1
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Ritson JP, Kennedy-Blundell O, Croft J, Templeton MR, Hawkins CE, Clark JM, Evans MG, Brazier RE, Smith D, Graham NJD. High frequency UV-Vis sensors estimate error in riverine dissolved organic carbon load estimates from grab sampling. Environ Monit Assess 2022; 194:831. [PMID: 36163406 PMCID: PMC9512721 DOI: 10.1007/s10661-022-10515-9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
High frequency ultraviolet - visible (UV-VIS) sensors offer a way of improving dissolved organic carbon (DOC) load estimates in rivers as they can be calibrated to DOC concentration. This is an improvement on periodic grab sampling, or the use of pumped sampling systems which store samples in-field before collection. We hypothesised that the move to high frequency measurements would increase the load estimate based on grab sampling due to systemic under-sampling of high flows. To test our hypotheses, we calibrated two sensors in contrasting catchments (Exe and Bow Brook, UK) against weekly grab sampled DOC measurements and then created an hourly time series of DOC for the two sites. Taking this measurement as a 'true' value of DOC load, we simulated 1,000 grab sampling campaigns at weekly, fortnightly and monthly frequency to understand the likely distribution of load and error estimates. We also performed an analysis of daily grab samples collected using a pumped storage sampling system with weekly collection. Our results show that: a) grab sampling systemically underestimates DOC loads and gives positively skewed distributions of results, b) this under-estimation and positive skew decreases with increasing sampling frequency, c) commonly used estimates of error in the load value are also systemically lowered by the oversampling of low, stable flows due to their dependence on the variance in the flow-weighted mean concentration, and d) that pumped storage systems may lead to under-estimation of DOC and over estimation of specific ultra-violet absorbance (SUVA), a proxy for aromaticity, due to biodegradation during storage.
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Affiliation(s)
- J P Ritson
- School of Environment, Education and Development, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - O Kennedy-Blundell
- School of Environment, Education and Development, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - J Croft
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - M R Templeton
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - C E Hawkins
- Department of Geography and Environmental Science, University of Reading, Whiteknights, PO box 227, Reading, RG6 6AB, UK
| | - J M Clark
- Department of Geography and Environmental Science, University of Reading, Whiteknights, PO box 227, Reading, RG6 6AB, UK
| | - M G Evans
- School of Environment, Education and Development, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - R E Brazier
- Centre for Resilience in Environment, Water and Waste, Geography, University of Exeter, Exeter, EX44RJ, UK
| | - D Smith
- South West Water, Peninsula House, Rydon Lane, Exeter, EX2 7HR, UK
| | - N J D Graham
- Department of Civil and Environmental Engineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
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2
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Campbell BB, Galati MA, Stone SC, Riemenschneider AN, Edwards M, Sudhaman S, Siddaway R, Komosa M, Nunes NM, Nobre L, Morrissy AS, Zatzman M, Zapotocky M, Joksimovic L, Kalimuthu SN, Samuel D, Mason G, Bouffet E, Morgenstern DA, Aronson M, Durno C, Malkin D, Maris JM, Taylor MD, Shlien A, Pugh TJ, Ohashi PS, Hawkins CE, Tabori U. Mutations in the RAS/MAPK Pathway Drive Replication Repair-Deficient Hypermutated Tumors and Confer Sensitivity to MEK Inhibition. Cancer Discov 2021; 11:1454-1467. [PMID: 33563663 DOI: 10.1158/2159-8290.cd-20-1050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/02/2020] [Accepted: 02/04/2021] [Indexed: 01/13/2023]
Abstract
The RAS/MAPK pathway is an emerging targeted pathway across a spectrum of both adult and pediatric cancers. Typically, this is associated with a single, well-characterized point mutation in an oncogene. Hypermutant tumors that harbor many somatic mutations may obscure the interpretation of such targetable genomic events. We find that replication repair-deficient (RRD) cancers, which are universally hypermutant and affect children born with RRD cancer predisposition, are enriched for RAS/MAPK mutations (P = 10-8). These mutations are not random, exist in subclones, and increase in allelic frequency over time. The RAS/MAPK pathway is activated both transcriptionally and at the protein level in patient-derived RRD tumors, and these tumors responded to MEK inhibition in vitro and in vivo. Treatment of patients with RAS/MAPK hypermutant gliomas reveals durable responses to MEK inhibition. Our observations suggest that hypermutant tumors may be addicted to oncogenic pathways, resulting in favorable response to targeted therapies. SIGNIFICANCE: Tumors harboring a single RAS/MAPK driver mutation are targeted individually for therapeutic purposes. We find that in RRD hypermutant cancers, mutations in the RAS/MAPK pathway are enriched, highly expressed, and result in sensitivity to MEK inhibitors. Targeting an oncogenic pathway may provide therapeutic options for these hypermutant polyclonal cancers.This article is highlighted in the In This Issue feature, p. 1307.
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Affiliation(s)
- Brittany B Campbell
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa A Galati
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simone C Stone
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandra N Riemenschneider
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Edwards
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumedha Sudhaman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert Siddaway
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Komosa
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nuno M Nunes
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liana Nobre
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A Sorana Morrissy
- Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Zatzman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michal Zapotocky
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lazar Joksimovic
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sangeetha N Kalimuthu
- Department of Pathology, Laboratory Medicine Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David Samuel
- Department of Hematology-Oncology, Valley Children's Hospital, Madera, California
| | - Gary Mason
- Department of Pediatric Hematology-Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Morgenstern
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol Durno
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David Malkin
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - John M Maris
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Pamela S Ohashi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Uri Tabori
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada. .,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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3
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Chan TSY, Picard D, Hawkins CE, Lu M, Pfister S, Korshunov A, Roussel MF, Wechsler-Reya RJ, Henkin J, Bouffet E, Huang A. Thrombospondin-1 mimetics are promising novel therapeutics for MYC-associated medulloblastoma. Neurooncol Adv 2021; 3:vdab002. [PMID: 33629064 PMCID: PMC7890793 DOI: 10.1093/noajnl/vdab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Medulloblastoma (MB) comprises four subtypes of which group 3 MB are the most aggressive. Although overall survival for MB has improved, the outcome of group 3 MB remains dismal. C-MYC (MYC) amplification or MYC overexpression which characterizes group 3 MB is a strong negative prognostic factor and is frequently associated with metastases and relapses. We previously reported that MYC expression alone promotes highly aggressive MB phenotypes, in part via repression of thrombospondin-1 (TSP-1), a potent tumor suppressor. METHODS In this study, we examined the potential role of TSP-1 and TSP-1 peptidomimetic ABT-898 in MYC-amplified human MB cell lines and two distinct murine models of MYC-driven group 3 MBs. RESULTS We found that TSP-1 reconstitution diminished metastases and prolonged survival in orthotopic xenografts and promoted chemo- and radio-sensitivity via AKT signaling. Furthermore, we demonstrate that ABT-898 can recapitulate the effects of TSP-1 expression in MB cells in vitro and specifically induced apoptosis in murine group 3 MB tumor cells. CONCLUSION Our data underscore the importance of TSP-1 as a critical tumor suppressor in MB and highlight TSP-1 peptidomimetics as promising novel therapeutics for the most lethal subtype of MB.
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Affiliation(s)
- Tiffany S Y Chan
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Arthur and Sonia Labatt Brain Tumour Research Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Picard
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia E Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Center, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumour Research Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stefan Pfister
- Division of Pediatric Neurooncology, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andrey Korshunov
- Division of Pediatric Neurooncology, Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martine F Roussel
- Department of Tumour Cell Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Jack Henkin
- Department of Chemistry, Northwestern University, Evanston, Illinois, USA
| | - Eric Bouffet
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Annie Huang
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Arthur and Sonia Labatt Brain Tumour Research Center, The Hospital for Sick Children, Toronto, Ontario, Canada
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4
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Chung J, Maruvka YE, Sudhaman S, Kelly J, Haradhvala NJ, Bianchi V, Edwards M, Forster VJ, Nunes NM, Galati MA, Komosa M, Deshmukh S, Cabric V, Davidson S, Zatzman M, Light N, Hayes R, Brunga L, Anderson ND, Ho B, Hodel KP, Siddaway R, Morrissy AS, Bowers DC, Larouche V, Bronsema A, Osborn M, Cole KA, Opocher E, Mason G, Thomas GA, George B, Ziegler DS, Lindhorst S, Vanan M, Yalon-Oren M, Reddy AT, Massimino M, Tomboc P, Van Damme A, Lossos A, Durno C, Aronson M, Morgenstern DA, Bouffet E, Huang A, Taylor MD, Villani A, Malkin D, Hawkins CE, Pursell ZF, Shlien A, Kunkel TA, Getz G, Tabori U. DNA Polymerase and Mismatch Repair Exert Distinct Microsatellite Instability Signatures in Normal and Malignant Human Cells. Cancer Discov 2020; 11:1176-1191. [PMID: 33355208 DOI: 10.1158/2159-8290.cd-20-0790] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022]
Abstract
Although replication repair deficiency, either by mismatch repair deficiency (MMRD) and/or loss of DNA polymerase proofreading, can cause hypermutation in cancer, microsatellite instability (MSI) is considered a hallmark of MMRD alone. By genome-wide analysis of tumors with germline and somatic deficiencies in replication repair, we reveal a novel association between loss of polymerase proofreading and MSI, especially when both components are lost. Analysis of indels in microsatellites (MS-indels) identified five distinct signatures (MS-sigs). MMRD MS-sigs are dominated by multibase losses, whereas mutant-polymerase MS-sigs contain primarily single-base gains. MS deletions in MMRD tumors depend on the original size of the MS and converge to a preferred length, providing mechanistic insight. Finally, we demonstrate that MS-sigs can be a powerful clinical tool for managing individuals with germline MMRD and replication repair-deficient cancers, as they can detect the replication repair deficiency in normal cells and predict their response to immunotherapy. SIGNIFICANCE: Exome- and genome-wide MSI analysis reveals novel signatures that are uniquely attributed to mismatch repair and DNA polymerase. This provides new mechanistic insight into MS maintenance and can be applied clinically for diagnosis of replication repair deficiency and immunotherapy response prediction.This article is highlighted in the In This Issue feature, p. 995.
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Affiliation(s)
- Jiil Chung
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yosef E Maruvka
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Sumedha Sudhaman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacalyn Kelly
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas J Haradhvala
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Harvard Graduate Program in Biophysics, Harvard University, Cambridge, Massachusetts
| | - Vanessa Bianchi
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Edwards
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Victoria J Forster
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nuno M Nunes
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa A Galati
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Komosa
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shriya Deshmukh
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,The Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Vanja Cabric
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Scott Davidson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthew Zatzman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Light
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reid Hayes
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ledia Brunga
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathaniel D Anderson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ben Ho
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karl P Hodel
- Department of Biochemistry and Molecular Biology, Tulane Cancer Center, Tulane University of Medicine, New Orleans, Louisiana
| | - Robert Siddaway
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A Sorana Morrissy
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Charbonneau Cancer Institute and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Daniel C Bowers
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.,Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, Texas
| | - Valérie Larouche
- Department of Pediatrics, Centre Mere-enfant Soleil du CHU de Quebec, CRCHU de Quebec, Universite Laval, Quebec City, Quebec, Canada
| | - Annika Bronsema
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Osborn
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Kristina A Cole
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Enrico Opocher
- Pediatric Oncology and Hematology, Azienda Ospedaliera-Universita' degli Studi di Padova, Padova, Italy
| | - Gary Mason
- Department of Pediatric Hematology-Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Gregory A Thomas
- Division of Pediatric Hematology-Oncology, Oregon Health and Science University, Portland, Oregon
| | - Ben George
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David S Ziegler
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Scott Lindhorst
- Neuro-Oncology, Department of Neurosurgery, and Department of Medicine, Division of Hematology/Medical Oncology, Medical University of South Carolina Charleston, South Carolina
| | - Magimairajan Vanan
- Department of Pediatric Hematology-Oncology, Cancer Care Manitoba; Research Institute in Oncology and Hematology (RIOH), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michal Yalon-Oren
- Pediatric Hemato-Oncology, Edmond and Lilly Safra Children's Hospital and Cancer Research Center, Sheba Medical Center, Tel Hashomer Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Alyssa T Reddy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milano, Italy
| | - Patrick Tomboc
- Department of Pediatrics Section of Hematology-Oncology, WVU Medicine Children's, Morgantown, West Virginia
| | - An Van Damme
- Division of Hematology and Oncology, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexander Lossos
- Department of Neurology, Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Carol Durno
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel A Morgenstern
- Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Malkin
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Program in Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zachary F Pursell
- Department of Biochemistry and Molecular Biology, Tulane Cancer Center, Tulane University of Medicine, New Orleans, Louisiana
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas A Kunkel
- Genome Integrity Structural Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Durham, North Carolina
| | - Gad Getz
- Massachusetts General Hospital Center for Cancer Research, Charlestown, Massachusetts. .,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Uri Tabori
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada. .,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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5
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Galati MA, Hodel KP, Gams MS, Sudhaman S, Bridge T, Zahurancik WJ, Ungerleider NA, Park VS, Ercan AB, Joksimovic L, Siddiqui I, Siddaway R, Edwards M, de Borja R, Elshaer D, Chung J, Forster VJ, Nunes NM, Aronson M, Wang X, Ramdas J, Seeley A, Sarosiek T, Dunn GP, Byrd JN, Mordechai O, Durno C, Martin A, Shlien A, Bouffet E, Suo Z, Jackson JG, Hawkins CE, Guidos CJ, Pursell ZF, Tabori U. Cancers from Novel Pole-Mutant Mouse Models Provide Insights into Polymerase-Mediated Hypermutagenesis and Immune Checkpoint Blockade. Cancer Res 2020; 80:5606-5618. [PMID: 32938641 PMCID: PMC8218238 DOI: 10.1158/0008-5472.can-20-0624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/25/2020] [Revised: 06/25/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
POLE mutations are a major cause of hypermutant cancers, yet questions remain regarding mechanisms of tumorigenesis, genotype-phenotype correlation, and therapeutic considerations. In this study, we establish mouse models harboring cancer-associated POLE mutations P286R and S459F, which cause rapid albeit distinct time to cancer initiation in vivo, independent of their exonuclease activity. Mouse and human correlates enabled novel stratification of POLE mutations into three groups based on clinical phenotype and mutagenicity. Cancers driven by these mutations displayed striking resemblance to the human ultrahypermutation and specific signatures. Furthermore, Pole-driven cancers exhibited a continuous and stochastic mutagenesis mechanism, resulting in intertumoral and intratumoral heterogeneity. Checkpoint blockade did not prevent Pole lymphomas, but rather likely promoted lymphomagenesis as observed in humans. These observations provide insights into the carcinogenesis of POLE-driven tumors and valuable information for genetic counseling, surveillance, and immunotherapy for patients. SIGNIFICANCE: Two mouse models of polymerase exonuclease deficiency shed light on mechanisms of mutation accumulation and considerations for immunotherapy.See related commentary by Wisdom and Kirsch p. 5459.
