic classification identifies 6 distinct biological subgroups of glioblastoma (GBM) throughout the age spectrum. Driver mutations in genes affecting histone H3.3 (K27M and G34R/V) coupled with mutations involving specific proteins (TP53, ATRX, DAXX, SETD2, ACVR1, FGFR1, NTRK) induce defects in chromatin remodeling and may play a central role in the genesis of many pediatric HGGs. Current clinical practice in pediatric HGGs includes surgical resection followed by radiation therapy (in children aged > 3 years) with concurrent and adjuvant chemotherapy with temozolomide. However, these multimodality treatment strategies have had a minimal impact on improving survival. Ongoing clinical trials are investigating new molecular targets, chemoradiation sensitization strategies, and immunotherapy. Future clinical trials of pediatric HGG will incorporate the distinction between GBM molecular subgroups and stratify patients using group-specific biomarkers.
Collapse
Affiliation(s)
- Magimairajan Issai Vanan
- Section of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics , University of Manitoba , Winnipeg, Manitoba , Canada (M.I.V.); Division of Hematology/Oncology and Palliative Care, Stollery Children's Hospital, Departments of Pediatrics, Medical Genetics and Oncology , University of Alberta , Edmonton, Alberta , Canada (D.D.E.)
| | - David D Eisenstat
- Section of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics , University of Manitoba , Winnipeg, Manitoba , Canada (M.I.V.); Division of Hematology/Oncology and Palliative Care, Stollery Children's Hospital, Departments of Pediatrics, Medical Genetics and Oncology , University of Alberta , Edmonton, Alberta , Canada (D.D.E.)
| |
Collapse
|
193
|
Abstract
Whole-genome sequencing studies have recently identified a quarter of cases of the rare childhood brainstem tumor diffuse intrinsic pontine glioma to harbor somatic mutations in ACVR1. This gene encodes the type I bone morphogenic protein receptor ALK2, with the residues affected identical to those that, when mutated in the germline, give rise to the congenital malformation syndrome fibrodysplasia ossificans progressiva (FOP), resulting in the transformation of soft tissue into bone. This unexpected link points toward the importance of developmental biology processes in tumorigenesis and provides an extensive experience in mechanistic understanding and drug development hard-won by FOP researchers to pediatric neurooncology. Here, we review the literature in both fields and identify potential areas for collaboration and rapid advancement for patients of both diseases.
Collapse
Affiliation(s)
- Kathryn R Taylor
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom. Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Maria Vinci
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom. Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Alex N Bullock
- Structural Genomics Consortium, University of Oxford, Oxford, United Kingdom
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom. Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom.
| |
Collapse
|
194
|
Pai Panandiker AS, Wong JK, Nedelka MA, Wu S, Gajjar A, Broniscer A. Effect of time from diagnosis to start of radiotherapy on children with diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2014; 61:1180-3. [PMID: 24482196 PMCID: PMC4378861 DOI: 10.1002/pbc.24971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/07/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Children with diffuse intrinsic pontine glioma (DIPG) continue to have poor outcomes, and radiotherapy (RT) is the only temporarily effective treatment. In this retrospective analysis, we studied the effect of time from diagnosis to start of RT on event-free survival (EFS) and overall survival (OS) in children with DIPG. METHODS Records of children (n = 95) with DIPG treated with RT at a single institution between April 1999 and September 2009 were analyzed. RT was delivered at doses of 54.0-55.8 Gy at 1.8 Gy per fraction, and children were followed prospectively. The effect of gender, race, interruption during treatment course, age at diagnosis, duration of symptoms prior to diagnosis, use of protocol-based chemotherapy, and time from diagnosis to initiation of RT on EFS and OS was assessed by the Cox proportional hazards model. RESULTS Time as a continuous variable from diagnosis to start of RT did not affect outcome. Time dichotomized to ≤14 days significantly affected OS (hazard ratio [HR] = 1.70, P = 0.014) and race other than white or black affected EFS (HR = 2.32, P = 0.017). The 95 patients had a 6-month EFS and OS of 60 ± 5% and 94.7 ± 2.3%, respectively, and a 12-month EFS and OS of 11.6 ± 3.1% and 49.5 ± 5%, respectively. CONCLUSIONS Time as a continuous variable did not affect OS or EFS in our cohort; however, children treated within 2 weeks of diagnosis had poor outcomes. Although rapid initiation of RT is desirable, our findings do not support intensive efforts aimed at shortening delays from diagnosis to start of RT.
