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Yoneda A, Shichino H, Hishiki T, Matsumoto K, Ohira M, Kamijo T, Kuroda T, Soejima T, Nakazawa A, Takimoto T, Yokota I, Teramukai S, Takahashi H, Fukushima T, Hara J, Kaneko M, Ikeda H, Tajiri T, Mugishima H, Nakagawara A. A nationwide phase II study of delayed local treatment for children with high-risk neuroblastoma: The Japan Children's Cancer Group Neuroblastoma Committee Trial JN-H-11. Pediatr Blood Cancer 2024; 71:e30976. [PMID: 38577760 DOI: 10.1002/pbc.30976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Survival rates of patients with high-risk neuroblastoma are unacceptable. A time-intensified treatment strategy with delayed local treatment to control systemic diseases has been developed in Japan. We conducted a nationwide, prospective, single-arm clinical trial with delayed local treatment. This study evaluated the safety and efficacy of delayed surgery to increase treatment intensity. PATIENTS AND METHODS Seventy-five patients with high-risk neuroblastoma were enrolled in this study between May 2011 and September 2015. Delayed local treatment consisted of five courses of induction chemotherapy (cisplatin, pirarubicin, vincristine, and cyclophosphamide) and myeloablative high-dose chemotherapy (melphalan, etoposide, and carboplatin), followed by local tumor extirpation with surgery and irradiation. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), response rate, adverse events, and surgical complications. RESULTS Seventy-five patients were enrolled, and 64 were evaluable (stage 3, n = 8; stage 4, n = 56). The estimated 3-year PFS and OS rates (95% confidence interval [CI]) were 44.4% [31.8%-56.3%] and 80.7% [68.5%-88.5%], resspectively. The response rate of INRC after completion of the treatment protocol was 66% (42/64; 95% CI: 53%-77%; 23 CR [complete response], 10 VGPR [very good partial response], and nine PR [partial response]). None of the patients died during the protocol treatment or within 30 days of completion. Grade 4 adverse effects, excluding hematological adverse effects, occurred in 48% of patients [31/64; 95% CI: 36%-61%]. Major Surgical complications were observed in 25% of patients [13/51; 95% CI: 14%-40%]. CONCLUSION This study indicates that delayed local treatment is feasible and shows promising efficacy, suggesting that this treatment should be considered further in a comparative study of high-risk neuroblastoma.
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Affiliation(s)
- Akihiro Yoneda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Surgery, Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
- Pediatric Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Shichino
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomoro Hishiki
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Chiba University, Chiba, Japan
| | - Kimikazu Matsumoto
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miki Ohira
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Takehiko Kamijo
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Tatsuo Kuroda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Toshinori Soejima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Kobe Proton Center, Kobe, Japan
| | - Atsuko Nakazawa
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Takimoto
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Clinical Epidemiology Research Center for Pediatric Cancer, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Yokota
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Satoshi Teramukai
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideto Takahashi
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- National Institute of Public Health, Saitama, Japan
| | - Takashi Fukushima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junichi Hara
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka, Japan
| | - Michio Kaneko
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Ibaraki Prefectural Association of Health Evaluation and Promotion, Mito, Japan
| | - Hitoshi Ikeda
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Tatsuro Tajiri
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideo Mugishima
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- Booth Memorial Aged Care Center GRACE, Tokyo, Japan
| | - Akira Nakagawara
- The Japan Children's Cancer Group (JCCG) Neuroblastoma Committee (JNBSG), Nagoya, Japan
- SAGA Heavy Ion Medical Accelerator in Tosu, Tosu, Japan
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Feng L, Yang X, Wang C, Zhang H, Wang W, Yang J. Predicting event-free survival after induction of remission in high-risk pediatric neuroblastoma: combining 123I-MIBG SPECT-CT radiomics and clinical factors. Pediatr Radiol 2024; 54:805-819. [PMID: 38492045 DOI: 10.1007/s00247-024-05901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Accurately quantifying event-free survival after induction of remission in high-risk neuroblastoma can lead to better subsequent treatment decisions, including whether more aggressive therapy or milder treatment is needed to reduce unnecessary treatment side effects, thereby improving patient survival. OBJECTIVE To develop and validate a 123I-metaiodobenzylguanidine (MIBG) single-photon emission computed tomography-computed tomography (SPECT-CT)-based radiomics nomogram and evaluate its value in predicting event-free survival after induction of remission in high-risk neuroblastoma. MATERIALS AND METHODS One hundred and seventy-two patients with high-risk neuroblastoma who underwent an 123I-MIBG SPECT-CT examination were retrospectively reviewed. Eighty-seven patients with high-risk neuroblastoma met the final inclusion and exclusion criteria and were randomized into training and validation cohorts in a 7:3 ratio. The SPECT-CT images of patients were visually analyzed to assess the Curie score. The 3D Slicer software tool was used to outline the region of interest of the lumbar 3-5 vertebral bodies on the SPECT-CT images. Radiomics features were extracted and screened, and a radiomics model was constructed with the selected radiomics features. Univariate and multivariate Cox regression analyses were used to determine clinical risk factors and construct the clinical model. The radiomics nomogram was constructed using multivariate Cox regression analysis by incorporating radiomics features and clinical risk factors. C-index and time-dependent receiver operating characteristic curves were used to evaluate the performance of the different models. RESULTS The Curie score had the lowest efficacy for the assessment of event-free survival, with a C-index of 0.576 and 0.553 in the training and validation cohorts, respectively. The radiomics model, constructed from 11 radiomics features, outperformed the clinical model in predicting event-free survival in both the training cohort (C-index, 0.780 vs. 0.653) and validation cohort (C-index, 0.687 vs. 0.667). The nomogram predicted the best prognosis for event-free survival in both the training and validation cohorts, with C-indices of 0.819 and 0.712, and 1-year areas under the curve of 0.899 and 0.748, respectively. CONCLUSION 123I-MIBG SPECT-CT-based radiomics can accurately predict the event-free survival of high-risk neuroblastoma after induction of remission The constructed nomogram may enable an individualized assessment of high-risk neuroblastoma prognosis and assist clinicians in optimizing patient treatment and follow-up plans, thereby potentially improving patient survival.
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Affiliation(s)
- Lijuan Feng
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Xu Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Chao Wang
- SinoUnion Healthcare Inc, Beijing, China
| | - Hui Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Wei Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China.
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Furman WL, McCarville B, Shulkin BL, Davidoff A, Krasin M, Hsu CW, Pan H, Wu J, Brennan R, Bishop MW, Helmig S, Stewart E, Navid F, Triplett B, Santana V, Santiago T, Hank JA, Gillies SD, Yu A, Sondel PM, Leung WH, Pappo A, Federico SM. Improved Outcome in Children With Newly Diagnosed High-Risk Neuroblastoma Treated With Chemoimmunotherapy: Updated Results of a Phase II Study Using hu14.18K322A. J Clin Oncol 2022; 40:335-344. [PMID: 34871104 PMCID: PMC8797508 DOI: 10.1200/jco.21.01375] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We evaluated whether combining a humanized antidisialoganglioside monoclonal antibody (hu14.18K322A) throughout therapy improves early response and outcomes in children with newly diagnosed high-risk neuroblastoma. PATIENTS AND METHODS We conducted a prospective, single-arm, three-stage, phase II clinical trial. Six cycles of induction chemotherapy were coadministered with hu14.18K322A, granulocyte-macrophage colony-stimulating factor (GM-CSF), and low-dose interleukin-2 (IL-2). The consolidation regimen included busulfan and melphalan. When available, an additional cycle of parent-derived natural killer cells with hu14.18K322A was administered during consolidation (n = 31). Radiation therapy was administered at the end of consolidation. Postconsolidation treatment included hu14.18K322A, GM-CSF, IL-2, and isotretinoin. Early response was assessed after the first two cycles of induction therapy. End-of-induction response, event-free survival (EFS), and overall survival (OS) were evaluated. RESULTS Sixty-four patients received hu14.18K322A with induction chemotherapy. This regimen was well tolerated, with continuous infusion narcotics. Partial responses (PRs) or better after the first two chemoimmunotherapy cycles occurred in 42 of 63 evaluable patients (66.7%; 95% CI, 55.0 to 78.3). Primary tumor volume decreased by a median of 75% (range, 100% [complete disappearance]-5% growth). Median peak hu14.18K322A serum levels in cycle one correlated with early response to therapy (P = .0154, one-sided t-test). Sixty of 62 patients (97%) had an end-of-induction partial response or better. No patients experienced progressive disease during induction. The 3-year EFS was 73.7% (95% CI, 60.0 to 83.4), and the OS was 86.0% (95% CI, 73.8 to 92.8), respectively. CONCLUSION Adding hu14.18K322A to induction chemotherapy improved early objective responses, significantly reduced tumor volumes in most patients, improved end-of-induction response rates, and yielded an encouraging 3-year EFS. These results, if validated in a larger study, may be practice changing.
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Affiliation(s)
- Wayne L. Furman
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | - Chia-Wei Hsu
- St Jude Children's Research Hospital, Memphis, TN
| | - Haitao Pan
- St Jude Children's Research Hospital, Memphis, TN
| | | | - Rachel Brennan
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Michael W. Bishop
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Sara Helmig
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Elizabeth Stewart
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Fariba Navid
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | | | | | | | - Jacquelyn A. Hank
- Departments of Pediatrics and Human Oncology, University of Wisconsin, Madison, WI
| | | | - Alice Yu
- University of California San Diego, San Diego, CA
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - Paul M. Sondel
- Departments of Pediatrics and Human Oncology, University of Wisconsin, Madison, WI
| | - Wing H. Leung
- Department of Pediatrics, University of Hong Kong, Hong Kong
| | - Alberto Pappo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Sara M. Federico
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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Li C, Peng X, Feng C, Xiong X, Li J, Liao N, Yang Z, Liu A, Wu P, Liang X, He Y, Tian X, Lin Y, Wang S, Li Y. Excellent Early Outcomes of Combined Chemotherapy With Arsenic Trioxide for Stage 4/M Neuroblastoma in Children: A Multicenter Nonrandomized Controlled Trial. Oncol Res 2021; 28:791-800. [PMID: 33858561 PMCID: PMC8420893 DOI: 10.3727/096504021x16184815905096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This nonrandomized, multicenter cohort, open-label clinical trial evaluated the efficacy and safety of combined chemotherapy with arsenic trioxide (ATO) in children with stage 4/M neuroblastoma (NB). We enrolled patients who were newly diagnosed with NB and assessed as stage 4/M and received either traditional chemotherapy or ATO combined with chemotherapy according to their own wishes. Twenty-two patients were enrolled in the trial group (ATO combined with chemotherapy), and 13 patients were enrolled in the control group (traditional chemotherapy). Objective response rate (ORR) at 4 weeks after completing induction chemotherapy was defined as the main outcome, and adverse events were monitored and graded in the meantime. Data cutoff date was December 31, 2019. Finally, we found that patients who received ATO combined with chemotherapy had a significantly higher response rate than those who were treated with traditional chemotherapy (ORR: 86.36% vs. 46.16%, p=0.020). Reversible cardiotoxicity was just observed in three patients who were treated with ATO, and no other differential adverse events were observed between the two groups. ATO combined with chemotherapy can significantly improve end-induction response in high-risk NB, and our novel regimen is well tolerated in pediatric patients. These results highlight the superiority of chemotherapy with ATO, which creates new opportunity for prolonging survival. In addition, this treatment protocol minimizes therapeutic costs compared with anti-GD2 therapy, MIBG, and proton therapy and can decrease the burden to families and society. However, we also need to evaluate more cases to consolidate our conclusion.
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Affiliation(s)
- Chunmou Li
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
| | - Xiaomin Peng
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
| | - Chuchu Feng
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
| | - Xilin Xiong
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
| | - Jianxin Li
- †Department of Hematology and Oncology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Ning Liao
- ‡Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, Nanning, P.R. China
| | - Zhen Yang
- §Department of Hematology, Kunming Children’s Hospital, Kunming, P.R. China
| | - Aiguo Liu
- ¶Department of Pediatric Hematology & Oncology, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Pingping Wu
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
| | - Xuehong Liang
- †Department of Hematology and Oncology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Yunyan He
- ‡Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, Nanning, P.R. China
| | - Xin Tian
- §Department of Hematology, Kunming Children’s Hospital, Kunming, P.R. China
| | - Yunbi Lin
- §Department of Hematology, Kunming Children’s Hospital, Kunming, P.R. China
| | - Songmi Wang
- ¶Department of Pediatric Hematology & Oncology, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, P.R. China
| | - Yang Li
- *Pediatric Hematology/Oncology, Sun Yet-Sen Memorial Hospital, Sun Yet-Sen University, Guangzhou, P.R. China
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Pan L, Cheng C, Duan P, Chen K, Wu Y, Wu Z. XPO1/CRM1 is a promising prognostic indicator for neuroblastoma and represented a therapeutic target by selective inhibitor verdinexor. J Exp Clin Cancer Res 2021; 40:255. [PMID: 34384466 PMCID: PMC8359549 DOI: 10.1186/s13046-021-02044-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/14/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND High-risk neuroblastoma patients have a 5-year survival rate of less than 50%. It's an urgent need to identify new therapeutic targets and the appropriate drugs. Exportin-1 (XPO1), also known as chromosomal region maintenance 1, plays important roles in the progression of tumorigenesis. However, the prognostic and therapeutic values of XPO1 in neuroblastoma have not been reported. METHODS Correlations between XPO1 expression level and clinical characteristics were analyzed using the Neuroblastoma Research Consortium (NRC) dataset and tissue microarray analysis. Cell proliferation assays, colony formation assays, apoptosis assays, cell cycle analysis were performed to analyze the anti-tumor effects of verdinexor (KPT-335) in vitro. Western blot and mRNA sequencing were performed to explore underlying mechanism. In vivo anti-tumor effects of verdinexor were studied in a neuroblastoma xenograft model. RESULTS Higher XPO1 levels were associated with advanced stage and poor prognosis in neuroblastoma patients. The specific inhibitor of XPO1 verdinexor suppressed the neuroblastoma cell growth both in vitro and in vivo. Specifically, inhibition of XPO1 suppressed the neuroblastoma cell proliferation and induced cell apoptosis by nuclear accumulation of FOXO1 and RB1 in the neuroblastoma due to the inhibition of the PI3K/AKT pathway, and induced G0/G1 phase cell cycle arrest by activation of P53 function. CONCLUSIONS XPO1 is a promising prognostic indicator for neuroblastoma and a novel target for antitumor treatment with selective inhibitor verdinexor.
