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Sojka C, Sloan SA. Gliomas: a reflection of temporal gliogenic principles. Commun Biol 2024; 7:156. [PMID: 38321118 PMCID: PMC10847444 DOI: 10.1038/s42003-024-05833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
The hijacking of early developmental programs is a canonical feature of gliomas where neoplastic cells resemble neurodevelopmental lineages and possess mechanisms of stem cell resilience. Given these parallels, uncovering how and when in developmental time gliomagenesis intersects with normal trajectories can greatly inform our understanding of tumor biology. Here, we review how elapsing time impacts the developmental principles of astrocyte (AS) and oligodendrocyte (OL) lineages, and how these same temporal programs are replicated, distorted, or circumvented in pathological settings such as gliomas. Additionally, we discuss how normal gliogenic processes can inform our understanding of the temporal progression of gliomagenesis, including when in developmental time gliomas originate, thrive, and can be pushed towards upon therapeutic coercion.
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Affiliation(s)
- Caitlin Sojka
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven A Sloan
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.
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2
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Modrzejewska M, Olejnik-Wojciechowska J, Roszyk A, Szychot E, Konczak TD, Szemitko M, Peregud-Pogorzelski JW. Optic Pathway Gliomas in Pediatric Population-Current Approach in Diagnosis and Management: Literature Review. J Clin Med 2023; 12:6709. [PMID: 37959175 PMCID: PMC10649937 DOI: 10.3390/jcm12216709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
In this paper, the authors present a clinical picture of the diagnosis and current treatment regimens of optic pathway glioma in the pediatric population, with an emphasis on the role of an ophthalmic diagnosis in the differentiation and monitoring of lesions. Glioma is the most common optic nerve tumor in children. MATERIAL Articles in PubMed, Scholar and Website were reviewed, taking into account current standards of management related to sporadic or NF1-related optic glioma, epidemiology, location, course of the disease, clinical manifestations, histological types of the tumor, genetic predisposition, diagnostic ophthalmic tests currently applicable in therapeutic monitoring of the tumor, neurological diagnosis, therapeutic management and prognosis. The importance of current screening recommendations, in line with standards, was emphasized. RESULTS Glioma occurs in children most often in the first decade of life. Initially, they may be asymptomatic, and clinically ophthalmic changes are associated with the organ of vision or with systemic changes. Gliomas associated with the NF1 mutation have a better prognosis for sporadic gliomas. Diagnosis includes radiological imaging methods/MRI/ophthalmology/OCT and visual acuity log MAR assessment. The basis of treatment is clinical observation. In the case of disease progression, surgical treatment, chemotherapy and targeted therapy are used. CONCLUSION Further research into novel techniques for detecting gliomas would allow for early monitoring of the disease.
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Affiliation(s)
- Monika Modrzejewska
- II Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Joanna Olejnik-Wojciechowska
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Agnieszka Roszyk
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Elwira Szychot
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
- Department of Paediatric Onclogy, Great Ormond Street Hospital for Children, London WC1N 1LE, UK
| | - Tomasz Dariusz Konczak
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Marcin Szemitko
- Department of Intervantional Radiology, Pomerian Medical University, 70-111 Szczecin, Poland
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Dal Bello S, Martinuzzi D, Tereshko Y, Veritti D, Sarao V, Gigli GL, Lanzetta P, Valente M. The Present and Future of Optic Pathway Glioma Therapy. Cells 2023; 12:2380. [PMID: 37830595 PMCID: PMC10572241 DOI: 10.3390/cells12192380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
Optic pathway gliomas (OPGs) encompass two distinct categories: benign pediatric gliomas, which are characterized by favorable prognosis, and malignant adult gliomas, which are aggressive cancers associated with a poor outcome. Our review aims to explore the established standards of care for both types of tumors, highlight the emerging therapeutic strategies for OPG treatment, and propose potential alternative therapies that, while originally studied in a broader glioma context, may hold promise for OPGs pending further investigation. These potential therapies encompass immunotherapy approaches, molecular-targeted therapy, modulation of the tumor microenvironment, nanotechnologies, magnetic hyperthermia therapy, cyberKnife, cannabinoids, and the ketogenic diet. Restoring visual function is a significant challenge in cases where optic nerve damage has occurred due to the tumor or its therapeutic interventions. Numerous approaches, particularly those involving stem cells, are currently being investigated as potential facilitators of visual recovery in these patients.
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Affiliation(s)
- Simone Dal Bello
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Deborah Martinuzzi
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Yan Tereshko
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Daniele Veritti
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Valentina Sarao
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medical Area, University of Udine, 33100 Udine, Italy
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4
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Bowman R, Walters B, Smith V, Prise KL, Handley SE, Green K, Mankad K, O'Hare P, Dahl C, Jorgensen M, Opocher E, Hargrave D, Thompson DA. Visual outcomes and predictors in optic pathway glioma: a single centre study. Eye (Lond) 2023; 37:1178-1183. [PMID: 35562551 PMCID: PMC10101957 DOI: 10.1038/s41433-022-02096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/AIMS Optic pathway gliomas (OPGs) may cause progressive visual loss despite chemotherapy. Newer, less toxic treatments might be given earlier, depending on visual prognosis. We aimed to investigate the prognostic value of visual evoked potentials (VEP) and optical coherence tomography (OCT). METHODS A retrospective study of OPG patients (treated 2003-2017) was conducted. Primary outcome was PEDIG category visual acuity in better and worse eyes (good < = 0.2, moderate 0.3-0.6 and poor > = 0.7 logMAR). Binary logistic regression analysis was used to identify predictors of these outcomes. RESULTS 60 patients (32 Neurofibromatosis type 1 [NF1] and 28 sporadic) had median presentation age 49 months (range 17-183) (NF1) and 27 months (range 4-92) (sporadic). Median follow up was 82 months (range 12-189 months). At follow up 24/32 (75%) of NF1 children and 14/28 (50%) of sporadic children had good better eye visual acuity and 11/32 (34%) of NF1 children and 15/28 (54%) of sporadics had poor worse eye acuity. Mean peripapillary retinal nerve fibre layer (RNFL) thickness predicted good better eye final acuity (OR 0.799, 95%CI 0.646-0.987, p = 0.038). Presenting with visual symptoms (OR 0.22 95% CI 0.001-0.508, p = 0.017) and poorer VEP scores (OR 2.35 95% CI 1.1-5.03, p = 0.027) predicted poor worse eye final acuity. 16 children had homonymous hemianopias at follow up, predicted by poor presenting binocular VEP score (OR 1.449 95%CI 1.052-1.995, p = 0.02). CONCLUSIONS We found that both RNFL thickness on OCT and VEP were useful in predicting future visual acuity and vision and potentially in planning treatment. We had a high prevalence of homonymous hemianopia.
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Affiliation(s)
- R Bowman
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England.
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England.
| | - B Walters
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - V Smith
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - K L Prise
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - S E Handley
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - K Green
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - K Mankad
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - P O'Hare
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - C Dahl
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - M Jorgensen
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - E Opocher
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - D Hargrave
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - D A Thompson
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
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5
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Chan PP, Sabus A, Hemenway MS, Chatfield KC, White CJ, Mirsky DM, Foreman NK, Dahl NA. Thromboembolic toxicity observed with concurrent trametinib and lenalidomide therapy. Pediatr Blood Cancer 2023; 70:e30190. [PMID: 36602034 PMCID: PMC10519171 DOI: 10.1002/pbc.30190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Abstract
The event-free survival of pediatric low-grade gliomas is poor, and patients often require multiple treatment strategies. While MEK and RAF inhibitors are efficacious in early-phase trials, not all patients respond, and many experience progression following completion of therapy. Evaluating combination therapies that may enhance efficacy or prolong disease stabilization is warranted. We report our institutional experience using concurrent trametinib and lenalidomide in the treatment of primary pediatric central and peripheral nervous system tumors. Two of four patients using this combination therapy experienced severe thromboembolic events, necessitating discontinuation of therapy. This combination requires further investigation, and we urge caution if used.
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Affiliation(s)
- Priya P Chan
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Ashley Sabus
- Department of Pharmacy, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Molly S Hemenway
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathryn C Chatfield
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christina J White
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicholas K Foreman
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nathan A Dahl
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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6
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Willman M, Willman J, Figg J, Dioso E, Sriram S, Olowofela B, Chacko K, Hernandez J, Lucke-Wold B. Update for astrocytomas: medical and surgical management considerations. EXPLORATION OF NEUROSCIENCE 2023; 2:1-26. [PMID: 36935776 PMCID: PMC10019464 DOI: 10.37349/en.2023.00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/10/2022] [Indexed: 02/25/2023]
Abstract
Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O 6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.
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Affiliation(s)
- Matthew Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jonathan Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - John Figg
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Emma Dioso
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Sai Sriram
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Bankole Olowofela
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kevin Chacko
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jairo Hernandez
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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7
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Ruggiero A, Attinà G, Campanelli A, Maurizi P, Triarico S, Romano A, Massimi L, Tamburrini G, Verdolotti T, Mastrangelo S. Pediatric low-grade glioma and neurofibromatosis type 1: A single-institution experience. J Cancer Res Ther 2023; 19:228-234. [PMID: 37313902 DOI: 10.4103/jcrt.jcrt_1677_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Neurofibromatosis type 1 (NF1)-related gliomas appear to have a clinical behavior different from that of sporadic cases. The purpose of the study was to investigate the role of different factors in influencing the tumor response rate of children receiving chemotherapy for their symptomatic glioma. Methods Between 1995 and 2015, 60 patients with low-grade glioma (42 sporadic cases and 18 cases with NF1) were treated. Patients with brainstem gliomas were excluded. Thirty-nine patients underwent exclusive or postsurgical chemotherapy (vincristine/carboplatin-based regimen). Results Disease reduction was achieved in 12 of the 28 patients (42.8%) with sporadic low-grade glioma and in 9 of the 11 patients (81.8%) with NF1, with a significant difference between the 2 groups (P < 0.05). The response to chemotherapy in both the patient groups was not significantly influenced by sex, age, tumor site, and histopathology, although disease reduction occurred more frequently in children aged under 3 years. Conclusions Our study showed that pediatric patients with low-grade glioma and NF1 are more likely to respond to chemotherapy than those with non-NF1.