Collapse
Affiliation(s)
- Atmaram S. Pai Panandiker
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee,Corresponding author: Atmaram S. Pai Panandiker, MD, Department of Radiological Sciences, Mail Stop 220, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, Phone: 901-595-3226; Fax: 901-595-3113;
| | - J. Karen Wong
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michele A. Nedelka
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| |
Collapse
|
195
|
Jansen MH, Veldhuijzen van Zanten SE, Sanchez Aliaga E, Heymans MW, Warmuth-Metz M, Hargrave D, van der Hoeven EJ, Gidding CE, de Bont ES, Eshghi OS, Reddingius R, Peeters CM, Schouten-van Meeteren AYN, Gooskens RHJ, Granzen B, Paardekooper GM, Janssens GO, Noske DP, Barkhof F, Kramm CM, Vandertop WP, Kaspers GJ, van Vuurden DG. Survival prediction model of children with diffuse intrinsic pontine glioma based on clinical and radiological criteria. Neuro Oncol 2014; 17:160-6. [PMID: 24903904 DOI: 10.1093/neuonc/nou104] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although diffuse intrinsic pontine glioma (DIPG) carries the worst prognosis of all pediatric brain tumors, studies on prognostic factors in DIPG are sparse. To control for confounding variables in DIPG studies, which generally include relatively small patient numbers, a survival prediction tool is needed. METHODS A multicenter retrospective cohort study was performed in the Netherlands, the UK, and Germany with central review of clinical data and MRI scans of children with DIPG. Cox proportional hazards with backward regression was used to select prognostic variables (P < .05) to predict the accumulated 12-month risk of death. These predictors were transformed into a practical risk score. The model's performance was validated by bootstrapping techniques. RESULTS A total of 316 patients were included. The median overall survival was 10 months. Multivariate Cox analysis yielded 5 prognostic variables of which the coefficients were included in the risk score. Age ≤3 years, longer symptom duration at diagnosis, and use of oral and intravenous chemotherapy were favorable predictors, while ring enhancement on MRI at diagnosis was an unfavorable predictor. With increasing risk score categories, overall survival decreased significantly. The model can distinguish between patients with very short, average, and increased overall survival (medians of 7.0, 9.7, and 13.7 mo, respectively). The area under the receiver operating characteristic curve was 0.68. CONCLUSIONS We developed a DIPG survival prediction tool that can be used to predict the outcome of patients and for stratification in trials. Validation of the model is needed in a prospective cohort.