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Affiliation(s)
- Lijia Pan
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China
| | - Cheng Cheng
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China
| | - Peiwen Duan
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China
| | - Kai Chen
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China
| | - Yeming Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China.
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215003, China.
| | - Zhixiang Wu
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Division of Pediatric Oncology, Shanghai Institute of Pediatric Research, Shanghai, 200092, China.
- Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215003, China.
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Abstract
Telomere maintenance plays important roles in genome stability and cell proliferation. Tumor cells acquire replicative immortality by activating a telomere-maintenance mechanism (TMM), either telomerase, a reverse transcriptase, or the alternative lengthening of telomeres (ALT) mechanism. Recent advances in the genetic and molecular characterization of TMM revealed that telomerase activation and ALT define distinct neuroblastoma (NB) subgroups with adverse outcomes, and represent promising therapeutic targets in high-risk neuroblastoma (HRNB), an aggressive childhood solid tumor that accounts for 15% of all pediatric-cancer deaths. Patients with HRNB frequently present with widely metastatic disease, with tumors harboring recurrent genetic aberrations (MYCN amplification, TERT rearrangements, and ATRX mutations), which are mutually exclusive and capable of promoting TMM. This review provides recent insights into our understanding of TMM in NB tumors, and highlights emerging therapeutic strategies as potential treatments for telomerase- and ALT-positive tumors.
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Affiliation(s)
- Jesmin Akter
- Saitama Cancer Center, Research Institute for Clinical Oncology, Saitama 362-0806, Japan;
| | - Takehiko Kamijo
- Saitama Cancer Center, Research Institute for Clinical Oncology, Saitama 362-0806, Japan;
- Laboratory of Tumor Molecular Biology, Department of Graduate School of Science and Engineering, Saitama University, Saitama 362-0806, Japan
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Balyasny S, Lee SM, Desai AV, Volchenboum SL, Naranjo A, Park JR, London WB, Cohn SL, Applebaum MA. Association Between Participation in Clinical Trials and Overall Survival Among Children With Intermediate- or High-risk Neuroblastoma. JAMA Netw Open 2021; 4:e2116248. [PMID: 34236408 PMCID: PMC8267607 DOI: 10.1001/jamanetworkopen.2021.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Participants in clinical trials may experience benefits associated with new therapeutic strategies as well as tight adherence to best supportive care practices. OBJECTIVES To investigate whether participation in a clinical trial is associated with improved survival among children with neuroblastoma and investigate potential recruitment bias of patients in clinical trials. DESIGN, SETTING, AND PARTICIPANTS This cohort study included pediatric patients with intermediate- or high-risk neuroblastoma in North American studies who were included in the International Neuroblastoma Risk Group Data Commons and who received a diagnosis between January 1, 1991, and March 1, 2020. EXPOSURE Enrollment in a clinical trial. MAIN OUTCOMES AND MEASURES Event-free survival and overall survival (OS) of patients with intermediate- or high-risk neuroblastoma enrolled in an up-front Children's Oncology Group (COG) clinical trial vs a biology study alone were analyzed using log-rank tests and Cox proportional hazards regression models. The racial/ethnic composition and the demographic characteristics of the patients in both groups were compared. RESULTS The cohort included 3058 children with intermediate-risk neuroblastoma (1533 boys [50.1%]; mean [SD] age, 10.7 [14.7] months) and 6029 children with high-risk neuroblastoma (3493 boys [57.9%]; mean [SD] age, 45.8 [37.4] months) who were enrolled in a Children's Oncology Group or legacy group neuroblastoma biology study between 1991 and 2020. A total of 1513 patients with intermediate-risk neuroblastoma (49.5%) and 2473 patients with high-risk neuroblastoma (41.0%) were also enrolled in a clinical trial, for a cohort total of 3986 of 9087 children (43.9%) enrolled in a clinical trial. The prevalence of prognostic markers for the clinical trial and non-clinical trial cohorts differed, although representation of patients from racial/ethnic minority groups was similar in both cohorts. Among patients with intermediate-risk neuroblastoma, OS was higher among those who participated in a clinical trial compared with those enrolled only in a biology study (OS, 95% [95% CI, 94%-96%] vs 91% [95% CI, 89%-94%]; P = .01). Among patients with high-risk neuroblastoma, participation in a clinical trial was not associated with OS (OS, 38% [95% CI, 35%-41%] in the clinical trial group vs 41% [95% CI, 38%-44%] in the biology study group; P = .23). CONCLUSIONS AND RELEVANCE Approximately 44% of patients in this large cohort of patients with neuroblastoma were enrolled in up-front clinical trials. Compared with children not enrolled in clinical trials, a higher prevalence of favorable prognostic markers was identified among patients with intermediate-risk neuroblastoma enrolled in clinical trials, and unfavorable features were more prevalent among patients with high-risk neuroblastoma enrolled in clinical trials. No evidence of recruitment bias according to race/ethnicity was observed. Participation in a clinical trial was not associated with OS in this cohort, likely reflecting the common practice of treating nontrial participants with therapeutic and supportive care regimens used in a previous therapeutic trial.
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Affiliation(s)
- Skye Balyasny
- College of the Liberal Arts, Penn State University, University Park, Pennsylvania
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Ami V. Desai
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | | | - Arlene Naranjo
- Children’s Oncology Group Statistics and Data Center, Department of Biostatistics, University of Florida, Gainesville
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington, Seattle
| | - Wendy B. London
- Boston Children’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Susan L. Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois
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8
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Li N, Torres MB, Spetz MR, Wang R, Peng L, Tian M, Dower CM, Nguyen R, Sun M, Tai CH, de Val N, Cachau R, Wu X, Hewitt SM, Kaplan RN, Khan J, St Croix B, Thiele CJ, Ho M. CAR T cells targeting tumor-associated exons of glypican 2 regress neuroblastoma in mice. Cell Rep Med 2021; 2:100297. [PMID: 34195677 PMCID: PMC8233664 DOI: 10.1016/j.xcrm.2021.100297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 05/10/2021] [Indexed: 01/05/2023]
Abstract
Targeting solid tumors must overcome several major obstacles, in particular, the identification of elusive tumor-specific antigens. Here, we devise a strategy to help identify tumor-specific epitopes. Glypican 2 (GPC2) is overexpressed in neuroblastoma. Using RNA sequencing (RNA-seq) analysis, we show that exon 3 and exons 7-10 of GPC2 are expressed in cancer but are minimally expressed in normal tissues. Accordingly, we discover a monoclonal antibody (CT3) that binds exons 3 and 10 and visualize the complex structure of CT3 and GPC2 by electron microscopy. The potential of this approach is exemplified by designing CT3-derived chimeric antigen receptor (CAR) T cells that regress neuroblastoma in mice. Genomic sequencing of T cells recovered from mice reveals the CAR integration sites that may contribute to CAR T cell proliferation and persistence. These studies demonstrate how RNA-seq data can be exploited to help identify tumor-associated exons that can be targeted by CAR T cell therapies.
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MESH Headings
- Animals
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/metabolism
- Antibodies, Monoclonal/pharmacology
- Cell Line, Tumor
- Cell Proliferation
- Exons
- Female
- Gene Expression
- Glypicans/antagonists & inhibitors
- Glypicans/chemistry
- Glypicans/genetics
- Glypicans/immunology
- Humans
- Immunotherapy, Adoptive/methods
- Mice
- Mice, Nude
- Models, Molecular
- Nervous System Neoplasms/genetics
- Nervous System Neoplasms/mortality
- Nervous System Neoplasms/pathology
- Nervous System Neoplasms/therapy
- Neuroblastoma/genetics
- Neuroblastoma/mortality
- Neuroblastoma/pathology
- Neuroblastoma/therapy
- Protein Binding
- Protein Conformation
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Chimeric Antigen/genetics
- Receptors, Chimeric Antigen/immunology
- Sequence Analysis, RNA
- Survival Analysis
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Tumor Burden
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Nan Li
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Madeline B. Torres
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Madeline R. Spetz
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ruixue Wang
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Luyi Peng
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meijie Tian
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Christopher M. Dower
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA
| | - Rosa Nguyen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ming Sun
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chin-Hsien Tai
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Natalia de Val
- Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD 21702, USA
- Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick, MD 21702, USA
| | - Raul Cachau
- Data Science and Information Technology Program, Leidos Biomedical Research, Frederick, MD 21702, USA
| | - Xiaolin Wu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc., Frederick, MD 21702, USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rosandra N. Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Javed Khan
- Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brad St Croix
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702, USA
| | - Carol J. Thiele
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mitchell Ho
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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9
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Lu M, Mishra A, Boschetti C, Lin J, Liu Y, Huang H, Kaminski CF, Huang Z, Tunnacliffe A, Kaminski Schierle GS. Sea Cucumber-Derived Peptides Alleviate Oxidative Stress in Neuroblastoma Cells and Improve Survival in C. elegans Exposed to Neurotoxic Paraquat. Oxid Med Cell Longev 2021; 2021:8842926. [PMID: 33959216 PMCID: PMC8075690 DOI: 10.1155/2021/8842926] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 01/22/2023]
Abstract
Oxidative stress results when the production of oxidants outweighs the capacity of the antioxidant defence mechanisms. This can lead to pathological conditions including cancer and neurodegeneration. Consequently, there is considerable interest in compounds with antioxidant activity, including those from natural sources. Here, we characterise the antioxidant activity of three novel peptides identified in protein hydrolysates from the sea cucumber Apostichopus japonicus. Under oxidative stress conditions, synthetic versions of the sea cucumber peptides significantly compensate for glutathione depletion, decrease mitochondrial superoxide levels, and alleviate mitophagy in human neuroblastoma cells. Moreover, orally supplied peptides improve survival of the Caenorhabditis elegans after treatment with paraquat, the latter of which leads to the production of excessive oxidative stress. Thus, the sea cucumber peptides exhibit antioxidant activity at both the cellular and organism levels and might prove attractive as nutritional supplements for healthy ageing.
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Affiliation(s)
- Meng Lu
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
| | - Ajay Mishra
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
| | - Chiara Boschetti
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
| | - Jing Lin
- Research Institute for Food Nutrition and Human Health, School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yushuang Liu
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Hongliang Huang
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Clemens F. Kaminski
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
| | - Zebo Huang
- Research Institute for Food Nutrition and Human Health, School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Alan Tunnacliffe
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
| | - Gabriele S. Kaminski Schierle
- Cambridge Infinitus Research Centre, Department of Chemical Engineering and Biotechnology, University of Cambridge, West Cambridge Site, Philippa Fawcett Drive, Cambridge CB3 0AS, UK
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10
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Miao L, Zhuo Z, Tang J, Huang X, Liu J, Wang H, Xia H, He J. FABP4 deactivates NF-κB-IL1α pathway by ubiquitinating ATPB in tumor-associated macrophages and promotes neuroblastoma progression. Clin Transl Med 2021; 11:e395. [PMID: 33931964 PMCID: PMC8087928 DOI: 10.1002/ctm2.395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/16/2021] [Accepted: 04/07/2021] [Indexed: 02/05/2023] Open
Abstract
Neuroblastoma (NB) is the most common and deadliest pediatric solid tumor. Targeting and reactivating tumor-associated macrophages (TAMs) is necessary for reversing immune suppressive state and stimulating immune defense to exert tumoricidal function. However, studies on the function and regulation of TAMs in NB progression are still limited. Fatty acid binding protein 4 (FABP4) in TAMs was correlated with advanced clinical stages and unfavorable histology of NB. FABP4-mediated macrophages increased migration, invasion, and tumor growth of NB cells. Mechanically, FABP4 could directly bind to ATPB to accelerate ATPB ubiquitination in macrophages. The consequently decreased ATP levels could deactivate NF-κB/RelA-IL1α pathway, which subsequently results in macrophages reprogrammed to an anti-inflammatory phenotype. We also demonstrated that FABP4-enhanced migration and invasion were significantly suppressed by IL1α blocking antibody. Furthermore, circulating FABP4 was also associated with the clinical stages of NB. Our findings suggest that FABP4-mediated macrophages may promote proliferation and migration phenotypes in NB cells through deactivating NF-κB-IL1α pathway by ubiquitinating ATPB. This study reveals the pathologic and biologic role of FABP4-mediated macrophages in NB development and exhibits a novel application of targeting FABP4 in macrophages for NB treatment.
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Affiliation(s)
- Lei Miao
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Zhenjian Zhuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Jue Tang
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Xiaomei Huang
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Jiabin Liu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Hai‐Yun Wang
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
- Department of Pathology, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhouChina
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11
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Bedekovics T, Hussain S, Zhang Y, Ali A, Jeon YJ, Galardy PJ. USP24 Is a Cancer-Associated Ubiquitin Hydrolase, Novel Tumor Suppressor, and Chromosome Instability Gene Deleted in Neuroblastoma. Cancer Res 2021; 81:1321-1331. [PMID: 33355202 DOI: 10.1158/0008-5472.can-20-1777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/16/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022]
Abstract
Deubiquitinating enzymes are increasingly recognized to play important roles in cancer, with many acting as oncogenes or tumor suppressors. In this study, we employed a bioinformatics approach to screen for enzymes from this family involved in cancer and found USP24 as a potent predictor of poor outcomes in neuroblastoma, an aggressive childhood cancer. USP24 resides in a region commonly deleted in neuroblastoma, yet was independently associated with poor outcomes in this disease. Deletion of Usp24 in a murine model resulted in degradation of collapsin response mediator protein 2 (CRMP2), a regulator of axon growth, guidance, and neuronal polarity. Cells lacking USP24 had significant increases in spindle defects, chromosome missegregation, and aneuploidy, phenotypes that were rescued by the restoration of CRMP2. USP24 prevented aneuploidy by maintaining spindle-associated CRMP2, which is required for mitotic accuracy. Our findings further indicate that USP24 is a tumor suppressor that may play an important role in the pathogenesis of neuroblastoma. SIGNIFICANCE: This study identifies the chromosome instability gene USP24 as frequently deleted in neuroblastoma and provides important insight into the pathogenesis of this aggressive childhood cancer.