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Affiliation(s)
- Antonio Ruggiero
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Anastasia Campanelli
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery Unit, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Verdolotti
- Radiology and Neuroradiology Unit, Department of Radiological Diagnostics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli Hospital Foundation IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
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Lin X, Liu H, Zhao H, Xia S, Li Y, Wang C, Huang Q, Wanggou S, Li X. Immune Infiltration Associated MAN2B1 Is a Novel Prognostic Biomarker for Glioma. Front Oncol 2022; 12:842973. [PMID: 35186771 PMCID: PMC8847305 DOI: 10.3389/fonc.2022.842973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Mannosidase Alpha Class 2B Member 1 (MAN2B1) gene encodes lysosomal alpha-d-mannosidase involved in the ordered degradation of N-linked glycoproteins. Alteration in MAN2B1 has been proved to be accountable for several diseases. However, the relationship between MAN2B1 and glioma malignancy remains unclear. In this study, RNA-seq data from The Cancer Genome Atlas and the Chinese Glioma Genome Atlas datasets were analyzed to explore the correlation between MAN2B1 and clinicopathological features, prognosis, and somatic mutations in gliomas. We found that MAN2B1 was elevated in glioma and was correlated with malignant clinical and molecular features. Upregulated expression of MAN2B1 is prognostic for poor outcomes in glioma patients. Different frequencies of somatic mutations were found in gliomas between high and low MAN2B1 expression. Real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry staining from glioma patient samples and cell lines were used to validate bioinformatic findings. Functional enrichment analysis showed that MAN2B1 was involved in immune and inflammation processes. Moreover, MAN2B1 expression was strongly correlated with M2 macrophages and weakly correlated with M1 macrophages. Further analysis confirmed that MAN2B1 was closely associated with the markers of M2 macrophages and tumor-associated macrophages. Taken together, MAN2B1 is a potential prognostic biomarker in glioma and associates with immune infiltration.
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Affiliation(s)
- Xuelei Lin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Hongwei Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyu Zhao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Shunjin Xia
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Yueshuo Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chaoqian Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Qi Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Hunan International Scientific and Technological Cooperation Base of BrainTumor Research, Xiangya Hospital, Central South University, Changsha, China
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9
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Lebrun L, Bizet M, Melendez B, Alexiou B, Absil L, Van Campenhout C, D'Haene N, Rorive S, Fuks F, Decaestecker C, Salmon I. Analyses of DNA Methylation Profiling in the Diagnosis of Intramedullary Astrocytomas. J Neuropathol Exp Neurol 2021; 80:663-673. [PMID: 34363673 PMCID: PMC8357340 DOI: 10.1093/jnen/nlab052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intramedullary astrocytomas (IMAs) consist of a heterogeneous group of rare central nervous system (CNS) tumors associated with variable outcomes. A DNA methylation-based classification approach has recently emerged as a powerful tool to further classify CNS tumors. However, no DNA methylation-related studies specifically addressing to IMAs have been performed yet. In the present study, we analyzed 16 IMA samples subjected to morphological and molecular analyses, including DNA methylation profiling. Among the 16 samples, only 3 cases were classified in a reference methylation class (MC) with the recommended calibrated score (≥0.9). The remaining cases were either considered “no-match” cases (calibrated score <0.3, n = 7) or were classified with low calibrated scores (ranging from 0.32 to 0.53, n = 6), including inconsistent classification. To obtain a more comprehensive tool for pathologists, we used different unsupervised analyses of DNA methylation profiles, including our data and those from the Heidelberg reference cohort. Even though our cohort included only 16 cases, hypotheses regarding IMA-specific classification were underlined; a potential specific MC of PA_SPINE was identified and high-grade IMAs, probably consisting of H3K27M wild-type IMAs, were mainly associated with ANA_PA MC. These hypotheses strongly suggest that a specific classification for IMAs has to be investigated.
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Affiliation(s)
- Laetitia Lebrun
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Martin Bizet
- Laboratory of Cancer Epigenetics, Faculty of Medicine, ULB-Cancer Research Center (U-CRC), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Barbara Melendez
- Molecular Pathology Research Unit, Department of Pathology, Virgen de la Salud Hospital, Toledo, Spain
| | - Barbara Alexiou
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lara Absil
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Claude Van Campenhout
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicky D'Haene
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sandrine Rorive
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Centre Universitaire inter Régional d'expertise en Anatomie Pathologique Hospitalière (CurePath, CHIREC, CHU Tivoli, ULB), Jumet, Belgium
| | - François Fuks
- Laboratory of Cancer Epigenetics, Faculty of Medicine, ULB-Cancer Research Center (U-CRC), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christine Decaestecker
- DIAPath, Center for Microscopy and Molecular Imaging, ULB, Gosselies, Belgium.,Laboratory of Image Synthesis and Analysis, Brussels School of Engineering/École Polytechnique de Brussels, ULB, Brussels, Belgium
| | - Isabelle Salmon
- From the Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.,DIAPath, Center for Microscopy and Molecular Imaging, ULB, Gosselies, Belgium.,Laboratory of Image Synthesis and Analysis, Brussels School of Engineering/École Polytechnique de Brussels, ULB, Brussels, Belgium
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10
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Pérez JPM, Muchart J, López VSM, Capella MS, Salvador N, Jaume SP, Martínez OC, La Madrid AM. Targeted therapy for pediatric low-grade glioma. Childs Nerv Syst 2021; 37:2511-2520. [PMID: 33864514 DOI: 10.1007/s00381-021-05138-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pediatric low-grade gliomas are the most frequent brain tumors in children. The standard approach for symptomatic unresectable tumors is chemotherapy. Recently, key molecular alterations/pathways have been identified and targeted drugs developed and tested in clinical trials. We describe our institutional experience with MAPK pathway targeted therapy. METHODS We retrospectively reviewed the medical reports of 23 patients diagnosed with PLGG and treated with either trametinib or dabrafenib at Hospital Sant Joan de Dèu (Barcelona, Spain). Patients with neurofibromatosis were excluded. Objective response rate (ORR) and disease control rate (DCR) were determined using the Response Assessment in Pediatric Neuro-Oncology criteria in low-grade glioma. ORR was defined as the proportion of patients with the best overall response including complete remission (CR) or partial remission (PR). DCR was the sum of the CR, PR, and stable disease (SD) rates. RESULTS ORR with trametinib was 0% (95% CI, 0%-23.2%) and DCR was 78.6% (95% CI, 49.2%-95.3%). Eleven patients had SD and three patients presented PD. ORR with dabrafenib was 41.7% (95% CI, 16.5%-71.4%), including four CR and one patient with PR. DCR with dabrafenib was 100% (95% CI, 73.5%-100%); there were seven SD and none PD. Treatment was well tolerated. Only three patients, on trametinib, presented grade 3 adverse effects: leukocytoclastic vasculitis, cheilitis, and bone infection. CONCLUSIONS Our experience adds to the growing data about the efficacy and tolerability of targeted therapy in patients with PLGG. When present, toxicity is mainly mild-moderate and transient. Ongoing prospective clinical trials are trying to address if its use should be advanced to first-line therapy.
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Affiliation(s)
| | - Jordi Muchart
- Pediatric Neuroradiology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Vicente Santa-María López
- Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
- Pediatric Neuro-Oncology Unit, Department of Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Deu 2, 08950, Barcelona, Spain
| | | | - Noelia Salvador
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sara Pérez Jaume
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ofelia Cruz Martínez
- Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
- Pediatric Neuro-Oncology Unit, Department of Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Deu 2, 08950, Barcelona, Spain
| | - Andrés Morales La Madrid
- Pediatric Hematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain.
- Pediatric Neuro-Oncology Unit, Department of Oncology, Hospital Sant Joan de Déu, Passeig Sant Joan de Deu 2, 08950, Barcelona, Spain.
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11
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Abstract
Central nervous system (CNS) tumors are the most common solid tumor in pediatrics and represent the largest cause of childhood cancer-related mortality. With advances in molecular characterization of tumors, considerable developments have occurred impacting diagnosis and management, and refined prognostication. Advances in management have led to better survival, but mortality remains high and significant morbidity persists. Novel therapeutic approaches targeting the biology of these tumors are being investigated to improve overall survival and decrease treatment-related morbidity. Further molecular understanding of pediatric CNS tumors will lead to continued refinement of tumor classification, management, and prognostication.
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Affiliation(s)
- Fatema Malbari
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neurosciences, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
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12
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Salles D, Laviola G, Malinverni ACDM, Stávale JN. Pilocytic Astrocytoma: A Review of General, Clinical, and Molecular Characteristics. J Child Neurol 2020; 35:852-858. [PMID: 32691644 DOI: 10.1177/0883073820937225] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pilocytic astrocytomas are the primary tumors most frequently found in children and adolescents, accounting for approximately 15.6% of all brain tumors and 5.4% of all gliomas. They are mostly found in infratentorial structures such as the cerebellum and in midline cerebral structures such as the optic nerve, hypothalamus, and brain stem. The present study aimed to list the main characteristics about this tumor, to better understand the diagnosis and treatment of these patients, and was conducted on search of the published studies available in NCBI, PubMed, MEDLINE, Scielo, and Google Scholar. It was possible to define the main histologic findings observed in these cases, such as mitoses, necrosis, and Rosenthal fibers. We described the locations usually most affected by tumor development, and this was associated with the most frequent clinical features. The comparison between the molecular diagnostic methods showed great use of fluorescent in situ hybridization, polymerase chain reaction (PCR), and reverse transcriptase-PCR, important techniques for the detection of BRAF V600E mutation and BRAF-KIAA1549 fusion, characteristic molecular alterations in pilocytic astrocytomas.
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Affiliation(s)
- Débora Salles
- Department of Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.,Laboratory of Molecular and Experimental Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
| | - Gabriela Laviola
- Department of Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.,Laboratory of Molecular and Experimental Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
| | - Andréa Cristina de Moraes Malinverni
- Department of Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.,Laboratory of Molecular and Experimental Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
| | - João Norberto Stávale
- Department of Pathology, 28105Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
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13
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Cacciotti C, Fleming A, Ramaswamy V. Advances in the molecular classification of pediatric brain tumors: a guide to the galaxy. J Pathol 2020; 251:249-261. [PMID: 32391583 DOI: 10.1002/path.5457] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/31/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
Central nervous system (CNS) tumors are the most common solid tumor in pediatrics, accounting for approximately 25% of all childhood cancers, and the second most common pediatric malignancy after leukemia. CNS tumors can be associated with significant morbidity, even those classified as low grade. Mortality from CNS tumors is disproportionately high compared to other childhood malignancies, although surgery, radiation, and chemotherapy have improved outcomes in these patients over the last few decades. Current therapeutic strategies lead to a high risk of side effects, especially in young children. Pediatric brain tumor survivors have unique sequelae compared to age-matched patients who survived other malignancies. They are at greater risk of significant impairment in cognitive, neurological, endocrine, social, and emotional domains, depending on the location and type of the CNS tumor. Next-generation genomics have shed light on the broad molecular heterogeneity of pediatric brain tumors and have identified important genes and signaling pathways that serve to drive tumor proliferation. This insight has impacted the research field by providing potential therapeutic targets for these diseases. In this review, we highlight recent progress in understanding the molecular basis of common pediatric brain tumors, specifically low-grade glioma, high-grade glioma, ependymoma, embryonal tumors, and atypical teratoid/rhabdoid tumor (ATRT). © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Chantel Cacciotti
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, ON, Canada.,Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| | - Adam Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada.,Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics and Pediatrics, University of Toronto, Toronto, ON, Canada
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14
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Malbari F, Lindsay H. Genetics of Common Pediatric Brain Tumors. Pediatr Neurol 2020; 104:3-12. [PMID: 31948735 DOI: 10.1016/j.pediatrneurol.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
Central nervous system tumors are the most common solid tumors in pediatrics and represent the largest cause of childhood cancer-related mortality. Improvements have occurred in the management of these patients leading to better survival, but significant morbidity persists. With the era of next generation sequencing, considerable advances have occurred in the understanding of these tumors both biologically and clinically. This information has impacted diagnosis and management. Subgroups have been identified, improving risk stratification. Novel therapeutic approaches, specifically targeting the biology of these tumors, are being investigated to improve overall survival and decrease treatment-related morbidity. The intent of this review is to discuss the genetics of common pediatric brain tumors and the clinical implications. This review will include known genetic disorders associated with central nervous system tumors, neurofibromatosis, tuberous sclerosis, Li-Fraumeni syndrome, Gorlin syndrome, and Turcot syndrome, as well as somatic mutations of glioma, medulloblastoma, and ependymoma.