Collapse
Affiliation(s)
- Marc H Jansen
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Sophie E Veldhuijzen van Zanten
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Esther Sanchez Aliaga
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Martijn W Heymans
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Monika Warmuth-Metz
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Darren Hargrave
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Erica J van der Hoeven
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Corrie E Gidding
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Eveline S de Bont
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Omid S Eshghi
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Roel Reddingius
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Cacha M Peeters
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Antoinette Y N Schouten-van Meeteren
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Rob H J Gooskens
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Bernd Granzen
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Gabriel M Paardekooper
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Geert O Janssens
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - David P Noske
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Frederik Barkhof
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Christof M Kramm
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - W Peter Vandertop
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Gertjan J Kaspers
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| | - Dannis G van Vuurden
- Department of Pediatric Oncology and Hematology, VU University Medical Center, Amsterdam, Netherlands (M.H.A.J., S.E.M.V.v.Z., E.J.v.d.H., G.J.L.K., D.G.v.V.); Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands (E.S.A., F.B.); Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands (M.W.H.); Department of Neuroradiology, Reference Center for Neuroradiology, Uniklinikum Wurzburg, University of Würzburg, Wurzburg, Germany (M.W-M.); Department of Oncology, Great Ormond Street Hospital London, London, UK (D.H.); Department of Pediatric Oncology and Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (C.E.G.); Department of Pediatric Oncology and Hematology, University Medical Center Groningen, Groningen, Netherlands (E.S.J.M.d.B.); Department of Radiology, University Medical Center Groningen, Groningen, Netherlands (O.S.E.); Department of Pediatric Oncology and Hematology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands (R.R.); Department of Pediatric Neurology, Leiden University Medical Center Rotterdam, Leiden, Netherlands (C.M.P.C.D.P.); Department of Pediatric Oncology and Hematology, Academic Medical Center Amsterdam, Emma Children's Hospital AMC, Amsterdam, Netherlands (A.Y.N.S-v.M.); Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, Netherlands (R.H.J.G.); Department of Pediatric Oncology and Hematology, University Hospital Maastricht, Maastricht, Netherlands (B.G.); Department of Radiotherapy, Isala Clinics Zwolle, Zwolle, Netherlands (G.M.R.N.P.); Department of Radiation Oncology (874), Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (G.O.J.); Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands (D.P.N., W.P.V.); University Children's Hospital, Halle, Germany (C.M.K.); Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medi
| |
Collapse
|
196
|
Ahsan S, Raabe EH, Haffner MC, Vaghasia A, Warren KE, Quezado M, Ballester LY, Nazarian J, Eberhart CG, Rodriguez FJ. Increased 5-hydroxymethylcytosine and decreased 5-methylcytosine are indicators of global epigenetic dysregulation in diffuse intrinsic pontine glioma. Acta Neuropathol Commun 2014; 2:59. [PMID: 24894482 PMCID: PMC4229804 DOI: 10.1186/2051-5960-2-59] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/26/2014] [Indexed: 01/14/2023] Open
Abstract
Introduction Diffuse intrinsic pontine glioma (DIPG) is a malignant pediatric brain tumor associated with dismal outcome. Recent high-throughput molecular studies have shown a high frequency of mutations in histone-encoding genes (H3F3A and HIST1B) and distinctive epigenetic alterations in these tumors. Epigenetic alterations described in DIPG include global DNA hypomethylation. In addition to the generally repressive methylcytosine DNA alteration, 5-hydroxymethylation of cytosine (5hmC) is recognized as an epigenetic mark associated with active chromatin. We hypothesized that in addition to alterations in DNA methylation, that there would be changes in 5hmC. To test this hypothesis, we performed immunohistochemical studies to compare epigenetic alterations in DIPG to extrapontine adult and pediatric glioblastoma (GBM) and normal brain. A total of 124 tumors were scored for histone 3 lysine 27 trimethylation (H3K27me3) and histone 3 lysine 9 trimethylation (H3K9me3) and 104 for 5hmC and 5-methylcytosine (5mC). An H-score was derived by multiplying intensity (0–2) by percentage of positive tumor nuclei (0-100%). Results We identified decreased H3K27me3 in the DIPG cohort compared to pediatric GBM (p < 0.01), adult GBM (p < 0.0001) and normal brain (p < 0.0001). H3K9me3 was not significantly different between tumor types. Global DNA methylation as measured by 5mC levels were significantly lower in DIPG compared to pediatric GBM (p < 0.001), adult GBM (p < 0.01), and normal brain (p < 0.01). Conversely, 5hmC levels were significantly higher in DIPG compared to pediatric GBM (p < 0.0001) and adult GBM (p < 0.0001). Additionally, in an independent set of DIPG tumor samples, TET1 and TET3 mRNAs were found to be overexpressed relative to matched normal brain. Conclusions Our findings extend the immunohistochemical study of epigenetic alterations in archival tissue to DIPG specimens. Low H3K27me3, decreased 5mC and increased 5hmC are characteristic of DIPG in comparison with extrapontine GBM. In DIPG, the relative imbalance of 5mC compared to 5hmC may represent an opportunity for therapeutic intervention. Electronic supplementary material The online version of this article (doi:10.1186/2051-5960-2-59) contains supplementary material, which is available to authorized users.