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Affiliation(s)
- Melissa A Galati
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karl P Hodel
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Miki S Gams
- Program in Developmental and Stem Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumedha Sudhaman
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Taylor Bridge
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Walter J Zahurancik
- The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio
| | - Nathan A Ungerleider
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vivian S Park
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ayse B Ercan
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lazar Joksimovic
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Iram Siddiqui
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Siddaway
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Edwards
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Richard de Borja
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dana Elshaer
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jiil Chung
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victoria J Forster
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nuno M Nunes
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melyssa Aronson
- The Familial Gastrointestinal Cancer Registry at the Zane Cohen Centre for Digestive Disease, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Xia Wang
- H Lee Moffitt Cancer Centre and Research Institute, Tampa, Florida
| | - Jagadeesh Ramdas
- Department of Pediatrics, Geisinger Medical Center, Danville, Pennsylvania
| | - Andrea Seeley
- Department of Pediatrics, Geisinger Medical Center, Danville, Pennsylvania
| | | | - Gavin P Dunn
- Department of Neurological Surgery, Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan N Byrd
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Oz Mordechai
- Department of Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Carol Durno
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alberto Martin
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam Shlien
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zucai Suo
- The Ohio State Biochemistry Program, The Ohio State University, Columbus, Ohio
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, Florida
| | - James G Jackson
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia J Guidos
- Program in Developmental and Stem Cell Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zachary F Pursell
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana
- Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana
| | - Uri Tabori
- Program in Genetics and Genome Biology, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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6
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D'Arcy CE, Nobre LF, Arnaldo A, Ramaswamy V, Taylor MD, Naz-Hazrati L, Hawkins CE. Immunohistochemical and nanoString-Based Subgrouping of Clinical Medulloblastoma Samples. J Neuropathol Exp Neurol 2020; 79:437-447. [PMID: 32053195 DOI: 10.1093/jnen/nlaa005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Accepted: 01/23/2020] [Indexed: 01/08/2023] Open
Abstract
The diagnosis of medulloblastoma incorporates the histologic and molecular subclassification of clinical medulloblastoma samples into wingless (WNT)-activated, sonic hedgehog (SHH)-activated, group 3 and group 4 subgroups. Accurate medulloblastoma subclassification has important prognostic and treatment implications. Immunohistochemistry (IHC)-based and nanoString-based subgrouping methodologies have been independently described as options for medulloblastoma subgrouping, however have not previously been directly compared. We describe our experience with nanoString-based subgrouping in a clinical setting and compare this with our IHC-based results. Study materials included FFPE tissue from 160 medulloblastomas. Clinical data and tumor histology were reviewed. Immunohistochemical-based subgrouping using β-catenin, filamin A and p53 antibodies and nanoString-based gene expression profiling were performed. The sensitivity and specificity of IHC-based subgrouping of WNT and SHH-activated medulloblastomas was 91.5% and 99.54%, respectively. Filamin A immunopositivity highly correlated with SHH/WNT-activated subgroups (sensitivity 100%, specificity 92.7%, p < 0.001). Nuclear β-catenin immunopositivity had a sensitivity of 76.2% and specificity of 99.23% for detection of WNT-activated tumors. Approximately 23.8% of WNT cases would have been missed using an IHC-based subgrouping method alone. nanoString could confidently predict medulloblastoma subgroup in 93% of cases and could distinguish group 3/4 subgroups in 96.3% of cases. nanoString-based subgrouping allows for a more prognostically useful classification of clinical medulloblastoma samples.
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Affiliation(s)
- Colleen E D'Arcy
- Department of Anatomical Pathology, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | - Cynthia E Hawkins
- Division of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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7
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Sin-Chan P, Mumal I, Suwal T, Ho B, Fan X, Singh I, Du Y, Lu M, Patel N, Torchia J, Popovski D, Fouladi M, Guilhamon P, Hansford JR, Leary S, Hoffman LM, Mulcahy Levy JM, Lassaletta A, Solano-Paez P, Rivas E, Reddy A, Gillespie GY, Gupta N, Van Meter TE, Nakamura H, Wong TT, Ra YS, Kim SK, Massimi L, Grundy RG, Fangusaro J, Johnston D, Chan J, Lafay-Cousin L, Hwang EI, Wang Y, Catchpoole D, Michaud J, Ellezam B, Ramanujachar R, Lindsay H, Taylor MD, Hawkins CE, Bouffet E, Jabado N, Singh SK, Kleinman CL, Barsyte-Lovejoy D, Li XN, Dirks PB, Lin CY, Mack SC, Rich JN, Huang A. A C19MC-LIN28A-MYCN Oncogenic Circuit Driven by Hijacked Super-enhancers Is a Distinct Therapeutic Vulnerability in ETMRs: A Lethal Brain Tumor. Cancer Cell 2019; 36:51-67.e7. [PMID: 31287992 DOI: 10.1016/j.ccell.2019.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 02/11/2019] [Revised: 04/26/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
Embryonal tumors with multilayered rosettes (ETMRs) are highly lethal infant brain cancers with characteristic amplification of Chr19q13.41 miRNA cluster (C19MC) and enrichment of pluripotency factor LIN28A. Here we investigated C19MC oncogenic mechanisms and discovered a C19MC-LIN28A-MYCN circuit fueled by multiple complex regulatory loops including an MYCN core transcriptional network and super-enhancers resulting from long-range MYCN DNA interactions and C19MC gene fusions. Our data show that this powerful oncogenic circuit, which entraps an early neural lineage network, is potently abrogated by bromodomain inhibitor JQ1, leading to ETMR cell death.
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MESH Headings
- Biomarkers, Tumor
- Brain Neoplasms/diagnosis
- Brain Neoplasms/etiology
- Brain Neoplasms/therapy
- Cell Cycle/genetics
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 2
- DNA Copy Number Variations
- Enhancer Elements, Genetic
- Epigenesis, Genetic
- Gene Expression Regulation
- Gene Regulatory Networks
- Genetic Association Studies
- Genetic Predisposition to Disease
- Humans
- MicroRNAs/genetics
- Models, Biological
- Multigene Family
- N-Myc Proto-Oncogene Protein/genetics
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/etiology
- Neoplasms, Germ Cell and Embryonal/therapy
- Oncogenes
- RNA-Binding Proteins/genetics
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Affiliation(s)
- Patrick Sin-Chan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Iqra Mumal
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada
| | - Tannu Suwal
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Xiaolian Fan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Irtisha Singh
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yuchen Du
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Mei Lu
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Neilket Patel
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Jonathon Torchia
- Princess Margaret Cancer Center-OICR Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, ON M5G0A3, Canada
| | - Dean Popovski
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Paul Guilhamon
- Developmental and Stem Cell Biology Program and Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Murdoch Children's Research Institute, Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Sarah Leary
- Department of Hematology-Oncology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Jean M Mulcahy Levy
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Alvaro Lassaletta
- Pediatric Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid 28009, Spain
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Seville 41013, Spain
| | - Eloy Rivas
- Department of Pathology, Neuropathology Division, Hospital Universitario Virgen del Rocio, Seville 41013, Spain
| | - Alyssa Reddy
- University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham AL 35294, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA
| | - Timothy E Van Meter
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University, Fukuoka 830-0011, Japan
| | - Tai-Tong Wong
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei 11031, Taiwan
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Luca Massimi
- Department of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Richard G Grundy
- Children's Brain Tumor Research Centre, Queen's Medical Centre University of Nottingham, Nottingham NG72UH, UK
| | - Jason Fangusaro
- Department of Pediatric Hematology and Oncology at Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Donna Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H8L1, Canada
| | - Jennifer Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Lucie Lafay-Cousin
- Department of Pediatric Oncology, Alberta Children's Hospital, Calgary, AB T3B6A8, Canada
| | - Eugene I Hwang
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC 20010, USA
| | - Yin Wang
- Department of Neuropathology Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Daniel Catchpoole
- The Tumor Bank, Children's Cancer Research Unit, Kids Research, the Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON K1H8M5, Canada
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC H3T1C5, Canada
| | - Ramya Ramanujachar
- Paediatric Haematology and Oncology, Southampton Children's Hospital, Southampton SO166YD, UK
| | - Holly Lindsay
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Michael D Taylor
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Department of Pathology, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Nada Jabado
- Departments of Pediatrics and Human Genetics, McGill University, Montréal, QC H3A0C7, Canada
| | - Sheila K Singh
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Claudia L Kleinman
- Departments of Pediatrics and Human Genetics, McGill University, Montréal, QC H3A0C7, Canada
| | | | - Xiao-Nan Li
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Peter B Dirks
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G0A4, Canada
| | - Charles Y Lin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stephen C Mack
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Jeremy N Rich
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, CA 92093, USA
| | - Annie Huang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON M5G0A4, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON M5S1A8, Canada; Division of Hematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON M5G1L7, Canada.
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8
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Lee DD, Leão R, Komosa M, Gallo M, Zhang CH, Lipman T, Remke M, Heidari A, Nunes NM, Apolónio JD, Price AJ, De Mello RA, Dias JS, Huntsman D, Hermanns T, Wild PJ, Vanner R, Zadeh G, Karamchandani J, Das S, Taylor MD, Hawkins CE, Wasserman JD, Figueiredo A, Hamilton RJ, Minden MD, Wani K, Diplas B, Yan H, Aldape K, Akbari MR, Danesh A, Pugh TJ, Dirks PB, Castelo-Branco P, Tabori U. DNA hypermethylation within TERT promoter upregulates TERT expression in cancer. J Clin Invest 2019; 129:1801. [PMID: 30932912 DOI: 10.1172/jci128527] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Garzia L, Kijima N, Morrissy AS, De Antonellis P, Guerreiro-Stucklin A, Holgado BL, Wu X, Wang X, Parsons M, Zayne K, Manno A, Kuzan-Fischer C, Nor C, Donovan LK, Liu J, Qin L, Garancher A, Liu KW, Mansouri S, Luu B, Thompson YY, Ramaswamy V, Peacock J, Farooq H, Skowron P, Shih DJH, Li A, Ensan S, Robbins CS, Cybulsky M, Mitra S, Ma Y, Moore R, Mungall A, Cho YJ, Weiss WA, Chan JA, Hawkins CE, Massimino M, Jabado N, Zapotocky M, Sumerauer D, Bouffet E, Dirks P, Tabori U, Sorensen PHB, Brastianos PK, Aldape K, Jones SJM, Marra MA, Woodgett JR, Wechsler-Reya RJ, Fults DW, Taylor MD. A Hematogenous Route for Medulloblastoma Leptomeningeal Metastases. Cell 2019; 172:1050-1062.e14. [PMID: 29474906 DOI: 10.1016/j.cell.2018.01.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/22/2017] [Accepted: 01/29/2018] [Indexed: 12/19/2022]
Abstract
While the preponderance of morbidity and mortality in medulloblastoma patients are due to metastatic disease, most research focuses on the primary tumor due to a dearth of metastatic tissue samples and model systems. Medulloblastoma metastases are found almost exclusively on the leptomeningeal surface of the brain and spinal cord; dissemination is therefore thought to occur through shedding of primary tumor cells into the cerebrospinal fluid followed by distal re-implantation on the leptomeninges. We present evidence for medulloblastoma circulating tumor cells (CTCs) in therapy-naive patients and demonstrate in vivo, through flank xenografting and parabiosis, that medulloblastoma CTCs can spread through the blood to the leptomeningeal space to form leptomeningeal metastases. Medulloblastoma leptomeningeal metastases express high levels of the chemokine CCL2, and expression of CCL2 in medulloblastoma in vivo is sufficient to drive leptomeningeal dissemination. Hematogenous dissemination of medulloblastoma offers a new opportunity to diagnose and treat lethal disseminated medulloblastoma.
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Affiliation(s)
- Livia Garzia
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Noriyuki Kijima
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - A Sorana Morrissy
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Pasqualino De Antonellis
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ana Guerreiro-Stucklin
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Borja L Holgado
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Xiaochong Wu
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Xin Wang
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael Parsons
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Kory Zayne
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alex Manno
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Claudia Kuzan-Fischer
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carolina Nor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Laura K Donovan
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jessica Liu
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lei Qin
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alexandra Garancher
- Tumor Initiation and Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Kun-Wei Liu
- Tumor Initiation and Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Sheila Mansouri
- MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Betty Luu
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yuan Yao Thompson
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - John Peacock
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hamza Farooq
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Patryk Skowron
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David J H Shih
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Angela Li
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Sherine Ensan
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Clinton S Robbins
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Peter Munk Cardiac Centre, Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Myron Cybulsky
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Siddhartha Mitra
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Richard Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Andy Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Yoon-Jae Cho
- Departments of Pediatrics, Neurological Surgery and Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Weiss
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer A Chan
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, QC, Canada
| | - Michal Zapotocky
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - David Sumerauer
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Eric Bouffet
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Poul H B Sorensen
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | | | - Kenneth Aldape
- MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency and Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - James R Woodgett
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Robert J Wechsler-Reya
- Tumor Initiation and Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA; Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Daniel W Fults
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.
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10
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Lee DD, Leão R, Komosa M, Gallo M, Zhang CH, Lipman T, Remke M, Heidari A, Nunes NM, Apolónio JD, Price AJ, De Mello RA, Dias JS, Huntsman D, Hermanns T, Wild PJ, Vanner R, Zadeh G, Karamchandani J, Das S, Taylor MD, Hawkins CE, Wasserman JD, Figueiredo A, Hamilton RJ, Minden MD, Wani K, Diplas B, Yan H, Aldape K, Akbari MR, Danesh A, Pugh TJ, Dirks PB, Castelo-Branco P, Tabori U. DNA hypermethylation within TERT promoter upregulates TERT expression in cancer. J Clin Invest 2018; 129:223-229. [PMID: 30358567 DOI: 10.1172/jci121303] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/09/2018] [Indexed: 01/02/2023] Open
Abstract
Replicative immortality is a hallmark of cancer cells governed by telomere maintenance. Approximately 90% of human cancers maintain their telomeres by activating telomerase, driven by the transcriptional upregulation of telomerase reverse transcriptase (TERT). Although TERT promoter mutations (TPMs) are a major cancer-associated genetic mechanism of TERT upregulation, many cancers exhibit TERT upregulation without TPMs. In this study, we describe the TERT hypermethylated oncological region (THOR), a 433-bp genomic region encompassing 52 CpG sites located immediately upstream of the TERT core promoter, as a cancer-associated epigenetic mechanism of TERT upregulation. Unmethylated THOR repressed TERT promoter activity regardless of TPM status, and hypermethylation of THOR counteracted this repressive function. THOR methylation analysis in 1,352 human tumors revealed frequent (>45%) cancer-associated DNA hypermethylation in 9 of 11 (82%) tumor types screened. Additionally, THOR hypermethylation, either independently or along with TPMs, accounted for how approximately 90% of human cancers can aberrantly activate telomerase. Thus, we propose that THOR hypermethylation is a prevalent telomerase-activating mechanism in cancer that can act independently of or in conjunction with TPMs, further supporting the utility of THOR hypermethylation as a prognostic biomarker.
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Affiliation(s)
- Donghyun D Lee
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ricardo Leão
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Martin Komosa
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marco Gallo
- Departments of Physiology and Pharmacology, Biochemistry and Molecular Biology, University of Calgary, Calgary, Alberta, Canada
| | - Cindy H Zhang
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tatiana Lipman
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Abolfazl Heidari
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nuno Miguel Nunes
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana D Apolónio
- Department of Biomedical Sciences and Medicine, and.,Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Aryeh J Price
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - João S Dias
- Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - David Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter J Wild
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Robert Vanner
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jason Karamchandani
- Department of Pathology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Sunit Das
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Robert J Hamilton
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Khalida Wani
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bill Diplas
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Hai Yan
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Kenneth Aldape
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mohammad R Akbari
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Arnavaz Danesh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter B Dirks
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Uri Tabori
- Program in Genetics and Genome Biology, and.,The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Garzia L, Kijima N, Morrissy AS, De Antonellis P, Guerreiro-Stucklin A, Holgado BL, Wu X, Wang X, Parsons M, Zayne K, Manno A, Kuzan-Fischer C, Nor C, Donovan LK, Liu J, Qin L, Garancher A, Liu KW, Mansouri S, Luu B, Thompson YY, Ramaswamy V, Peacock J, Farooq H, Skowron P, Shih DJH, Li A, Ensan S, Robbins CS, Cybulsky M, Mitra S, Ma Y, Moore R, Mungall A, Cho YJ, Weiss WA, Chan JA, Hawkins CE, Massimino M, Jabado N, Zapotocky M, Sumerauer D, Bouffet E, Dirks P, Tabori U, Sorensen PHB, Brastianos PK, Aldape K, Jones SJM, Marra MA, Woodgett JR, Wechsler-Reya RJ, Fults DW, Taylor MD. A Hematogenous Route for Medulloblastoma Leptomeningeal Metastases. Cell 2018; 173:1549. [PMID: 29856958 DOI: 10.1016/j.cell.2018.05.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Berlow NE, Svalina MN, Quist MJ, Settelmeyer TP, Zherebitskiy V, Kogiso M, Qi L, Du Y, Hawkins CE, Hulleman E, Li XN, Gultekin SH, Keller C. IL-13 receptors as possible therapeutic targets in diffuse intrinsic pontine glioma. PLoS One 2018; 13:e0193565. [PMID: 29621254 PMCID: PMC5886401 DOI: 10.1371/journal.pone.0193565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/12/2017] [Accepted: 02/14/2018] [Indexed: 11/19/2022] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a universally fatal childhood cancer of the brain. Despite the introduction of conventional chemotherapy and radiotherapy, improvements in survival have been marginal and long-term survivorship is uncommon. Thus, new targets for therapeutics are critically needed. Early phase clinical trials exploring molecularly-targeted therapies against the epidermal growth factor receptor (EGFR) and novel immunotherapies targeting interleukin receptor-13α2 (IL-13Rα2) have demonstrated activity in this disease. To identify additional therapeutic markers for cell surface receptors, we performed exome sequencing (16 new samples, 22 previously published samples, total 38 with 26 matched normal DNA samples), RNA deep sequencing (17 new samples, 11 previously published samples, total 28 with 18 matched normal RNA samples), and immunohistochemistry (17 DIPG tissue samples) to examine the expression of the interleukin-4 (IL-4) signaling axis components (IL-4, interleukin 13 (IL-13), and their respective receptors IL-4Rα, IL-13Rα1, and IL-13Rα2). In addition, we correlated cytokine and receptor expression with expression of the oncogenes EGFR and c-MET. In DIPG tissues, transcript-level analysis found significant expression of IL-4, IL-13, and IL-13Rα1/2, with strong differential expression of IL-13Rα1/2 in tumor versus normal brain. At the protein level, immunohistochemical studies revealed high content of IL-4 and IL-13Rα1/2 but notably low expression of IL-13. Additionally, a strong positive correlation was observed between c-Met and IL-4Rα. The genomic and transcriptional landscape across all samples was also summarized. These data create a foundation for the design of potential new immunotherapies targeting IL-13 cell surface receptors in DIPG.