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Affiliation(s)
- Tibor Bedekovics
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sajjad Hussain
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ying Zhang
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Asma Ali
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Young J Jeon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pharmacology, Chosun University College of Medicine, Gwangju, South Korea
| | - Paul J Galardy
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
- Division of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
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12
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Moreno L, Guo D, Irwin MS, Berthold F, Hogarty M, Kamijo T, Morgenstern D, Pasqualini C, Ash S, Potschger U, Ladenstein R, Valteau-Couanet D, Cohn SL, Pearson ADJ, London WB. A nomogram of clinical and biologic factors to predict survival in children newly diagnosed with high-risk neuroblastoma: An International Neuroblastoma Risk Group project. Pediatr Blood Cancer 2021; 68:e28794. [PMID: 33205902 DOI: 10.1002/pbc.28794] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/16/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Long-term outcome remains poor for children with high-risk neuroblastoma (five-year overall survival [OS] ∼50%). Our objectives were to (a) identify prognostic biomarkers and apply them in a nomogram to identify the subgroup of ultra-high-risk patients at highest risk of disease progression/death, for whom novel frontline therapy is urgently needed; and (b) validate the nomogram in an independent cohort. METHODS A total of 1820 high-risk patients (≥18 months old with metastatic neuroblastoma), diagnosed 1998-2015, from the International Neuroblastoma Risk Groups (INRG) Data Commons were analyzed in a retrospective cohort study. Using multivariable Cox regression of OS from diagnosis, a nomogram was created from prognostic biomarkers to predict three-year OS. External validation was performed using the SIOPEN HR-NBL1 trial cohort (n = 521), evidenced by receiver operating characteristic curves. RESULTS The nomogram, including MYCN status (P < 0.0001), lactate dehydrogenase (LDH) (P = 0.0007), and presence of bone marrow metastases (P = 0.004), had robust performance and was validated. Applying the nomogram at diagnosis (a) gives prognosis of an individual patient and (b) identifies patients predicted to have poor outcome (three-year OS was 30% ± 5% for patients with a nomogram score of > 82 points; 58% ± 1% for those ≤82 points). Median follow-up time was 5.5 years (range, 0-14.1). CONCLUSIONS In high-risk neuroblastoma, a novel, publicly available nomogram using prognostic biomarkers (MYCN status, LDH, presence of bone marrow metastases; https://neuroblastoma.shinyapps.io/High-Risk-Neuroblastoma-Nomogram/) has the flexibility to apply a clinically suitable and context-specific cutoff to identify patients at highest risk of death. This will facilitate testing urgently needed new frontline treatment options to improve outcome for these children.
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Affiliation(s)
- Lucas Moreno
- Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Dongjing Guo
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Meredith S Irwin
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Michael Hogarty
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Takehiko Kamijo
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Daniel Morgenstern
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Shifra Ash
- Pediatric Hematology Oncology Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | | | | | - Susan L Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Andrew D J Pearson
- Division of Clinical Studies, Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
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13
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Pan LJ, Chen JL, Wu ZX, Wu YM. Exportin-T: A Novel Prognostic Predictor and Potential Therapeutic Target for Neuroblastoma. Technol Cancer Res Treat 2021; 20:15330338211039132. [PMID: 34469238 PMCID: PMC8414936 DOI: 10.1177/15330338211039132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/22/2021] [Indexed: 01/06/2023] Open
Abstract
Exportins as the key mediators of nucleocytoplasmic transport have been identified as the controllers of the passage of numerous types of crucial cancer-related proteins. Targeting exportins in cancer cells might represent an emerging strategy in cancer intervention with the potential to affect clinical outcomes. Here, we focused on the prognostic and therapeutic values of Exportin-T (XPOT) in neuroblastoma. The correlation between the expression and prognostic values of XPOT in patients with neuroblastoma was investigated based on both published transcriptome data and our clinical data. Then, decision curve analysis (DCA) was implemented to identify a XPOT risk prediction model. In addition, RNA inference was performed to silence the expression of XPOT to further investigate the specific roles of XPOT in the progression of neuroblastoma in vitro. Overexpression of XPOT mRNA was associated with poor clinical characteristics, such as age at diagnosis more than 18 months, amplification of MYCN, and advanced International Neuroblastoma Staging System (INSS) stage, and XPOT expression was identified as an independent poor prognosis factor for neuroblastoma using Cox proportional hazards model (P < .001). DCA suggested that neuroblastoma patients could benefit from XPOT risk prediction model-guided interventions (status of MYCN + INSS stage + XPOT). Experimentally, knockdown of XPOT by small interfering RNA inhibited the proliferation and migration in neuroblastoma cells. XPOT is identified as a novel prognostic predictor and potential therapeutic target for neuroblastoma patients. Further investigation should focus on the profound molecular mechanism underlying the tumor inhibition activity of XPOT inhibitors.
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Affiliation(s)
- Li-Jia Pan
- Xinhua Hospital Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Research, Shanghai, China
| | - Jian-Lei Chen
- Children’s Hospital of Soochow
University, Suzhou, China
| | - Zhi-Xiang Wu
- Xinhua Hospital Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Research, Shanghai, China
- Children’s Hospital of Soochow
University, Suzhou, China
| | - Ye-Ming Wu
- Xinhua Hospital Affiliated to Shanghai
Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Pediatric Research, Shanghai, China
- Children’s Hospital of Soochow
University, Suzhou, China
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14
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Yu Y, Chen F, Jin Y, Yang Y, Wang S, Zhang J, Chen C, Zeng Q, Han W, Wang H, Guo Y, Ni X. Downregulated NORAD in neuroblastoma promotes cell proliferation via chromosomal instability and predicts poor prognosis. Acta Biochim Pol 2020; 67:595-603. [PMID: 33326736 DOI: 10.18388/abp.2020_5454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022]
Abstract
Increasing evidence suggests that long non-coding RNAs (lncRNAs) are involved in neuroblastoma (NB) pathogenesis. The aim of this study was to elucidate the roles and underlying mechanism of non-coding RNA activated by DNA damage (NORAD) in childhood NB. Both public data and clinical specimens were used to determine NORAD expression. Colony formation, cell proliferation and wound healing assays were performed to evaluate NORAD effects on proliferation and migration of SH-SY5Y and SK-N-BE(2) cells. Flow cytometry was used to examine the cell cycle changes. The expression of genes and proteins involved in chromosomal instability was determined by qRT-PCR and western blotting, respectively. Our results showed that low NORAD expression correlated with advanced tumor stage, high risk and MYCN amplification in both public data and clinical samples. Kaplan-Meier analysis indicated that patients with low NORAD expression had poor survival outcomes. Functional research showed that NORAD knockdown promoted cell proliferation and migration, and arrested the cell cycle at the G2/M phase. Moreover, the expression of the DNA damage sensor, PARP1, increased after NORAD knockdown, indicating a potential contribution of NORAD to DNA damage repair. NORAD silencing also affected the expression of genes and proteins related to sister chromatid cohesion and segregation, which are involved in chromosomal instability and consequent aneuploidy. These results suggest that NORAD may serve as a tumor suppressor in NB pathogenesis and progression. Thus, NORAD is a potential therapeutic target and a promising prognostic marker for NB patients.
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Affiliation(s)
- Yongbo Yu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Feng Chen
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Yaqiong Jin
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Yeran Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Wei Han
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China; 2Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing 100045, China
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15
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George SL, Lorenzi F, King D, Hartlieb S, Campbell J, Pemberton H, Toprak UH, Barker K, Tall J, da Costa BM, van den Boogaard ML, Dolman MEM, Molenaar JJ, Bryant HE, Westermann F, Lord CJ, Chesler L. Therapeutic vulnerabilities in the DNA damage response for the treatment of ATRX mutant neuroblastoma. EBioMedicine 2020; 59:102971. [PMID: 32846370 PMCID: PMC7452577 DOI: 10.1016/j.ebiom.2020.102971] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In neuroblastoma, genetic alterations in ATRX, define a distinct poor outcome patient subgroup. Despite the need for new therapies, there is a lack of available models and a dearth of pre-clinical research. METHODS To evaluate the impact of ATRX loss of function (LoF) in neuroblastoma, we utilized CRISPR-Cas9 gene editing to generate neuroblastoma cell lines isogenic for ATRX. We used these and other models to identify therapeutically exploitable synthetic lethal vulnerabilities associated with ATRX LoF. FINDINGS In isogenic cell lines, we found that ATRX inactivation results in increased DNA damage, homologous recombination repair (HRR) defects and impaired replication fork processivity. In keeping with this, high-throughput compound screening showed selective sensitivity in ATRX mutant cells to multiple PARP inhibitors and the ATM inhibitor KU60019. ATRX mutant cells also showed selective sensitivity to the DNA damaging agents, sapacitabine and irinotecan. HRR deficiency was also seen in the ATRX deleted CHLA-90 cell line, and significant sensitivity demonstrated to olaparib/irinotecan combination therapy in all ATRX LoF models. In-vivo sensitivity to olaparib/irinotecan was seen in ATRX mutant but not wild-type xenografts. Finally, sustained responses to olaparib/irinotecan therapy were seen in an ATRX deleted neuroblastoma patient derived xenograft. INTERPRETATION ATRX LoF results in specific DNA damage repair defects that can be therapeutically exploited. In ATRX LoF models, preclinical sensitivity is demonstrated to olaparib and irinotecan, a combination that can be rapidly translated into the clinic. FUNDING This work was supported by Christopher's Smile, Neuroblastoma UK, Cancer Research UK, and the Royal Marsden Hospital NIHR BRC.
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Affiliation(s)
- Sally L George
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT United Kingdom.
| | - Federica Lorenzi
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - David King
- Academic Unit of Molecular Oncology, Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom
| | - Sabine Hartlieb
- Neuroblastoma Genomics, Hopp Children`s Cancer Center Heidelberg (KiTZ) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - James Campbell
- Bioinformatics Core Facility, The Institute of Cancer Research, London, United Kingdom
| | - Helen Pemberton
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research London, SW3 6JB, United Kingdom
| | - Umut H Toprak
- Neuroblastoma Genomics, Hopp Children`s Cancer Center Heidelberg (KiTZ) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Karen Barker
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Jennifer Tall
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | - Barbara Martins da Costa
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom
| | | | - M Emmy M Dolman
- Princess Maxima Center for Pediatric Cancer, Utrecht, The Netherlands
| | - Jan J Molenaar
- Princess Maxima Center for Pediatric Cancer, Utrecht, The Netherlands
| | - Helen E Bryant
- Academic Unit of Molecular Oncology, Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom
| | - Frank Westermann
- Neuroblastoma Genomics, Hopp Children`s Cancer Center Heidelberg (KiTZ) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher J Lord
- CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research London, SW3 6JB, United Kingdom
| | - Louis Chesler
- Paediatric Tumour Biology, Division of Clinical Studies, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, United Kingdom; Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT United Kingdom
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16
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Ye M, Liu B, Zhang J, Dong K. Role of long noncoding RNA in neuroblastoma. Discov Med 2020; 30:71-82. [PMID: 33382963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neuroblastoma (NB) is the most common extracranial solid tumor in children. Despite a variety of treatments, patients with advanced stage disease still have a poor prognosis. The molecular mechanisms underlying NB pathogenesis are not fully known. Increasing evidence shows that long noncoding RNA (lncRNA) is important in multiple ways in NB progression. LncRNA could act as competitive endogenous RNA, serve as a scaffold for proteins, or participate in histone modification, thus affecting proliferation, migration, invasion, and differentiation of NB. Numerous lncRNAs polymorphisms are significantly associated with NB susceptibility. Differently expressed lncRNAs can be used to construct risk scores to evaluate patient outcomes. In conclusion, these lncRNAs have the potential to be diagnostic markers as well as promising therapeutic targets in the future.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cell Differentiation/drug effects
- Cell Differentiation/genetics
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Movement/genetics
- Cell Proliferation/drug effects
- Cell Proliferation/genetics
- Child
- Disease Progression
- Drug Resistance, Neoplasm/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Gene Expression Regulation, Neoplastic/genetics
- Genetic Predisposition to Disease
- Humans
- MicroRNAs/metabolism
- Neoplasm Invasiveness/genetics
- Neuroblastoma/diagnosis
- Neuroblastoma/drug therapy
- Neuroblastoma/genetics
- Neuroblastoma/mortality
- Polymorphism, Single Nucleotide
- Prognosis
- Progression-Free Survival
- RNA, Long Noncoding/antagonists & inhibitors
- RNA, Long Noncoding/genetics
- RNA, Long Noncoding/metabolism
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Affiliation(s)
- Mujie Ye
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, China
| | - Baihui Liu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, China
| | - Jingjing Zhang
- Department of Medical Imaging, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
- Corresponding author
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, China
- Corresponding author
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17
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Abstract
The focus of this review is the ganglio-series of glycosphingolipids found in neuroblastoma (NB) and the myriad of unanswered questions associated with their possible role(s) in this cancer. NB is one of the more common solid malignancies of children. Five-year survival for those diagnosed with low risk NB is 90-95%, while that for children with high-risk NB is around 40-50%. Much of the survival rate reflects age of diagnosis with children under a year having a much better prognosis than those over two. Identification of expression of GD2 on the surface of most NB cells led to studies of the effectiveness and subsequent approval of anti-GD2 antibodies as a treatment modality. Despite much success, a subset of patients, possibly those whose tumors fail to express concentrations of gangliosides such as GD1b and GT1b found in tumors from patients with a good prognosis, have tumors refractory to treatment. These observations support discussion of what is known about control of ganglioside synthesis, and their actual functions in NB, as well as their possible relationship to treatment response.
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Affiliation(s)
- Cara-Lynne Schengrund
- Department of Biochemistry and Molecular Biology, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
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18
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Abstract
INTRODUCTION Neuroblastoma (NB) with MYCN amplification has a poor prognosis and high mortality. The potential molecular biological relationship between clinical features and MYCN amplification should be explored. METHODS NB patients were examined by fluorescence in situ hybridization (FISH) for MYCN amplification in the tumor mass or bone marrow samples to determine whether MYCN was amplified. A series of eleven MYCN-amplified NB patients were included. The age, primary site, tumor size, specific biomarkers, and invaded organs were analyzed. All patients accepted standardized treatment of surgery, chemotherapy, and radiotherapy. Progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS The median age at diagnosis was 24 months. Nine patients (81.8%) were in stage IV, with high serum neuron-specific enolase (NSE) expression, normal urine vanillylmandelic acid (VMA) level and extensive metastases. All patients accepted a chemotherapy protocol with 8 to 10 cycles, and 9 patients (81.8%) were sensitive to the initial chemotherapy protocol. At the end of follow-up, four patients (36.3%) died with a median OS of 15 months. Five patients (45%) survived with a median PFS of 13 months. Two patients were still receiving chemotherapy. CONCLUSION Given the effect of MYCN amplification on poor outcome in NB, novel treatments targeting MYCN should be developed for patients with NB.