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Affiliation(s)
- Fatema Malbari
- Division of Pediatric Neurology and Developmental Neurosciences, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Holly Lindsay
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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15
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Abstract
Tumors of the central nervous system comprise nearly a quarter of all childhood cancers and are the most frequent solid tumor in the pediatric population. The most common location is in the posterior fossa, but tumors can occur anywhere intracranially. The spectrum of lesions encountered varies, from being completely benign and requiring surveillance alone to being highly malignant and requiring aggressive treatment in the form of surgery and adjuvant therapy. The extent of resection plays a crucial role in the oncological outcome of many of these tumors. A variety of surgical approaches are available for the spectrum of lesions encountered. This review focuses on summarizing the location, types, and neurosurgical management strategies for pediatric brain intracranial brain tumors. Here, we discuss neurosurgical approaches for a variety of brain tumors and regions, including the management of tumors of the posterior fossa, brainstem, pineal region, intraventricular region, sellar and suprasellar regions, optic pathway and hypothalamus, and supratentorial hemispheres.
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Affiliation(s)
- Adikarige H D Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, England, WC1N 3JH, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, England, WC1N 3JH, UK.
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16
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Toll SA, Tran HN, Cotter J, Judkins AR, Tamrazi B, Biegel JA, Dhall G, Robison NJ, Waters K, Patel P, Cooper R, Margol AS. Sustained response of three pediatric BRAF V600E mutated high-grade gliomas to combined BRAF and MEK inhibitor therapy. Oncotarget 2019; 10:551-557. [PMID: 30728904 PMCID: PMC6355184 DOI: 10.18632/oncotarget.26560] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/27/2018] [Indexed: 01/07/2023] Open
Abstract
Outcomes for children with high-grade gliomas (HGG) remain dismal despite aggressive treatment strategies. The use of targeted therapy for BRAFV600E mutated malignancies including HGG is being explored as a potentially well tolerated and effective therapeutic option. The results of adult melanoma studies demonstrating that combination therapy with BRAF inhibitors and MEK inhibitors results in prolonged survival led us to employ this treatment strategy in children with BRAFV600E mutated HGG. In this case series, we describe three pediatric patients with HGG with confirmed BRAFV600E mutation who demonstrated responses to combination therapy with dabrafenib and trametinib.
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Affiliation(s)
- Stephanie A Toll
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Hung N Tran
- Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Jennifer Cotter
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander R Judkins
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Benita Tamrazi
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Radiology and Imaging, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Girish Dhall
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Nathan J Robison
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kaaren Waters
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Palak Patel
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Robert Cooper
- Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Ashley S Margol
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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17
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Sexton-Oates A, Dodgshun A, Hovestadt V, Jones DTW, Ashley DM, Sullivan M, MacGregor D, Saffery R. Methylation profiling of paediatric pilocytic astrocytoma reveals variants specifically associated with tumour location and predictive of recurrence. Mol Oncol 2018; 12:1219-1232. [PMID: 28388012 PMCID: PMC6068350 DOI: 10.1002/1878-0261.12062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Childhood pilocytic astrocytomas (PA) are low-grade tumours with an excellent prognosis. However, a minority, particularly those in surgically inaccessible locations, have poorer long-term outcome. At present, it is unclear whether anatomical location in isolation, or in combination with underlying biological variation, determines clinical behaviour. Here, we have tested the utility of DNA methylation profiling to inform tumour biology and to predict behaviour in paediatric PA. Genome-wide DNA methylation profiles were generated for 117 paediatric PAs. Using a combination of analyses, we identified DNA methylation variants specific to tumour location and predictive of behaviour. Receiver-operating characteristic analysis was used to test the predictive utility of clinical and/or DNA methylation features to classify tumour behaviour at diagnosis. Unsupervised analysis distinguished three methylation clusters associated with tumour location (cortical, midline and infratentorial). Differential methylation of 5404 sites identified enrichment of genes involved in 'embryonic nervous system development'. Specific hypermethylation of NEUROG1 and NR2E1 was identified as a feature of cortical tumours. A highly accurate method to classify tumours according to behaviour, which combined three clinical features (age, location and extent of resection) and methylation level at a single site, was identified. Our findings show location-specific epigenetic profiles for PAs, potentially reflecting their cell type of origin. This may account for differences in clinical behaviour according to location independent of histopathology. We also defined an accurate method to predict tumour behaviour at diagnosis. This warrants further testing in similar patient cohorts.
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Affiliation(s)
- Alexandra Sexton-Oates
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Andrew Dodgshun
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - David M Ashley
- School of Medicine, Deakin University, Waurn Ponds, Australia
| | - Michael Sullivan
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Duncan MacGregor
- Department of Anatomical Pathology, The Royal Children's Hospital, Parkville, Australia.,Department of Pathology, The University of Melbourne, Parkville, Australia
| | - Richard Saffery
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
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18
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Banerjee A, Jakacki RI, Onar-Thomas A, Wu S, Nicolaides T, Young Poussaint T, Fangusaro J, Phillips J, Perry A, Turner D, Prados M, Packer RJ, Qaddoumi I, Gururangan S, Pollack IF, Goldman S, Doyle LA, Stewart CF, Boyett JM, Kun LE, Fouladi M. A phase I trial of the MEK inhibitor selumetinib (AZD6244) in pediatric patients with recurrent or refractory low-grade glioma: a Pediatric Brain Tumor Consortium (PBTC) study. Neuro Oncol 2018; 19:1135-1144. [PMID: 28339824 DOI: 10.1093/neuonc/now282] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Activation of the mitogen-activated protein kinase pathway is important for growth of pediatric low-grade gliomas (LGGs). The aim of this study was to determine the recommended phase II dose (RP2D) and the dose-limiting toxicities (DLTs) of the MEK inhibitor selumetinib in children with progressive LGG. Methods Selumetinib was administered orally starting at 33 mg/m2/dose b.i.d., using the modified continual reassessment method. Pharmacokinetic analysis was performed during the first course. BRAF aberrations in tumor tissue were determined by real-time polymerase chain reaction and fluorescence in situ hybridization. Results Thirty-eight eligible subjects were enrolled. Dose levels 1 and 2 (33 and 43 mg/m2/dose b.i.d.) were excessively toxic. DLTs included grade 3 elevated amylase/lipase (n = 1), headache (n = 1), mucositis (n = 2), and grades 2-3 rash (n = 6). At dose level 0 (25 mg/m2/dose b.i.d, the RP2D), only 3 of 24 subjects experienced DLTs (elevated amylase/lipase, rash, and mucositis). At the R2PD, the median (range) area under the curve (AUC0-∞) and apparent oral clearance of selumetinib were 3855 ng*h/mL (1780 to 7250 ng × h/mL) and 6.5 L × h-1 × m-2 (3.4 to 14.0 L × h-1 × m-2), respectively. Thirteen of 19 tumors had BRAF abnormalities. Among the 5 (20%) of 25 subjects with sustained partial responses, all at the RP2D, 4 had BRAF aberrations, 1 had insufficient tissue. Subjects received a median of 13 cycles (range: 1-26). Fourteen (37%) completed all protocol treatment (26 cycles [n = 13], 13 cycles [n = 1]) with at least stable disease; 2-year progression-free survival at the RP2D was 69 ± SE 9.8%. Conclusion Selumetinib has promising antitumor activity in children with LGG. Rash and mucositis were the most common DLTs.
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Affiliation(s)
- Anuradha Banerjee
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Regina I Jakacki
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arzu Onar-Thomas
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shengjie Wu
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore Nicolaides
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tina Young Poussaint
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Fangusaro
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Phillips
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arie Perry
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Turner
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Prados
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roger J Packer
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ibrahim Qaddoumi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sridharan Gururangan
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ian F Pollack
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stewart Goldman
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence A Doyle
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Clinton F Stewart
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James M Boyett
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Larry E Kun
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maryam Fouladi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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19
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Type 1 IGF Receptor Localization in Paediatric Gliomas: Significant Association with WHO Grading and Clinical Outcome. Discov Oncol 2018. [PMID: 29524179 DOI: 10.1007/s12672-018-0328-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nuclear localization of insulin-like growth factor receptor type 1 (IGF-1R) has been described as adverse prognostic factor in some cancers. We studied the expression and localization of IGF-1R in paediatric patients with gliomas, as well as its association with World Health Organization (WHO) grading and survival. We conducted a single cohort, prospective study of paediatric patients with gliomas. Samples were taken at the time of the initial surgery; IGF-1R expression and localization were characterized by immunohistochemistry (IHC), subcellular fractionation and western blotting. Tumours (47/53) showed positive staining for IGF-1R by IHC. IGF-1R nuclear labelling was observed in 10/47 cases. IGF-1R staining was mostly non-nuclear in low-grade tumours, while IGF-1R nuclear labelling was predominant in high-grade gliomas (p = 0.0001). Survival was significantly longer in patients with gliomas having non-nuclear IGF-1R localization than in patients with nuclear IGF-1R tumours (p = 0.016). In gliomas, IGF-1R nuclear localization was significantly associated with both high-grade tumours and increased risk of death. Based on a prospective design, we provide evidence of a potential usefulness of intracellular localization of IGF-1R as prognostic factor in paediatric patients with gliomas.