Collapse
|
197
|
Pollack IF, Jakacki RI, Butterfield LH, Hamilton RL, Panigrahy A, Potter DM, Connelly AK, Dibridge SA, Whiteside TL, Okada H. Antigen-specific immune responses and clinical outcome after vaccination with glioma-associated antigen peptides and polyinosinic-polycytidylic acid stabilized by lysine and carboxymethylcellulose in children with newly diagnosed malignant brainstem and nonbrainstem gliomas. J Clin Oncol 2014; 32:2050-8. [PMID: 24888813 DOI: 10.1200/jco.2013.54.0526] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Diffuse brainstem gliomas (BSGs) and other high-grade gliomas (HGGs) of childhood carry a dismal prognosis despite current treatments, and new therapies are needed. Having identified a series of glioma-associated antigens (GAAs) commonly overexpressed in pediatric gliomas, we initiated a pilot study of subcutaneous vaccinations with GAA epitope peptides in HLA-A2-positive children with newly diagnosed BSG and HGG. PATIENTS AND METHODS GAAs were EphA2, interleukin-13 receptor alpha 2 (IL-13Rα2), and survivin, and their peptide epitopes were emulsified in Montanide-ISA-51 and given every 3 weeks with intramuscular polyinosinic-polycytidylic acid stabilized by lysine and carboxymethylcellulose for eight courses, followed by booster vaccinations every 6 weeks. Primary end points were safety and T-cell responses against vaccine-targeted GAA epitopes. Treatment response was evaluated clinically and by magnetic resonance imaging. RESULTS Twenty-six children were enrolled, 14 with newly diagnosed BSG treated with irradiation and 12 with newly diagnosed BSG or HGG treated with irradiation and concurrent chemotherapy. No dose-limiting non-CNS toxicity was encountered. Five children had symptomatic pseudoprogression, which responded to dexamethasone and was associated with prolonged survival. Only two patients had progressive disease during the first two vaccine courses; 19 had stable disease, two had partial responses, one had a minor response, and two had prolonged disease-free status after surgery. Enzyme-linked immunosorbent spot analysis in 21 children showed positive anti-GAA immune responses in 13: to IL-13Rα2 in 10, EphA2 in 11, and survivin in three. CONCLUSION GAA peptide vaccination in children with gliomas is generally well tolerated and has preliminary evidence of immunologic and clinical responses. Careful monitoring and management of pseudoprogression is essential.
Collapse
Affiliation(s)
- Ian F Pollack
- All authors: University of Pittsburgh, Pittsburgh, PA.
| | | | | | | | | | | | | | | | | | - Hideho Okada
- All authors: University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
198
|
Robison NJ, Kieran MW. Diffuse intrinsic pontine glioma: a reassessment. J Neurooncol 2014; 119:7-15. [PMID: 24792486 DOI: 10.1007/s11060-014-1448-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/13/2014] [Indexed: 11/25/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a disease of childhood whose abysmal prognosis has remained unchanged for over 50 years. Biologic investigation has been stymied by lack of pretreatment tissue, as biopsy has been reserved for atypical cases. Recent advances in surgical and molecular-analytic techniques have increased the safety and potential utility of biopsy; brainstem biopsy has now been incorporated into several prospective clinical trials. These and other recent efforts have yielded new insights into DIPG molecular pathogenesis, and opened new avenues for investigation.
