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Colafati GS, Voicu IP, Carducci C, Miele E, Carai A, Di Loreto S, Marrazzo A, Cacchione A, Cecinati V, Tornesello A, Mastronuzzi A. MRI features as a helpful tool to predict the molecular subgroups of medulloblastoma: state of the art. Ther Adv Neurol Disord 2018; 11:1756286418775375. [PMID: 29977341 PMCID: PMC6024494 DOI: 10.1177/1756286418775375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/28/2018] [Indexed: 12/20/2022] Open
Abstract
Medulloblastoma is the most common malignant pediatric brain tumor. Medulloblastoma should not be viewed as a single disease, but as a heterogeneous mixture of various subgroups with distinct characteristics. Based on genomic profiles, four distinct molecular subgroups are identified: Wingless (WNT), Sonic Hedgehog (SHH), Group 3 and Group 4. Each of these subgroups are associated with specific genetic aberrations, typical age of onset as well as survival prognosis. Magnetic resonance imaging (MRI) is performed for all patients with brain tumors, and has a key role in the diagnosis, surgical guidance and follow up of patients with medulloblastoma. Several studies indicate MRI as a promising tool for early detection of medulloblastoma subgroups. The early identification of the subgroup can influence the extent of surgical resection, radiotherapy and chemotherapy targeted treatments. In this article, we review the state of the art in MRI-facilitated medulloblastoma subgrouping, with a summary of the main MRI features in medulloblastoma and a brief discussion on molecular characterization of medulloblastoma subgroups. The main focus of the article is MRI features that correlate with medulloblastoma subtypes, as well as features suggestive of molecular subgroups. Finally, we briefly discuss the latest trends in MRI studies and latest developments in molecular characterization.
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Affiliation(s)
| | - Ioan Paul Voicu
- Department of Imaging, Neuroradiology Unit and Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Carducci
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Evelina Miele
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Carai
- Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simona Di Loreto
- Dipartimento di Pediatria, Università degli studi di Chieti, Chieti, Italy
| | - Antonio Marrazzo
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Valerio Cecinati
- Pediatric Hematology and Oncology Unit, Department of Hematology, Transfusion Medicine and Biotechnology, Pescara, Italy
| | | | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
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Chaturvedi NK, Kling MJ, Coulter DW, McGuire TR, Ray S, Kesherwani V, Joshi SS, Sharp JG. Improved therapy for medulloblastoma: targeting hedgehog and PI3K-mTOR signaling pathways in combination with chemotherapy. Oncotarget 2018; 9:16619-16633. [PMID: 29682173 PMCID: PMC5908274 DOI: 10.18632/oncotarget.24618] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/21/2018] [Indexed: 02/07/2023] Open
Abstract
Aberrant activation and interactions of hedgehog (HH) and PI3K/AKT/mTOR signaling pathways are frequently associated with high-risk medulloblastoma (MB). Thus, combined targeting of the HH and PI3K/AKT/mTOR pathways could be a viable therapeutic strategy to treat high-risk patients. Therefore, we investigated the anti-MB efficacies of combined HH inhibitor Vismodegib and PI3K-mTOR dual-inhibitor BEZ235 together or combined individually with cisplatin against high-risk MB. Using non-MYC- and MYC-amplified cell lines, and a xenograft mouse model, the in vitro and in vivo efficacies of these therapies on cell growth/survival and associated molecular mechanism(s) were investigated. Results showed that combined treatment of Vismodegib and BEZ235 together, or with cisplatin, significantly decreased MB cell growth/survival in a dose-dependent-fashion. Corresponding changes in the expression of targeted molecules following therapy were observed. Results demonstrated that inhibitors not only suppressed MB cell growth/survival when combined, but also significantly enhanced cisplatin-mediated cytotoxicity. Of these combinations, BEZ235 exhibited a significantly greater efficacy in enhancing cisplatin-mediated MB cytotoxicity. Results also demonstrated that the MYC-amplified MB lines showed a higher sensitivity to combined therapies compared to non-MYC-amplified cell lines. Therefore, we tested the efficacy of combined approaches against MYC-amplified MB growing in NSG mice. In vivo results showed that combination of Vismodegib and BEZ235 or their combination with cisplatin, significantly delayed MB tumor growth and increased survival of xenografted mice by targeting HH and mTOR pathways. Thus, our studies lay a foundation for translating these combined therapeutic strategies to the clinical setting to determine their efficacies in high-risk MB patients.