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20
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Liu H, Murphy CJ, Karreth FA, Emdal KB, White FM, Elemento O, Toker A, Wulf GM, Cantley LC. Identifying and Targeting Sporadic Oncogenic Genetic Aberrations in Mouse Models of Triple-Negative Breast Cancer. Cancer Discov 2018; 8:354-369. [PMID: 29203461 PMCID: PMC5907916 DOI: 10.1158/2159-8290.cd-17-0679] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/11/2017] [Accepted: 11/27/2017] [Indexed: 02/07/2023]
Abstract
Triple-negative breast cancers (TNBC) are genetically characterized by aberrations in TP53 and a low rate of activating point mutations in common oncogenes, rendering it challenging in applying targeted therapies. We performed whole-exome sequencing (WES) and RNA sequencing (RNA-seq) to identify somatic genetic alterations in mouse models of TNBCs driven by loss of Trp53 alone or in combination with Brca1 Amplifications or translocations that resulted in elevated oncoprotein expression or oncoprotein-containing fusions, respectively, as well as frameshift mutations of tumor suppressors were identified in approximately 50% of the tumors evaluated. Although the spectrum of sporadic genetic alterations was diverse, the majority had in common the ability to activate the MAPK/PI3K pathways. Importantly, we demonstrated that approved or experimental drugs efficiently induce tumor regression specifically in tumors harboring somatic aberrations of the drug target. Our study suggests that the combination of WES and RNA-seq on human TNBC will lead to the identification of actionable therapeutic targets for precision medicine-guided TNBC treatment.Significance: Using combined WES and RNA-seq analyses, we identified sporadic oncogenic events in TNBC mouse models that share the capacity to activate the MAPK and/or PI3K pathways. Our data support a treatment tailored to the genetics of individual tumors that parallels the approaches being investigated in the ongoing NCI-MATCH, My Pathway Trial, and ESMART clinical trials. Cancer Discov; 8(3); 354-69. ©2017 AACR.See related commentary by Natrajan et al., p. 272See related article by Matissek et al., p. 336This article is highlighted in the In This Issue feature, p. 253.
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Affiliation(s)
- Hui Liu
- Department of Pathology, and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Charles J Murphy
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, New York
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Florian A Karreth
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristina B Emdal
- Department of Biological Engineering, Koch Institute for Integrative Cancer Research, MIT, Cambridge, Massachusetts
| | - Forest M White
- Department of Biological Engineering, Koch Institute for Integrative Cancer Research, MIT, Cambridge, Massachusetts
| | - Olivier Elemento
- Institute for Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | - Alex Toker
- Department of Pathology, and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Pathology, and Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, and Ludwig Center at Harvard, Boston, Massachusetts
| | - Gerburg M Wulf
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lewis C Cantley
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York.
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Management and Survival of Adult Patients with Pilocytic Astrocytoma in the National Cancer Database. World Neurosurg 2018; 112:e881-e887. [PMID: 29427814 DOI: 10.1016/j.wneu.2018.01.208] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. METHODS The study cohort comprised all patients age >18 years diagnosed with a CNS PA diagnosed between 2004 and 2014 and included in the National Cancer Database. Clinical and treatment-related characteristics were recorded and analyzed for associations with OS following diagnosis using univariate and multivariate analyses. RESULTS A total of 3057 adult patients, with a median age of 32 years, met the inclusion criteria. At diagnosis, 1138 patients (41%) had cerebral tumors, 832 (30%) had cerebellar tumors, 252 (9%) had tumors of the spinal cord, and 534 (19%) had tumors of unspecified location. More than three-quarters (77%) of the patients underwent surgery alone as local therapy, with the remainder split among surgery plus radiation (11.9%), radiation alone (4.5%), and biopsy alone (6.9%). On multivariate analysis, factors associated with inferior OS included older age (hazard ratio [HR], 1.05; P < 0.001), lower income (P < 0.001), higher Charlson/Deyo score (P = 0.023), larger tumor size (P = 0.023), and radiation therapy technique (P < 0.001; HR, 3.37 for external beam radiation therapy [EBRT]). CONCLUSIONS Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
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22
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Zapotocky M, Ramaswamy V, Lassaletta A, Bouffet E. Adolescents and young adults with brain tumors in the context of molecular advances in neuro-oncology. Pediatr Blood Cancer 2018; 65. [PMID: 29049858 DOI: 10.1002/pbc.26861] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022]
Abstract
Adolescents and young adults (AYA) comprise a specific group of oncology patients with a distinct biological and epidemiological spectrum of central nervous system neoplasms. It has been well documented that they differ clinically, especially in relation to prognosis and chemotherapy tolerance; however, the underlying reasons for this are unclear. Recent advances in the genomics of both childhood and adult brain tumors have provided new explanations and insights into the previously described age-dependent heterogeneity. Herein, we summarize the current state of the AYA population in neuro-oncology, specifically how biological advances can help personalize therapy for this unique group of patients.
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Affiliation(s)
- Michal Zapotocky
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical School, Charles University, Prague, Czech Republic.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Pediatric Hematology Oncology Department, Hospital Niño Jesús, Madrid, Spain
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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23
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Robert-Boire V, Rosca L, Samson Y, Ospina LH, Perreault S. Clinical Presentation and Outcome of Patients With Optic Pathway Glioma. Pediatr Neurol 2017; 75:55-60. [PMID: 28847625 DOI: 10.1016/j.pediatrneurol.2017.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Optic pathway gliomas (OPGs) occur sporadically or in patients with neurofibromatosis type 1 (NF1). The purpose of this study was to evaluate the clinical presentation at diagnosis and at progression of patients with OPGs. METHODS We conducted a chart review of patients with OPGs diagnosed in a single center over a period of 15 years. Demographic data including age, sex, NF1 status, clinical presentation, and outcome were collected. RESULTS Of the 40 patients who were identified, 23 had sporadic tumors (57.5%) and 17 had NF1-related tumors (42.5%). Among the children with NF1, there was a significant overrepresentation of girls (82.3%) (P = 0.02), while among the children without NF1, there were slightly more boys (56.5%) than girls (43.5%). The presence of nystagmus was strongly associated with sporadic optic pathway gliomas. Poor visual outcome was related to tumor affecting both optic pathways, hydrocephalus at diagnosis, and optic nerve atrophy. Of the 40 patients, five died of OPG complications (12.5%) and all had sporadic tumors. CONCLUSIONS Our cohort is one of the largest with OPGs and a detailed description of the clinical presentation both at diagnosis and at progression. We observed a significant difference between sporadic and NF1 optic pathway gliomas in terms of demographics, clinical presentation, and outcome.
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Affiliation(s)
- Viviane Robert-Boire
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Lorena Rosca
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Yvan Samson
- Department of Pediatrics, Division of Hemato-Oncology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Luis H Ospina
- Department of Ophthalmology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Sébastien Perreault
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada.
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24
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Johnson MD, O’Connell M, Walter K, Silberstein H. mTOR activation is increased in pilocytic astrocytomas from older adults compared with children. Surg Neurol Int 2017; 8:85. [PMID: 28607819 PMCID: PMC5461564 DOI: 10.4103/sni.sni_367_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/20/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Recent studies suggest that the behavior and biology of WHO grade I pilocytic astrocytomas (PAs) in adults is different than that associated with grade I PAs in children. METHODS We evaluated Ki-67 labeling, BRAF abnormalities, isocitrate dehydrogenase R132 immunoreactivity phosphorylation (activation) of p44/42 mitogen activated protein kinase (MAPK), and mammalian target of rapamycin (mTOR) in formalin-fixed tissue from 21 adult (18 years or older, mean age 37 years) and 10 children (mean age 9.4 years) WHO grade I PAs. RESULTS The mean Ki-67 labeling was 4.8% in adults and 3.8% in children. There was no significant difference between Ki-67 labeling in children and adults or either subgroups of adults. No differences were found in phospho p44/42MAPK in adult subgroups (18-33 years and 34 and older) compared to children. Activation/phosphorylation of mTOR was biphasic in adults being significantly lower than children in young adults but significantly higher than children in older adults (age 34 and older). CONCLUSIONS Identifying mTOR phosphorylation/activation may represent a difference in biology and a new marker to guide chemotherapy with recently approved mTOR inhibitors.
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Affiliation(s)
- Mahlon D. Johnson
- Department of Pathology, Division of Neuropathology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Mary O’Connell
- Department of Pathology, Division of Neuropathology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Kevin Walter
- Department of Neurosurgery, University of Rochester School of Medicine, Rochester, New York, USA
| | - Howard Silberstein
- Department of Neurosurgery, University of Rochester School of Medicine, Rochester, New York, USA
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25
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Lehtinen B, Raita A, Kesseli J, Annala M, Nordfors K, Yli-Harja O, Zhang W, Visakorpi T, Nykter M, Haapasalo H, Granberg KJ. Clinical association analysis of ependymomas and pilocytic astrocytomas reveals elevated FGFR3 and FGFR1 expression in aggressive ependymomas. BMC Cancer 2017; 17:310. [PMID: 28468611 PMCID: PMC5415775 DOI: 10.1186/s12885-017-3274-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fibroblast growth factor receptors (FGFRs) are well-known proto-oncogenes in several human malignancies and are currently therapeutically targeted in clinical trials. Among glioma subtypes, activating FGFR1 alterations have been observed in a subpopulation of pilocytic astrocytomas while FGFR3 fusions occur in IDH wild-type diffuse gliomas, resulting in high FGFR3 protein expression. The purpose of this study was to associate FGFR1 and FGFR3 protein levels with clinical features and genetic alterations in ependymoma and pilocytic astrocytoma. METHODS FGFR1 and FGFR3 expression levels were detected in ependymoma and pilocytic astrocytoma tissues using immunohistochemistry. Selected cases were further analyzed using targeted sequencing. RESULTS Expression of both FGFR1 and FGFR3 varied within all tumor types. In ependymomas, increased FGFR3 or FGFR1 expression was associated with high tumor grade, cerebral location, young patient age, and poor prognosis. Moderate-to-strong expression of FGFR1 and/or FGFR3 was observed in 76% of cerebral ependymomas. Cases with moderate-to-strong expression of both proteins had poor clinical prognosis. In pilocytic astrocytomas, moderate-to-strong FGFR3 expression was detected predominantly in non-pediatric patients. Targeted sequencing of 12 tumors found no protein-altering mutations or fusions in FGFR1 or FGFR3. CONCLUSIONS Elevated FGFR3 and FGFR1 protein expression is common in aggressive ependymomas but likely not driven by genetic alterations. Further studies are warranted to evaluate whether ependymoma patients with high FGFR3 and/or FGFR1 expression could benefit from treatment with FGFR inhibitor based therapeutic approaches currently under evaluation in clinical trials.