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Affiliation(s)
- Noah E. Berlow
- Children's Cancer Therapy Development Institute, Beaverton, OR, United States of America
| | - Matthew N. Svalina
- Children's Cancer Therapy Development Institute, Beaverton, OR, United States of America
| | - Michael J. Quist
- Children's Cancer Therapy Development Institute, Beaverton, OR, United States of America
| | - Teagan P. Settelmeyer
- Children's Cancer Therapy Development Institute, Beaverton, OR, United States of America
| | - Viktor Zherebitskiy
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States of America
| | - Mari Kogiso
- Department of Pediatrics, Texas Children's Cancer Center, Houston, TX, United States of America
| | - Lin Qi
- Department of Pediatrics, Texas Children's Cancer Center, Houston, TX, United States of America
| | - Yuchen Du
- Department of Pediatrics, Texas Children's Cancer Center, Houston, TX, United States of America
| | - Cynthia E. Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, CANADA
| | - Esther Hulleman
- Neuro-Oncology Research Group, Cancer Center Amsterdam, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
| | - Xiao-Nan Li
- Department of Pediatrics, Texas Children's Cancer Center, Houston, TX, United States of America
| | - Sakir H. Gultekin
- Department of Pathology, Oregon Health & Science University, Portland, OR, United States of America
| | - Charles Keller
- Children's Cancer Therapy Development Institute, Beaverton, OR, United States of America
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States of America
- * E-mail:
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13
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Tabori U, Bouffet E, Hawkins CE. Reply to D.T.W. Jones et al. J Clin Oncol 2018; 36:97. [DOI: 10.1200/jco.2017.76.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Uri Tabori
- Uri Tabori, Eric Bouffet, and Cynthia E. Hawkins, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Uri Tabori, Eric Bouffet, and Cynthia E. Hawkins, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia E. Hawkins
- Uri Tabori, Eric Bouffet, and Cynthia E. Hawkins, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Lassaletta A, Scheinemann K, Zelcer SM, Hukin J, Wilson BA, Jabado N, Carret AS, Lafay-Cousin L, Larouche V, Hawkins CE, Pond GR, Poskitt K, Keene D, Johnston DL, Eisenstat DD, Krishnatry R, Mistry M, Arnoldo A, Ramaswamy V, Huang A, Bartels U, Tabori U, Bouffet E. Phase II Weekly Vinblastine for Chemotherapy-Naïve Children With Progressive Low-Grade Glioma: A Canadian Pediatric Brain Tumor Consortium Study. J Clin Oncol 2017; 34:3537-3543. [PMID: 27573663 DOI: 10.1200/jco.2016.68.1585] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Vinblastine monotherapy has shown promising activity and a low-toxicity profile in patients with pediatric low-grade glioma (PLGG) who experienced treatment failure after initial treatment with chemotherapy and/or radiation. The aim of this study was to assess the activity of vinblastine in therapy-naïve children. Patients and Methods Patients < 18 years old with unresectable and/or progressive therapy-naïve PLGG were eligible. Vinblastine was administered once per week at a dose of 6 mg/m2 intravenously over a period of 70 weeks. Vision, quality of life, neurofibromatosis type 1 (NF1) status, and BRAF mutation/fusion status were also determined and correlated with outcome. Results Fifty-four patients were enrolled onto the study, with a median age of 8 years (range, 0.7 to 17.2 years). Most patients had chiasmatic/hypothalamic tumors (55.5%), and 13 patients (24.1%) had NF1. The most common histology was pilocytic astrocytoma (46.3%). Seventeen patients were diagnosed using radiologic criteria alone. Best response to chemotherapy was centrally reviewed with a response rate (complete, partial, or minor response) of 25.9%. Disease stabilization (complete, partial, or minor response or stable disease) was achieved in 47 patients (87.0%). Visual improvement was observed in 20% of patients with optic pathway glioma. Five-year overall survival and progression-free survival (PFS) rates were 94.4% (95% CI, 88.5% to 100%) and 53.2% (95% CI, 41.3% to 68.5%), respectively, for the entire cohort. Patients with NF1 had a significantly better PFS (85.1%; 95% CI, 68.0% to 100%) when compared with patients without NF1 (42.0%; 95% CI, 29.1% to 60.7%; P = .012). Age< 3 years or > 10 years was not associated with poor outcome. Treatment was well tolerated, and quality of life was not affected during treatment. In this trial, there was no correlation between BRAF alterations and outcome. Conclusion Vinblastine administered once per week is well tolerated in children with treatment naïve PLGG. Overall survival and PFS are comparable to current therapies, with a favorable toxicity profile and a maintained quality of life.
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Affiliation(s)
- Alvaro Lassaletta
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Katrin Scheinemann
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Shayna M Zelcer
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Juliette Hukin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Beverley A Wilson
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Nada Jabado
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anne Sophie Carret
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Lucie Lafay-Cousin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Valerie Larouche
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Cynthia E Hawkins
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Russell Pond
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Poskitt
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Keene
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Donna L Johnston
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - David D Eisenstat
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rahul Krishnatry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Mistry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Arnoldo
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Vijay Ramaswamy
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Annie Huang
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ute Bartels
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Uri Tabori
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Bouffet
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
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15
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Ryall S, Arnoldo A, Krishnatry R, Mistry M, Khor K, Sheth J, Ling C, Leung S, Zapotocky M, Guerreiro Stucklin A, Lassaletta A, Shago M, Tabori U, Hawkins CE. Multiplex Detection of Pediatric Low-Grade Glioma Signature Fusion Transcripts and Duplications Using the NanoString nCounter System. J Neuropathol Exp Neurol 2017; 76:562-570. [DOI: 10.1093/jnen/nlx042] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, Garzia L, Torchia J, Nor C, Morrissy AS, Agnihotri S, Thompson YY, Kuzan-Fischer CM, Farooq H, Isaev K, Daniels C, Cho BK, Kim SK, Wang KC, Lee JY, Grajkowska WA, Perek-Polnik M, Vasiljevic A, Faure-Conter C, Jouvet A, Giannini C, Nageswara Rao AA, Li KKW, Ng HK, Eberhart CG, Pollack IF, Hamilton RL, Gillespie GY, Olson JM, Leary S, Weiss WA, Lach B, Chambless LB, Thompson RC, Cooper MK, Vibhakar R, Hauser P, van Veelen MLC, Kros JM, French PJ, Ra YS, Kumabe T, López-Aguilar E, Zitterbart K, Sterba J, Finocchiaro G, Massimino M, Van Meir EG, Osuka S, Shofuda T, Klekner A, Zollo M, Leonard JR, Rubin JB, Jabado N, Albrecht S, Mora J, Van Meter TE, Jung S, Moore AS, Hallahan AR, Chan JA, Tirapelli DPC, Carlotti CG, Fouladi M, Pimentel J, Faria CC, Saad AG, Massimi L, Liau LM, Wheeler H, Nakamura H, Elbabaa SK, Perezpeña-Diazconti M, Chico Ponce de León F, Robinson S, Zapotocky M, Lassaletta A, Huang A, Hawkins CE, Tabori U, Bouffet E, Bartels U, Dirks PB, Rutka JT, Bader GD, Reimand J, Goldenberg A, Ramaswamy V, Taylor MD. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell 2017; 31:737-754.e6. [PMID: 28609654 PMCID: PMC6163053 DOI: 10.1016/j.ccell.2017.05.005] [Citation(s) in RCA: 720] [Impact Index Per Article: 102.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/24/2017] [Accepted: 05/08/2017] [Indexed: 02/07/2023]
Abstract
While molecular subgrouping has revolutionized medulloblastoma classification, the extent of heterogeneity within subgroups is unknown. Similarity network fusion (SNF) applied to genome-wide DNA methylation and gene expression data across 763 primary samples identifies very homogeneous clusters of patients, supporting the presence of medulloblastoma subtypes. After integration of somatic copy-number alterations, and clinical features specific to each cluster, we identify 12 different subtypes of medulloblastoma. Integrative analysis using SNF further delineates group 3 from group 4 medulloblastoma, which is not as readily apparent through analyses of individual data types. Two clear subtypes of infants with Sonic Hedgehog medulloblastoma with disparate outcomes and biology are identified. Medulloblastoma subtypes identified through integrative clustering have important implications for stratification of future clinical trials.
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Affiliation(s)
- Florence M G Cavalli
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Düsseldorf 40225, Germany; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Department of Pediatric Neuro-Oncogenomics, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Düsseldorf 40225, Germany
| | - Ladislav Rampasek
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - John Peacock
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - David J H Shih
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Livia Garzia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jonathon Torchia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Carolina Nor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - A Sorana Morrissy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sameer Agnihotri
- UPCI Brain Tumor Program, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Yuan Yao Thompson
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Claudia M Kuzan-Fischer
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Hamza Farooq
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Keren Isaev
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Craig Daniels
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Byung-Kyu Cho
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 30322, South Korea
| | - Wieslawa A Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw 04-730, Poland
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron 69677, France; ONCOFLAM - Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon 69008, France
| | | | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Bron 69677, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Charles G Eberhart
- Departments of Pathology, Ophthalmology and Oncology, John Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - G Yancey Gillespie
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - James M Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA; Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - Sarah Leary
- Division of Pediatric Hematology/Oncology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 98145-5005, USA
| | - William A Weiss
- Departments of Pediatrics, Neurological Surgery and Neurology, University of California San Francisco, San Francisco, CA 94143-0112, USA
| | - Boleslaw Lach
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada; Department of Pathology and Laboratory Medicine, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN 37232, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Marie-Lise C van Veelen
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam 3015 CN, the Netherlands
| | - Pim J French
- Department of Neurology, Erasmus University Medical Center, Rotterdam 3015 CE, the Netherlands
| | - Young Shin Ra
- Department of Neurosurgery, University of Ulsan, Asan Medical Center, Seoul 05505, South Korea
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City 06720, Mexico
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno 625 00, Czech Republic
| | - Gaetano Finocchiaro
- Department of Neuro-Oncology, Istituto Neurologico Besta, Milan 20133, Italy
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan 20133, Italy
| | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka 540-0006, Japan
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Medical and Health Science Centre, Debrecen 4032, Hungary
| | - Massimo Zollo
- Dipartimento di Biochimica e Biotecnologie Mediche, University of Naples, Naples 80145, Italy
| | - Jeffrey R Leonard
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Nada Jabado
- Division of Hematology/Oncology, Department of Pediatrics, McGill University, Montreal, QC H4A 3J1, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada; Department of Pathology, Montreal Children's Hospital, Montreal, QC H4A 3J1, Canada
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona 08950, Spain
| | - Timothy E Van Meter
- Department of Pediatrics, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298-0646, USA
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun 519-763, Chonnam South Korea
| | - Andrew S Moore
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Andrew R Hallahan
- Lady Cilento Children's Hospital, The University of Queensland, Brisbane QLD 4102, Australia; Oncology Service, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4029, Australia
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Daniela P C Tirapelli
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Carlos G Carlotti
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo 14049-900, Brazil
| | - Maryam Fouladi
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon 1649-035, Portugal
| | - Ali G Saad
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Luca Massimi
- Department of Pediatric Neurosurgery, Catholic University Medical School, Rome 00198, Italy
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Helen Wheeler
- Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW 2065, Australia
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto 860-8555, Japan
| | - Samer K Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | - Shenandoah Robinson
- Division of Pediatric Neurosurgery, Rainbow & Babies Children's Hospital, Case Western Reserve, Cleveland, OH 44106, USA
| | - Michal Zapotocky
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Alvaro Lassaletta
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Annie Huang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Cynthia E Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Pathology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Eric Bouffet
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Ute Bartels
- Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Peter B Dirks
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - James T Rutka
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Gary D Bader
- The Donnelly Centre, University of Toronto, Toronto, ON M5S 3E1, Canada; Banting and Best Department of Medical Research, University of Toronto, Toronto, ON M5G 1L6, Canada; McLaughlin Centre, University of Toronto, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada; Samuel Lunenfeld Research Institute at Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Jüri Reimand
- Informatics Program, Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Anna Goldenberg
- Department of Computer Science, University of Toronto, Toronto, ON M5S 2E4, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Division of Haematology / Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Program in Neuroscience and Mental Health and Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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17
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Torchia J, Golbourn B, Feng S, Ho KC, Sin-Chan P, Vasiljevic A, Norman JD, Guilhamon P, Garzia L, Agamez NR, Lu M, Chan TS, Picard D, de Antonellis P, Khuong-Quang DA, Planello AC, Zeller C, Barsyte-Lovejoy D, Lafay-Cousin L, Letourneau L, Bourgey M, Yu M, Gendoo DMA, Dzamba M, Barszczyk M, Medina T, Riemenschneider AN, Morrissy AS, Ra YS, Ramaswamy V, Remke M, Dunham CP, Yip S, Ng HK, Lu JQ, Mehta V, Albrecht S, Pimentel J, Chan JA, Somers GR, Faria CC, Roque L, Fouladi M, Hoffman LM, Moore AS, Wang Y, Choi SA, Hansford JR, Catchpoole D, Birks DK, Foreman NK, Strother D, Klekner A, Bognár L, Garami M, Hauser P, Hortobágyi T, Wilson B, Hukin J, Carret AS, Van Meter TE, Hwang EI, Gajjar A, Chiou SH, Nakamura H, Toledano H, Fried I, Fults D, Wataya T, Fryer C, Eisenstat DD, Scheinemann K, Fleming AJ, Johnston DL, Michaud J, Zelcer S, Hammond R, Afzal S, Ramsay DA, Sirachainan N, Hongeng S, Larbcharoensub N, Grundy RG, Lulla RR, Fangusaro JR, Druker H, Bartels U, Grant R, Malkin D, McGlade CJ, Nicolaides T, Tihan T, Phillips J, Majewski J, Montpetit A, Bourque G, Bader GD, Reddy AT, Gillespie GY, Warmuth-Metz M, Rutkowski S, Tabori U, Lupien M, Brudno M, Schüller U, Pietsch T, Judkins AR, Hawkins CE, Bouffet E, Kim SK, Dirks PB, Taylor MD, Erdreich-Epstein A, Arrowsmith CH, De Carvalho DD, Rutka JT, Jabado N, Huang A. Integrated (epi)-Genomic Analyses Identify Subgroup-Specific Therapeutic Targets in CNS Rhabdoid Tumors. Cancer Cell 2016; 30:891-908. [PMID: 27960086 PMCID: PMC5500911 DOI: 10.1016/j.ccell.2016.11.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/19/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
We recently reported that atypical teratoid rhabdoid tumors (ATRTs) comprise at least two transcriptional subtypes with different clinical outcomes; however, the mechanisms underlying therapeutic heterogeneity remained unclear. In this study, we analyzed 191 primary ATRTs and 10 ATRT cell lines to define the genomic and epigenomic landscape of ATRTs and identify subgroup-specific therapeutic targets. We found ATRTs segregated into three epigenetic subgroups with distinct genomic profiles, SMARCB1 genotypes, and chromatin landscape that correlated with differential cellular responses to a panel of signaling and epigenetic inhibitors. Significantly, we discovered that differential methylation of a PDGFRB-associated enhancer confers specific sensitivity of group 2 ATRT cells to dasatinib and nilotinib, and suggest that these are promising therapies for this highly lethal ATRT subtype.
