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Mischkulnig M, Kiesel B, Rötzer-Pejrimovsky T, Borkovec M, Lang A, Millesi M, Wadiura LI, Hervey-Jumper S, Penninger JM, Berger MS, Widhalm G, Erhart F. The impact of heme biosynthesis regulation on glioma aggressiveness: Correlations with diagnostic molecular markers. Front Mol Neurosci 2022; 15:928355. [PMID: 36187350 PMCID: PMC9515895 DOI: 10.3389/fnmol.2022.928355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background The prognosis of diffusely infiltrating glioma patients is dismal but varies greatly between individuals. While characterization of gliomas primarily relied on histopathological features, molecular markers increasingly gained importance and play a key role in the recently published 5th edition of the World Health Organization (WHO) classification. Heme biosynthesis represents a crucial pathway due to its paramount importance in oxygen transport, energy production and drug metabolism. Recently, we described a “heme biosynthesis mRNA expression signature” that correlates with histopathological glioma grade and survival. The aim of the current study was to correlate this heme biosynthesis mRNA expression signature with diagnostic molecular markers and investigate its continued prognostic relevance. Materials and methods In this study, patient data were derived from the “The Cancer Genome Atlas” (TCGA) lower-grade glioma and glioblastoma cohorts. We identified diffusely infiltrating gliomas correlating molecular tumor diagnosis according to the most recent WHO classification with heme biosynthesis mRNA expression. The following molecular markers were analyzed: EGFR amplification, TERT promoter mutation, CDKN2A/B homozygous loss, chromosome 7 + /10- aneuploidy, MGMT methylation, IDH mutation, ATRX loss, p53 mutation and 1p19q codeletion. Subsequently, we calculated the heme biosynthesis mRNA expression signature for correlation with distinct molecular glioma markers/molecular subgroups and performed survival analyses. Results A total of 649 patients with available data on up-to-date molecular markers and heme biosynthesis mRNA expression were included. According to analysis of individual molecular markers, we found a significantly higher heme biosynthesis mRNA expression signature in gliomas with IDH wildtype (p < 0.0005), without 1p19q codeletion (p < 0.0005), with homozygous CDKN2A/B loss (p < 0.0005) and with EGFR amplification (p = 0.001). Furthermore, we observed that the heme biosynthesis mRNA expression signature increased with molecular subgroup aggressiveness (p < 0.0005), being lowest in WHO grade 2 oligodendrogliomas and highest in WHO grade 4 glioblastomas. Finally, the heme biosynthesis mRNA expression signature was a statistically significant survival predictor after multivariate correction for all molecular markers (p < 0.0005). Conclusion Our data demonstrate a significant correlation between heme biosynthesis regulation and diagnostic molecular markers and a prognostic relevance independent of these established markers. Consequently, heme biosynthesis expression is a promising biomarker for glioma aggressiveness and might constitute a potential target for novel therapeutic approaches.
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Affiliation(s)
- Mario Mischkulnig
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Rötzer-Pejrimovsky
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martin Borkovec
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Department of Statistics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Alexandra Lang
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Lisa I. Wadiura
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Josef M. Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Vienna, Austria
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- *Correspondence: Georg Widhalm,
| | - Friedrich Erhart
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Central Nervous System Tumors Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Friedrich Erhart,
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Mischkulnig M, Kiesel B, Lötsch D, Roetzer T, Borkovec M, Wadiura LI, Roessler K, Hervey-Jumper S, Penninger JM, Berger MS, Widhalm G, Erhart F. Heme Biosynthesis mRNA Expression Signature: Towards a Novel Prognostic Biomarker in Patients with Diffusely Infiltrating Gliomas. Cancers (Basel) 2021; 13:cancers13040662. [PMID: 33562253 PMCID: PMC7916021 DOI: 10.3390/cancers13040662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Diffusely infiltrating gliomas are frequent brain tumors with variable prognosis. In addition to the blood pigment’s role of oxygen transportation, the metabolic pathway synthesizing heme has been shown to play a role in the biochemistry of various tumors. In this study we thus investigated the impact of heme biosynthesis factors mRNA expression on the survival in glioma patients and observed a progressive decrease in survival time with increasing mRNA expression signature. This association was present for overall as well as progression-free survival and remained statistically significant after correction for established prognostic factors such as patient age and tumor grade. Abstract Diffusely infiltrating gliomas are characterized by a variable clinical course, and thus novel prognostic biomarkers are needed. The heme biosynthesis cycle constitutes a fundamental metabolic pathway and might play a crucial role in glioma biology. The aim of this study was thus to investigate the role of the heme biosynthesis mRNA expression signature on prognosis in a large glioma patient cohort. Glioma patients with available sequencing data on heme biosynthesis expression were retrieved from The Cancer Genome Atlas (TCGA). In each patient, the heme biosynthesis mRNA expression signature was calculated and categorized into low, medium, and high expression subgroups. Differences in progression-free and overall survival between these subgroups were investigated including a multivariate analysis correcting for WHO grade, tumor subtype, and patient age and sex. In a total of 693 patients, progression-free and overall survival showed a strictly monotonical decrease with increasing mRNA expression signature subgroups. In detail, median overall survival was 134.2 months in the low, 79.9 months in the intermediate, and 16.5 months in the high mRNA expression signature subgroups, respectively. The impact of mRNA expression signature on progression-free and overall survival was independent of the other analyzed prognostic factors. Our data indicate that the heme biosynthesis mRNA expression signature might serve as an additional novel prognostic marker in patients with diffusely infiltrating gliomas to optimize postoperative management.
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Affiliation(s)
- Mario Mischkulnig
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Daniela Lötsch
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Thomas Roetzer
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
- Department of Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria;
| | - Martin Borkovec
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
| | - Lisa I. Wadiura
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA; (S.H.-J.); (M.S.B.)
| | - Josef M. Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Dr.-Bohr-Gasse 3, 1030 Vienna, Austria;
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, C201–4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA; (S.H.-J.); (M.S.B.)
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
- Correspondence:
| | - Friedrich Erhart
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria; (M.M.); (B.K.); (D.L.); (M.B.); (L.I.W.); (K.R.); (F.E.)
- Comprehensive Cancer Center—Central Nervous System Tumours Unit, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
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