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Affiliation(s)
- Birgitta Lehtinen
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland
| | - Annina Raita
- Fimlab Laboratories Ltd., Tampere University Hospital, Biokatu 4, 33520, Tampere, Finland.,Department of Pathology, University of Tampere, 33014, Tampere, Finland
| | - Juha Kesseli
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland
| | - Matti Annala
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland
| | - Kristiina Nordfors
- Fimlab Laboratories Ltd., Tampere University Hospital, Biokatu 4, 33520, Tampere, Finland.,Department of Pediatrics, Tampere University Hospital; Tampere Center for Child Health Research, University of Tampere, 33014, Tampere, Finland
| | - Olli Yli-Harja
- Department of Signal Processing, Tampere University of Technology, Korkeakoulunkatu 10, 33720, Tampere, Finland
| | - Wei Zhang
- Department of Signal Processing, Tampere University of Technology, Korkeakoulunkatu 10, 33720, Tampere, Finland.,Department of Cancer Biology, Comprehensive Cancer Center of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Tapio Visakorpi
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland.,Fimlab Laboratories Ltd., Tampere University Hospital, Biokatu 4, 33520, Tampere, Finland
| | - Matti Nykter
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland.,Science Center, Tampere University Hospital, Biokatu 6, 33520, Tampere, Finland
| | - Hannu Haapasalo
- Fimlab Laboratories Ltd., Tampere University Hospital, Biokatu 4, 33520, Tampere, Finland. .,Department of Pathology, University of Tampere, 33014, Tampere, Finland.
| | - Kirsi J Granberg
- BioMediTech Institute and Faculty of Medicine and Life Sciences, Biokatu 8, 33520, Tampere, Finland. .,Department of Signal Processing, Tampere University of Technology, Korkeakoulunkatu 10, 33720, Tampere, Finland. .,Science Center, Tampere University Hospital, Biokatu 6, 33520, Tampere, Finland.
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26
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Miller C, Guillaume D, Dusenbery K, Clark HB, Moertel C. Report of effective trametinib therapy in 2 children with progressive hypothalamic optic pathway pilocytic astrocytoma: documentation of volumetric response. J Neurosurg Pediatr 2017; 19:319-324. [PMID: 28009226 DOI: 10.3171/2016.9.peds16328] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Brain tumors are the most common solid tumor in childhood, and astrocytomas account for the largest proportion of these tumors. Increasing sophistication in genetic testing has allowed for the detection of specific mutations within tumor subtypes that may represent targets for individualized tumor treatment. The mitogen-activating protein kinase (MAPK) pathway and, more specifically, BRAF mutations have been shown to be prevalent in pediatric pilocytic astrocytomas and may represent one such area to target. Herein, the authors describe 2 cases of inoperable, chemotherapy-resistant pediatric pilocytic astrocytomas with a documented response to trametinib, an MAPK pathway inhibitor. While these cases were not treated in the setting of a clinical trial, their data support further ongoing clinical trial investigation to evaluate the safety and efficacy of this agent in pediatric low-grade gliomas.
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Affiliation(s)
| | | | | | | | - Christopher Moertel
- Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota
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27
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Avery RA, Mansoor A, Idrees R, Trimboli-Heidler C, Ishikawa H, Packer RJ, Linguraru MG. Optic pathway glioma volume predicts retinal axon degeneration in neurofibromatosis type 1. Neurology 2016; 87:2403-2407. [PMID: 27815398 DOI: 10.1212/wnl.0000000000003402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine whether tumor size is associated with retinal nerve fiber layer (RNFL) thickness, a measure of axonal degeneration and an established biomarker of visual impairment in children with optic pathway gliomas (OPGs) secondary to neurofibromatosis type 1 (NF1). METHODS Children with NF1-OPGs involving the optic nerve (extension into the chiasm and tracts permitted) who underwent both volumetric MRI analysis and optical coherence tomography (OCT) within 2 weeks of each other were included. Volumetric measurement of the entire anterior visual pathway (AVP; optic nerve, chiasm, and tract) was performed using high-resolution T1-weighted MRI. OCT measured the average RNFL thickness around the optic nerve. Linear regression models evaluated the relationship between RNFL thickness and AVP dimensions and volume. RESULTS Thirty-eight participants contributed 55 study eyes. The mean age was 5.78 years. Twenty-two participants (58%) were female. RNFL thickness had a significant negative relationship to total AVP volume and total brain volume (p < 0.05, all comparisons). For every 1 mL increase in AVP volume, RNFL thickness declined by approximately 5 microns. A greater AVP volume of OPGs involving the optic nerve and chiasm, but not the tracts, was independently associated with a lower RNFL thickness (p < 0.05). All participants with an optic chiasm volume >1.3 mL demonstrated axonal damage (i.e., RNFL thickness <80 microns). CONCLUSIONS Greater OPG and AVP volume predicts axonal degeneration, a biomarker of vision loss, in children with NF1-OPGs. MRI volumetric measures may help stratify the risk of visual loss from NF1-OPGs.
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Affiliation(s)
- Robert A Avery
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA.
| | - Awais Mansoor
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Rabia Idrees
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Carmelina Trimboli-Heidler
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Hiroshi Ishikawa
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Roger J Packer
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
| | - Marius George Linguraru
- From the Center for Neuroscience and Behavior (R.A.A., R.J.P.), The Gilbert Family Neurofibromatosis Institute (R.A.A., C.T.-H., R.J.P.), Sheikh Zayed Institute for Pediatric Surgical Innovation (A.M., M.G.L.), and The Brain Tumor Institute (R.J.P.), Children's National Health System; The George Washington University School of Medicine and Health Sciences (R.I., M.G.L.), Washington, DC; UPMC Eye Center, Eye and Ear Institute (H.I.), Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine; and Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA
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An integrative molecular and genomic analysis of pediatric hemispheric low-grade gliomas: an update. Childs Nerv Syst 2016; 32:1789-97. [PMID: 27659822 DOI: 10.1007/s00381-016-3163-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
Abstract
Hemispheric low-grade gliomas account for the second most common location in pediatric low-grade gliomas (PLGGs) after the cerebellum. The pathological spectrum includes gangliogliomas, dysembryoplastic neuroepithelial tumors (DNETs), diffuse astrocytomas, pilocytic astrocytomas, and pleomorphic xanthoastrocytomas (PXAs), among others. Clinically, hemispheric PLGGs represent a well-recognized cause of intractable epilepsy in children and adolescents. With an excellent long-term outcome, surgery remains the cornerstone and patients with gross total resection typically do not need any further therapies. The recent literature about hemispheric PLGGs was reviewed to provide an up-to-date overview of the molecular and cell biology of these tumors. Hemispheric PLGGs can harbor multiple alterations involving BRAFV600E, FGFR, NTRK, MYB/MYBL1, IDH, and BRAF-KIAA1549 fusions. However, the clinical significance of most of these alterations is still to be defined. The role of RAS/MAPK mutations and other alterations in hemispheric PLGGs is of interest from diagnostic, prognostic, and therapeutic perspectives. Molecular testing for these tumors should be encouraged, since the findings can have an important impact not only in prognosis but also in therapeutic strategies.
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29
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Chetty R, Serra S. Molecular and morphological correlation in gastrointestinal stromal tumours (GISTs): an update and primer. J Clin Pathol 2016; 69:754-60. [PMID: 27317811 DOI: 10.1136/jclinpath-2016-203807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/19/2022]
Abstract
Gastrointestinal stromal tumours (GISTs) are a commonly encountered tumour in routine practice. In the main, the morphology of spindle, epithelioid or mixed are well recognised along with mutations of c-kit However, there are other genes that are mutated resulting in characteristic clinicopathological correlations. GISTs harbouring platelet-derived growth factor receptor α (PDGFRα) gene mutations lead to a typical morphological constellation of findings: gastric and omental location, gross tumour that is cystic and haemorrhagic, composed of epithelioid, plasmacytoid cells exhibiting pleomorphism, low mitotic count and containing characteristic giant cells with peripherally placed nuclei. These cells are set in a myxoid stroma containing several mast cells. In addition, perivascular/intratumoural hyalinisation is often seen. These tumours are CD117 and DOG-1 positive. GISTs with SDH mutations are multinodular/bilobed/dumb-bell shape tumour masses with mucosal ulceration and histologically characterised by fibrous bands around and within nodules of epithelioid or mixed epithelioid/spindle cells. Lymphovascular invasion with lymph node metastases are usual. Immunohistochemically, the GISTs are CD117, DOG-1 positive, SDHA negative (if SDHA mutated), SDHA positive (if SDHA intact) and SDHB negative. BRAF and NF-1 mutated GISTs do not have any characteristic morphological features.
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Affiliation(s)
- Runjan Chetty
- Departments of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Stefano Serra
- Departments of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Avery RA, Trimboli-Heidler C, Kilburn LB. Separation of outer retinal layers secondary to selumetinib. J AAPOS 2016; 20:268-71. [PMID: 27108842 PMCID: PMC4912405 DOI: 10.1016/j.jaapos.2016.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 11/26/2022]
Abstract
New therapeutic agents targeting the mitogen-activated protein (MAP) kinase pathway, including MEK inhibitors, are currently being evaluated in phase 1 and 2 clinical trials for pediatric brain tumors. Ophthalmologic side effects from MEK inhibitors have previously only been reported in adults and included retinal vein occlusion, central retinal artery occlusion, and separation of the neurosensory retina. We report 2 patients with optic pathway gliomas who developed outer retinal layer separation visualized by optical coherence tomography while taking the MEK inhibitor selumetinib. After discontinuation of selumetinib, the outer retinal layer separation resolved without visual sequelae. One patient has been retreated with selumetinib and experienced recurrence of these findings.
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Affiliation(s)
- Robert A Avery
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Washington, DC; Center for Neuroscience and Behavior, Children's National Health System, Washington, DC.
| | | | - Lindsay B Kilburn
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC; The Brain Tumor Institute, Children's National Health System, Washington, DC
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31
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Jeyapalan JN, Doctor GT, Jones TA, Alberman SN, Tep A, Haria CM, Schwalbe EC, Morley ICF, Hill AA, LeCain M, Ottaviani D, Clifford SC, Qaddoumi I, Tatevossian RG, Ellison DW, Sheer D. DNA methylation analysis of paediatric low-grade astrocytomas identifies a tumour-specific hypomethylation signature in pilocytic astrocytomas. Acta Neuropathol Commun 2016; 4:54. [PMID: 27229157 PMCID: PMC4882864 DOI: 10.1186/s40478-016-0323-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/04/2016] [Indexed: 12/30/2022] Open
Abstract
Low-grade gliomas (LGGs) account for about a third of all brain tumours in children. We conducted a detailed study of DNA methylation and gene expression to improve our understanding of the biology of pilocytic and diffuse astrocytomas. Pilocytic astrocytomas were found to have a distinctive signature at 315 CpG sites, of which 312 were hypomethylated and 3 were hypermethylated. Genomic analysis revealed that 182 of these sites are within annotated enhancers. The signature was not present in diffuse astrocytomas, or in published profiles of other brain tumours and normal brain tissue. The AP-1 transcription factor was predicted to bind within 200 bp of a subset of the 315 differentially methylated CpG sites; the AP-1 factors, FOS and FOSL1 were found to be up-regulated in pilocytic astrocytomas. We also analysed splice variants of the AP-1 target gene, CCND1, which encodes cell cycle regulator cyclin D1. CCND1a was found to be highly expressed in both pilocytic and diffuse astrocytomas, but diffuse astrocytomas have far higher expression of the oncogenic variant, CCND1b. These findings highlight novel genetic and epigenetic differences between pilocytic and diffuse astrocytoma, in addition to well-described alterations involving BRAF, MYB and FGFR1.