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Affiliation(s)
- Jonathon Torchia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Brian Golbourn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Shengrui Feng
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - King Ching Ho
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Patrick Sin-Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Alexandre Vasiljevic
- Department of Pathology, Groupement Hospitalier Est, CHU de Lyon, Lyon-Bron 69677, France
| | - Joseph D Norman
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Paul Guilhamon
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Livia Garzia
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Natalia R Agamez
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mei Lu
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiffany S Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Daniel Picard
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Pasqualino de Antonellis
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Dong-Anh Khuong-Quang
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Aline C Planello
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Constanze Zeller
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Dalia Barsyte-Lovejoy
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Lucie Lafay-Cousin
- Division of Pediatric Hematology/Oncology, Alberta Children's Hospital, AB T3B6A8, Canada
| | - Louis Letourneau
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Mathieu Bourgey
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Man Yu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Deena M A Gendoo
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Misko Dzamba
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Mark Barszczyk
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiago Medina
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Alexandra N Riemenschneider
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - A Sorana Morrissy
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Marc Remke
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Christopher P Dunham
- Division of Anatomic Pathology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, V6T1Z3, Canada
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Qiang Lu
- Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Jose Pimentel
- Divison of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Claudia C Faria
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Lucia Roque
- Cytometry and Cytogenetic Laboratory, CIPM, Portuguese Cancer Institute, Lisbon 1099-023, Portugal
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Andrew S Moore
- Oncology Service, Children's Health Queensland Hospital; University of Queensland Diamantina Institute, Brisbane, QLD 4102, Australia
| | - Yin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China
| | - Seung Ah Choi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Jordan R Hansford
- Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Daniel Catchpoole
- Children's Cancer Research Unit, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Diane K Birks
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | | | - Doug Strother
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Laszló Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Miklós Garami
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Péter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Tibor Hortobágyi
- Department of Histopathology, University of Szeged, Szeged 6720, Hungary
| | - Beverly Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Juliette Hukin
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Anne-Sophie Carret
- Department of Pediatrics, Division of Hematology-Oncology, Université de Montréal/CHU Sainte-Justine, Montreal, QC H3T1C5, Canada
| | - Timothy E Van Meter
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC 20010, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shih-Hwa Chiou
- Department of Medical Research, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto 860-8556, Japan
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Children's Medical Center of Israel, Petach Tikva 49202, Isreal
| | - Iris Fried
- Department of Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Daniel Fults
- Department of Neurosurgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Chris Fryer
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - David D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Adam J Fleming
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Donna L Johnston
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Jean Michaud
- Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Shayna Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital, London Health Sciences Center, London, ON N6A5A5, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Samina Afzal
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H4R2, Canada
| | - David A Ramsay
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham NG72RD, England
| | - Rishi R Lulla
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jason R Fangusaro
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Harriet Druker
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - David Malkin
- Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - C Jane McGlade
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Theodore Nicolaides
- Department of Pediatrics (Hematology/Oncology), University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Tarik Tihan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Joanna Phillips
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Alexandre Montpetit
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Gary D Bader
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Alyssa T Reddy
- Department of Pediatric Hematology and Oncology, University of Alabama, Birmingham, AL 35233, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama, Birmingham, AL 35233, USA
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University of Würzburg, Würzburg 97070, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Uri Tabori
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mathieu Lupien
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ulrich Schüller
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Torsten Pietsch
- Institute for Neuropathology, University of Bonn Medical Center, Bonn 53105, Germany
| | - Alexander R Judkins
- Department of Pathology & Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Pathology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Peter B Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Anat Erdreich-Epstein
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Cheryl H Arrowsmith
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Daniel D De Carvalho
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada.
| | - James T Rutka
- Department of Surgery, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada.
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
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18
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Seong BKA, Fathers KE, Hallett R, Yung CK, Stein LD, Mouaaz S, Kee L, Hawkins CE, Irwin MS, Kaplan DR. A Metastatic Mouse Model Identifies Genes That Regulate Neuroblastoma Metastasis. Cancer Res 2016; 77:696-706. [PMID: 27899382 DOI: 10.1158/0008-5472.can-16-1502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/06/2016] [Accepted: 11/05/2016] [Indexed: 11/16/2022]
Abstract
Metastatic relapse is the major cause of death in pediatric neuroblastoma, where there remains a lack of therapies to target this stage of disease. To understand the molecular mechanisms mediating neuroblastoma metastasis, we developed a mouse model using intracardiac injection and in vivo selection to isolate malignant cell subpopulations with a higher propensity for metastasis to bone and the central nervous system. Gene expression profiling revealed primary and metastatic cells as two distinct cell populations defined by differential expression of 412 genes and of multiple pathways, including CADM1, SPHK1, and YAP/TAZ, whose expression independently predicted survival. In the metastatic subpopulations, a gene signature was defined (MET-75) that predicted survival of neuroblastoma patients with metastatic disease. Mechanistic investigations demonstrated causal roles for CADM1, SPHK1, and YAP/TAZ in mediating metastatic phenotypes in vitro and in vivo Notably, pharmacologic targeting of SPHK1 or YAP/TAZ was sufficient to inhibit neuroblastoma metastasis in vivo Overall, we identify gene expression signatures and candidate therapeutics that could improve the treatment of metastatic neuroblastoma. Cancer Res; 77(3); 696-706. ©2017 AACR.
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Affiliation(s)
- Bo Kyung A Seong
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Program in Cell Biology, The Hospital for Sick Children, Toronto, Canada
| | - Kelly E Fathers
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Robin Hallett
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Christina K Yung
- Informatics and Bio-computing, Ontario Institute of Cancer Research, Toronto, Canada
| | - Lincoln D Stein
- Informatics and Bio-computing, Ontario Institute of Cancer Research, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Samar Mouaaz
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Lynn Kee
- Program in Cell Biology, The Hospital for Sick Children, Toronto, Canada
| | - Cynthia E Hawkins
- Program in Cell Biology, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Meredith S Irwin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada. .,Program in Cell Biology, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - David R Kaplan
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada. .,Department of Molecular Genetics, University of Toronto, Toronto, Canada
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19
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Torchia J, Feng S, Ho KC, Letourneau L, Picard D, Chan TS, Vasiljevic A, Khuong Quang DA, Golbourn B, Barsyte-Lovejoy D, Zeller C, Sin-Chan P, Agamez NR, Lu M, Lafay-Cousin L, Norman JD, Fouladi M, Hoffman LM, Rutkowski S, Pietsch T, Judkins AR, Bouffet E, Rutka JT, Hawkins CE, Arrowsmith CH, De Carvalho D, Jabado N, Huang A. Abstract LB-179: Integrated (epi)genomic analyses identify subgroup-specific therapeutic targets in CNS rhabdoid tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Atypical Teratoid Rhabdoid Tumors (ATRTs) are the most common malignant embryonal brain tumors arising in younger children that are distinctly lethal cancers for which effective therapies are lacking. Although ATRTs exhibit substantial clinical heterogeneity, exome studies reveal a relatively bland coding genome with only recurrent alterations of SMARCB1. Despite apparent genomic/genetic homogeneity, we recently reported that ATRTs comprise at least two transcriptional subclasses that correlate with different clinical features and treatment outcomes. However, the biological mechanisms and basis for molecular and therapeutic heterogeneity in ATRTs remained unclear. In this study, we integrated whole genome, exome, RNAseq as well as genome wide methylation and nucleosomal profiling analyses to comprehensively define the genomic and epigenomic landscape of ATRT sub-groups and identify sub-group specific therapeutic targets. Integration of multiplatform genomic analyses revealed novel recurrent genetic alterations in upto 20% of ATRTs. We observed predominantly structural coding events that targeted genes with functions in neural development and epigenetic regulation including BCR, MKL1 and EP300, thus suggesting greater complexity to the ATRT genome than previously appreciated. Global methylation (162) and gene expression analyses (90) of primary tumors indicated further segregation of ATRTs into three epigenetic sub-groups (group 1, 2A and 2B) that correlated with distinct lineage enriched gene expression profiles, global and SMARCB1 specific genotypes and different anatomic tumor locations and age at diagnosis. Group 1 ATRT exhibited enrichment of neurogenic/NOTCH signaling loci (ASCL1, FABP7, MYCN, C1ORF61, HES5/6, DLL1) and were predominantly supra-tentorial tumors arising in children at a median age of 24 months. In contrast Group 2A tumors arose predominantly in infra-tentorial locations in the youngest patients, while group 2B tumors were characteristically spinal in location. BMP signaling and mesenchymal differentiation genes (BMP4, BAMBI, PDGFRB) were commonly enriched in group 2A and B tumors; Group 2B tumors were additionally characterized by enrichment of MYCC, HOXB & C gene clusters. Remarkably, ATAC-seq analyses revealed distinct chromatin landscape associated with each ATRT sub-group, that correlated strikingly with sub-group specific therapeutic response in ATRT cell lines to a panel of signaling (NOTCH, BMP, Dasatinib) and epigenetic (EZH2, G9a, BRD4) inhibitors. Significantly, we discovered that differential methylation of a novel, PDGFRβ associated enhancer element confers robust sensitivity to tyrosine kinase inhibitors Dasatinib and Nilotinib in group 2 ATRTs, and suggest these as novel agents for this highly lethal ATRT sub-type.
Citation Format: Jonathon Torchia, Shengrui Feng, King Ching Ho, Louis Letourneau, Daniel Picard, Tiffany S. Chan, Alexandre Vasiljevic, Dong Anh Khuong Quang, Brian Golbourn, Dalia Barsyte-Lovejoy, Constanze Zeller, Patrick Sin-Chan, Natalia R. Agamez, Mei Lu, Lucie Lafay-Cousin, Joseph D. Norman, Maryam Fouladi, Lindsey M. Hoffman, Stefan Rutkowski, Torsten Pietsch, Alexander R. Judkins, Eric Bouffet, James T. Rutka, Cynthia E. Hawkins, Cheryl H. Arrowsmith, Daniel De Carvalho, Nada Jabado, Annie Huang. Integrated (epi)genomic analyses identify subgroup-specific therapeutic targets in CNS rhabdoid tumors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-179.
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Affiliation(s)
| | | | - King Ching Ho
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louis Letourneau
- 3Genome Quebec Innovation Centre, McGill University, Montreal, Quebec, Canada
| | - Daniel Picard
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Brian Golbourn
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Constanze Zeller
- 6Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - Mei Lu
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Maryam Fouladi
- 8Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Eric Bouffet
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James T. Rutka
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Daniel De Carvalho
- 6Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nada Jabado
- 5McGill University, Montreal, Quebec, Canada
| | - Annie Huang
- 2The Hospital for Sick Children, Toronto, Ontario, Canada
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20
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Ramaswamy V, Hielscher T, Mack SC, Lassaletta A, Lin T, Pajtler KW, Jones DTW, Luu B, Cavalli FMG, Aldape K, Remke M, Mynarek M, Rutkowski S, Gururangan S, McLendon RE, Lipp ES, Dunham C, Hukin J, Eisenstat DD, Fulton D, van Landeghem FKH, Santi M, van Veelen MLC, Van Meir EG, Osuka S, Fan X, Muraszko KM, Tirapelli DPC, Oba-Shinjo SM, Marie SKN, Carlotti CG, Lee JY, Rao AAN, Giannini C, Faria CC, Nunes S, Mora J, Hamilton RL, Hauser P, Jabado N, Petrecca K, Jung S, Massimi L, Zollo M, Cinalli G, Bognár L, Klekner A, Hortobágyi T, Leary S, Ermoian RP, Olson JM, Leonard JR, Gardner C, Grajkowska WA, Chambless LB, Cain J, Eberhart CG, Ahsan S, Massimino M, Giangaspero F, Buttarelli FR, Packer RJ, Emery L, Yong WH, Soto H, Liau LM, Everson R, Grossbach A, Shalaby T, Grotzer M, Karajannis MA, Zagzag D, Wheeler H, von Hoff K, Alonso MM, Tuñon T, Schüller U, Zitterbart K, Sterba J, Chan JA, Guzman M, Elbabaa SK, Colman H, Dhall G, Fisher PG, Fouladi M, Gajjar A, Goldman S, Hwang E, Kool M, Ladha H, Vera-Bolanos E, Wani K, Lieberman F, Mikkelsen T, Omuro AM, Pollack IF, Prados M, Robins HI, Soffietti R, Wu J, Metellus P, Tabori U, Bartels U, Bouffet E, Hawkins CE, Rutka JT, Dirks P, Pfister SM, Merchant TE, Gilbert MR, Armstrong TS, Korshunov A, Ellison DW, Taylor MD. Therapeutic Impact of Cytoreductive Surgery and Irradiation of Posterior Fossa Ependymoma in the Molecular Era: A Retrospective Multicohort Analysis. J Clin Oncol 2016; 34:2468-77. [PMID: 27269943 DOI: 10.1200/jco.2015.65.7825] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Posterior fossa ependymoma comprises two distinct molecular variants termed EPN_PFA and EPN_PFB that have a distinct biology and natural history. The therapeutic value of cytoreductive surgery and radiation therapy for posterior fossa ependymoma after accounting for molecular subgroup is not known. METHODS Four independent nonoverlapping retrospective cohorts of posterior fossa ependymomas (n = 820) were profiled using genome-wide methylation arrays. Risk stratification models were designed based on known clinical and newly described molecular biomarkers identified by multivariable Cox proportional hazards analyses. RESULTS Molecular subgroup is a powerful independent predictor of outcome even when accounting for age or treatment regimen. Incompletely resected EPN_PFA ependymomas have a dismal prognosis, with a 5-year progression-free survival ranging from 26.1% to 56.8% across all four cohorts. Although first-line (adjuvant) radiation is clearly beneficial for completely resected EPN_PFA, a substantial proportion of patients with EPN_PFB can be cured with surgery alone, and patients with relapsed EPN_PFB can often be treated successfully with delayed external-beam irradiation. CONCLUSION The most impactful biomarker for posterior fossa ependymoma is molecular subgroup affiliation, independent of other demographic or treatment variables. However, both EPN_PFA and EPN_PFB still benefit from increased extent of resection, with the survival rates being particularly poor for subtotally resected EPN_PFA, even with adjuvant radiation therapy. Patients with EPN_PFB who undergo gross total resection are at lower risk for relapse and should be considered for inclusion in a randomized clinical trial of observation alone with radiation reserved for those who experience recurrence.