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19
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Koneru B, Lopez G, Farooqi A, Conkrite KL, Nguyen TH, Macha SJ, Modi A, Rokita JL, Urias E, Hindle A, Davidson H, Mccoy K, Nance J, Yazdani V, Irwin MS, Yang S, Wheeler DA, Maris JM, Diskin SJ, Reynolds CP. Telomere Maintenance Mechanisms Define Clinical Outcome in High-Risk Neuroblastoma. Cancer Res 2020; 80:2663-2675. [PMID: 32291317 PMCID: PMC7313726 DOI: 10.1158/0008-5472.can-19-3068] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/05/2019] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
Neuroblastoma is a childhood cancer with heterogeneous clinical outcomes. To comprehensively assess the impact of telomere maintenance mechanism (TMM) on clinical outcomes in high-risk neuroblastoma, we integrated the C-circle assay [a marker for alternative lengthening of telomeres (ALT)], TERT mRNA expression by RNA-sequencing, whole-genome/exome sequencing, and clinical covariates in 134 neuroblastoma patient samples at diagnosis. In addition, we assessed TMM in neuroblastoma cell lines (n = 104) and patient-derived xenografts (n = 28). ALT was identified in 23.4% of high-risk neuroblastoma tumors and genomic alterations in ATRX were detected in 60% of ALT tumors; 40% of ALT tumors lacked genomic alterations in known ALT-associated genes. Patients with high-risk neuroblastoma were classified into three subgroups (TERT-high, ALT+, and TERT-low/non-ALT) based on presence of C-circles and TERT mRNA expression (above or below median TERT expression). Event-free survival was similar among TERT-high, ALT+, or TERT-low/non-ALT patients. However, overall survival (OS) for TERT-low/non-ALT patients was significantly higher relative to TERT-high or ALT patients (log-rank test; P < 0.01) independent of current clinical and molecular prognostic markers. Consistent with the observed higher OS in patients with TERT-low/non-ALT tumors, continuous shortening of telomeres and decreasing viability occurred in low TERT-expressing, non-ALT patient-derived high-risk neuroblastoma cell lines. These findings demonstrate that assaying TMM with TERT mRNA expression and C-circles provides precise stratification of high-risk neuroblastoma into three subgroups with substantially different OS: a previously undescribed TERT-low/non-ALT cohort with superior OS (even after relapse) and two cohorts of patients with poor survival that have distinct molecular therapeutic targets. SIGNIFICANCE: These findings assess telomere maintenance mechanisms with TERT mRNA and the ALT DNA biomarker C-circles to stratify neuroblastoma into three groups, with distinct overall survival independent of currently used clinical risk classifiers.
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Affiliation(s)
- Balakrishna Koneru
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Gonzalo Lopez
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahsan Farooqi
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Karina L Conkrite
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thinh H Nguyen
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Shawn J Macha
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Apexa Modi
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jo Lynne Rokita
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eduardo Urias
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Ashly Hindle
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Heather Davidson
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Kristyn Mccoy
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Jonas Nance
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Vanda Yazdani
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - Meredith S Irwin
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shengping Yang
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas
| | - David A Wheeler
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - John M Maris
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon J Diskin
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C Patrick Reynolds
- Cancer Center and Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center School of Medicine, Texas.
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
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20
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Amoroso L, Castel V, Bisogno G, Casanova M, Marquez-Vega C, Chisholm JC, Doz F, Moreno L, Ruggiero A, Gerber NU, Fagioli F, Hingorani P, Melcón SG, Slepetis R, Chen N, le Bruchec Y, Simcock M, Vassal G. Phase II results from a phase I/II study to assess the safety and efficacy of weekly nab-paclitaxel in paediatric patients with recurrent or refractory solid tumours: A collaboration with the European Innovative Therapies for Children with Cancer Network. Eur J Cancer 2020; 135:89-97. [PMID: 32554315 DOI: 10.1016/j.ejca.2020.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The phase I component of a phase I/II study defined the recommended phase II dose and established the tolerability of nab-paclitaxel monotherapy in paediatric patients with recurrent or refractory solid tumours. The activity and safety of nab-paclitaxel monotherapy was further investigated in this phase II study. PATIENTS AND METHODS Paediatric patients with recurrent or refractory Ewing sarcoma, neuroblastoma or rhabdomyosarcoma received 240 mg/m2 of nab-paclitaxel on days 1, 8 and 15 of each 28-day cycle. The primary end-point was the overall response rate (ORR; complete response [CR] + partial response [PR]). Secondary end-points included duration of response, disease control rate (DCR; CR + PR + stable disease [SD]), progression-free survival, 1-year overall survival, safety and pharmacokinetics. RESULTS Forty-two patients were enrolled, 14 each with Ewing sarcoma, neuroblastoma and rhabdomyosarcoma. The ORRs were 0%, 0% and 7.1% (1 confirmed PR), respectively. The DCRs were 30.8% (4 SD), 7.1% (1 SD) and 7.1% (1 confirmed PR and 0 SD) in the Ewing sarcoma, neuroblastoma and rhabdomyosarcoma groups, respectively. The median progression-free survival was 13.0, 7.4 and 5.1 weeks, respectively, and the 1-year overall survival rates were 48%, 25% and 15%, respectively. The most common grade III/4IVadverse events were haematologic (neutropenia [50%] and anaemia [48%]), and grade III/IV peripheral neuropathy occurred in 2 patients (14%) in the rhabdomyosarcoma group. Pharmacokinetics analyses revealed that paclitaxel tissue distribution was both rapid and extensive. CONCLUSIONS In this phase II study, limited activity was observed; however, the safety of nab-paclitaxel in paediatric patients was confirmed. TRIAL REGISTRATION NCT01962103 and EudraCT 2013-000144-26.
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Affiliation(s)
| | - Victoria Castel
- Pediatric Hematology/Oncology Unit, University Hospital La Fe, Valencia, Spain
| | - Gianni Bisogno
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - François Doz
- Institut Curie and Paris Descartes University, Paris, France
| | - Lucas Moreno
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | | | | | - Franca Fagioli
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e Della Scienza di Torino, Turin, Italy; Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Pooja Hingorani
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Yvan le Bruchec
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Mathew Simcock
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
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21
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Abstract
Retroperitoneal neuroblastoma is a rare subtype of neuroblastoma and the role of age in its clinical prognosis is still unknown.To describe the age distribution and investigate the association between age and survival outcomes in patients diagnosed with retroperitoneal neuroblastoma.We retrospectively analyzed patients registered for retroperitoneal neuroblastoma in the Surveillance, Epidemiology, and End Results (SEER) national database from 1973 to 2015. Age distribution was described and Cox proportional hazard regression was used to evaluate the measured effect of age on overall survival and disease-specific survival.A total of 399 retroperitoneal neuroblastoma patients with a median follow-up of 53.0 (interquartile range 17.0-133.5) months were included. We found a unimodal distribution of age with a median age of diagnosis to be 1.0 (interquartile range 0.0-4.0) years. Univariate analysis suggested that transformed age was associated with an increased risk of total death and disease-specific death (OR = 4.2, 95% CI 3.0-5.9; OR = 4.7, 95% CI 3.2-6.8). Adjusted smoothed plots showed a nonlinear correlation between age and disease-specific death. The risk of disease-specific death did not increase sharply as the age increased until reaching the inflection point (age < 3 years, OR = 0.4, 95% CI 0.2-1.0; age ≥ 3 years, OR = 1.2, 95% CI 0.9-1.5). There was, however, a linear relationship between age and total deaths (OR = 1.0, 95% CI 0.7-1.2). Adjusted multivariate Cox regression analysis showed that ages ≥ 3 years were associated with a significant increased risks of disease-specific death and total death (OR = 2.5, 95% CI 1.7-3.8; OR = 2.3, 95% CI 1.6-3.3, respectively).There was a unimodal age distribution of retroperitoneal neuroblastoma usually presented in infants or younger child. Older age was associated with a lower chance of overall survival and the risk of disease-specific death increased sharply after 3 years of age.
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22
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Adam K, Lesperance J, Hunter T, Zage PE. The Potential Functional Roles of NME1 Histidine Kinase Activity in Neuroblastoma Pathogenesis. Int J Mol Sci 2020; 21:ijms21093319. [PMID: 32392889 PMCID: PMC7247550 DOI: 10.3390/ijms21093319] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
Neuroblastoma is the most common extracranial solid tumor in childhood. Gain of chromosome 17q material is found in >60% of neuroblastoma tumors and is associated with poor patient prognosis. The NME1 gene is located in the 17q21.3 region, and high NME1 expression is correlated with poor neuroblastoma patient outcomes. However, the functional roles and signaling activity of NME1 in neuroblastoma cells and tumors are unknown. NME1 and NME2 have been shown to possess histidine (His) kinase activity. Using anti-1- and 3-pHis specific monoclonal antibodies and polyclonal anti-pH118 NME1/2 antibodies, we demonstrated the presence of pH118-NME1/2 and multiple additional pHis-containing proteins in all tested neuroblastoma cell lines and in xenograft neuroblastoma tumors, supporting the presence of histidine kinase activity in neuroblastoma cells and demonstrating the potential significance of histidine kinase signaling in neuroblastoma pathogenesis. We have also demonstrated associations between NME1 expression and neuroblastoma cell migration and differentiation. Our demonstration of NME1 histidine phosphorylation in neuroblastoma and of the potential role of NME1 in neuroblastoma cell migration and differentiation suggest a functional role for NME1 in neuroblastoma pathogenesis and open the possibility of identifying new therapeutic targets and developing novel approaches to neuroblastoma therapy.
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Affiliation(s)
- Kevin Adam
- Molecular and Cell Biology Laboratory, Salk Institute for Biological Studies, 10010 N Torrey Pines Road, La Jolla, CA 92037, USA; (K.A.); (T.H.)
| | - Jacqueline Lesperance
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, CA 92093, USA;
| | - Tony Hunter
- Molecular and Cell Biology Laboratory, Salk Institute for Biological Studies, 10010 N Torrey Pines Road, La Jolla, CA 92037, USA; (K.A.); (T.H.)
| | - Peter E. Zage
- Department of Pediatrics, Division of Hematology-Oncology, University of California San Diego, La Jolla, CA 92093, USA;
- Correspondence:
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23
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Olivera GG, Yáñez Y, Gargallo P, Sendra L, Aliño SF, Segura V, Sanz MÁ, Cañete A, Castel V, Font De Mora J, Hervás D, Berlanga P, Herrero MJ. MTHFR and VDR Polymorphisms Improve the Prognostic Value of MYCN Status on Overall Survival in Neuroblastoma Patients. Int J Mol Sci 2020; 21:E2714. [PMID: 32295184 PMCID: PMC7215604 DOI: 10.3390/ijms21082714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in Pharmacogenetics can play an important role in the outcomes of the chemotherapy treatment in Neuroblastoma, helping doctors maximize efficacy and minimize toxicity. Employing AgenaBioscience MassArray, 96 SNPs were genotyped in 95 patients looking for associations of SNP with response to induction therapy (RIT) and grade 3-4 toxicities, in High Risk patients. Associations of SNPs with overall (OS) and event-free (EFS) survival in the whole cohort were also explored. Cox and logistic regression models with Elastic net penalty were employed. Association with grade 3-4 gastrointestinal and infectious toxicities was found for 8 different SNPs. Better RIT was correlated with rs726501 AG, rs3740066 GG, rs2010963 GG and rs1143684 TT (OR = 2.87, 1.79, 1.23, 1.14, respectively). EFS was affected by rs2032582, rs4880, rs3814058, rs45511401, rs1544410 and rs6539870. OS was influenced by rs 1801133, rs7186128 and rs1544410. Remarkably, rs1801133 in MTHFR (p = 0.02) and rs1544410 in VDR (p = 0.006) also added an important predictive value for OS to the MYCN status, with a more accurate substratification of the patients. Although validation studies in independent cohorts will be required, the data obtained supports the utility of Pharmacogenetics for predicting Neuroblastoma treatment outcomes.
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Affiliation(s)
- Gladys G. Olivera
- Pharmacogenetics Platform, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (G.G.O.); (M.J.H.)
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
| | - Yania Yáñez
- Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (Y.Y.)
| | - Pablo Gargallo
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain (A.C.)
| | - Luis Sendra
- Pharmacogenetics Platform, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (G.G.O.); (M.J.H.)
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
| | - Salvador F. Aliño
- Pharmacogenetics Platform, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (G.G.O.); (M.J.H.)
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
- Clinical Pharmacology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Vanessa Segura
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain (A.C.)
| | - Miguel Ángel Sanz
- Hematology and Hemotherapy Service, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Adela Cañete
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain (A.C.)
| | - Victoria Castel
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain (A.C.)
| | - Jaime Font De Mora
- Clinical and Translational Research in Cancer, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (Y.Y.)
| | - David Hervás
- Data Science, Biostatistics and Bioinformatics Platform, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Institute Gustave Roussy Center, 94800 Villejuif, France;
| | - María José Herrero
- Pharmacogenetics Platform, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (G.G.O.); (M.J.H.)
- Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
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24
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Abstract
Neuroblastoma is the most prevalent malignancy in infants characterized by heterogeneous prognosis. It is critical to stratify the risks for patients with neuroblastoma. To stratify the risks for neuroblastoma, clinical characteristics of neuroblastoma patients were retrieved from the Therapeutically Applicable Research to Generate Effective Treatment program. All patients were randomly sampled into the development and validation sets. Cox regression was used to construct a prediction nomogram. The discrimination and calibration capacity of the nomogram was assessed. Prognostic index (PI) was calculated and tested to evaluate the performance of the nomogram. This nomogram demonstrated reasonable discrimination and calibration capacity. The nomogram derived PI exhibited acceptable accuracy in predicting the prognosis for neuroblastoma patients. The overall survival rate was significantly different between the PI discriminated high and low-risk patient subgroups. In conclusion, besides traditional staging systems, some newly defined risk factors could be involved in risk stratification for patients with neuroblastoma. Our nomogram may aid the risk stratification for neuroblastoma patients.