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Affiliation(s)
- Jennie N Jeyapalan
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Gabriel T Doctor
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Tania A Jones
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Samuel N Alberman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Alexander Tep
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Chirag M Haria
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Edward C Schwalbe
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Isabel C F Morley
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Alfred A Hill
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Magdalena LeCain
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Diego Ottaviani
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Steven C Clifford
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ibrahim Qaddoumi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ruth G Tatevossian
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, 38105-3678, USA
| | - David W Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, 38105-3678, USA.
| | - Denise Sheer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
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Abdolrahimzadeh B, Piraino DC, Albanese G, Cruciani F, Rahimi S. Neurofibromatosis: an update of ophthalmic characteristics and applications of optical coherence tomography. Clin Ophthalmol 2016; 10:851-60. [PMID: 27257370 PMCID: PMC4874640 DOI: 10.2147/opth.s102830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis (NF) is a multisystem disorder and tumor predisposition syndrome caused by genetic mutation on chromosome 17-17q11.2 in NF type 1 (NF1), and on chromosome 22-22q12.2 in NF type 2. The disorder is characterized by considerable heterogeneity of clinical expression. NF1 is the form with the most characteristic ocular manifestations. Lisch nodules of the iris are among the well-known diagnostic criteria for the disease. Glaucoma and associated globe enlargement have been described in a significant proportion of patients with NF1 and orbital–facial involvement. Optic nerve glioma may cause strabismus and proptosis, and palpebral neurofibroma may reach considerable size and occasionally show malignant transformation. Near infrared reflectance has greatly contributed to enhancing our knowledge on choroidal alterations in NF1. Indeed, some authors have proposed to include these among the diagnostic criteria. Optical coherence tomography has given new insight on retinal alterations and is a noninvasive tool in the management of optic nerve gliomas in children. Ocular manifestations in NF type 2 can range from early-onset cataracts in up to 80% of cases to optic nerve hamartomas and combined pigment epithelial and retinal hamartomas.
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Affiliation(s)
| | - Domenica Carmen Piraino
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Giorgio Albanese
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Filippo Cruciani
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Siavash Rahimi
- Pathology Centre, Queen Alexandra Hospital, Portsmouth, UK
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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.
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Jin Y, Xiao W, Song T, Feng G, Dai Z. Expression and Prognostic Significance of p53 in Glioma Patients: A Meta-analysis. Neurochem Res 2016; 41:1723-31. [PMID: 27038932 DOI: 10.1007/s11064-016-1888-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 12/19/2022]
Abstract
Glioma is a brain tumor deriving from the neoplastic glial cells or neuroglia. Due to its resistance to anticancer drugs and different disease progress of individuals, patients with high-grade glioma are difficult to completely cure, leading to a poor prognosis and low overall survival. Therefore, there is an urgent need to look for prognostic and diagnostic indicators that can predict glioma grades. P53 is one of the widely studied biomarkers in human glioma. The purpose of this study was to comprehensively evaluate the significance of p53 expression in glioma grades and overall survival. We searched commonly used electronic databases to retrieve related articles of p53 expression in glioma. Overall, a total of 21 studies including 1322 glioma patients were finally screened out. We observed that the frequency of p53 immuno-positivity was higher in high-grade patients than that in low-grade category (63.8 vs. 41.6 %), and our statistic analysis indicated that p53 expression was associated with pathological grade of glioma (OR 2.93, 95 % CI 1.87-4.60, P < 0.00001). This significant correction was also found in 1-, 3- and 5-year overall survival. However, no positive relationship was found between age, sex, tumor size and p53 expression in patients with glioma. In conclusion, our results suggested that p53 immunohistochemical expression might have an effective usefulness in predicting the prognosis in patients with glioma.
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Affiliation(s)
- Yueling Jin
- Department of Pathology, Shanghai University of Medicine & Health Sciences, Meilong Road 21, Shanghai, 200237, China
| | - Weizhong Xiao
- Department of Neurology, Shanghai Pudong Hospital Affiliated to Fudan University, Gongwei Road No. 2008, Huinan Town, Pudong New District, Shanghai, 201399, China
| | - Tingting Song
- Shanghai Putuo District Changfeng Lane Baiyu Community Health Service Center, Caoyang Road 421, Putuo District, Shanghai, 200063, China
| | - Guangjia Feng
- Department of Hematology, Shanghai Pudong Hospital Affiliated to Fudan University, Gongwei Road No. 2008, Huinan Town, Pudong New District, Shanghai, 201399, China
| | - Zhensheng Dai
- Department of Hematology, Shanghai Pudong Hospital Affiliated to Fudan University, Gongwei Road No. 2008, Huinan Town, Pudong New District, Shanghai, 201399, China.
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Yap P, Super L, Qin J, Burgess T, Prodanovic Z, Edwards C, Thomas R, Carpenter K, Tan TY. Congenital Retroperitoneal Teratoma in Neurofibromatosis Type 1. Pediatr Blood Cancer 2016; 63:706-8. [PMID: 26514327 DOI: 10.1002/pbc.25812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022]
Abstract
Neurofibromatosis type 1 (NF1) is caused by mutations in the tumor suppressor gene NF1. The increased tumor risk in affected individuals is well established, caused by somatic biallelic inactivation of NF1 due to loss of heterozygosity. Pediatric teratoma has not been reported in individuals with NF1 previously. We report a case of congenital teratoma in an infant with a heterozygous maternally inherited pathogenic NF1 mutation (c.[1756_1759delACTA] and p.[Thr586Valfs*18]). We detected a "second hit" in the form of mosaic whole NF1 deletion in the tumor tissue using multiplex ligation-dependent probe amplification, as a proof to support the hypothesis of NF1 involvement in the pathogenesis of teratoma.
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Affiliation(s)
- Patrick Yap
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Leanne Super
- Monash Children's Cancer Centre, Monash Medical Centre, Clayton, Victoria, Australia
| | - Jinyi Qin
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Western Australia, Australia
| | - Trent Burgess
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | | | - Caitlin Edwards
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Western Australia, Australia
| | - Rosemary Thomas
- Monash Children's Cancer Centre, Monash Medical Centre, Clayton, Victoria, Australia
| | - Karen Carpenter
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Western Australia, Australia
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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Li X, Zheng J, Diao H, Liu Y. RUNX3 is down-regulated in glioma by Myc-regulated miR-4295. J Cell Mol Med 2016; 20:518-25. [PMID: 26756701 PMCID: PMC4759466 DOI: 10.1111/jcmm.12736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/16/2015] [Indexed: 12/25/2022] Open
Abstract
MicroRNAs are increasingly reported as tumour suppressors that regulate gene expression after transcription. Our results demonstrated that miR-4295 is overexpression in glioma tissues and its level is significantly correlated with clinical stage. We also found that miR-4295 inhibited the cell G0/G1 arrest and apoptosis leading to promoted cell proliferation and activity. The murine modelling study revealed that female nude mice injected with U87/anti-miR-4295 exhibit subcutaneous tumours in the right groin. Compared with anti-NC, the tumour volume was significantly decreased in anti-miR-4295 treatment group. Furthermore, we confirmed miR-4295 mediates the expression of RUNX3 by targeting its 3'untranslation region. In addition, N-myc protein also could bind to the promoter of pri-miR-4295 and inhibit the expression of RUNX3 in glioma cells. These results validate a pathogenetic role of a miR-4295 in gliomas and establish a potentially regulatory and signalling pathway involving N-myc/miR-4295/RUNX3 in gliomas.
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Affiliation(s)
- Xinxing Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jihui Zheng
- Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Hongyu Diao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
The etiologies of brain tumors are in the most cases unknown, but improvements in genetics and DNA screening have helped to identify a wide range of brain tumor predisposition disorders. In this review we are discussing some of the most common predisposition disorders, namely: neurofibromatosis type 1 and 2, schwannomatosis, rhabdoid tumor predisposition disorder, nevoid basal cell carcinoma syndrome (Gorlin), tuberous sclerosis complex, von Hippel-Lindau, Li-Fraumeni and Turcot syndromes. Recent findings from the GLIOGENE collaboration and the newly identified glioma causing gene POT1, will also be discussed. Genetics. We will describe these disorders from a genetic and clinical standpoint, focusing on the difference in clinical symptoms depending on the underlying gene or germline mutation. Central nervous system (CNS) tumors. Most of these disorders predispose the carriers to a wide range of symptoms. Herein, we will focus particularly on tumors affecting the CNS and discuss improvements of targeted therapy for the particular disorders.
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Affiliation(s)
- Gunnar Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ulrika Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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Henrich CJ, Cartner LK, Wilson JA, Fuller RW, Rizzo AE, Reilly KM, McMahon JB, Gustafson KR. Deguelins, Natural Product Modulators of NF1-Defective Astrocytoma Cell Growth Identified by High-Throughput Screening of Partially Purified Natural Product Extracts. JOURNAL OF NATURAL PRODUCTS 2015; 78:2776-81. [PMID: 26467198 PMCID: PMC6352732 DOI: 10.1021/acs.jnatprod.5b00753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A high-throughput screening assay for modulators of Trp53/NF1 mutant astrocytoma cell growth was adapted for use with natural product extracts and applied to a novel collection of prefractionated/partially purified extracts. Screening 68 427 samples identified active fractions from 95 unique extracts, including the terrestrial plant Millettia ichthyotona. Only three of these extracts showed activity in the crude extract form, thus demonstrating the utility of a partial purification approach for natural product screening. The NF1 screening assay was used to guide purification of active compounds from the M. ichthyotona extract, which yielded the two rotenones deguelin (1) and dehydrodeguelin (2). The deguelins have been reported to affect growth of a number of cancer cell lines. They potently inhibited growth of only one of a panel of NF1/Trp53 mutant murine astrocytoma cell lines, possibly related to epigenetic factors, but had no effect on the growth of normal astrocytes. These results suggest the potential utility of deguelins as tools for further investigating NF1 astrocytoma cell growth. These bioprobes were identified only as a result of screening partially purified natural product extracts.