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Affiliation(s)
- Vijay Ramaswamy
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Thomas Hielscher
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Stephen C Mack
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Alvaro Lassaletta
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Tong Lin
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Kristian W Pajtler
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - David T W Jones
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Betty Luu
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Florence M G Cavalli
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Kenneth Aldape
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Marc Remke
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Martin Mynarek
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Stefan Rutkowski
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Sridharan Gururangan
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Roger E McLendon
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Eric S Lipp
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Christopher Dunham
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Juliette Hukin
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - David D Eisenstat
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Dorcas Fulton
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Frank K H van Landeghem
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Mariarita Santi
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Marie-Lise C van Veelen
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Erwin G Van Meir
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Satoru Osuka
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Xing Fan
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Karin M Muraszko
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Daniela P C Tirapelli
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Sueli M Oba-Shinjo
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Suely K N Marie
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Carlos G Carlotti
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ji Yeoun Lee
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Amulya A Nageswara Rao
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Caterina Giannini
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Claudia C Faria
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Sofia Nunes
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jaume Mora
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ronald L Hamilton
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Peter Hauser
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Nada Jabado
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Kevin Petrecca
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Shin Jung
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Luca Massimi
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Massimo Zollo
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Giuseppe Cinalli
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - László Bognár
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Almos Klekner
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Tibor Hortobágyi
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Sarah Leary
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ralph P Ermoian
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - James M Olson
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jeffrey R Leonard
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Corrine Gardner
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Wieslawa A Grajkowska
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Lola B Chambless
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jason Cain
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Charles G Eberhart
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Sama Ahsan
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Maura Massimino
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Felice Giangaspero
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Francesca R Buttarelli
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Roger J Packer
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Lyndsey Emery
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - William H Yong
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Horacio Soto
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Linda M Liau
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Richard Everson
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Andrew Grossbach
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Tarek Shalaby
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Michael Grotzer
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Matthias A Karajannis
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - David Zagzag
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Helen Wheeler
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Katja von Hoff
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Marta M Alonso
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Teresa Tuñon
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ulrich Schüller
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Karel Zitterbart
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jaroslav Sterba
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jennifer A Chan
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Miguel Guzman
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Samer K Elbabaa
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Howard Colman
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Girish Dhall
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Paul G Fisher
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Maryam Fouladi
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Amar Gajjar
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Stewart Goldman
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Eugene Hwang
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Marcel Kool
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Harshad Ladha
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Elizabeth Vera-Bolanos
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Khalida Wani
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Frank Lieberman
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Tom Mikkelsen
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Antonio M Omuro
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ian F Pollack
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Michael Prados
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - H Ian Robins
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Riccardo Soffietti
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Jing Wu
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Phillipe Metellus
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Uri Tabori
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Ute Bartels
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Eric Bouffet
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Cynthia E Hawkins
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - James T Rutka
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Peter Dirks
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Stefan M Pfister
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Thomas E Merchant
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Mark R Gilbert
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Terri S Armstrong
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Andrey Korshunov
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - David W Ellison
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
| | - Michael D Taylor
- Vijay Ramaswamy, Stephen C. Mack, Alvaro Lassaletta, Betty Luu, Florence M.G. Cavalli, Uri Tabori, Ute Bartels, Eric Bouffet, Cynthia E. Hawkins, James T. Rutka, Peter Dirks, and Michael D. Taylor, The Hospital for Sick Children; Vijay Ramaswamy, Kenneth Aldape, James T. Rutka, and Michael D. Taylor, University of Toronto; Kenneth Aldape, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario; Christopher Dunham and Juliette Hukin, British Columbia Children's Hospital; Juliette Hukin, University of British Columbia, Vancouver, British Columbia; David D. Eisenstat, Dorcas Fulton, and Frank K.H. van Landeghem, University of Alberta, Edmonton; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Nada Jabado and Kevin Petrecca, McGill University, Montreal, Quebec, Canada; Thomas Hielscher, Kristian W. Pajtler, David T.W. Jones, Marcel Kool, Stefan M. Pfister, and Andrey Korshunov, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Marc Remke, University Hospital Düsseldorf, Düsseldorf; Martin Mynarek, Stefan Rutkowski, and Katja von Hoff, University Medical Center Hamburg-Eppendorf, Hamburg; Ulrich Schüller, Ludwig-Maximilians-Universität, Munich, Germany; Stephen C. Mack, Cleveland Clinic Foundation, Cleveland; Maryam Fouladi, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Tong Lin, Amar Gajjar, Thomas E. Merchant, and David W. Ellison, St Jude Children's Research Hospital, Memphis; Lola B. Chambless, Vanderbilt Medical Center, Nashville, TN; Sridharan Gururangan, Roger E. McLendon, and Eric S. Lipp, Duke University, Durham; Jing Wu, University of North Carolina at Chapel Hill, Chapel Hill, NC; Mariarita Santi, Children's Hospital of Philadelphia; Lyndsey Emery, Hospital of the University of Pennsylvania, Philadelphia; Ronald L. Hamilton and Ian F. Pollack, University of Pittsburgh School of Medicine; Frank Lieberman, University of Pittsburgh Medical Cen
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Torchia J, Feng S, Ho KC, Letourneau L, Picard D, Chan TS, Vasiljevic A, Quang DAK, Golbourn B, Barsyte-Lovejoy D, Zeller C, Sin-Chan P, Agamez NR, Lu M, Lafay-Cousin L, Norman JD, Fouladi M, Hoffman LM, Rutkowski S, Pietsch T, Judkins AR, Bouffet E, Rutka JT, Hawkins CE, Arrowsmith CH, De Carvalho D, Jabado N, Huang A. AT-21INTEGRATED (EPI)GENOMIC ANALYSES IDENTIFY SUB-GROUP SPECIFIC THERAPEUTIC TARGETS IN CNS RHABDOID TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now065.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bouffet E, Larouche V, Campbell BB, Merico D, de Borja R, Aronson M, Durno C, Krueger J, Cabric V, Ramaswamy V, Zhukova N, Mason G, Farah R, Afzal S, Yalon M, Rechavi G, Magimairajan V, Walsh MF, Constantini S, Dvir R, Elhasid R, Reddy A, Osborn M, Sullivan M, Hansford J, Dodgshun A, Klauber-Demore N, Peterson L, Patel S, Lindhorst S, Atkinson J, Cohen Z, Laframboise R, Dirks P, Taylor M, Malkin D, Albrecht S, Dudley RWR, Jabado N, Hawkins CE, Shlien A, Tabori U. Immune Checkpoint Inhibition for Hypermutant Glioblastoma Multiforme Resulting From Germline Biallelic Mismatch Repair Deficiency. J Clin Oncol 2016; 34:2206-11. [PMID: 27001570 DOI: 10.1200/jco.2016.66.6552] [Citation(s) in RCA: 612] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Recurrent glioblastoma multiforme (GBM) is incurable with current therapies. Biallelic mismatch repair deficiency (bMMRD) is a highly penetrant childhood cancer syndrome often resulting in GBM characterized by a high mutational burden. Evidence suggests that high mutation and neoantigen loads are associated with response to immune checkpoint inhibition. PATIENTS AND METHODS We performed exome sequencing and neoantigen prediction on 37 bMMRD cancers and compared them with childhood and adult brain neoplasms. Neoantigen prediction bMMRD GBM was compared with responsive adult cancers from multiple tissues. Two siblings with recurrent multifocal bMMRD GBM were treated with the immune checkpoint inhibitor nivolumab. RESULTS All malignant tumors (n = 32) were hypermutant. Although bMMRD brain tumors had the highest mutational load because of secondary polymerase mutations (mean, 17,740 ± standard deviation, 7,703), all other high-grade tumors were hypermutant (mean, 1,589 ± standard deviation, 1,043), similar to other cancers that responded favorably to immune checkpoint inhibitors. bMMRD GBM had a significantly higher mutational load than sporadic pediatric and adult gliomas and all other brain tumors (P < .001). bMMRD GBM harbored mean neoantigen loads seven to 16 times higher than those in immunoresponsive melanomas, lung cancers, or microsatellite-unstable GI cancers (P < .001). On the basis of these preclinical data, we treated two bMMRD siblings with recurrent multifocal GBM with the anti-programmed death-1 inhibitor nivolumab, which resulted in clinically significant responses and a profound radiologic response. CONCLUSION This report of initial and durable responses of recurrent GBM to immune checkpoint inhibition may have implications for GBM in general and other hypermutant cancers arising from primary (genetic predisposition) or secondary MMRD.
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Affiliation(s)
- Eric Bouffet
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Valérie Larouche
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Brittany B Campbell
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Daniele Merico
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Richard de Borja
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Melyssa Aronson
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Carol Durno
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Joerg Krueger
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Vanja Cabric
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Vijay Ramaswamy
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Nataliya Zhukova
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Gary Mason
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Roula Farah
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Samina Afzal
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Michal Yalon
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Gideon Rechavi
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Vanan Magimairajan
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Michael F Walsh
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Shlomi Constantini
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Rina Dvir
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Ronit Elhasid
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Alyssa Reddy
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Michael Osborn
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Michael Sullivan
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Jordan Hansford
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Andrew Dodgshun
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Nancy Klauber-Demore
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Lindsay Peterson
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Sunil Patel
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Scott Lindhorst
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Jeffrey Atkinson
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Zane Cohen
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Rachel Laframboise
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Peter Dirks
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Michael Taylor
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - David Malkin
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Steffen Albrecht
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Roy W R Dudley
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Nada Jabado
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Cynthia E Hawkins
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Adam Shlien
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC
| | - Uri Tabori
- Eric Bouffet, Brittany B. Campbell, Daniele Merico, Richard de Borja, Carol Durno, Joerg Krueger, Vanja Cabric, Vijay Ramaswamy, Nataliya Zhukova, Peter Dirks, Michael Taylor, David Malkin, Cynthia E. Hawkins, Adam Shlien, and Uri Tabori, The Hospital for Sick Children, Toronto; Melyssa Aronson, and Zane Cohen, Zane Cohen Centre for Digestive Diseases, Mount Sinai, Ontario; Valérie Larouche and Rachel Laframboise, Université Laval, Quebec City; Jeffrey Atkinson, Montreal Children's Hospital; Steffen Albrecht, Roy W.R. Dudley, and Nada Jabado, McGill University, Montreal, Montreal, Quebec; Samina Afzal, IWK Health Centre, Halifax, Nova Scotia; Vanan Magimairajan, Cancer Care Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada; Gary Mason, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA; Roula Farah, Saint George Hospital University Medical Center, Beirut, Lebanon; Michal Yalon and Gideon Rechavi, Sheba Medical Center, Tel Hashomer; Shlomi Constantini, Rina Dvir, and Ronit Elhasid, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Michael F. Walsh, Memorial Sloan Kettering Center, New York, NY; Alyssa Reddy, University of Alabama at Birmingham, Birmingham, AL; Michael Osborn, Women's and Children's Hospital, North Adelaide, South Australia; Michael Sullivan, Jordan Hansford, and Andrew Dodgshun, Royal Children's Hospital, Melbourne, Victoria, Australia; and Nancy Klauber-Demore, Lindsay Peterson, Sunil Patel, and Scott Lindhorst, Medical University of South Carolina, Charleston, SC.
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Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, McLendon RE, Bigner DD, Lipp ES, Perreault S, Cho YJ, Grant G, Kim SK, Lee JY, Rao AAN, Giannini C, Li KKW, Ng HK, Yao Y, Kumabe T, Tominaga T, Grajkowska WA, Perek-Polnik M, Low DCY, Seow WT, Chang KTE, Mora J, Pollack IF, Hamilton RL, Leary S, Moore AS, Ingram WJ, Hallahan AR, Jouvet A, Fèvre-Montange M, Vasiljevic A, Faure-Conter C, Shofuda T, Kagawa N, Hashimoto N, Jabado N, Weil AG, Gayden T, Wataya T, Shalaby T, Grotzer M, Zitterbart K, Sterba J, Kren L, Hortobágyi T, Klekner A, László B, Pócza T, Hauser P, Schüller U, Jung S, Jang WY, French PJ, Kros JM, van Veelen MLC, Massimi L, Leonard JR, Rubin JB, Vibhakar R, Chambless LB, Cooper MK, Thompson RC, Faria CC, Carvalho A, Nunes S, Pimentel J, Fan X, Muraszko KM, López-Aguilar E, Lyden D, Garzia L, Shih DJH, Kijima N, Schneider C, Adamski J, Northcott PA, Kool M, Jones DTW, Chan JA, Nikolic A, Garre ML, Van Meir EG, Osuka S, Olson JJ, Jahangiri A, Castro BA, Gupta N, Weiss WA, Moxon-Emre I, Mabbott DJ, Lassaletta A, Hawkins CE, Tabori U, Drake J, Kulkarni A, Dirks P, Rutka JT, Korshunov A, Pfister SM, Packer RJ, Ramaswamy V, Taylor MD. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol 2016; 17:484-495. [PMID: 26976201 PMCID: PMC4907853 DOI: 10.1016/s1470-2045(15)00581-1] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 12/12/2022]
Abstract
Background Incomplete surgical resection of medulloblastoma is controversially considered a marker of high-risk disease; driving aggressive surgical resections, “second-look” surgeries, and/or intensified chemoradiotherapy. All prior publications evaluating the clinical importance of extent of resection (EOR) failed to account for molecular subgroup. We analysed the prognostic value of EOR across 787 medulloblastoma samples in a subgroup-specific manner. Methods We retrospectively identified patients from Medulloblastoma Advanced Genomics International Consortium (MAGIC) centres with a histological diagnosis of medulloblastoma and complete extent of resection and survival data. Specimens were collected from 35 international institutions. Medulloblastoma subgroup affiliation was determined using nanoString gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. Extent of resection (EOR) based on post-operative imaging was classified as gross total (GTR), near total (NTR, <1·5cm2), or subtotal (STR, ≥ 1·5cm2). Overall survival (OS) and progression-free survival (PFS) multivariable analyses including subgroup, age, metastatic status, geographical location of therapy (North America/Australia vs world), and adjuvant therapy regimen were performed. The primary endpoint was the impact of surgical EOR by molecular subgroup and other clinical variables on OS and PFS. Findings 787 medulloblastoma patients (86 WNT, 242 SHH, 163 Group 3, and 296 Group 4) were included in a multivariable Cox model of PFS and OS. The marked benefit of EOR in the overall cohort was greatly attenuated after including molecular subgroup in the multivariable analysis. There was an observed PFS benefit of GTR over STR (hazard ration [HR] 1·45, 95% CI; 1·07–1·96, p=0·02) but there was no observed PFS or OS benefit of GTR over NTR (HR 1·05, 0·71–1·53, p=0·82 and HR 1·14, 0·75–1·72, p=0.55). There was no statistically significant survival benefit to greater EOR for patients with WNT, SHH, or Group 3 patients (HR 1·03, 0·67–1·58, p=0·9 for STR vs. GTR). There was a PFS benefit for GTR over STR in patients with Group 4 medulloblastoma (HR1·97, 1·22–3·17, p=0·01), particularly those with metastatic disease (HR 2·22, 1–4·93, p=0·05). A nomogram based on this multivariable cox proportional hazards model shows the comparably smaller impact of EOR on relative risk for PFS and OS than subgroup affiliation, metastatic status, radiation dose, and adjuvant chemotherapy. Interpretation The prognostic benefit of EOR for patients with medulloblastoma is attenuated after accounting for molecular subgroup affiliation. Although maximal safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high as there is no definitive benefit to GTR over NTR. Our results suggest a re-evaluation of the long-term implications of intensified craniospinal irradiation (36 Gy) in children with small residual portions of medulloblastoma. Funding Funding Canadian Cancer Society Research Institute, Terry Fox Research Institute, Canadian Institutes of Health Research, National Institutes of Health, Pediatric Brain Tumor Foundation, Garron Family Chair in Childhood Cancer Research.