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Affiliation(s)
- Qinglin Liu
- Department of Neuroradiology, Beijing Neurosurgical Institute & Beijing Tiantan Hospital, Capital Medical University, Beijing
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Feng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wandong Su
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Gang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
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25
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He X, Qin C, Zhao Y, Zou L, Zhao H, Cheng C. Gene signatures associated with genomic aberrations predict prognosis in neuroblastoma. Cancer Commun (Lond) 2020; 40:105-118. [PMID: 32237073 PMCID: PMC7163660 DOI: 10.1002/cac2.12016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neuroblastoma (NB) is a heterogeneous disease with respect to genomic abnormalities and clinical behaviors. Despite recent advances in our understanding of the association between the genetic aberrations and clinical features, it remains one of the major challenges to predict prognosis and stratify patients for determining personalized therapy in this disease. The aim of this study was to develop an effective prognosis prediction model for NB patients. METHODS We integrated diverse computational analyses to define gene signatures that reflect MYCN activity and chromosomal aberrations including deletion of chromosome 1p (Chr1p_del) and chromosome 11q (Chr11q_del) as well as chromosome 11q whole loss (Chr11q_wls). We evaluated the prognostic and predictive values of these signatures in seven NB gene expression datasets (the number of samples ranges from 94 to 498, with a total of 2120) generated from both RNA sequencing and microarray platforms. RESULTS MYCN signature was a more effective prognostic marker than MYCN amplification status and MYCN expression. Similarly, the Chr1p_del score was more prognostic than Chr1p status. The activity scores of MYCN, Chr1p_del and Chr11q_del were associated with poor prognosis, while the Chr11q_wls score was linked to good outcome. We integrated the activity scores of MYCN, Chr1p_del, Chr11q_del, and Chr11q_wls and clinical variables into an integrative prognostic model, which displayed significant performance over the clinical variables or each genomic aberration alone. CONCLUSIONS Our integrative gene signature model shows a significantly improved forecast performance with prognostic and predictive information, and thereby can be served as a biomarker to stratify NB patients for prognosis evaluation and surveillance programs.
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Affiliation(s)
- Xiaoyan He
- Center for Clinical Molecular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of PediatricsChildren's Hospital of Chongqing Medical UniversityChongqing400014P. R. China
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNH03766USA
| | - Chao Qin
- Beijing Key Lab of Traffic Data Analysis and MiningSchool of Computer and Information TechnologyBeijing Jiaotong UniversityBeijing100044P. R. China
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNH03766USA
| | - Yanding Zhao
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNH03766USA
| | - Lin Zou
- Center for Clinical Molecular Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of PediatricsChildren's Hospital of Chongqing Medical UniversityChongqing400014P. R. China
| | - Hui Zhao
- School of Biomedical SciencesFaculty of MedicineThe Chinese University of Hong KongHong Kong999077P. R. China
| | - Chao Cheng
- Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonNH03766USA
- Department of MedicineBaylor College of MedicineHoustonTX77030USA
- Institute for Clinical and Translational ResearchBaylor College of MedicineHoustonTX77030USA
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Chen S, Tang W, Yang R, Hu X, Li Z. Pediatric Patients with Adrenal Neuroblastoma: A SEER Analysis, 2004-2013. Am Surg 2020; 86:127-133. [PMID: 32167055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adrenal neuroblastoma (NB) is a relatively common malignancy in children. The Surveillance, Epidemiology, and End Results database was used to present demographic data and a survival analysis with the aim of making tumor management better. The Surveillance, Epidemiology, and End Results database was used to search pediatric patients (age ≤16 years) with NB from 2004 to 2013. The Kaplan-Meier method was used to calculate the overall survival. And, we used Cox regression analysis to determine hazard ratios for prognostic variables. Independent prognostic factors were selected into the nomogram to predict individual's three-, five-, and seven-year overall survival. The study included a total of 1870 pediatric patients with NB in our cohort. Overall, three-, five-, and seven-year survival rates for adrenal NB were 0.777, 0.701, and 0.665, respectively, whereas the rates for nonadrenal NB were 0.891, 0.859, and 0.832, respectively. The multivariate analysis identified age >1 year, no complete resection (CR)/CR, radiation, and regional/distant metastasis as independent predictors of mortality for adrenal NB. Concordance index of the nomogram was 0.665 (95% confidence interval, 0.627-0.703). Pediatric patients with adrenal NB have significantly worse survival than those with nonadrenal NB. Adrenal NB with age <1 year, treated with surgery, no radiation, and localized tumor leads to a better survival. There was no survival difference for patients to receive CR and no CR.
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Zhao X, Li D, Yang F, Lian H, Wang J, Wang X, Fang E, Song H, Hu A, Guo Y, Liu Y, Li H, Chen Y, Huang K, Zheng L, Tong Q. Long Noncoding RNA NHEG1 Drives β-Catenin Transactivation and Neuroblastoma Progression through Interacting with DDX5. Mol Ther 2020; 28:946-962. [PMID: 31982037 DOI: 10.1016/j.ymthe.2019.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 12/11/2022] Open
Abstract
Recent studies suggest that long noncoding RNAs (lncRNAs) play essential roles in tumor progression. However, the functional roles and underlying mechanisms of lncRNAs in neuroblastoma (NB), the most common malignant solid tumor in pediatric population, still remain elusive. Herein, through integrating analysis of a public RNA sequencing dataset, neuroblastoma highly expressed 1 (NHEG1) was identified as a risk-associated lncRNA, contributing to an unfavorable outcome of NB. Depletion of NHEG1 led to facilitated differentiation and decreased growth and aggressiveness of NB cells. Mechanistically, NHEG1 bound to and stabilized DEAD-box helicase 5 (DDX5) protein through repressing proteasome-mediated degradation, resulting in β-catenin transactivation that altered target gene expression associated with NB progression. We further determined a lymphoid enhancer binding factor 1 (LEF1)/transcription factor 7-like 2 (TCF7L2)/NHEG1/DDX5/β-catenin axis with a positive feedback loop and demonstrated that NHEG1 harbored oncogenic properties via its interplay with DDX5. Administration of small interfering RNAs against NHEG1 or DDX5 reduced tumor growth and prolonged survival of nude mice bearing xenografts. High NHEG1 or DDX5 expression was associated with poor survival of NB patients. These results indicate that lncRNA NHEG1 exhibits oncogenic activity that affects NB progression via stabilizing the DDX5 protein, which might serve as a potential therapeutic target for NB.
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Affiliation(s)
- Xiang Zhao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Dan Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Feng Yang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Heng Lian
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Jianqun Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Xiaojing Wang
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Erhu Fang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Huajie Song
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Anpei Hu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Yanhua Guo
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Yang Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Hongjun Li
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Yajun Chen
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Kai Huang
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China
| | - Liduan Zheng
- Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China; Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China.
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China; Clinical Center of Human Genomic Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P.R. China.
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Abstract
BACKGROUND AND OBJECTIVE N6-methyladenosine (m6a) is the most abundant form of methylated modification in eukaryotic mRNA. However, the role of m6A-related genes in neuroblastoma (NB), one of the most common paediatric malignant tumours, is not well known. This study aimed to determine the prognostic role of m6A-related genes in neuroblastoma. METHODS We analysed the expression of 20 published m6A methylation regulators in 498 patients with NB from the Gene Expression Omnibus database. To determine the independent prognostic factors, we used univariate Cox analysis, the least absolute shrinkage and selection operator (LASSO) regression. The multivariate Cox analysis was used to construct a prognostic risk prediction model. 120 NB tissues from "Therapeutically Applicable Research To Generate Effective Treatments" (TARGET ) database was used to test the prognostic value. Gene set enrichment analysis was performed to discover the potential biological function of the m6A signature. RESULTS The risk prediction model consisted of five genes (METT14, WTAP, HNRNPC, YTHDF1 and IGF2BP2). The receiving operating characteristic curve showed the high exactitude of the risk model. Cox regression analysis revealed that the risk model was an independent prognostic factor of overall survival. These results were reproduced using another published independent dataset. Further functional enrichment analysis suggested the involvement of the 5-gene signature in several malignancies. CONCLUSION The five m6A regulatory genes identified in this study enable clinical prognosis of NB and may serve as novel therapeutic targets for NB.
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Affiliation(s)
- Zhichao Wang
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
- Department of Pediatric Surgery, First Hospital of Jilin University, Changchun, Jilin, China
| | - Huiyan Cheng
- Department of Gynecology and Obstetrics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Huali Xu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
| | - Xiaofeng Yu
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
| | - Dayun Sui
- Department of Pharmacology, School of Pharmaceutical Sciences, Jilin University, Changchun, Jilin, China
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Zhang L, Zhou H, Li J, Wang X, Zhang X, Shi T, Feng G. Comprehensive Characterization of Circular RNAs in Neuroblastoma Cell Lines. Technol Cancer Res Treat 2020; 19:1533033820957622. [PMID: 33000697 PMCID: PMC7533920 DOI: 10.1177/1533033820957622] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022] Open
Abstract
Neuroblastoma (NB) is a rare type of cancer but frequently occurred in children. However, it is still unclear whether circular RNAs (circRNAs) play key roles in NB tumorigenesis or progression. In this study, we identified 39,022 circRNAs across the 39 neuroblastoma and 2 normal cell lines. With the gene and circRNA expression data, we classified the NB cell lines, identified and characterized the functional circRNAs in the 3 NB classes. Specifically, 29 circRNAs were found to be dysregulated in the NB classes. Notably, 7 circRNAs located within MYCN-amplified regions were upregulated in cell lines with the high activities of MYC targets and MYCN amplification, and were highly correlated with expression of their parental gene, NBAS. Subsequently, we constructed ceRNA networks for the functional circRNAs. Specifically, hsa_circ_0005379 was identified as a critical regulator in the ceRNA networks because of targeting 13 genes, which formed a complex competing endogenous RNA (ceRNA) network. Moreover, hsa_circ_0002343, which was connected with few genes, might regulate the PI3K/Akt/mTOR signaling via RAC1. Furthermore, 3 genes, including NOTCH2, SERPINH1, and LAMC1, involved in epithelial mesenchymal transition (EMT) were observed to connect with hsa_circ_0001361, suggesting that this circRNA was closely associated with EMT. Consequently, 7 genes, such as DAD1, PPIA, NOTCH2, PGK1, BUB1, EIF2S1, and TCF7L2, were found to be closely associated with both event-free survival (EFS) and overall survival (OS). In conclusion, the present study identified functional circRNAs and predicted their functionality in neuroblastoma cell lines, which not only improved the understanding of circRNAs in neuroblastoma, but also provided the evidences for the related researchers.
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Affiliation(s)
- Li Zhang
- Big Data and Engineering Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science-MOE, School of Statistics, East China Normal University, Shanghai, China
- The authors contributed equally to this paper
| | - Hangyu Zhou
- Department of Clinical Laboratory, Dongzhimen Hospital Beijing University of Chinese Medicine, Beijing, China
- The authors contributed equally to this paper
| | - Jing Li
- Department of Neurosurgery, Huai’an Second People’s Hospital, the Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an, China
- The authors contributed equally to this paper
| | - Xinyu Wang
- Big Data and Engineering Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
| | - Xin Zhang
- Big Data and Engineering Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
| | - Tieliu Shi
- Center for Bioinformatics and Computational Biology, and the Institute of Biomedical Sciences, School of Life Sciences, East China Normal University, Shanghai, China
| | - Guoshuang Feng
- Big Data and Engineering Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing, China
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Wang J, Wang Z, Yao W, Dong K, Zheng S, Li K. The association between lncRNA LINC01296 and the clinical characteristics in neuroblastoma. J Pediatr Surg 2019; 54:2589-2594. [PMID: 31522796 DOI: 10.1016/j.jpedsurg.2019.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Neuroblastoma is the most common extracranial solid tumor in childhood. In this work, the clinical value of long noncoding RNA LINC01296 was evaluated in patients with neuroblastoma. METHODS LncRNA microarray was conducted to identify differentially expressed lncRNAs in 5 early stage and 5 advanced stage tumor tissues of neuroblastoma. RT-qPCR was carried out to validate the result of microarray. Clinical information was reviewed to analyze the relationship between lncRNA and clinical characteristics. The public database R2 was used to analyze prognosis. RESULTS 765 differentially expressed lncRNAs were identified. LINC01296 was the most overexpressed lncRNA in advanced stage patients. RT-qPCR was conducted in 28 tumor tissues, confirming the tendency with microarray. Higher expression of LINC01296 was associated with age > 18 months (p = 0.004) and advanced stage (p = 0.021). Furthermore, LINC01296 was correlated with tumor size (r = 0.4060, p = 0.0321), LDH level (r = 0.6904, p = 0.0002), and NSE level (r = 0.5772, p = 0.0013). The neuroblastoma dataset shows patients with overexpression of LINC01296 obtained a shorter overall survival than low expression (n = 88, log-rank: P < 0.0001). CONCLUSION LINC01296 is associated with clinical characteristics of neuroblastoma and may function as a prognostic predictor. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jing Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Zuopeng Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
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Ognibene M, Podestà M, Garaventa A, Pezzolo A. Role of GOLPH3 and TPX2 in Neuroblastoma DNA Damage Response and Cell Resistance to Chemotherapy. Int J Mol Sci 2019; 20:ijms20194764. [PMID: 31557970 PMCID: PMC6801815 DOI: 10.3390/ijms20194764] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/28/2022] Open
Abstract
Neuroblastoma (NB) is an aggressive, relapse-prone infancy tumor of the sympathetic nervous system and is the leading cause of death among preschool age diseases, so the search for novel therapeutic targets is crucial. Golgi phosphoprotein 3 (GOLPH3) has been reported to be involved in the development, and in the DNA damage response, of various human cancers. Golgi dispersal is a common feature of DNA damage response in mammalian cells. Understanding how cells react to DNA damage is essential in order to recognize the systems used to escape from elimination. We induced DNA damage in two human neuroblastoma cell lines by curcumin. The exposure of neuroblastoma cells to curcumin induced: (a) up-regulation of GOLPH3+ cells; (b) augmentation of double-strand breaks; (c) Golgi fragmentation and dispersal throughout the cytoplasm; (d) increase of apoptosis and autophagy; (e) increased expression of TPX2 oncoprotein, able to repair DNA damage. Primary neuroblastoma samples analysis confirmed these observations. Our findings suggest that GOLPH3 expression levels may represent a clinical marker of neuroblastoma patients’ responsiveness to DNA damaging therapies—and of possible resistance to them. Novel molecules able to interfere with GOLPH3 and TPX2 pathways may have therapeutic benefits when used in combination with standard DNA damaging therapeutic agents in neuroblastoma
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Affiliation(s)
- Marzia Ognibene
- Laboratorio Cellule Staminali Post Natali e Terapie Cellulari, IRCCS Giannina Gaslini, 16147 Genova, Italy.
| | - Marina Podestà
- Laboratorio Cellule Staminali Post Natali e Terapie Cellulari, IRCCS Giannina Gaslini, 16147 Genova, Italy.
| | - Alberto Garaventa
- Divisione di Oncologia, IRCCS Giannina Gaslini, 16147 Genova, Italy.
| | - Annalisa Pezzolo
- Laboratorio Cellule Staminali Post Natali e Terapie Cellulari, IRCCS Giannina Gaslini, 16147 Genova, Italy.