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Affiliation(s)
- Curtis J. Henrich
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702-1201, United States
| | - Laura K. Cartner
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
- Basic Science Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702-1201, United States
| | - Jennifer A. Wilson
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
| | - Richard W. Fuller
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
| | - Anthony E. Rizzo
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland 21702-1201, United States
| | - Karlyne M. Reilly
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, Maryland 21702-1201, United States
| | - James B. McMahon
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
| | - Kirk R. Gustafson
- Molecular Targets Laboratory, Center for Cancer Research, and National Cancer Institute, Frederick, Maryland 21702-1201, United States
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Zakrzewski K, Jarząb M, Pfeifer A, Oczko-Wojciechowska M, Jarząb B, Liberski PP, Zakrzewska M. Transcriptional profiles of pilocytic astrocytoma are related to their three different locations, but not to radiological tumor features. BMC Cancer 2015; 15:778. [PMID: 26497896 PMCID: PMC4619381 DOI: 10.1186/s12885-015-1810-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/16/2015] [Indexed: 01/06/2023] Open
Abstract
Background Pilocytic astrocytoma is the most common type of brain tumor in the pediatric population, with a generally favorable prognosis, although recurrences or leptomeningeal dissemination are sometimes also observed. For tumors originating in the supra-or infratentorial location, a different molecular background was suggested, but plausible correlations between the transcriptional profile and radiological features and/or clinical course are still undefined. The purpose of this study was to identify gene expression profiles related to the most frequent locations of this tumor, subtypes based on various radiological features, and the clinical pattern of the disease. Methods Eighty six children (55 males and 31 females) with histologically verified pilocytic astrocytoma were included in this study. Their age at the time of diagnosis ranged from fourteen months to seventeen years, with a mean age of seven years. There were 40 cerebellar, 23 optic tract/hypothalamic, 21 cerebral hemispheric, and two brainstem tumors. According to the radiological features presented on MRI, all cases were divided into four subtypes: cystic tumor with a non-enhancing cyst wall; cystic tumor with an enhancing cyst wall; solid tumor with central necrosis; and solid or mainly solid tumor. In 81 cases primary surgical resection was the only and curative treatment, and in five cases progression of the disease was observed. In 47 cases the analysis was done by using high density oligonucleotide microarrays (Affymetrix HG-U133 Plus 2.0) with subsequent bioinformatic analyses and confirmation of the results by independent RT-qPCR (on 39 samples). Results Bioinformatic analyses showed that the gene expression profile of pilocytic astrocytoma is highly dependent on the tumor location. The most prominent differences were noted for IRX2, PAX3, CXCL14, LHX2, SIX6, CNTN1 and SIX1 genes expression even within different compartments of the supratentorial region. Analysis of the genes potentially associated with radiological features showed much weaker transcriptome differences. Single genes showed association with the tendency to progression. Conclusions Here we have shown that pilocytic astrocytomas of three different locations can be precisely differentiated on the basis of their gene expression level, but their transcriptional profiles does not strongly reflect the radiological appearance of the tumor or the course of the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1810-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother Memorial Hospital Research Institute, Rzgowska 281/289, 93-338, Lodz, Poland.
| | - Michał Jarząb
- Third Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland.
| | - Aleksandra Pfeifer
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland.
| | - Małgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland.
| | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland.
| | - Paweł P Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland.
| | - Magdalena Zakrzewska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland.
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Abstract
INTRODUCTION Cerebellar astrocytomas (CA) are one of the most common posterior fossa tumors in children. The vast majority is low grade, and prognosis for long-term survival is excellent. METHODS Recent literature about CA was reviewed to provide an up to date overview of the epidemiology, pathology, molecular and cell biology, diagnosis, presentation, management, and long-term outcomes. RESULTS Surgical resection remains the first-line treatment with complete removal of the tumor the goal. However, even when only subtotal resection has been achieved, there is a significant chance that the tumor will remain stable or will regress spontaneously. Adjuvant chemotherapy is reserved for those tumors that progress despite surgery, and more personalized chemotherapy is being pursued with better understanding of the molecular genetics of this tumor. Radiotherapy has generally not been recommended, but stereotactic radiotherapy and conformal proton beam radiotherapy may be reasonable options in the setting of relapse or progression. In the long term, permanent neurologic deficits, mainly cerebellar dysfunction, are common, but quality of life and cognitive function are generally good. CONCLUSIONS Low-grade CA remains primarily a surgical disease, with excellent survival rates. Care must be taken with surgery and adjuvant treatments to preserve neurologic function to allow for optimal outcomes in the long term.
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KIAA1549: BRAF Gene Fusion and FGFR1 Hotspot Mutations Are Prognostic Factors in Pilocytic Astrocytomas. J Neuropathol Exp Neurol 2015; 74:743-54. [PMID: 26083571 PMCID: PMC4470527 DOI: 10.1097/nen.0000000000000213] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Up to 20% of patients with pilocytic astrocytoma (PA) experience a poor outcome. BRAF alterations and Fibroblast growth factor receptor 1 (FGFR1) point mutations are key molecular alterations in Pas, but their clinical implications are not established. We aimed to determine the frequency and prognostic role of these alterations in a cohort of 69 patients with PAs. We assessed KIAA1549:BRAF fusion by fluorescence in situ hybridization and BRAF (exon 15) mutations by capillary sequencing. In addition, FGFR1 expression was analyzed using immunohistochemistry, and this was compared with gene amplification and hotspot mutations (exons 12 and 14) assessed by fluorescence in situ hybridization and capillary sequencing. KIAA1549:BRAF fusion was identified in almost 60% of cases. Two tumors harbored mutated BRAF. Despite high FGFR1 expression overall, no cases had FGFR1 amplifications. Three cases harbored a FGFR1 p.K656E point mutation. No correlation was observed between BRAF and FGFR1 alterations. The cases were predominantly pediatric (87%), and no statistical differences were observed in molecular alterations–related patient ages. In summary, we confirmed the high frequency of KIAA1549:BRAF fusion in PAs and its association with a better outcome. Oncogenic mutations of FGFR1, although rare, occurred in a subset of patients with worse outcome. These molecular alterations may constitute alternative targets for novel clinical approaches, when radical surgical resection is unachievable.
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Gessi M, Engels AC, Lambert S, Rothämel T, von Hornstein S, Collins VP, Denkhaus D, Gnekow A, Pietsch T. Molecular characterization of disseminated pilocytic astrocytomas. Neuropathol Appl Neurobiol 2015; 42:273-8. [DOI: 10.1111/nan.12256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/14/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. Gessi
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - A. C. Engels
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - S. Lambert
- Department of Pathology; University of Cambridge; Cambridge UK
| | - T. Rothämel
- Department of Forensic Medicine; University of Hannover Medical School; Hannover Germany
| | - S. von Hornstein
- Department of Pediatric Oncology; Klinikum Augsburg; Augsburg Germany
| | - V. P. Collins
- Department of Pathology; University of Cambridge; Cambridge UK
| | - D. Denkhaus
- Institute of Neuropathology; University of Bonn; Bonn Germany
| | - A. Gnekow
- Department of Pediatric Oncology; Klinikum Augsburg; Augsburg Germany
| | - T. Pietsch
- Institute of Neuropathology; University of Bonn; Bonn Germany
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43
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Rakotonjanahary J, De Carli E, Delion M, Kalifa C, Grill J, Doz F, Leblond P, Bertozzi AI, Rialland X. Mortality in Children with Optic Pathway Glioma Treated with Up-Front BB-SFOP Chemotherapy. PLoS One 2015; 10:e0127676. [PMID: 26098902 PMCID: PMC4476571 DOI: 10.1371/journal.pone.0127676] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/17/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In terms of overall survival (OS), limited data are available for the very long-term outcomes of children treated for optic pathway glioma (OPG) with up-front chemotherapy. Therefore, we undertook this study with the aim of clarifying long-term OS and causes of death in these patients. METHODS We initiated and analyzed a historical cohort study of 180 children with OPG treated in France with BB-SFOP chemotherapy between 1990 and 2004. The survival distributions were estimated using Kaplan-Meier method. The effect of potential risk factors on the risk of death was described using Cox regression analysis. RESULTS The OS was 95% [95% CI: 90.6-97.3] 5 years after diagnosis and significantly decreased over time without ever stabilizing: 91.6% at 10 years [95% CI: 86.5-94.8], 80.7% at 15 years [95% CI: 72.7-86.8] and 75.5% [95% CI: 65.6-83] at 18 years. Tumor progression was the most common cause of death (65%). Age and intracranial hypertension at diagnosis were significantly associated with a worse prognosis. Risk of death was increased by 3.1[95% CI: 1.5-6.2] (p=0.002) for patients less than 1 year old at diagnosis and by 5.2[95% CI: 1.5-17.6] (p=0.007) for patients with initial intracranial hypertension. Boys without diencephalic syndrome had a better prognosis (HR: 0.3 [95% CI: 0.1-0.8], p=0.007). CONCLUSIONS This study shows that i) in children with OPG, OS is not as favorable as previously described and ii) patients can be classified into 2 groups depending on risk factors (age, intracranial hypertension, sex and diencephalic syndrome) with an OS rate of 50.4% at 18 years [95% CI: 31.4-66.6] in children with the worst prognosis. These findings could justify, depending on the initial risk, a different therapeutic approach to this tumor with more aggressive treatment (especially chemotherapy) in patients with high risk factors.
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Affiliation(s)
- Josué Rakotonjanahary
- Department of Pediatric Oncology, University Hospital, Angers, France
- INSERM CIE5 Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Emilie De Carli
- Department of Pediatric Oncology, University Hospital, Angers, France
| | - Matthieu Delion
- Department of Neurosurgery, University Hospital, Angers, France
| | - Chantal Kalifa
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - François Doz
- Department of Pediatric Oncology, Curie Institute and University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Leblond
- Department of Pediatric Oncology, Oscar Lambret Center, Lille, France
| | | | - Xavier Rialland
- Department of Pediatric Oncology, University Hospital, Angers, France
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Khatua S, Wang J, Rajaram V. Review of low-grade gliomas in children--evolving molecular era and therapeutic insights. Childs Nerv Syst 2015; 31:643-52. [PMID: 25722047 DOI: 10.1007/s00381-015-2653-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 11/29/2022]
Abstract
Low-grade gliomas are the commonest brain tumor in children comprising heterogeneous pathological entities. Though the overall prognosis is good, unresectable, and recurrent or progressive tumors in eloquent areas of the brain remain major therapeutic challenge even with advances in chemotherapeutic strategies. With the evolving surge of molecular data, improved understanding of the biology of these tumors is now perceivable that could provide insights into novel therapies. We hope the new era will enable us to profile comprehensive histopathological/molecular classification and prognostic molecular markers in these tumors and guide us to tailor optimal targeted therapy.