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Affiliation(s)
- Eric M Thompson
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marc Remke
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Betty Luu
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Darell D Bigner
- Department of Pathology, Duke University, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
| | - Eric S Lipp
- Department of Pathology, Duke University, Durham, NC, USA
| | | | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford, CA, USA
| | - Seung-Ki Kim
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | | | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kay Ka Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yu Yao
- Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology & Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald L Hamilton
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah Leary
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Andrew S Moore
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Wendy J Ingram
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Andrew R Hallahan
- UQ Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia; Oncology Service, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Anne Jouvet
- Centre de Pathologie EST, Groupement Hospitalier EST, Université de Lyon, Lyon, France
| | - Michelle Fèvre-Montange
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences, Université de Lyon, Lyon, France
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; ONCOFLAM, Neuro-Oncologie et Neuro-Inflammation Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | | | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, Osaka, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, QC, Canada
| | - Alexander G Weil
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Tenzin Gayden
- Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Takafumi Wataya
- Department of Pediatric Neurosurgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Tarek Shalaby
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Michael Grotzer
- Departments of Oncology and Neuro-Oncology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Sterba
- Department of Pediatric Oncology, School of Medicine, Masaryk University, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | - Tibor Hortobágyi
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Almos Klekner
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Bognár László
- Division of Neuropathology, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | - Tímea Pócza
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Woo-Youl Jang
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Hwasun-gun, Chonnam South Korea
| | - Pim J French
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan M Kros
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Luca Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Jeffrey R Leonard
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Joshua B Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Michael K Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Alice Carvalho
- Departamento de Oncologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Sofia Nunes
- Unidade de Neuro-Oncologia Pediátrica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - José Pimentel
- Divison of Pathology, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Xing Fan
- Department of Neurosurgery and Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Enrique López-Aguilar
- Division of Pediatric Hematology/Oncology, Hospital Pediatría Centro Médico Nacional Century XXI, Mexico City, Mexico
| | - David Lyden
- Department of Pediatrics and Cell and Developmental Biology, Weill Cornell Medical College, New York, NY, USA
| | - Livia Garzia
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - David J H Shih
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Noriyuki Kijima
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christian Schneider
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Adamski
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul A Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Ana Nikolic
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Erwin G Van Meir
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Satoru Osuka
- Department of Hematology & Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Arman Jahangiri
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brandyn A Castro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - William A Weiss
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Iska Moxon-Emre
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Program in Neuroscience and Mental Health and Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia E Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Drake
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Abhaya Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Roger J Packer
- Department of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Vijay Ramaswamy
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada; Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Hoffman LM, DeWire M, Ryall S, Buczkowicz P, Leach J, Miles L, Ramani AK, Brudno M, Kumar SS, Drissi R, Dexheimer P, Salloum R, Chow L, Hummel T, Stevenson C, Lu QR, Jones B, Witte D, Aronow B, Hawkins CE, Fouladi M. Erratum: Spatial genomic heterogeneity in diffuse intrinsic pontine and midline high-grade glioma: implications for diagnostic biopsy and targeted therapeutics. Acta Neuropathol Commun 2016; 4:13. [PMID: 26860432 PMCID: PMC4748490 DOI: 10.1186/s40478-016-0283-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/26/2022] Open
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Hoffman LM, DeWire M, Ryall S, Buczkowicz P, Leach J, Miles L, Ramani A, Brudno M, Kumar SS, Drissi R, Dexheimer P, Salloum R, Chow L, Hummel T, Stevenson C, Lu QR, Jones B, Witte D, Aronow B, Hawkins CE, Fouladi M. Spatial genomic heterogeneity in diffuse intrinsic pontine and midline high-grade glioma: implications for diagnostic biopsy and targeted therapeutics. Acta Neuropathol Commun 2016; 4:1. [PMID: 26727948 PMCID: PMC4700584 DOI: 10.1186/s40478-015-0269-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Diffuse intrinsic pontine glioma (DIPG) and midline high-grade glioma (mHGG) are lethal childhood brain tumors. Spatial genomic heterogeneity has been well-described in adult HGG but has not been comprehensively characterized in pediatric HGG. We performed whole exome sequencing on 38-matched primary, contiguous, and metastatic tumor sites from eight children with DIPG (n = 7) or mHGG (n = 1) collected using a unique MRI-guided autopsy protocol. Validation was performed using Sanger sequencing, Droplet Digital polymerase-chain reaction, immunohistochemistry, and fluorescent in-situ hybridization. Results Median age at diagnosis was 6.1 years (range: 2.9–23.3 years). Median overall survival was 13.2 months (range: 11.2–32.2 months). Contiguous tumor infiltration and distant metastases were observed in seven and six patients, respectively, including leptomeningeal dissemination in three DIPGs. Histopathological heterogeneity was evident in seven patients, including intra-pontine heterogeneity in two DIPGs, ranging from World Health Organization grade II to IV astrocytoma. We found conservation of heterozygous K27M mutations in H3F3A (n = 4) or HIST1H3B (n = 3) across all primary, contiguous, and metastatic tumor sites in all DIPGs. ACVR1 (n = 2), PIK3CA (n = 2), FGFR1 (n = 2), and MET (n = 1) were also intra-tumorally conserved. ACVR1 was co-mutated with HIST1H3B (n = 2). In contrast, PDGFRA amplification and mutation were spatially heterogeneous, as were mutations in BCOR (n = 1), ATRX (n = 2), and MYC (n = 1). TP53 aberrations (n = 3 patients) varied by type and location between primary and metastatic tumors sites but were intra-tumorally conserved. Conclusion Spatial conservation of prognostically-relevant and therapeutically-targetable somatic mutations in DIPG and mHGG contrasts the significant heterogeneity of driver mutations seen in adult HGG and supports uniform implementation of diagnostic biopsy in DIPG and mHGG to classify molecular risk groups and guide therapeutic strategy. Electronic supplementary material The online version of this article (doi:10.1186/s40478-015-0269-0) contains supplementary material, which is available to authorized users.
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Ichimura K, Narita Y, Hawkins CE. Diffusely infiltrating astrocytomas: pathology, molecular mechanisms and markers. Acta Neuropathol 2015; 129:789-808. [PMID: 25975377 DOI: 10.1007/s00401-015-1439-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 04/09/2015] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
Diffusely infiltrating astrocytomas include diffuse astrocytomas WHO grade II and anaplastic astrocytomas WHO grade III and are classified under astrocytic tumours according to the current WHO Classification. Although the patients generally have longer survival as compared to those with glioblastoma, the timing of inevitable malignant progression ultimately determines the prognosis. Recent advances in molecular genetics have uncovered that histopathologically diagnosed astrocytomas may consist of two genetically different groups of tumours. The majority of diffusely infiltrating astrocytomas regardless of WHO grade have concurrent mutations of IDH1 or IDH2, TP53 and ATRX. Among these astrocytomas, no other genetic markers that may distinguish grade II and grade III tumours have been identified. Those astrocytomas without IDH mutation tend to have a distinct genotype and a poor prognosis comparable to that of glioblastomas. On the other hand, diffuse astrocytomas that arise in children do not harbour IDH/TP53 mutations, but instead display mutations of BRAF or structural alterations involving MYB/MYBL1 or FGFR1. A molecular classification may thus help delineate diffusely infiltrating astrocytomas into distinct pathogenic and prognostic groups, which could aid in determining individualised therapeutic strategies.
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Affiliation(s)
- Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan,
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Torchia J, Picard D, Lafay-Cousin L, Hawkins CE, Kim SK, Letourneau L, Ra YS, Ho KC, Chan TSY, Sin-Chan P, Dunham CP, Yip S, Ng HK, Lu JQ, Albrecht S, Pimentel J, Chan JA, Somers GR, Zielenska M, Faria CC, Roque L, Baskin B, Birks D, Foreman N, Strother D, Klekner A, Garami M, Hauser P, Hortobágyi T, Bognár L, Wilson B, Hukin J, Carret AS, Van Meter TE, Nakamura H, Toledano H, Fried I, Fults D, Wataya T, Fryer C, Eisenstat DD, Scheineman K, Johnston D, Michaud J, Zelcer S, Hammond R, Ramsay DA, Fleming AJ, Lulla RR, Fangusaro JR, Sirachainan N, Larbcharoensub N, Hongeng S, Barakzai MA, Montpetit A, Stephens D, Grundy RG, Schüller U, Nicolaides T, Tihan T, Phillips J, Taylor MD, Rutka JT, Dirks P, Bader GD, Warmuth-Metz M, Rutkowski S, Pietsch T, Judkins AR, Jabado N, Bouffet E, Huang A. Molecular subgroups of atypical teratoid rhabdoid tumours in children: an integrated genomic and clinicopathological analysis. Lancet Oncol 2015; 16:569-82. [PMID: 25882982 DOI: 10.1016/s1470-2045(15)70114-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rhabdoid brain tumours, also called atypical teratoid rhabdoid tumours, are lethal childhood cancers with characteristic genetic alterations of SMARCB1/hSNF5. Lack of biological understanding of the substantial clinical heterogeneity of these tumours restricts therapeutic advances. We integrated genomic and clinicopathological analyses of a cohort of patients with atypical teratoid rhabdoid tumours to find out the molecular basis for clinical heterogeneity in these tumours. METHODS We obtained 259 rhabdoid tumours from 37 international institutions and assessed transcriptional profiles in 43 primary tumours and copy number profiles in 38 primary tumours to discover molecular subgroups of atypical teratoid rhabdoid tumours. We used gene and pathway enrichment analyses to discover group-specific molecular markers and did immunohistochemical analyses on 125 primary tumours to evaluate clinicopathological significance of molecular subgroup and ASCL1-NOTCH signalling. FINDINGS Transcriptional analyses identified two atypical teratoid rhabdoid tumour subgroups with differential enrichment of genetic pathways, and distinct clinicopathological and survival features. Expression of ASCL1, a regulator of NOTCH signalling, correlated with supratentorial location (p=0·004) and superior 5-year overall survival (35%, 95% CI 13-57, and 20%, 6-34, for ASCL1-positive and ASCL1-negative tumours, respectively; p=0·033) in 70 patients who received multimodal treatment. ASCL1 expression also correlated with superior 5-year overall survival (34%, 7-61, and 9%, 0-21, for ASCL1-positive and ASCL1-negative tumours, respectively; p=0·001) in 39 patients who received only chemotherapy without radiation. Cox hazard ratios for overall survival in patients with differential ASCL1 enrichment treated with chemotherapy with or without radiation were 2·02 (95% CI 1·04-3·85; p=0·038) and 3·98 (1·71-9·26; p=0·001). Integrated analyses of molecular subgroupings with clinical prognostic factors showed three distinct clinical risk groups of tumours with different therapeutic outcomes. INTERPRETATION An integration of clinical risk factors and tumour molecular groups can be used to identify patients who are likely to have improved long-term radiation-free survival and might help therapeutic stratification of patients with atypical teratoid rhabdoid tumours. FUNDING C17 Research Network, Genome Canada, b.r.a.i.n.child, Mitchell Duckman, Tal Doron and Suri Boon foundations.
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Affiliation(s)
- Jonathon Torchia
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Daniel Picard
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Lucie Lafay-Cousin
- Alberta Children's Hospital, and Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia E Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, Hospital for Sick Children, Toronto, ON, Canada
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Louis Letourneau
- Genome Quebec Innovation Centre, McGill University, Montreal, QC, Canada
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Songpa-gu, Seoul, South Korea
| | - King Ching Ho
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tiffany Sin Yu Chan
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Patrick Sin-Chan
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Christopher P Dunham
- Division of Anatomic Pathology, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada
| | - Stephen Yip
- Department of Neuropathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Qiang Lu
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Steffen Albrecht
- Department of Pathology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, QC, Canada
| | - José Pimentel
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Gino R Somers
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Maria Zielenska
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Claudia C Faria
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Lucia Roque
- Cytogenetic Laboratory, Centro de Investigação em Patobiologia Molecular, Portuguese Cancer Institute, Lisbon, Portugal
| | - Berivan Baskin
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Diane Birks
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Nick Foreman
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Douglas Strother
- Alberta Children's Hospital, and Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Miklos Garami
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Tibor Hortobágyi
- Department of Histopathology, Faculty of Medicine, University of Szeged, Hungary
| | - Laszló Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Beverly Wilson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Juliette Hukin
- Division of Neurology and Oncology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anne-Sophie Carret
- Division of Hematology-Oncology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Timothy E Van Meter
- Pediatric Hematology-Oncology, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
| | - Helen Toledano
- Oncology Department, Schneider Hospital, Petach Tikva, Israel
| | - Iris Fried
- Pediatric Hematology Oncology Department, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Daniel Fults
- Department of Neurosurgery, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, Aoi-ku, Shizuoka, Japan
| | - Chris Fryer
- Division of Hematology and Oncology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - David D Eisenstat
- Departments of Pediatrics and Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | | | - Donna Johnston
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, Ottawa Hospital and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shayna Zelcer
- Division of Children's Health and Therapeutics, Children's Health Research Institute, London, ON, Canada
| | - Robert Hammond
- Department of Pathology, University of Western Ontario, London, ON, Canada
| | - David A Ramsay
- Department of Pathology, London Health Sciences Centre, London, ON, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, ON, Canada
| | - Rishi R Lulla
- Division of Pediatrics-Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jason R Fangusaro
- Division of Pediatrics-Hematology, Oncology and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nongnuch Sirachainan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suradej Hongeng
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Derek Stephens
- Department of Clinical Research Services, Hospital for Sick Children, Toronto, ON, Canada
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, School of Clinical Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany
| | - Theodore Nicolaides
- Department of Pediatrics Hematology/Oncology, University of California, San Francisco, CA, USA
| | - Tarik Tihan
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Joanna Phillips
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael D Taylor
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Gary D Bader
- Department of Computer Science, Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, ON, Canada; Department of Molecular Genetics, University of Toronto, ON, Canada
| | | | - Stefan Rutkowski
- Department of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Alexander R Judkins
- Department of Pathology and Laboratory Medicine at Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, QC, Canada; Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Eric Bouffet
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Annie Huang
- Division of Hematology-Oncology, University of Toronto, Toronto, ON, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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Mistry M, Zhukova N, Merico D, Rakopoulos P, Krishnatry R, Shago M, Stavropoulos J, Alon N, Pole JD, Ray PN, Navickiene V, Mangerel J, Remke M, Buczkowicz P, Ramaswamy V, Guerreiro Stucklin A, Li M, Young EJ, Zhang C, Castelo-Branco P, Bakry D, Laughlin S, Shlien A, Chan J, Ligon KL, Rutka JT, Dirks PB, Taylor MD, Greenberg M, Malkin D, Huang A, Bouffet E, Hawkins CE, Tabori U. BRAF mutation and CDKN2A deletion define a clinically distinct subgroup of childhood secondary high-grade glioma. J Clin Oncol 2015; 33:1015-22. [PMID: 25667294 DOI: 10.1200/jco.2014.58.3922] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To uncover the genetic events leading to transformation of pediatric low-grade glioma (PLGG) to secondary high-grade glioma (sHGG). PATIENTS AND METHODS We retrospectively identified patients with sHGG from a population-based cohort of 886 patients with PLGG with long clinical follow-up. Exome sequencing and array CGH were performed on available samples followed by detailed genetic analysis of the entire sHGG cohort. Clinical and outcome data of genetically distinct subgroups were obtained. RESULTS sHGG was observed in 2.9% of PLGGs (26 of 886 patients). Patients with sHGG had a high frequency of nonsilent somatic mutations compared with patients with primary pediatric high-grade glioma (HGG; median, 25 mutations per exome; P = .0042). Alterations in chromatin-modifying genes and telomere-maintenance pathways were commonly observed, whereas no sHGG harbored the BRAF-KIAA1549 fusion. The most recurrent alterations were BRAF V600E and CDKN2A deletion in 39% and 57% of sHGGs, respectively. Importantly, all BRAF V600E and 80% of CDKN2A alterations could be traced back to their PLGG counterparts. BRAF V600E distinguished sHGG from primary HGG (P = .0023), whereas BRAF and CDKN2A alterations were less commonly observed in PLGG that did not transform (P < .001 and P < .001 respectively). PLGGs with BRAF mutations had longer latency to transformation than wild-type PLGG (median, 6.65 years [range, 3.5 to 20.3 years] v 1.59 years [range, 0.32 to 15.9 years], respectively; P = .0389). Furthermore, 5-year overall survival was 75% ± 15% and 29% ± 12% for children with BRAF mutant and wild-type tumors, respectively (P = .024). CONCLUSION BRAF V600E mutations and CDKN2A deletions constitute a clinically distinct subtype of sHGG. The prolonged course to transformation for BRAF V600E PLGGs provides an opportunity for surgical interventions, surveillance, and targeted therapies to mitigate the outcome of sHGG.