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Peinemann F, van Dalen EC, Enk H, Tytgat GAM. Anti-GD2 antibody-containing immunotherapy postconsolidation therapy for people with high-risk neuroblastoma treated with autologous haematopoietic stem cell transplantation. Cochrane Database Syst Rev 2019; 4:CD012442. [PMID: 31016728 PMCID: PMC6479178 DOI: 10.1002/14651858.cd012442.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroblastoma is a rare malignant disease that primarily affects children. The tumours mainly develop in the adrenal medullary tissue, and an abdominal mass is the most common presentation. High-risk disease is characterised by metastasis and other primary tumour characteristics resulting in increased risk for an adverse outcome. The GD2 carbohydrate antigen is expressed on the cell surface of neuroblastoma tumour cells and is thus a promising target for anti-GD2 antibody-containing immunotherapy. OBJECTIVES To assess the efficacy of anti-GD2 antibody-containing postconsolidation immunotherapy after high-dose chemotherapy (HDCT) and autologous haematopoietic stem cell transplantation (HSCT) compared to standard therapy after HDCT and autologous HSCT in people with high-risk neuroblastoma. Our primary outcomes were overall survival and treatment-related mortality. Our secondary outcomes were progression-free survival, event-free survival, early toxicity, late non-haematological toxicity, and health-related quality of life. SEARCH METHODS We searched the electronic databases CENTRAL (2018, Issue 9), MEDLINE (PubMed), and Embase (Ovid) on 20 September 2018. We searched trial registries and conference proceedings on 28 October 2018. Further searches included reference lists of recent reviews and relevant articles as well as contacting experts in the field. There were no limits on publication year or language. SELECTION CRITERIA Randomised controlled trials evaluating anti-GD2 antibody-containing immunotherapy after HDCT and autologous HSCT in people with high-risk neuroblastoma. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, abstracted data on study and participant characteristics, and assessed risk of bias and GRADE. Any differences were resolved by discussion, with third-party arbitration unnecessary. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. We used the five GRADE considerations, that is study limitations, consistency of effect, imprecision, indirectness, and publication bias, to judge the quality of the evidence. MAIN RESULTS We identified one randomised controlled trial that included 226 people with high-risk neuroblastoma who were pre-treated with autologous HSCT. The study randomised 113 participants to receive immunotherapy including isotretinoin, granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-2, and ch14.18, a type of anti-GD2 antibody also known as dinutuximab. The study randomised another 113 participants to receive standard therapy including isotretinoin.The results on overall survival favoured the dinutuximab-containing immunotherapy group (hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31 to 0.80; P = 0.004). The results on event-free survival also favoured the dinutuximab-containing immunotherapy group (HR 0.61, 95% CI 0.41 to 0.92; P = 0.020). Randomised data on adverse events were not reported separately. The study did not report progression-free survival, late non-haematological toxicity, and health-related quality of life as separate endpoints. We graded the quality of the evidence as moderate. AUTHORS' CONCLUSIONS The evidence base favours dinutuximab-containing immunotherapy compared to standard therapy concerning overall survival and event-free survival in people with high-risk neuroblastoma pre-treated with autologous HSCT. Randomised data on adverse events are lacking, therefore more research is needed before definitive conclusions can be made regarding this outcome.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
| | - Heike Enk
- c/o Cochrane Childhood CancerAmsterdamNetherlands
| | - Godelieve AM Tytgat
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
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Moreno L, Vaidya SJ, Schrey D, Pinkerton CR, Lewis IJ, Kearns PR, Machin D, Pearson ADJ. Long-term analysis of children with metastatic neuroblastoma treated in the ENSG5 randomised clinical trial. Pediatr Blood Cancer 2019; 66:e27565. [PMID: 30516328 DOI: 10.1002/pbc.27565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European Neuroblastoma Study Group 5 (ENSG5) trial showed that time-intensive "rapid" induction chemotherapy (COJEC) was superior to "standard" 3-weekly chemotherapy for children with high-risk metastatic neuroblastoma. Long-term outcomes of the ENSG5 trial were analysed. PROCEDURE Patients with metastatic neuroblastoma aged ≥12 months were randomly assigned to "standard" or "rapid" induction, receiving the same chemotherapy drugs and doses. Event-free survival (EFS) and overall survival (OS) were analysed and prognostic factors evaluated. Amongst patients surviving >5 years, a population of children with persistent metastatic disease after the end of treatment was identified and described. RESULTS Ten-year EFS was 18.2% (95% confidence interval: 12.2-25.2) for the "standard" arm and 26.8% (19.5-34.7) for the "rapid" arm (hazard ratio [HR] 0.85, P = 0.28). Ten-year OS for the "standard" arm was 19.7% (13.4-26.8) and 28.3% (20.8-36.2) for the "rapid arm" (HR 0.83, P = 0.19). There was a trend for worse EFS and OS for patients having MYCN amplification (HR 1.37 and 1.40, respectively) and those with partial and mixed response to induction (HR 1.69 and 1.75 for EFS and 1.66 and 2.00 for OS, respectively). Among 69 patients who survived >5 years, six had persistent metastatic disease after the end of treatment. CONCLUSION The benefit of the "rapid" induction regimen seems to be maintained in the long term, although the small number of survivors could justify the lack of statistical significance. MYCN amplification and poor metastatic response to induction could be associated with worse outcomes. A small group of patients with persistent metastatic disease that survived long term has been described.
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Affiliation(s)
- Lucas Moreno
- Clinical Trials Unit, Department of, Paediatric Haematology, Oncology and SCT, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sucheta J Vaidya
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dominik Schrey
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Ian J Lewis
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - David Machin
- Department of Cancer Studies, Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, United Kingdom
| | - Andrew D J Pearson
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom (retired)
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Yerukala Sathipati S, Sahu D, Huang HC, Lin Y, Ho SY. Identification and characterization of the lncRNA signature associated with overall survival in patients with neuroblastoma. Sci Rep 2019; 9:5125. [PMID: 30914706 PMCID: PMC6435792 DOI: 10.1038/s41598-019-41553-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/05/2019] [Indexed: 01/16/2023] Open
Abstract
Neuroblastoma (NB) is a commonly occurring cancer among infants and young children. Recently, long non-coding RNAs (lncRNAs) have been using as prognostic biomarkers for therapeutics and interventions in various cancers. Considering the poor survival of NB, the lncRNA-based therapeutic strategies must be improved. This work proposes an overall survival time estimator called SVR-NB to identify the lncRNA signature that is associated with the overall survival of patients with NB. SVR-NB is an optimized support vector regression (SVR)-based method that uses an inheritable bi-objective combinatorial genetic algorithm for feature selection. The dataset of 231 NB patients that contains overall survival information and expression profiles of 783 lncRNAs was used to design and evaluate SVR-NB from the database of gene expression omnibus accession GSE62564. SVR-NB identified a signature of 35 lncRNAs and achieved a mean squared correlation coefficient of 0.85 and a mean absolute error of 0.56 year between the actual and estimated overall survival time using 10-fold cross-validation. Further, we ranked and characterized the 35 lncRNAs according to their contribution towards the estimation accuracy. Functional annotations and co-expression gene analysis of LOC440896, LINC00632, and IGF2-AS revealed the association of co-expressed genes in Kyoto Encyclopedia of Genes and Genomes pathways.
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Grants
- This work was funded by Ministry of Science and Technology ROC under the contract numbers MOST 106-2634-F-075-001-, 106-2218-E-009-031-, 107-2221-E-009-154-, 107-2218-E-029-001-, and 107-2314-B-039-025-. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
- This work was funded by Ministry of Science and Technology ROC under the contract numbers MOST 107-2221-E-009 -154 &#x2013;, 107-2634-F-075 -001 &#x2013;, 107-2218-E-009 -005 &#x2013;, 107-2218-E-029 -001 &#x2013;, and 107-2319-B-400 -001 &#x2013;, and was financially supported by the &#x201C;Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B)&#x201D; from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Affiliation(s)
| | - Divya Sahu
- Institute of Biomedical Informatics, Center for Systems and Synthetic Biology, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Cheng Huang
- Institute of Biomedical Informatics, Center for Systems and Synthetic Biology, National Yang-Ming University, Taipei, Taiwan
- Bioinformatics Program, Taiwan International Graduate Program, Institute of Information Science, Academia Sinica, Taipei, Taiwan
| | - Yenching Lin
- Interdisciplinary Neuroscience Ph.D. Program, National Chiao Tung University, Hsinchu, Taiwan
| | - Shinn-Ying Ho
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.
- Bioinformatics Program, Taiwan International Graduate Program, Institute of Information Science, Academia Sinica, Taipei, Taiwan.
- Interdisciplinary Neuroscience Ph.D. Program, National Chiao Tung University, Hsinchu, Taiwan.
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
- Center For Intelligent Drug Systems and Smart Bio-devices (IDSB), National Chiao Tung University, Hsinchu, Taiwan.
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Domizi P, Malizia F, Chazarreta-Cifre L, Diacovich L, Banchio C. KDM2B regulates choline kinase expression and neuronal differentiation of neuroblastoma cells. PLoS One 2019; 14:e0210207. [PMID: 30629659 PMCID: PMC6328129 DOI: 10.1371/journal.pone.0210207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
The process of neuronal differentiation is associated with neurite elongation and membrane biogenesis, and phosphatidylcholine (PtdCho) is the major membrane phospholipid in mammalian cells. During neuroblast differentiation, the transcription of two genes involved in PtdCho biosynthesis are stimulated: Chka gene for choline kinase (CK) alpha isoform and Pcyt1a gene for CTP:phosphocholine cytidylyltransferase (CCT) alpha isoform. Here we show that CKα is essential for neuronal differentiation. In addition, we demonstrated that KDM2B regulates CKα expression and, as a consequence, neuronal differentiation. This factor is up-regulated in the course of the neuroblasts proliferative and undifferentiated state and down-regulated during differentiation induced by retinoic acid (RA). During proliferation, KDM2B binds to the Box2 located in the Chka promoter repressing its transcription. Interestingly, KDM2B knockdown enhances the levels of CKα expression in neuroblast cells and induces neuronal differentiation even in the absence of RA. These results suggest that KDM2B is required for the appropriate regulation of CKα during neuronal differentiation and to the maintaining of the undifferentiated stage of neuroblast cells.
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Affiliation(s)
- Pablo Domizi
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET) Ocampo y Esmeralda, Predio CONICET and Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Florencia Malizia
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET) Ocampo y Esmeralda, Predio CONICET and Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Lorena Chazarreta-Cifre
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET) Ocampo y Esmeralda, Predio CONICET and Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Lautaro Diacovich
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET) Ocampo y Esmeralda, Predio CONICET and Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Claudia Banchio
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET) Ocampo y Esmeralda, Predio CONICET and Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
- * E-mail:
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Rossa A, Cacciavillano W, Rose A, Flores P, Chantada G, Zubizarreta P. Neuroblastoma in patients under 18 months. Single institution experience in Argentina. Medicina (B Aires) 2019; 79:280-283. [PMID: 31487248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The purpose of the study was to evaluate the outcome of patients under 18 months diagnosed with neuroblastoma. Between April 2006 and December 2013, 45 consecutive patients followed in Hospital de Pediatría Garrahan, were retrospectively reviewed. With a median age of 9.3 months (1-18 months) N-myc amplification was detected in 5 out of 38 patients, 1p deletion (del1p) in 4 patients, and 11q aberration in one patient. With a median follow-up of 53 (range: 6-109 months), at 24 months the event free survival (EFS) of all patients was 83% (SE 6%) and overall survival (OS) of 88% (SE 5%). Significant difference was found in OS and EFS between patients with stages L1, L2 and Ms vs. stage M (p = 0.01 and p = 0.01 respectively). EFS for each stage: L1 85% (SE 7%), L2 100%, MS 100%, vs. M 55% (SE 16%). OS: L1 90% (SE 6%), L2 100%, MS 100%, vs. M 66% (SE 15%). OS and EFS results are similar to those reported in international studies. However, better identification of biological prognostic factors will warr ant accurate staging and consequently an appropriate treatment.
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Affiliation(s)
- Ana Rossa
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina. E-mail:
| | - Walter Cacciavillano
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Adriana Rose
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Paula Flores
- Servicio de Cirugía, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Guillermo Chantada
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Pedro Zubizarreta
- Servicio de Hematología y Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Kaufmann MR, Camilon PR, Janz TA, Levi JR. Factors Associated With the Improved Survival of Head and Neck Neuroblastomas Compared to Other Body Sites. Ann Otol Rhinol Laryngol 2018; 128:241-248. [PMID: 30565471 DOI: 10.1177/0003489418818586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine pediatric neuroblastoma survival and management in the head and neck compared to other body sites. STUDY DESIGN Retrospective analysis of a large population database. METHODS Patients in the Surveillance, Epidemiology, and End Results (SEER) database with neuroblastoma, NOS; ganglioneuroblastoma; or olfactory neuroblastoma diagnosed from birth to 18 years between 1973 and 2014 were included. These patients were classified into 1 of 3 categories based on primary tumor site: head and neck, adrenal, and "other." RESULTS Four thousand five hundred neuroblastoma cases were identified. One hundred seventy-five (3.9%) occurred in the head and neck, 1,934 (43.0%) occurred in the adrenal gland, and 2,391 (53.1%) occurred in "other" sites. The mean age at diagnosis was 4.21 years in the head and neck, 2.23 years in the adrenal gland, and 2.47 years in the "other" cohorts (P < .001). Two- and 5-year disease-specific survival rates were 89% and 84% in the head and neck versus 77% and 65% in the adrenal and 84% and 77% in the "other" cohorts (P < .001). The risk of disease-specific death (DSD) was higher in the adrenal cohort (adjusted hazard ratio [aHR] = 2.85; 95% CI, 1.54-5.27) compared to the head and neck cohort. Patients treated with surgery only had the lowest risk of DSD (aHR = 0.22; 95% CI, 0.13-0.35) compared to all other studied treatments. CONCLUSION Our results demonstrate that primary neuroblastoma of the head and neck has a better prognosis than primary neuroblastoma of the adrenal gland.