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Affiliation(s)
- Nagendra K Chaturvedi
- Departments of Pediatrics, Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Matthew J Kling
- Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Don W Coulter
- Departments of Pediatrics, Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Timothy R McGuire
- Pharmacy Practice, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Sutapa Ray
- Departments of Pediatrics, Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Varun Kesherwani
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - Shantaram S Joshi
- Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 69198, USA
| | - J Graham Sharp
- Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 69198, USA
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IDO1 involvement in mTOR pathway: a molecular mechanism of resistance to mTOR targeting in medulloblastoma. Oncotarget 2018; 7:52900-52911. [PMID: 27174915 PMCID: PMC5288157 DOI: 10.18632/oncotarget.9284] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/11/2016] [Indexed: 12/14/2022] Open
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in children. Despite therapeutic advancements, high-risk groups still present significant mortality. A deeper knowledge of the signaling pathways contributing to MB formation and aggressiveness would help develop new successful therapies. The target of rapamycin, mTOR signaling, is known to be involved in MB and is already targetable in the clinical setting. Furthermore, mTOR is a master metabolic regulator able to control cell growth versus autophagy decisions in conditions of amino-acid deprivation that can be due to IDO1 enzymatic activity. IDO1 has been also implicated in the regulation of inflammation, as well as of T cell-mediated immune responses, in a variety of pathological conditions, including brain tumors. In particular, IDO1 induces expansion of regulatory T-cells (Treg), preventing immune response against tumor cells. Analysis of 27 MB tissue specimens for the expression of both mTOR and IDO1 showed their widespread expression in all samples. Testing their cooperation in vitro, a significant involvement of IDO1 in mTOR immunogenic pathway was found, able to counteract the aim of rapamycin treatment. In MB cell lines, inhibition of mTOR strongly induced IDO1 expression and activity, corroborating its ability to recruit Treg cells in the tumor microenvironment. The mTOR/IDO1 cross talk was found to be strictly specific of MB cells. We demonstrated that mTOR pathway cross talks with IDO1 pathway to promote MB immune escape, possibly contributing to failure of mTOR- targeted therapy.
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Henderson JJ, Wagner JP, Hofmann NE, Eide CA, Cho YJ, Druker BJ, Davare MA. Functional validation of the oncogenic cooperativity and targeting potential of tuberous sclerosis mutation in medulloblastoma using a MYC-amplified model cell line. Pediatr Blood Cancer 2017; 64. [PMID: 28409891 DOI: 10.1002/pbc.26553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/07/2017] [Accepted: 02/23/2017] [Indexed: 01/22/2023]
Abstract
Medulloblastoma is the most common malignant brain tumor of childhood. To identify targetable vulnerabilities, we employed inhibitor screening that revealed mTOR inhibitor hypersensitivity in the MYC-overexpressing medulloblastoma cell line, D341. Concomitant exome sequencing unveiled an uncharacterized missense mutation, TSC2A415V , in these cells. We biochemically demonstrate that the TSC2A415V mutation is functionally deleterious, leading to shortened half-life and proteasome-mediated protein degradation. These data suggest that MYC cooperates with activated kinase pathways, enabling pharmacologic intervention in these treatment refractory tumors. We propose that identification of activated kinase pathways may allow for tailoring targeted therapy to improve survival and treatment-related morbidity in medulloblastoma.
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Affiliation(s)
- Jacob J Henderson
- Department of Pediatrics, Doernbecher Children's Hospital, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Jacob P Wagner
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Nicolle E Hofmann
- Department of Pediatrics, Doernbecher Children's Hospital, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Christopher A Eide
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Howard Hughes Medical Institute, Portland, Oregon
| | - Yoon-Jae Cho
- Department of Pediatrics, Doernbecher Children's Hospital, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon.,Department of Pediatric Neurology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon
| | - Brian J Druker
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Howard Hughes Medical Institute, Portland, Oregon
| | - Monika A Davare
- Department of Pediatrics, Doernbecher Children's Hospital, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
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Peron A, Vignoli A, La Briola F, Volpi A, Montanari E, Morenghi E, Ghelma F, Bulfamante G, Cefalo G, Canevini MP. Do patients with tuberous sclerosis complex have an increased risk for malignancies? Am J Med Genet A 2016; 170:1538-44. [PMID: 27061015 DOI: 10.1002/ajmg.a.37644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/20/2016] [Indexed: 02/01/2023]
Abstract
Tuberous Sclerosis Complex (TSC) is generally characterized by the presence of benign tumors, but some patients with malignancies have been reported in the literature. We examined a large Italian TSC population (240 individuals followed from 2001 to 2015, aged 3 months-74 years), assessing the frequency of malignancies to determine whether there is an increased risk for cancer in this disorder, and looking for possible features associated with the development of neoplasia. Fifteen patients had malignancies (6.25%); median age at diagnosis was 37.5 years (range of 1.6-58). Five of seven renal tumors were renal cell carcinomas. Eight patients had a non-renal malignancy (3.3%), but we did not find a more prevalent type of cancer. No patient developed more than one malignancy. The prevalence of all malignant tumors was compatible with the prevalence in the general population (5.6%, 95%CI 2.99-9.31%, vs. 4.4% in Italy). Median age at cancer diagnosis was lower (37.5 years, 95%CI 28.6-44.7, vs. 66.0 years). Two patients (13.3%) died of their cancer, while outcome was favorable in the remaining individuals. Malignant tumors were more frequently diagnosed in patients with mutations in TSC1 when compared to TSC2 and patients with no mutation identified (P = 0.032). Our study demonstrated that TSC patients do not seem to have an increased risk for malignancies besides renal cell carcinoma. However, when cancer develops, age at diagnosis is lower than in the general population, and malignant tumors are more frequently diagnosed in patients with mutations in TSC1. Further studies are needed to confirm these data. ©2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Angela Peron
- Child Neurology Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Aglaia Vignoli
- Child Neurology Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Francesca La Briola
- Child Neurology Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Angela Volpi
- Nephrology Unit, San Paolo Hospital, Milan, Italy
| | - Emanuele Montanari
- Urology Unit, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Emanuela Morenghi
- Biostatististics Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Filippo Ghelma
- DAMA Unit (Disabled Advanced Medical Assistance), San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gaetano Bulfamante
- Human Pathology Unit, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Graziella Cefalo
- Pediatrics Department, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria Paola Canevini
- Child Neurology Unit-Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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