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Affiliation(s)
- Matthew Mistry
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Nataliya Zhukova
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Daniele Merico
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Patricia Rakopoulos
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Rahul Krishnatry
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Mary Shago
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - James Stavropoulos
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Noa Alon
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Jason D Pole
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Peter N Ray
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Vilma Navickiene
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Joshua Mangerel
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Marc Remke
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Pawel Buczkowicz
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Vijay Ramaswamy
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Ana Guerreiro Stucklin
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Martin Li
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Edwin J Young
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Cindy Zhang
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Pedro Castelo-Branco
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Doua Bakry
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Suzanne Laughlin
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Adam Shlien
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Jennifer Chan
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Keith L Ligon
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - James T Rutka
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Peter B Dirks
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Michael D Taylor
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Mark Greenberg
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - David Malkin
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Annie Huang
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Eric Bouffet
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Cynthia E Hawkins
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA
| | - Uri Tabori
- Matthew Mistry, Nataliya Zhukova, Daniele Merico, Rahul Krishnatry, Mary Shago, James Stavropoulos, Noa Alon, Peter N. Ray, Vilma Navickiene, Joshua Mangerel, Marc Remke, Vijay Ramaswamy, Ana Guerreiro Stucklin, Martin Li, Edwin J. Young, Cindy Zhang, Pedro Castelo-Branco, Doua Bakry, Suzanne Laughlin, James T. Rutka, Peter B. Dirks, Michael D. Taylor, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori; The Hospital for Sick Children; Matthew Mistry, Patricia Rakopoulos, Rahul Krishnatry, Joshua Mangerel, Pawel Buczkowicz, Ana Guerreiro Stucklin, Doua Bakry, Adam Shlien, Mark Greenberg, David Malkin, Annie Huang, Eric Bouffet, Cynthia E. Hawkins, and Uri Tabori, University of Toronto; Jason D. Pole, Pediatric Oncology Group of Ontario, Toronto, Ontario; Jennifer Chan, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Pedro Castelo-Branco, Universidade do Algarve, Faro, Portugal; Keith L. Ligon, Dana-Farber/Boston Children's Cancer Center, Boston, MA.
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Zhukova N, Ramaswamy V, Remke M, Martin DC, Castelo-Branco P, Zhang CH, Fraser M, Tse K, Poon R, Shih DJH, Baskin B, Ray PN, Bouffet E, Dirks P, von Bueren AO, Pfaff E, Korshunov A, Jones DTW, Northcott PA, Kool M, Pugh TJ, Pomeroy SL, Cho YJ, Pietsch T, Gessi M, Rutkowski S, Bognár L, Cho BK, Eberhart CG, Conter CF, Fouladi M, French PJ, Grajkowska WA, Gupta N, Hauser P, Jabado N, Vasiljevic A, Jung S, Kim SK, Klekner A, Kumabe T, Lach B, Leonard JR, Liau LM, Massimi L, Pollack IF, Ra YS, Rubin JB, Van Meir EG, Wang KC, Weiss WA, Zitterbart K, Bristow RG, Alman B, Hawkins CE, Malkin D, Clifford SC, Pfister SM, Taylor MD, Tabori U. WNT activation by lithium abrogates TP53 mutation associated radiation resistance in medulloblastoma. Acta Neuropathol Commun 2014; 2:174. [PMID: 25539912 PMCID: PMC4297452 DOI: 10.1186/s40478-014-0174-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022] Open
Abstract
TP53 mutations confer subgroup specific poor survival for children with medulloblastoma. We hypothesized that WNT activation which is associated with improved survival for such children abrogates TP53 related radioresistance and can be used to sensitize TP53 mutant tumors for radiation. We examined the subgroup-specific role of TP53 mutations in a cohort of 314 patients treated with radiation. TP53 wild-type or mutant human medulloblastoma cell-lines and normal neural stem cells were used to test radioresistance of TP53 mutations and the radiosensitizing effect of WNT activation on tumors and the developing brain. Children with WNT/TP53 mutant medulloblastoma had higher 5-year survival than those with SHH/TP53 mutant tumours (100% and 36.6% ± 8.7%, respectively (p < 0.001)). Introduction of TP53 mutation into medulloblastoma cells induced radioresistance (survival fractions at 2Gy (SF2) of 89% ± 2% vs. 57.4% ± 1.8% (p < 0.01)). In contrast, β-catenin mutation sensitized TP53 mutant cells to radiation (p < 0.05). Lithium, an activator of the WNT pathway, sensitized TP53 mutant medulloblastoma to radiation (SF2 of 43.5% ± 1.5% in lithium treated cells vs. 56.6 ± 3% (p < 0.01)) accompanied by increased number of γH2AX foci. Normal neural stem cells were protected from lithium induced radiation damage (SF2 of 33% ± 8% for lithium treated cells vs. 27% ± 3% for untreated controls (p = 0.05). Poor survival of patients with TP53 mutant medulloblastoma may be related to radiation resistance. Since constitutive activation of the WNT pathway by lithium sensitizes TP53 mutant medulloblastoma cells and protect normal neural stem cells from radiation, this oral drug may represent an attractive novel therapy for high-risk medulloblastomas.
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Spence T, Sin-Chan P, Picard D, Barszczyk M, Hoss K, Lu M, Kim SK, Ra YS, Nakamura H, Fangusaro J, Hwang E, Kiehna E, Toledano H, Wang Y, Shi Q, Johnston D, Michaud J, La Spina M, Buccoliero AM, Adamek D, Camelo-Piragua S, Peter Collins V, Jones C, Kabbara N, Jurdi N, Varlet P, Perry A, Scharnhorst D, Fan X, Muraszko KM, Eberhart CG, Ng HK, Gururangan S, Van Meter T, Remke M, Lafay-Cousin L, Chan JA, Sirachainan N, Pomeroy SL, Clifford SC, Gajjar A, Shago M, Halliday W, Taylor MD, Grundy R, Lau CC, Phillips J, Bouffet E, Dirks PB, Hawkins CE, Huang A. CNS-PNETs with C19MC amplification and/or LIN28 expression comprise a distinct histogenetic diagnostic and therapeutic entity. Acta Neuropathol 2014; 128:291-303. [PMID: 24839957 PMCID: PMC4159569 DOI: 10.1007/s00401-014-1291-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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: 11/26/2013] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 10/26/2022]
Abstract
Amplification of the C19MC oncogenic miRNA cluster and high LIN28 expression has been linked to a distinctly aggressive group of cerebral CNS-PNETs (group 1 CNS-PNETs) arising in young children. In this study, we sought to evaluate the diagnostic specificity of C19MC and LIN28, and the clinical and biological spectra of C19MC amplified and/or LIN28+ CNS-PNETs. We interrogated 450 pediatric brain tumors using FISH and IHC analyses and demonstrate that C19MC alteration is restricted to a sub-group of CNS-PNETs with high LIN28 expression; however, LIN28 immunopositivity was not exclusive to CNS-PNETs but was also detected in a proportion of other malignant pediatric brain tumors including rhabdoid brain tumors and malignant gliomas. C19MC amplified/LIN28+ group 1 CNS-PNETs arose predominantly in children <4 years old; a majority arose in the cerebrum but 24 % (13/54) of tumors had extra-cerebral origins. Notably, group 1 CNS-PNETs encompassed several histologic classes including embryonal tumor with abundant neuropil and true rosettes (ETANTR), medulloepithelioma, ependymoblastoma and CNS-PNETs with variable differentiation. Strikingly, gene expression and methylation profiling analyses revealed a common molecular signature enriched for primitive neural features, high LIN28/LIN28B and DNMT3B expression for all group 1 CNS-PNETs regardless of location or tumor histology. Our collective findings suggest that current known histologic categories of CNS-PNETs which include ETANTRs, medulloepitheliomas, ependymoblastomas in various CNS locations, comprise a common molecular and diagnostic entity and identify inhibitors of the LIN28/let7/PI3K/mTOR axis and DNMT3B as promising therapeutics for this distinct histogenetic entity.
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Affiliation(s)
- Tara Spence
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Patrick Sin-Chan
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Daniel Picard
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
| | - Mark Barszczyk
- Department of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Katharina Hoss
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
| | - Mei Lu
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul, South Korea
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
| | - Jason Fangusaro
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Children’s Memorial Hospital, Chicago, IL USA
| | - Eugene Hwang
- Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC USA
| | - Erin Kiehna
- Department of Neurosurgery, Children’s Hospital of Los Angeles, Los Angeles, CA USA
| | - Helen Toledano
- Oncology Department, Schneider Hospital, Petach Tikva, Israel
| | - Yin Wang
- Department of Neuropathology Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Shi
- Department of Pathology, Shanghai Children’s Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donna Johnston
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
| | - Milena La Spina
- Paediatric Haematology and Oncology Division, University of Catania, Sicily, Italy
| | | | - Dariusz Adamek
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Chris Jones
- Department of Paediatric Molecular Pathology, Institute of Cancer Research, Sutton, UK
| | - Nabil Kabbara
- Division of Pediatric Hematology Oncology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Nawaf Jurdi
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pascale Varlet
- Medical and Department of Neuropathology, Sainte-Anne Hospital, University Paris V Descartes, Paris, France
| | - Arie Perry
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA USA
| | - David Scharnhorst
- Department of Pathology, Children’s Hospital Central California, Madera, CA USA
| | - Xing Fan
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI USA
| | - Karin M. Muraszko
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI USA
| | - Charles G. Eberhart
- Division of Pathology, John Hopkins University School of Medicine, Baltimore, MD USA
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Physiology, Chinese University of Hong Kong, Hong Kong, China
| | | | - Timothy Van Meter
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA USA
| | - Marc Remke
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Lucie Lafay-Cousin
- Department of Pediatric Oncology, Alberta Children’s Hospital, Calgary, AB Canada
| | - Jennifer A. Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB Canada
| | - Nongnuch Sirachainan
- Departments of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Scott L. Pomeroy
- Department of Neurology, Children’s Hospital Boston, Boston, MA USA
| | - Steven C. Clifford
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Amar Gajjar
- Neuro-oncology Division, St Jude Children’s Research Hospital, Memphis, TN USA
| | - Mary Shago
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON Canada
| | - William Halliday
- Department of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Michael D. Taylor
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Richard Grundy
- Children’s Brain Tumor Research Centre, Queen’s Medical Centre University of Nottingham, Nottingham, UK
| | - Ching C. Lau
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX USA
| | - Joanna Phillips
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA USA
| | - Eric Bouffet
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
| | - Peter B. Dirks
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Cynthia E. Hawkins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Department of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Annie Huang
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Arthur and Sonia Labatt Brain Tumor Research Centre, Peter Gilgan CRL,686 Bay Street, 17th Floor, 179712, Toronto, ON M5G0A4 Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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Shih DJH, Northcott PA, Remke M, Korshunov A, Ramaswamy V, Kool M, Luu B, Yao Y, Wang X, Dubuc AM, Garzia L, Peacock J, Mack SC, Wu X, Rolider A, Morrissy AS, Cavalli FMG, Jones DTW, Zitterbart K, Faria CC, Schüller U, Kren L, Kumabe T, Tominaga T, Shin Ra Y, Garami M, Hauser P, Chan JA, Robinson S, Bognár L, Klekner A, Saad AG, Liau LM, Albrecht S, Fontebasso A, Cinalli G, De Antonellis P, Zollo M, Cooper MK, Thompson RC, Bailey S, Lindsey JC, Di Rocco C, Massimi L, Michiels EMC, Scherer SW, Phillips JJ, Gupta N, Fan X, Muraszko KM, Vibhakar R, Eberhart CG, Fouladi M, Lach B, Jung S, Wechsler-Reya RJ, Fèvre-Montange M, Jouvet A, Jabado N, Pollack IF, Weiss WA, Lee JY, Cho BK, Kim SK, Wang KC, Leonard JR, Rubin JB, de Torres C, Lavarino C, Mora J, Cho YJ, Tabori U, Olson JM, Gajjar A, Packer RJ, Rutkowski S, Pomeroy SL, French PJ, Kloosterhof NK, Kros JM, Van Meir EG, Clifford SC, Bourdeaut F, Delattre O, Doz FF, Hawkins CE, Malkin D, Grajkowska WA, Perek-Polnik M, Bouffet E, Rutka JT, Pfister SM, Taylor MD. Cytogenetic prognostication within medulloblastoma subgroups. J Clin Oncol 2014; 32:886-96. [PMID: 24493713 DOI: 10.1200/jco.2013.50.9539] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, Group 3, and Group 4. Current medulloblastoma protocols stratify patients based on clinical features: patient age, metastatic stage, extent of resection, and histologic variant. Stark prognostic and genetic differences among the four subgroups suggest that subgroup-specific molecular biomarkers could improve patient prognostication. PATIENTS AND METHODS Molecular biomarkers were identified from a discovery set of 673 medulloblastomas from 43 cities around the world. Combined risk stratification models were designed based on clinical and cytogenetic biomarkers identified by multivariable Cox proportional hazards analyses. Identified biomarkers were tested using fluorescent in situ hybridization (FISH) on a nonoverlapping medulloblastoma tissue microarray (n = 453), with subsequent validation of the risk stratification models. RESULTS Subgroup information improves the predictive accuracy of a multivariable survival model compared with clinical biomarkers alone. Most previously published cytogenetic biomarkers are only prognostic within a single medulloblastoma subgroup. Profiling six FISH biomarkers (GLI2, MYC, chromosome 11 [chr11], chr14, 17p, and 17q) on formalin-fixed paraffin-embedded tissues, we can reliably and reproducibly identify very low-risk and very high-risk patients within SHH, Group 3, and Group 4 medulloblastomas. CONCLUSION Combining subgroup and cytogenetic biomarkers with established clinical biomarkers substantially improves patient prognostication, even in the context of heterogeneous clinical therapies. The prognostic significance of most molecular biomarkers is restricted to a specific subgroup. We have identified a small panel of cytogenetic biomarkers that reliably identifies very high-risk and very low-risk groups of patients, making it an excellent tool for selecting patients for therapy intensification and therapy de-escalation in future clinical trials.
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Affiliation(s)
- David J H Shih
- David J.H. Shih, Marc Remke, Vijay Ramaswamy, Betty Luu, Yuan Yao, Xin Wang, Adrian M. Dubuc, Livia Garzia, John Peacock, Stephen C. Mack, Xiaochong Wu, Adi Rolider, A. Sorana Morrissy, Florence M.G. Cavalli, Claudia C. Faria, Stephen W. Scherer, Uri Tabori, Cynthia E. Hawkins, David Malkin, Eric Bouffet, James T. Rutka, and Michael D. Taylor, Hospital for Sick Children; David J.H. Shih, Marc Remke, Vijay Ramaswamy, Yuan Yao, Xin Wang, Adrian M. Dubuc, John Peacock, Stephen C. Mack, and Michael D. Taylor, University of Toronto, Toronto; Boleslaw Lach, McMaster University, Hamilton, Ontario; Jennifer A. Chan, University of Calgary, Calgary, Alberta; Steffen Albrecht, Adam Fontebasso, and Nada Jabado, McGill University, Montreal, Quebec, Canada; Paul A. Northcott, Andrey Korshunov, Marcel Kool, David T.W. Jones, and Stefan M. Pfister, German Cancer Research Center; Stefan M. Pfister, University Hospital Heidelberg, Heidelberg; Ulrich Schüller, Ludwig-Maximilians-University, Munich; Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Karel Zitterbart, Masaryk University School of Medicine; Karel Zitterbart and Leos Kren, University Hospital Brno, Brno, Czech Republic; Toshihiro Kumabe and Teiji Tominaga, Tohoku University Graduate School of Medicine, Sendai, Japan; Young Shin Ra, University of Ulsan, Asan Medical Center; Ji-Yeoun Lee, Byung-Kyu Cho, Seung-Ki Kim, and Kyu-Chang Wang, Seoul National University Children's Hospital, Seoul; Shin Jung, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Chonnam, South Korea; Peter Hauser and Miklós Garami, Semmelweis University, Budapest; László Bognár and Almos Klekner, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary; Shenandoah Robinson, Boston Children's Hospital; Scott L. Pomeroy, Harvard Medical School, Boston, MA; Ali G. Saad, University of Arkansas for Medical Sciences, Little
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Pambid MR, Berns R, Adomat HH, Hu K, Triscott J, Maurer N, Zisman N, Ramaswamy V, Hawkins CE, Taylor MD, Dunham C, Guns E, Dunn SE. Overcoming resistance to Sonic Hedgehog inhibition by targeting p90 ribosomal S6 kinase in pediatric medulloblastoma. Pediatr Blood Cancer 2014; 61:107-15. [PMID: 23940083 DOI: 10.1002/pbc.24675] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/03/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Molecular subtyping has allowed for the beginning of personalized treatment in children suffering from medulloblastoma (MB). However, resistance inevitably emerges against these therapies, particularly in the Sonic Hedgehog (SHH) subtype. We found that children with SHH subtype have the worst outcome underscoring the need to identify new therapeutic targets. PROCEDURE High content screening of a 129 compound library identified agents that inhibited SHH MB growth. Lead molecular target levels, p90 ribosomal S6 kinase (RSK) were characterized by immunoblotting and qRT-PCR. Comparisons were made to human neural stem cells (hNSC). Impact of inhibiting RSK with the small molecule BI-D1870 or siRNA was assessed in growth assays (monolayer, neurosphere, and soft agar). NanoString was used to detect RSK in a cohort of 66 patients with MB. To determine BI-D1870 pharmacokinetics/pharmacodynamics, 100 mg/kg was I.P. injected into mice and tissues were collected at various time points. RESULTS Daoy, ONS76, UW228, and UW426 MB cells were exquisitely sensitive to BI-D1870 but unresponsive to SHH inhibitors. Anti-tumor growth corresponded with inactivation of RSK in MB cells. BI-D1870 had no effect on hNSCs. Inhibiting RSK with siRNA or BI-D1870 suppressed growth, induced apoptosis, and sensitized cells to SHH agents. Notably, RSK expression is correlated with SHH patients. In mice, BI-D1870 was well-tolerated and crossed the blood-brain barrier (BBB). CONCLUSIONS RSK inhibitors are promising because they target RSK which is correlated with SHH patients as well as cause high levels of apoptosis to only MB cells. Importantly, BI-D1870 crosses the BBB, acting as a scaffold for development of more long-lived RSK inhibitors.