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Affiliation(s)
- Soumen Khatua
- Pediatric Neuro-Oncology, Children's Cancer Hospital, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX, 77030, USA,
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45
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Reis GF, Tihan T. Therapeutic targets in pilocytic astrocytoma based on genetic analysis. Semin Pediatr Neurol 2015; 22:23-7. [PMID: 25976257 DOI: 10.1016/j.spen.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pilocytic astrocytoma (PA) is the most common astrocytic neoplasm of childhood. Patients have an extremely favorable prognosis after surgical resection, qualifying tumors for a grade I designation by the World Health Organization. The molecular data on PA support a key role for the BRAF oncogene in the pathogenesis of these tumors, with the KIAA1549-BRAF fusion being the most common alteration identified in sporadic cases, particularly those occurring in the posterior fossa. Constitutive activation of BRAF leads to downstream activation of the MEK/MAPK/ERK/p16 pathway, which interestingly is also used by cells to activate oncogene-induced senescence (OIS). In fact, the presence of an active OIS pathway might explain the periods of dormancy or spontaneous regression or both, that can be seen in PA. In addition to reviewing the historical evolution, clinicopathologic, predictive, prognostic, and molecular features of PA, we discuss current therapeutic strategies and the caveats that should be considered for the development of therapies that could be used to more effectively treat challenging cases. Individualized treatment requires identification of the type of MAPK alteration, as several alterations in BRAF have been described in addition to the KIAA1549-BRAF fusion. Combination regimens would also appear crucial to achieve tumor eradication and prevent the development of drug resistance. Balancing mitogen-activated protein kinases (MAPK) pathway inhibition with abrogation of an active OIS should be carefully considered as well to preserve any existing protective pathways. Importantly, PAs are largely indolent tumors, and care should be taken to avoid overtreatment, as aggressive therapy could cause more harm than good.
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Affiliation(s)
- Gerald F Reis
- Department of Pathology, UCSF School of Medicine, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, UCSF School of Medicine, San Francisco, CA.
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Abstract
The pilocytic astrocytoma is predominantly a tumor of childhood and the most common type of circumscribed astrocytoma. The indolent nature of this tumor allows for prolonged survival for most patients, rendering the disease a rather "chronic" one, with potential long-term sequelae that are occasionally related to treatment. Two critical features of this tumor are its tendency to remain dormant, or involute even after subtotal resection, and the exceptional anaplastic transformation, sometimes following adjuvant therapy. The biological behavior of pilocytic astrocytoma can often be related to molecular alterations in the MAPK pathway.
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Affiliation(s)
- Gerald F Reis
- Neuropathology Division, Department of Pathology, UCSF School of Medicine, UCSF Medical Center, 505 Parnassus Avenue, San Francisco, CA 94143-0102, USA
| | - Tarik Tihan
- Neuropathology Division, Department of Pathology, UCSF School of Medicine, UCSF Medical Center, 505 Parnassus Avenue, San Francisco, CA 94143-0102, USA.
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47
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Molecular Biology of Pediatric Brain Tumors and Impact on Novel Therapies. Curr Neurol Neurosci Rep 2015; 15:10. [DOI: 10.1007/s11910-015-0532-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pećina-Šlaus N, Gotovac K, Kafka A, Tomas D, Borovečki F. Genetic changes observed in a case of adult pilocytic astrocytoma revealed by array CGH analysis. Mol Cytogenet 2014; 7:95. [PMID: 25606054 PMCID: PMC4300045 DOI: 10.1186/s13039-014-0095-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A palette of copy number changes in a case of adult pilocytic astrocytoma analyzed by Array Comparative Genomic Hybridization (aCGH) is presented. Pilocytic astrocytomas are specific gliomas that are benign and biologically distinct and the molecular mechanisms responsible for their development remain unexplained. The aCGH was performed using SurePrint G3 Human CGH microarrays 4 × 180 K (Agilent Technologies). To ascertain whether some of the aberrations were of constitutive nature, we also analyzed the blood sample from the same patient. RESULTS The result of aCGH analysis demonstrated differences in the tumor tissue when compared to normal control on the array and also to autologous DNA from patient's blood. The total number of aberrations found in our case was 41 including 37 deletions and 4 amplifications. Whole chromosomal gains and losses were not observed. Collectively, our results showed three deletions and one amplification at 1p, two deletions at 2q, two deletions at 4q, two deletion at 5q, two deletions at 7p and two deletions at 7q; there were also three deletions at 8q, one deletion at 9p, one deletion at 10p, three deletions and one amplification at 10q. Chromosome 11 showed two deletions at 11p, while there was one deletion at 12p and one at 12q. Four deletions at 14q; two deletions at 15q, one amplification at 17q and one deletion at 17q; one deletion at 18p, two deletions at 22q and finally one deletion at Xp and one deletion and one amplification at Xq. Among the signaling pathways, olfactory transduction, Fc gamma R-mediated phagocytosis and p53 signaling pathway showed significant enrichment ascertained by gene ontology (GO) analysis using the DAVID software. CONCLUSIONS Our aCGH analysis is bringing subtle genomic alterations thus broadening genetic spectrum of adult pilocytic astrocytoma in order to offer new molecular biomarkers that will help in diagnostics and therapeutic decision-making.
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Affiliation(s)
- Nives Pećina-Šlaus
- />Laboratory of Neurooncology, Croatian Institute for Brain Research, School of Medicine University of Zagreb, Šalata 12, 10000 Zagreb, Croatia
- />Department of Biology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Kristina Gotovac
- />Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, and University Hospital Center Zagreb, Šalata 2, 10 000 Zagreb, Croatia
| | - Anja Kafka
- />Laboratory of Neurooncology, Croatian Institute for Brain Research, School of Medicine University of Zagreb, Šalata 12, 10000 Zagreb, Croatia
- />Department of Biology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Davor Tomas
- />Department of Pathology, School of Medicine, University of Zagreb, Šalata 10, 10000 Zagreb, Croatia
- />Hospital Center “Sisters of Charity”, Vinogradska 29, 10000 Zagreb, Croatia
| | - Fran Borovečki
- />Department for Functional Genomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, and University Hospital Center Zagreb, Šalata 2, 10 000 Zagreb, Croatia
- />Department of Neurology, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
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Solin SL, Wang Y, Mauldin J, Schultz LE, Lincow DE, Brodskiy PA, Jones CA, Syrkin-Nikolau J, Linn JM, Essner JJ, Hostetter JM, Whitley EM, Cameron JD, Chou HH, Severin AJ, Sakaguchi DS, McGrail M. Molecular and cellular characterization of a zebrafish optic pathway tumor line implicates glia-derived progenitors in tumorigenesis. PLoS One 2014; 9:e114888. [PMID: 25485542 PMCID: PMC4259487 DOI: 10.1371/journal.pone.0114888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/14/2014] [Indexed: 12/29/2022] Open
Abstract
In this study we describe the molecular and cellular characterization of a zebrafish mutant that develops tumors in the optic pathway. Heterozygous Tg(flk1:RFP)is18 transgenic adults develop tumors of the retina, optic nerve and optic tract. Molecular and genetic mapping demonstrate the tumor phenotype is linked to a high copy number transgene array integrated in the lincRNA gene lincRNAis18/Zv9_00007276 on chromosome 3. TALENs were used to isolate a 147kb deletion allele that removes exons 2–5 of the lincRNAis18 gene. Deletion allele homozygotes are viable and do not develop tumors, indicating loss of function of the lincRNAis18 locus is not the trigger for tumor onset. Optic pathway tumors in the Tg(flk1:RFP)is18 mutant occur with a penetrance of 80–100% by 1 year of age. The retinal tumors are highly vascularized and composed of rosettes of various sizes embedded in a fibrous matrix. Immunohistochemical analysis showed increased expression of the glial markers GFAP and BLBP throughout retinal tumors and in dysplastic optic nerve. We performed transcriptome analysis of pre-tumorous retina and retinal tumor tissue and found changes in gene expression signatures of radial glia and astrocytes (slc1a3), activated glia (atf3, blbp, apoeb), proliferating neural progenitors (foxd3, nestin, cdh2, her9/hes1), and glioma markers (S100β, vim). The transcriptome also revealed activation of cAMP, Stat3 and Wnt signal transduction pathways. qRT-PCR confirmed >10-fold overexpression of the Wnt pathway components hbegfa, ascl1a, and insm1a. Together the data indicate Müller glia and/or astrocyte-derived progenitors could contribute to the zebrafish Tg(flk1:RFP)is18 optic pathway tumors.
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Affiliation(s)
- Staci L. Solin
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Ying Wang
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Joshua Mauldin
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Laura E. Schultz
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Deborah E. Lincow
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Pavel A. Brodskiy
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Crystal A. Jones
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Judith Syrkin-Nikolau
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Jasmine M. Linn
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Jeffrey J. Essner
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Jesse M. Hostetter
- Department of Veterinary Pathology, Iowa State University, Ames, Iowa, United States of America
| | - Elizabeth M. Whitley
- Department of Veterinary Pathology, Iowa State University, Ames, Iowa, United States of America
| | - J. Douglas Cameron
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Hui-Hsien Chou
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Andrew J. Severin
- Genome Informatics Facility, Office of Biotechnology, Iowa State University, Ames, Iowa, United States of America
| | - Donald S. Sakaguchi
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
| | - Maura McGrail
- Department of Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa, United States of America
- * E-mail:
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50
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Pachow D, Wick W, Gutmann DH, Mawrin C. The mTOR signaling pathway as a treatment target for intracranial neoplasms. Neuro Oncol 2014; 17:189-99. [PMID: 25165193 DOI: 10.1093/neuonc/nou164] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Inhibition of the mammalian target of rapamycin (mTOR) signaling pathway has become an attractive target for human cancer therapy. Hyperactivation of mTOR has been reported in both sporadic and syndromic (hereditary) brain tumors. In contrast to the large number of successful clinical trials employing mTOR inhibitors in different types of epithelial neoplasms, their use to treat intracranial neoplasms is more limited. In this review, we summarize the role of mTOR activation in brain tumor pathogenesis and growth relevant to new human brain tumor trials currently under way using mTOR inhibitors.
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Affiliation(s)
- Doreen Pachow
- Department of Neuropathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany (D.P., C.M.); Department of Neurology, Washington University School of Medicine, St Louis, Missouri (D.H.G.); Department of Neuro-Oncology, Neurology Clinic & National Center for Tumor Diseases, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- Department of Neuropathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany (D.P., C.M.); Department of Neurology, Washington University School of Medicine, St Louis, Missouri (D.H.G.); Department of Neuro-Oncology, Neurology Clinic & National Center for Tumor Diseases, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (W.W.)
| | - David H Gutmann
- Department of Neuropathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany (D.P., C.M.); Department of Neurology, Washington University School of Medicine, St Louis, Missouri (D.H.G.); Department of Neuro-Oncology, Neurology Clinic & National Center for Tumor Diseases, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (W.W.)
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany (D.P., C.M.); Department of Neurology, Washington University School of Medicine, St Louis, Missouri (D.H.G.); Department of Neuro-Oncology, Neurology Clinic & National Center for Tumor Diseases, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (W.W.)
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