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Affiliation(s)
| | | | - Tyler A Janz
- University of Central Florida College of Medicine, Orlando, FL, USA
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Zhao Z, Partridge V, Sousares M, Shelton SD, Holland CL, Pertsemlidis A, Du L. microRNA-2110 functions as an onco-suppressor in neuroblastoma by directly targeting Tsukushi. PLoS One 2018; 13:e0208777. [PMID: 30550571 PMCID: PMC6294380 DOI: 10.1371/journal.pone.0208777] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022] Open
Abstract
microRNA-2110 (miR-2110) was previously identified as inducing neurite outgrowth in a neuroblastoma cell lines BE(2)-C, suggesting its differentiation-inducing and oncosuppressive function in neuroblastoma. In this study, we demonstrated that synthetic miR-2110 mimic had a generic effect on reducing cell survival in neuroblastoma cell lines with distinct genetic backgrounds, although the induction of cell differentiation traits varied between cell lines. In investigating the mechanisms underlying such functions of miR-2110, we identified that among its predicted target genes down-regulated by miR-2110, knockdown of Tsukushi (TSKU) expression showed the most potent effect in inducing cell differentiation and reducing cell survival, suggesting that TSKU protein plays a key role in mediating the functions of miR-2110. In investigating the clinical relevance of miR-2110 and TSKU expression in neuroblastoma patients, we found that low tumor miR-2110 levels were significantly correlated with high tumor TSKU mRNA levels, and that both low miR-2110 and high TSKU mRNA levels were significantly correlated with poor patient survival. These findings altogether support the oncosuppressive function of miR-2110 and suggest an important role for miR-2110 and its target TSKU in neuroblastoma tumorigenesis and in determining patient prognosis.
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Affiliation(s)
- Zhenze Zhao
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
| | - Veronica Partridge
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
| | - Michaela Sousares
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
| | - Spencer D. Shelton
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
| | - Cory L. Holland
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
| | - Alexander Pertsemlidis
- Greehey Children’s Cancer Research Institute, UT Health San Antonio, San Antonio, Texas, United States of America
- Department of Cell Systems and Anatomy, The University of Texas Health, San Antonio, Texas, United States of America
- Department of Pediatrics, The University of Texas Health, San Antonio, Texas, United States of America
| | - Liqin Du
- Department of Chemistry and Biochemistry, Texas State University, San Marcos, Texas, United States of America
- * E-mail:
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Abstract
Neuroblastoma is a unique malignancy in infants often presenting with either localized or metastatic disease. The study was carried out to explore the risk stratification of the poor prognosis for patients underwent surgical treatment.60 patients diagnosed with neuroblastoma were primarily enrolled in the study from April 2008 to April 2016. All the patients underwent surgical treatment and received 5-year follow-up. Clinical variables, including age, International Neuroblastoma Staging System (INSS) stage, tumor size and site, histology, and MYCN status were retrospectively analyzed, and EFS was chosen as the endpoint.The median age of patients was 8.2 months and average follow-up period was 40.2 ± 8.6 months. Among 60 patients, complete remission was achieved in 35 patients and partial remission in 14 subjects. Poor prognosis including patient death and tumor progression were overserved in 11 patients. Cox multifactor regression analysis revealed that age, histology and MYCN status had significant prognostic effect on event-free survival (EFS) rate for neuroblastoma patients underwent surgical treatment.In our study, we identified a series of prognostic factors including age, histology, and MYCN status predicting the prognosis of neuroblastoma patients after surgical treatment.
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Affiliation(s)
- Kai Zhou
- Department of General Surgery, Children's Hospital of Soochow University, Suzhou
- Department of Pediatric Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiao-lu Li
- Department of General Surgery, Children's Hospital of Soochow University, Suzhou
| | - Jian Pan
- Department of General Surgery, Children's Hospital of Soochow University, Suzhou
| | - Jian-zhong Xu
- Department of Pediatric Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jian Wang
- Department of General Surgery, Children's Hospital of Soochow University, Suzhou
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Corrias MV, Parodi S, Tchirkov A, Lammens T, Vicha A, Pasqualini C, Träger C, Yáñez Y, Dallorso S, Varesio L, Luksch R, Laureys G, Valteau-Couanet D, Canete A, Pöetschger U, Ladenstein R, Burchill SA. Event-free survival of infants and toddlers enrolled in the HR-NBL-1/SIOPEN trial is associated with the level of neuroblastoma mRNAs at diagnosis. Pediatr Blood Cancer 2018; 65:e27052. [PMID: 29603574 DOI: 10.1002/pbc.27052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/25/2018] [Accepted: 02/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate whether levels of neuroblastoma mRNAs in bone marrow and peripheral blood from stage M infants (≤12 months of age at diagnosis, MYCN amplified) and toddlers (between 12 and 18 months, any MYCN status) predict event-free survival (EFS). METHODS Bone marrow aspirates and peripheral blood samples from 97 infants/toddlers enrolled in the European High-Risk Neuroblastoma trial were collected at diagnosis in PAXgene™ blood RNA tubes. Samples were analyzed by reverse transcription quantitative polymerase chain reaction according to standardized procedures. RESULTS Bone marrow tyrosine hydroxylase (TH) or paired-like homeobox 2b (PHOX2B) levels in the highest tertile were associated with worse EFS; hazard ratios, adjusted for age and MYCN status, were 1.5 and 1.8 respectively. Expression of both TH and PHOX2B in the highest tertile predicted worse outcome (p = 0.015), and identified 20 (23%) infants/toddlers with 5-year EFS of 20% (95%CI: 4%-44%). Prognostic significance was maintained after adjusting for over-fitting bias (p = 0.038), age and MYCN status. In peripheral blood, PHOX2B levels in the highest tertile predicted a two-fold increased risk of an event (p = 0.032), and identified 23 (34%) infants/toddlers with 5-year EFS of 29% (95%CI: 12%-48%). Time-dependent receiver operating characteristic analysis confirmed the prognostic value of combined TH and PHOX2B in bone marrow and of PHOX2B in peripheral blood during the first year of follow-up. CONCLUSIONS High levels of bone marrow TH and PHOX2B and of peripheral blood PHOX2B at diagnosis allow early identification of a group of high-risk infant and toddlers with neuroblastoma who may be candidates for alternative treatments. Integration with additional biomarkers, as well as validation in additional international trials is warranted.
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Affiliation(s)
- Maria V Corrias
- Unit of Experimental Therapy in Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Parodi
- Unit of Experimental Therapy in Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Andrei Tchirkov
- CHU Clermont-Ferrand, Service de Cytogénétique Médicale and Université Clermont Auvergne, Clermont-Ferrand, France
| | - Tim Lammens
- Department of Pediatric Hematology/Oncology, Ghent University Hospital, Ghent, Belgium
| | - Ales Vicha
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and Faculty Hospital Motol, Prague, Czech Republic
| | - Claudia Pasqualini
- Department of Child and Adolescent Cancer, Institut Gustave Roussy, Villejuif, France
| | - Catarina Träger
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yania Yáñez
- Oncología Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Sandro Dallorso
- Unit of Experimental Therapy in Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Luigi Varesio
- Unit of Experimental Therapy in Oncology, Istituto Giannina Gaslini, Genoa, Italy
| | - Roberto Luksch
- Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Genevieve Laureys
- Department of Pediatric Hematology/Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Adela Canete
- Oncología Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ulrike Pöetschger
- Department of Pediatric Oncology, CCRI/St. Anna Children's Hospital, Vienna, Austria
| | - Ruth Ladenstein
- Department of Pediatric Oncology, CCRI/St. Anna Children's Hospital, Vienna, Austria
| | - Susan A Burchill
- Children's Cancer Research Group, Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
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Salmaggi A, Luksch R, Forno MG, Pozzi A, Silvani A, Boiardi A, Gasparini M, Nemni R. Antineuronal Antibodies in Patients with Neuroblastoma: Relationships with Clinical Features. Tumori 2018; 83:953-7. [PMID: 9526591 DOI: 10.1177/030089169708300616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the frequency of serum antineuronal antibodies in a cohort of 39 neuroblastoma patients and related their presence to clinical features. Twelve patients displayed antineuronal antibodies at immunocytochemistry. Only one of these 12 patients suffered from a clinically overt paraneoplastic syndrome. No significant differences emerged between autoantibody-positive and autoantibody-negative patients in terms of progression-free and overall survival, although when only patients evolving to disease progression were considered, the time interval between diagnosis and progression was slightly longer in autoantibody-positive patients.
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Affiliation(s)
- A Salmaggi
- Istituto Nazionale Neurologico C. Besta, Milan, Italy
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Abstract
The authors considered 59 stage III and IV neuroblastoma cases, which were observed from January 1967 to June 1979. 13 patients (13/59 = 22%) are surviving in complete remission 3 years after surgery: 9/20 (45%) with stage III and 4/39 (10%) with stage IV disease. The children subjected to complete surgical excision are all alive irregardless of age; the children who were not operated on or subjected to a biopsy, have all died. Of the 33 patients who underwent a reductive excision, 6 (all under 2 years of age) are in complete remission (18%). A better prognosis was found in those patients in whom the site of the primary tumor was at the mediastinal level. These data show the importance of the role of the surgeon in the multidisciplinary treatment of stage III and IV neuroblastomas; our experience is also favorable to the practice of second-look surgery.
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Abstract
Gli autori espongono i risultati di uno studio statistico concernente le correlazioni tra quadro istopatologico e durata di sopravvivenza, in 41 bambini affetti da neuroblastoma. Dopo aver accennato alla significatività di alcuni elementi clinici, vengono descritti i reperti istologici che possono fornire indicazioni sul comportamento della neoplasia. Tali reperti sono rappresentati dal grado di differenziazione e dal grado di infiltrazione linfocitaria del tessuto neoplastico. Infatti dal confronto dell'incidenza di tali reperti nei soggetti deceduti ed in quelli sopravvissuti si sono rilevate differenze statisticamente significative (p < 0.001). Gli autori sottolineano, inoltre, che il grado di differenziazione cellulare si identifica con il numero degli elementi in evoluzione maturativa e non con il numero delle cellule del tutto mature.
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Zimmerman MW, Liu Y, He S, Durbin AD, Abraham BJ, Easton J, Shao Y, Xu B, Zhu S, Zhang X, Li Z, Weichert-Leahey N, Young RA, Zhang J, Look AT. MYC Drives a Subset of High-Risk Pediatric Neuroblastomas and Is Activated through Mechanisms Including Enhancer Hijacking and Focal Enhancer Amplification. Cancer Discov 2018; 8:320-335. [PMID: 29284669 PMCID: PMC5856009 DOI: 10.1158/2159-8290.cd-17-0993] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
The amplified MYCN gene serves as an oncogenic driver in approximately 20% of high-risk pediatric neuroblastomas. Here, we show that the family member MYC is a potent transforming gene in a separate subset of high-risk neuroblastoma cases (∼10%), based on (i) its upregulation by focal enhancer amplification or genomic rearrangements leading to enhancer hijacking, and (ii) its ability to transform neuroblastoma precursor cells in a transgenic animal model. The aberrant regulatory elements associated with oncogenic MYC activation include focally amplified distal enhancers and translocation of highly active enhancers from other genes to within topologically associating domains containing the MYC gene locus. The clinical outcome for patients with high levels of MYC expression is virtually identical to that of patients with amplification of the MYCN gene, a known high-risk feature of this disease. Together, these findings establish MYC as a bona fide oncogene in a clinically significant group of high-risk childhood neuroblastomas.Significance: Amplification of the MYCN oncogene is a recognized hallmark of high-risk pediatric neuroblastoma. Here, we demonstrate that MYC is also activated as a potent oncogene in a distinct subset of neuroblastoma cases through either focal amplification of distal enhancers or enhancer hijacking mediated by chromosomal translocation. Cancer Discov; 8(3); 320-35. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 253.
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Affiliation(s)
- Mark W Zimmerman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yu Liu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shuning He
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam D Durbin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Brian J Abraham
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ying Shao
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shizhen Zhu
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Xiaoling Zhang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Zhaodong Li
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nina Weichert-Leahey
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Richard A Young
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts.
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - A Thomas Look
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Schultz CR, Geerts D, Mooney M, El-Khawaja R, Koster J, Bachmann AS. Synergistic drug combination GC7/DFMO suppresses hypusine/spermidine-dependent eIF5A activation and induces apoptotic cell death in neuroblastoma. Biochem J 2018; 475:531-545. [PMID: 29295892 DOI: 10.1042/bcj20170597] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/19/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2023]
Abstract
The eukaryotic initiation factor 5A (eIF5A), which contributes to several crucial processes during protein translation, is the only protein that requires activation by a unique post-translational hypusine modification. eIF5A hypusination controls cell proliferation and has been linked to cancer. eIF5A hypusination requires the enzymes deoxyhypusine synthase (DHPS) and deoxyhypusine hydroxylase and uniquely depends on the polyamine (PA) spermidine as the sole substrate. Ornithine decarboxylase (ODC) is the rate-limiting enzyme in PA biosynthesis. Both ODC and PAs control cell proliferation and are frequently dysregulated in cancer. Since only spermidine can activate eIF5A, we chose the hypusine-PA nexus as a rational target to identify new drug combinations with synergistic antiproliferative effects. We show that elevated mRNA levels of the two target enzymes DHPS and ODC correlate with poor prognosis in a large cohort of neuroblastoma (NB) tumors. The DHPS inhibitor GC7 (N1-guanyl-1,7-diaminoheptane) and the ODC inhibitor α-difluoromethylornithine (DFMO) are target-specific and in combination induced synergistic effects in NB at concentrations that were not individually cytotoxic. Strikingly, while each drug alone at higher concentrations is known to induce p21/Rb- or p27/Rb-mediated G1 cell cycle arrest, we found that the drug combination induced caspase 3/7/9, but not caspase 8-mediated apoptosis, in NB cells. Hypusinated eIF5A levels and intracellular spermidine levels correlated directly with drug treatments, signifying specific drug targeting effects. This two-pronged GC7/DFMO combination approach specifically inhibits both spermidine biosynthesis and post-translational, spermidine-dependent hypusine-eIF5A activation, offering an exciting clue for improved NB drug therapy.
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Affiliation(s)
- Chad R Schultz
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, U.S.A
| | - Dirk Geerts
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marie Mooney
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, U.S.A
| | | | - Jan Koster
- Department of Oncogenomics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - André S Bachmann
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, U.S.A.