Collapse
Affiliation(s)
- Nathan J Robison
- Pediatric Neuro-Oncology Program, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 W Sunset Blvd, MS#54, Los Angeles, CA, 90027, USA,
| | | |
Collapse
|
199
|
Taylor KR, Mackay A, Truffaux N, Butterfield Y, Morozova O, Philippe C, Castel D, Grasso CS, Vinci M, Carvalho D, Carcaboso AM, de Torres C, Cruz O, Mora J, Entz-Werle N, Ingram WJ, Monje M, Hargrave D, Bullock AN, Puget S, Yip S, Jones C, Grill J. Recurrent activating ACVR1 mutations in diffuse intrinsic pontine glioma. Nat Genet 2014; 46:457-461. [PMID: 24705252 PMCID: PMC4018681 DOI: 10.1038/ng.2925] [Citation(s) in RCA: 373] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 02/21/2014] [Indexed: 12/24/2022]
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) are highly infiltrative malignant glial neoplasms of the ventral pons that, due to their location within the brain, are unsuitable for surgical resection and consequently have a universally dismal clinical outcome. The median survival time is 9-12 months, with neither chemotherapeutic nor targeted agents showing substantial survival benefit in clinical trials in children with these tumors. We report the identification of recurrent activating mutations in the ACVR1 gene, which encodes a type I activin receptor serine/threonine kinase, in 21% of DIPG samples. Strikingly, these somatic mutations (encoding p.Arg206His, p.Arg258Gly, p.Gly328Glu, p.Gly328Val, p.Gly328Trp and p.Gly356Asp substitutions) have not been reported previously in cancer but are identical to mutations found in the germ line of individuals with the congenital childhood developmental disorder fibrodysplasia ossificans progressiva (FOP) and have been shown to constitutively activate the BMP-TGF-β signaling pathway. These mutations represent new targets for therapeutic intervention in this otherwise incurable disease.
Collapse
Affiliation(s)
| | | | | | | | - Olena Morozova
- Howard Hughes Medical Institute, Los Angeles, CA, USA
- University of California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | - Jaume Mora
- Hospital Sant Joan de Deu, Barcelona, Spain
| | - Natacha Entz-Werle
- Centre Hospitalier Régional et Universitaire Hautepierre, Strasbourg, France
| | - Wendy J Ingram
- Queensland Children’s Tumour Bank, Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Michelle Monje
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Alex N Bullock
- Structural Genomics Consortium, University of Oxford, UK
| | | | | | | | | |
Collapse
|
200
|
Caretti V, Sewing ACP, Lagerweij T, Schellen P, Bugiani M, Jansen MHA, van Vuurden DG, Navis AC, Horsman I, Vandertop WP, Noske DP, Wesseling P, Kaspers GJL, Nazarian J, Vogel H, Hulleman E, Monje M, Wurdinger T. Human pontine glioma cells can induce murine tumors. Acta Neuropathol 2014; 127:897-909. [PMID: 24777482 DOI: 10.1007/s00401-014-1272-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/07/2014] [Accepted: 03/20/2014] [Indexed: 01/12/2023]
Abstract
Diffuse intrinsic pontine glioma (DIPG), with a median survival of only 9 months, is the leading cause of pediatric brain cancer mortality. Dearth of tumor tissue for research has limited progress in this disease until recently. New experimental models for DIPG research are now emerging. To develop preclinical models of DIPG, two different methods were adopted: cells obtained at autopsy (1) were directly xenografted orthotopically into the pons of immunodeficient mice without an intervening cell culture step or (2) were first cultured in vitro and, upon successful expansion, injected in vivo. Both strategies resulted in pontine tumors histopathologically similar to the original human DIPG tumors. However, following the direct transplantation method all tumors proved to be composed of murine and not of human cells. This is in contrast to the indirect method that included initial in vitro culture and resulted in xenografts comprising human cells. Of note, direct injection of cells obtained postmortem from the pons and frontal lobe of human brains not affected by cancer did not give rise to neoplasms. The murine pontine tumors exhibited an immunophenotype similar to human DIPG, but were also positive for microglia/macrophage markers, such as CD45, CD68 and CD11b. Serial orthotopic injection of these murine cells results in lethal tumors in recipient mice. Direct injection of human DIPG cells in vivo can give rise to malignant murine tumors. This represents an important caveat for xenotransplantation models of DIPG. In contrast, an initial in vitro culture step can allow establishment of human orthotopic xenografts. The mechanism underlying this phenomenon observed with direct xenotransplantation remains an open question.
Collapse
Affiliation(s)
- Viola Caretti
- Departments of Neurology, Neurosurgery and Pediatrics, Stanford University School of Medicine, Stanford, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|