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London WB, Bagatell R, Weigel BJ, Fox E, Guo D, Van Ryn C, Naranjo A, Park JR. Historical time to disease progression and progression-free survival in patients with recurrent/refractory neuroblastoma treated in the modern era on Children's Oncology Group early-phase trials. Cancer 2017; 123:4914-4923. [PMID: 28885700 PMCID: PMC5716896 DOI: 10.1002/cncr.30934] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early-phase trials in patients with recurrent neuroblastoma historically used an objective "response" of measureable disease (Response Evaluation Criteria In Solid Tumors [RECIST], without bone/bone marrow assessment) to select agents for further study. Historical cohorts may be small and potentially biased; to the authors' knowledge, disease recurrence studies from international registries are outdated. Using a large recent cohort of patients with recurrent/refractory neuroblastoma from Children's Oncology Group (COG) modern-era early-phase trials, the authors determined outcome and quantified parameters for designing future studies. METHODS The first early-phase COG trial enrollment (sequential) of 383 distinct patients with recurrent/refractory neuroblastoma on 23 phase 1, 3 phase 1/2, and 9 phase 2 trials (August 2002 to January 2014) was analyzed for progression-free survival (PFS), overall survival (OS), and time to disease progression (TTP). Planned frontline therapy for patients with high-risk neuroblastoma included hematopoietic stem cell transplantation (approximately two-thirds of patients underwent ≥1 hematopoietic stem cell transplantation); 13.2% of patients received dinutuximab. RESULTS From the time of the patient's first early-phase trial enrollment (383 patients), the 1-year and 4-year PFS rates ( ± standard error) were 21% ± 2% and 6% ± 1%, respectively, whereas the 1-year and 4-year OS rates were 57% ± 3% and 20% ± 2%, respectively. The median TTP was 58 days (interquartile range, 31-183 days [350 patients]); the median follow-up was 25.3 months (33 patients were found to be without disease recurrence/progression). The median time from diagnosis to first disease recurrence/progression was 18.7 months (range, 1.4-64.8 months) (176 patients). MYCN amplification and 11q loss of heterozygosity were prognostic of worse PFS and OS (P = .003 and P<.0001, respectively, and P = .02 and P = .03, respectively) after early-phase trial enrollment. CONCLUSIONS This recent COG cohort of patients with recurrent/refractory neuroblastoma is inclusive and representative. To the authors' knowledge, the current study is the first meta-analysis of PFS, TTP, and OS within the context of modern therapy. These results will inform the design of future phase 2 studies by providing a) historical context during the search for more effective agents; and, b) factors prognostic of PFS and OS after disease recurrence to stratify randomization. Cancer 2017;123:4914-23. © 2017 American Cancer Society.
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Affiliation(s)
- Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rochelle Bagatell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brenda J Weigel
- Department of Pediatrics, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Elizabeth Fox
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dongjing Guo
- Boston Children's Hospital, Boston, Massachusetts
| | - Collin Van Ryn
- Department of Biostatistics, University of Florida, Gainesville, Florida
- Children's Oncology Group Statistics and Data Center, Gainesville, Florida
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Gainesville, Florida
- Children's Oncology Group Statistics and Data Center, Gainesville, Florida
| | - Julie R Park
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Takagi M, Yoshida M, Nemoto Y, Tamaichi H, Tsuchida R, Seki M, Uryu K, Nishii R, Miyamoto S, Saito M, Hanada R, Kaneko H, Miyano S, Kataoka K, Yoshida K, Ohira M, Hayashi Y, Nakagawara A, Ogawa S, Mizutani S, Takita J. Loss of DNA Damage Response in Neuroblastoma and Utility of a PARP Inhibitor. J Natl Cancer Inst 2017; 109:4096548. [PMID: 29059438 DOI: 10.1093/jnci/djx062] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background Neuroblastoma (NB) is the most common solid tumor found in children, and deletions within the 11q region are observed in 11% to 48% of these tumors. Notably, such tumors are associated with poor prognosis; however, little is known regarding the molecular targets located in 11q. Methods Genomic alterations of ATM , DNA damage response (DDR)-associated genes located in 11q ( MRE11A, H2AFX , and CHEK1 ), and BRCA1, BARD1, CHEK2, MDM2 , and TP53 were investigated in 45 NB-derived cell lines and 237 fresh tumor samples. PARP (poly [ADP-ribose] polymerase) inhibitor sensitivity of NB was investigated in in vitro and invivo xenograft models. All statistical tests were two-sided. Results Among 237 fresh tumor samples, ATM, MRE11A, H2AFX , and/or CHEK1 loss or imbalance in 11q was detected in 20.7% of NBs, 89.8% of which were stage III or IV. An additional 7.2% contained ATM rare single nucleotide variants (SNVs). Rare SNVs in DDR-associated genes other than ATM were detected in 26.4% and were mutually exclusive. Overall, samples with SNVs and/or copy number alterations in these genes accounted for 48.4%. ATM-defective cells are known to exhibit dysfunctions in homologous recombination repair, suggesting a potential for synthetic lethality by PARP inhibition. Indeed, 83.3% NB-derived cell lines exhibited sensitivity to PARP inhibition. In addition, NB growth was markedly attenuated in the xenograft group receiving PARP inhibitors (sham-treated vs olaprib-treated group; mean [SD] tumor volume of sham-treated vs olaprib-treated groups = 7377 [1451] m 3 vs 298 [312] m 3 , P = .001, n = 4). Conclusions Genomic alterations of DDR-associated genes including ATM, which regulates homologous recombination repair, were observed in almost half of NBs, suggesting that synthetic lethality could be induced by treatment with a PARP inhibitor. Indeed, DDR-defective NB cell lines were sensitive to PARP inhibitors. Thus, PARP inhibitors represent candidate NB therapeutics.
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Affiliation(s)
- Masatoshi Takagi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Misa Yoshida
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Yoshino Nemoto
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Hiroyuki Tamaichi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Rika Tsuchida
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Masafumi Seki
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Kumiko Uryu
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Rina Nishii
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Satoshi Miyamoto
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Masahiro Saito
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Ryoji Hanada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Hideo Kaneko
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Satoru Miyano
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Keisuke Kataoka
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Kenichi Yoshida
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Miki Ohira
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Yasuhide Hayashi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Akira Nakagawara
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Seishi Ogawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Shuki Mizutani
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
| | - Junko Takita
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Laboratory of DNA Information Analysis, Human Genome Center, Institute of Medical Science, Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatric Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan, Department of Pediatrics, Nagara Medical Center, Gifu, Japan; Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Division of Cancer Genomics, Saitama Cancer Center Research Institute, Saitama, Japan; Division of Cancer Genomics, Chiba Cancer Center, Chiba, Japan; Gunma Children's Medical Center, Gunma, Japan; Saga Medical Center, Saga, Japan
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Corroyer-Dulmont A, Falzone N, Kersemans V, Thompson J, Allen DP, Able S, Kartsonaki C, Malcolm J, Kinchesh P, Hill MA, Vojnovic B, Smart SC, Gaze MN, Vallis KA. Improved outcome of 131I-mIBG treatment through combination with external beam radiotherapy in the SK-N-SH mouse model of neuroblastoma. Radiother Oncol 2017; 124:488-495. [PMID: 28595752 PMCID: PMC5636618 DOI: 10.1016/j.radonc.2017.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 05/03/2017] [Accepted: 05/04/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE To assess the efficacy of different schedules for combining external beam radiotherapy (EBRT) with molecular radiotherapy (MRT) using 131I-mIBG in the management of neuroblastoma. MATERIALS AND METHODS BALB/c nu/nu mice bearing SK-N-SH neuroblastoma xenografts were assigned to five treatment groups: 131I-mIBG 24h after EBRT, EBRT 6days after 131I-mIBG, EBRT alone, 131I-mIBG alone and control (untreated). A total of 56 mice were assigned to 3 studies. Study 1: Vessel permeability was evaluated using dynamic contrast-enhanced (DCE)-MRI (n=3). Study 2: Tumour uptake of 131I-mIBG in excised lesions was evaluated by γ-counting and autoradiography (n=28). Study 3: Tumour volume was assessed by longitudinal MR imaging and survival was analysed (n=25). Tumour dosimetry was performed using Monte Carlo simulations of absorbed fractions with the radiation transport code PENELOPE. RESULTS Given alone, both 131I-mIBG and EBRT resulted in a seven-day delay in tumour regrowth. Following EBRT, vessel permeability was evaluated by DCE-MRI and showed an increase at 24h post irradiation that correlated with an increase in 131I-mIBG tumour uptake, absorbed dose and overall survival in the case of combined treatment. Similarly, EBRT administered seven days after MRT to coincide with tumour regrowth, significantly decreased the tumour volume and increased overall survival. CONCLUSIONS This study demonstrates that combining EBRT and MRT has an enhanced therapeutic effect and emphasizes the importance of treatment scheduling according to pathophysiological criteria such as tumour vessel permeability and tumour growth kinetics.
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Affiliation(s)
| | - Nadia Falzone
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Veerle Kersemans
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - James Thompson
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Danny P Allen
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Sarah Able
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | | | - Javian Malcolm
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Paul Kinchesh
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Mark A Hill
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Boris Vojnovic
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Sean C Smart
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK
| | - Mark N Gaze
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Katherine A Vallis
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, Oxford University, UK.
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Peinemann F, van Dalen EC, Enk H, Berthold F. Retinoic acid postconsolidation therapy for high-risk neuroblastoma patients treated with autologous haematopoietic stem cell transplantation. Cochrane Database Syst Rev 2017; 8:CD010685. [PMID: 28840597 PMCID: PMC6483698 DOI: 10.1002/14651858.cd010685.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumours mainly develop in the adrenal medullary tissue, with an abdominal mass as the most common presentation. About 50% of patients have metastatic disease at diagnosis. The high-risk group is characterised by metastasis and other features that increase the risk of an adverse outcome. High-risk patients have a five-year event-free survival of less than 50%. Retinoic acid has been shown to inhibit growth of human neuroblastoma cells and has been considered as a potential candidate for improving the outcome of patients with high-risk neuroblastoma. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate the efficacy and safety of additional retinoic acid as part of a postconsolidation therapy after high-dose chemotherapy (HDCT) followed by autologous haematopoietic stem cell transplantation (HSCT), compared to placebo retinoic acid or to no additional retinoic acid in people with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 11), MEDLINE in PubMed (1946 to 24 November 2016), and Embase in Ovid (1947 to 24 November 2016). Further searches included trial registries (on 22 December 2016), conference proceedings (on 23 March 2017) and reference lists of recent reviews and relevant studies. We did not apply limits by publication year or languages. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating additional retinoic acid after HDCT followed by HSCT for people with high-risk neuroblastoma compared to placebo retinoic acid or to no additional retinoic acid. Primary outcomes were overall survival and treatment-related mortality. Secondary outcomes were progression-free survival, event-free survival, early toxicity, late toxicity, and health-related quality of life. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS The update search did not identify any additional studies. We identified one RCT that included people with high-risk neuroblastoma who received HDCT followed by autologous HSCT (N = 98) after a first random allocation and who received retinoic acid (13-cis-retinoic acid; N = 50) or no further therapy (N = 48) after a second random allocation. These 98 participants had no progressive disease after HDCT followed by autologous HSCT. There was no clear evidence of difference between the treatment groups either in overall survival (hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.46 to 1.63; one trial; P = 0.66) or in event-free survival (HR 0.86, 95% CI 0.50 to 1.49; one trial; P = 0.59). We calculated the HR values using the complete follow-up period of the trial. The study also reported overall survival estimates at a fixed point in time. At the time point of five years, the survival estimate was reported to be 59% for the retinoic acid group and 41% for the no-further-therapy group (P value not reported). We did not identify results for treatment-related mortality, progression-free survival, early or late toxicity, or health-related quality of life. We could not rule out the possible presence of selection bias, performance bias, attrition bias, and other bias. We judged the evidence to be of low quality for overall survival and event-free survival, downgraded because of study limitations and imprecision. AUTHORS' CONCLUSIONS We identified one RCT that evaluated additional retinoic acid as part of a postconsolidation therapy after HDCT followed by autologous HSCT versus no further therapy in people with high-risk neuroblastoma. There was no clear evidence of a difference in overall survival and event-free survival between the treatment alternatives. This could be the result of low power. Information on other outcomes was not available. This trial was performed in the 1990s, since when many changes in treatment and risk classification have occurred. Based on the currently available evidence, we are therefore uncertain about the effects of retinoic acid in people with high-risk neuroblastoma. More research is needed for a definitive conclusion.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room H4‐139)AmsterdamNetherlands1100 DD
| | - Heike Enk
- c/o Cochrane Childhood CancerAmsterdamNetherlands
| | - Frank Berthold
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
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50
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Modak S, Kushner BH, Basu E, Roberts SS, Cheung NKV. Combination of bevacizumab, irinotecan, and temozolomide for refractory or relapsed neuroblastoma: Results of a phase II study. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26448. [PMID: 28111925 PMCID: PMC5555116 DOI: 10.1002/pbc.26448] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rationale for studying the combination of bevacizumab, irinotecan, and temozolomide (BIT) in neuroblastoma (NB) is based on the following: (i) vascular endothelial growth factor (VEGF) expression is associated with an aggressive phenotype, (ii) anti-VEGF antibody bevacizumab enhances irinotecan-mediated suppression of NB xenografts, (iii) bevacizumab safety has been established in pediatric phase I studies, and (iv) irinotecan + temozolomide (IT) is a standard salvage chemotherapy. PROCEDURE We conducted a phase II study of BIT in patients with measurable/evaluable refractory or relapsed high-risk NB (www.clinicaltrials.gov, NCT01114555). Each cycle consisted of bevacizumab (15 mg/kg intravenously [IV]) on days 1 and 15 plus irinotecan (50 mg/m2 /day IV) and temozolomide (150 mg/m2 /day orally) on days 4-8. Patients could have previously received, but not relapsed on, IT. An early stopping rule mandated continuing therapy only if more than five patients of 27 evaluable patients achieved partial response (PR) or complete response (CR) after four cycles. RESULTS Thirty-three heavily pretreated patients (nine primary refractory; 24 relapsed) received one to eight cycles of BIT. Toxicities were expected and transient. Grade 4 toxicities were neutropenia (30%) and thrombocytopenia (24%). Grade 3 toxicities included hepatic transaminitis (15%), proteinuria (9%), and diarrhea (3%). Overall responses were as follows: three CR (all in prior IT-treated patients), 18 no response, and 12 progressive disease. Only one of 23 patients assessable for the early stopping rule regarding efficacy achieved PR/CR, so patient accrual was discontinued. Median progression-free survival and overall survival was 7.7 ± 1.7 and 31.5 ± 5.6 months, respectively; all patients continued anti-NB therapy post-BIT. CONCLUSIONS BIT was well tolerated, but the addition of bevacizumab did not improve response rates in resistant NB compared to historical data for IT.
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Affiliation(s)
- Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, New York 10065, USA
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, New York 10065, USA
| | - Ellen Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, New York 10065, USA
| | - Stephen S. Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, New York 10065, USA
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Ave. New York, New York 10065, USA
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