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Affiliation(s)
- Mary Rose Pambid
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Remke M, Ramaswamy V, Peacock J, Shih DJH, Koelsche C, Northcott PA, Hill N, Cavalli FMG, Kool M, Wang X, Mack SC, Barszczyk M, Morrissy AS, Wu X, Agnihotri S, Luu B, Jones DTW, Garzia L, Dubuc AM, Zhukova N, Vanner R, Kros JM, French PJ, Van Meir EG, Vibhakar R, Zitterbart K, Chan JA, Bognár L, Klekner A, Lach B, Jung S, Saad AG, Liau LM, Albrecht S, Zollo M, Cooper MK, Thompson RC, Delattre OO, Bourdeaut F, Doz FF, Garami M, Hauser P, Carlotti CG, Van Meter TE, Massimi L, Fults D, Pomeroy SL, Kumabe T, Ra YS, Leonard JR, Elbabaa SK, Mora J, Rubin JB, Cho YJ, McLendon RE, Bigner DD, Eberhart CG, Fouladi M, Wechsler-Reya RJ, Faria CC, Croul SE, Huang A, Bouffet E, Hawkins CE, Dirks PB, Weiss WA, Schüller U, Pollack IF, Rutkowski S, Meyronet D, Jouvet A, Fèvre-Montange M, Jabado N, Perek-Polnik M, Grajkowska WA, Kim SK, Rutka JT, Malkin D, Tabori U, Pfister SM, Korshunov A, von Deimling A, Taylor MD. TERT promoter mutations are highly recurrent in SHH subgroup medulloblastoma. Acta Neuropathol 2013; 126:917-29. [PMID: 24174164 PMCID: PMC3830749 DOI: 10.1007/s00401-013-1198-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [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: 09/02/2013] [Accepted: 10/15/2013] [Indexed: 11/27/2022]
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations were recently shown to drive telomerase activity in various cancer types, including medulloblastoma. However, the clinical and biological implications of TERT mutations in medulloblastoma have not been described. Hence, we sought to describe these mutations and their impact in a subgroup-specific manner. We analyzed the TERT promoter by direct sequencing and genotyping in 466 medulloblastomas. The mutational distributions were determined according to subgroup affiliation, demographics, and clinical, prognostic, and molecular features. Integrated genomics approaches were used to identify specific somatic copy number alterations in TERT promoter-mutated and wild-type tumors. Overall, TERT promoter mutations were identified in 21 % of medulloblastomas. Strikingly, the highest frequencies of TERT mutations were observed in SHH (83 %; 55/66) and WNT (31 %; 4/13) medulloblastomas derived from adult patients. Group 3 and Group 4 harbored this alteration in <5 % of cases and showed no association with increased patient age. The prognostic implications of these mutations were highly subgroup-specific. TERT mutations identified a subset with good and poor prognosis in SHH and Group 4 tumors, respectively. Monosomy 6 was mostly restricted to WNT tumors without TERT mutations. Hallmark SHH focal copy number aberrations and chromosome 10q deletion were mutually exclusive with TERT mutations within SHH tumors. TERT promoter mutations are the most common recurrent somatic point mutation in medulloblastoma, and are very highly enriched in adult SHH and WNT tumors. TERT mutations define a subset of SHH medulloblastoma with distinct demographics, cytogenetics, and outcomes.
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Affiliation(s)
- Marc Remke
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - John Peacock
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - David J. H. Shih
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Christian Koelsche
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paul A. Northcott
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadia Hill
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Florence M. G. Cavalli
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Xin Wang
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Stephen C. Mack
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Mark Barszczyk
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - A. Sorana Morrissy
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Xiaochong Wu
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Sameer Agnihotri
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - David T. W. Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Livia Garzia
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
| | - Adrian M. Dubuc
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Nataliya Zhukova
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Robert Vanner
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Johan M. Kros
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pim J. French
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erwin G. Van Meir
- Departments of Neurosurgery and Hematology and Medical Oncology, School of Medicine and Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Aurora, CO USA
| | - Karel Zitterbart
- Department of Pediatric Oncology, School of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Jennifer A. Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB Canada
| | - László Bognár
- Department of Neurosurgery, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary
| | - Almos Klekner
- Department of Neurosurgery, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary
| | - Boleslaw Lach
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
| | - Shin Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Chonnam, South Korea
| | - Ali G. Saad
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Linda M. Liau
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | - Massimo Zollo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, University of Naples, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Michael K. Cooper
- Department of Neurology, Vanderbilt Medical Center, Nashville, TN USA
| | - Reid C. Thompson
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN USA
| | - Oliver O. Delattre
- Laboratoire de Génétique et Biologie des Cancers, Institut Curie, Paris, France
| | - Franck Bourdeaut
- Laboratoire de Génétique et Biologie des Cancers, Institut Curie, Paris, France
| | - François F. Doz
- Department of Pediatric Oncology, Institut Curie and University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Miklós Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Carlos G. Carlotti
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Timothy E. Van Meter
- Pediatric Hematology-Oncology, School of Medicine, Virginia Commonwealth University, Richmond, VA USA
| | - Luca Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
| | - Daniel Fults
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT USA
| | - Scott L. Pomeroy
- Department of Neurology, Harvard Medical School, Children’s Hospital Boston, Boston, ME USA
| | - Toshiro Kumabe
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Young Shin Ra
- Department of Neurosurgery, Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Jeffrey R. Leonard
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO USA
| | - Samer K. Elbabaa
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Jaume Mora
- Developmental Tumor Biology Laboratory, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joshua B. Rubin
- Departments of Pediatrics, Anatomy and Neurobiology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO USA
| | - Yoon-Jae Cho
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA USA
| | | | | | - Charles G. Eberhart
- Departments of Pathology, Ophthalmology and Oncology, John Hopkins University School of Medicine, Baltimore, MD USA
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | | | - Claudia C. Faria
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children and The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON Canada
- Division of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisbon, Portugal
| | - Sidney E. Croul
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Annie Huang
- Division of Haematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Cynthia E. Hawkins
- Department of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Peter B. Dirks
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children and The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON Canada
| | - William A. Weiss
- Department of Neurology, University of California, San Francisco, San Francisco, CA USA
| | - Ulrich Schüller
- Center for Neuropathology and Prion Research, University of Munich, Munich, Germany
| | - Ian F. Pollack
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Meyronet
- Neuro-oncology and Neuro-inflammation Team, Inserm U1028, CNRS UMR 5292, Neuroscience Center, University Lyon 1, 69000 Lyon, France
- Hospices Civils de Lyon, Centre de Pathologie et de Neuropathologie Est, Lyon, 69003 France
| | - Anne Jouvet
- Neuro-oncology and Neuro-inflammation Team, Inserm U1028, CNRS UMR 5292, Neuroscience Center, University Lyon 1, 69000 Lyon, France
- Hospices Civils de Lyon, Centre de Pathologie et de Neuropathologie Est, Lyon, 69003 France
| | - Michelle Fèvre-Montange
- Centre de Recherche en Neurosciences, INSERM U1028, CNRS UMR5292, Université de Lyon, Lyon, France
| | - Nada Jabado
- Division of Experimental Medicine, McGill University, Montreal, QC Canada
| | - Marta Perek-Polnik
- Department of Oncology, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children’s Hospital, Seoul, Korea
| | - James T. Rutka
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children and The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON Canada
| | - David Malkin
- Division of Haematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Uri Tabori
- Division of Haematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael D. Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children and The Arthur and Sonia Labatt Brain Tumour Research Centre, Toronto, ON Canada
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Wong JC, O'Neill B, Hawkins CE, Kleinschmidt-DeMasters BK, Hazrati LN. Child Neurology: Pediatric seizures with hyaline astrocytic inclusions. Neurology 2013; 81:e14-6. [PMID: 23858415 DOI: 10.1212/wnl.0b013e31829bfe54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Janice C Wong
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Northcott PA, Shih DJH, Peacock J, Garzia L, Morrissy AS, Zichner T, Stütz AM, Korshunov A, Reimand J, Schumacher SE, Beroukhim R, Ellison DW, Marshall CR, Lionel AC, Mack S, Dubuc A, Yao Y, Ramaswamy V, Luu B, Rolider A, Cavalli FMG, Wang X, Remke M, Wu X, Chiu RYB, Chu A, Chuah E, Corbett RD, Hoad GR, Jackman SD, Li Y, Lo A, Mungall KL, Nip KM, Qian JQ, Raymond AGJ, Thiessen NT, Varhol RJ, Birol I, Moore RA, Mungall AJ, Holt R, Kawauchi D, Roussel MF, Kool M, Jones DTW, Witt H, Fernandez-L A, Kenney AM, Wechsler-Reya RJ, Dirks P, Aviv T, Grajkowska WA, Perek-Polnik M, Haberler CC, Delattre O, Reynaud SS, Doz FF, Pernet-Fattet SS, Cho BK, Kim SK, Wang KC, Scheurlen W, Eberhart CG, Fèvre-Montange M, Jouvet A, Pollack IF, Fan X, Muraszko KM, Gillespie GY, Di Rocco C, Massimi L, Michiels EMC, Kloosterhof NK, French PJ, Kros JM, Olson JM, Ellenbogen RG, Zitterbart K, Kren L, Thompson RC, Cooper MK, Lach B, McLendon RE, Bigner DD, Fontebasso A, Albrecht S, Jabado N, Lindsey JC, Bailey S, Gupta N, Weiss WA, Bognár L, Klekner A, Van Meter TE, Kumabe T, Tominaga T, Elbabaa SK, Leonard JR, Rubin JB, Liau LM, Van Meir EG, Fouladi M, Nakamura H, Cinalli G, Garami M, Hauser P, Saad AG, Iolascon A, Jung S, Carlotti CG, Vibhakar R, Ra YS, Robinson S, Zollo M, Faria CC, Chan JA, Levy ML, Sorensen PHB, Meyerson M, Pomeroy SL, Cho YJ, Bader GD, Tabori U, Hawkins CE, Bouffet E, Scherer SW, Rutka JT, Malkin D, Clifford SC, Jones SJM, Korbel JO, Pfister SM, Marra MA, Taylor MD. Subgroup-specific structural variation across 1,000 medulloblastoma genomes. Nature 2012; 488:49-56. [PMID: 22832581 DOI: 10.1038/nature11327] [Citation(s) in RCA: 648] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/14/2012] [Indexed: 01/22/2023]
Abstract
Medulloblastoma, the most common malignant paediatric brain tumour, is currently treated with nonspecific cytotoxic therapies including surgery, whole-brain radiation, and aggressive chemotherapy. As medulloblastoma exhibits marked intertumoural heterogeneity, with at least four distinct molecular variants, previous attempts to identify targets for therapy have been underpowered because of small samples sizes. Here we report somatic copy number aberrations (SCNAs) in 1,087 unique medulloblastomas. SCNAs are common in medulloblastoma, and are predominantly subgroup-enriched. The most common region of focal copy number gain is a tandem duplication of SNCAIP, a gene associated with Parkinson's disease, which is exquisitely restricted to Group 4α. Recurrent translocations of PVT1, including PVT1-MYC and PVT1-NDRG1, that arise through chromothripsis are restricted to Group 3. Numerous targetable SCNAs, including recurrent events targeting TGF-β signalling in Group 3, and NF-κB signalling in Group 4, suggest future avenues for rational, targeted therapy.
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Affiliation(s)
- Paul A Northcott
- Developmental & Stem Cell Biology Program, The Hospital for Sick Children, Toronto, Ontario M5G 1L7, Canada
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Picard D, Miller S, Hawkins CE, Bouffet E, Rogers HA, Chan TSY, Kim SK, Ra YS, Fangusaro J, Korshunov A, Toledano H, Nakamura H, Hayden JT, Chan J, Lafay-Cousin L, Hu PX, Fan X, Muraszko KM, Pomeroy SL, Lau CC, Ng HK, Jones C, Meter TV, Clifford SC, Eberhart C, Gajjar A, Pfister SM, Grundy RG, Huang A. Markers of survival and metastatic potential in childhood CNS primitive neuro-ectodermal brain tumours: an integrative genomic analysis. Lancet Oncol 2012; 13:838-48. [PMID: 22691720 PMCID: PMC3615440 DOI: 10.1016/s1470-2045(12)70257-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood CNS primitive neuro-ectodermal brain tumours (PNETs) are very aggressive brain tumours for which the molecular features and best treatment approaches are unknown. We assessed a large cohort of these rare tumours to identify molecular markers to enhance clinical management of this disease. METHODS We obtained 142 primary hemispheric CNS PNET samples from 20 institutions in nine countries and examined transcriptional profiles for a subset of 51 samples and copy number profiles for a subset of 77 samples. We used clustering, gene, and pathway enrichment analyses to identify tumour subgroups and group-specific molecular markers, and applied immunohistochemical and gene-expression analyses to validate and assess the clinical significance of the subgroup markers. FINDINGS We identified three molecular subgroups of CNS PNETs that were distinguished by primitive neural (group 1), oligoneural (group 2), and mesenchymal lineage (group 3) gene-expression signatures with differential expression of cell-lineage markers LIN28 and OLIG2. Patients with group 1 tumours were most often female (male:female ratio 0·61 for group 1 vs 1·25 for group 2 and 1·63 for group 3; p=0·043 [group 1 vs groups 2 and 3]), youngest (median age at diagnosis 2·9 years [95% CI 2·4-5·2] for group 1 vs 7·9 years [6·0-9·7] for group 2 and 5·9 years [4·9-7·8] for group 3; p=0·005), and had poorest survival (median survival 0·8 years [95% CI 0·5-1·2] in group 1, 1·8 years [1·4-2·3] in group 2 and 4·3 years [0·8-7·8] in group 3; p=0·019). Patients with group 3 tumours had the highest incidence of metastases at diagnosis (no distant metastasis:metastasis ratio 0·90 for group 3 vs 2·80 for group 1 and 5·67 for group 2; p=0·037). INTERPRETATION LIN28 and OLIG2 are promising diagnostic and prognostic molecular markers for CNS PNET that warrant further assessment in prospective clinical trials. FUNDING Canadian Institute of Health Research, Brainchild/SickKids Foundation, and the Samantha Dickson Brain Tumour Trust.
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Affiliation(s)
- Daniel Picard
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Dept of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Suzanne Miller
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | | | - Eric Bouffet
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Dept of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Hazel A Rogers
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Tiffany SY Chan
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Dept of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Seung-Ki Kim
- Dept of Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Young-Shin Ra
- Dept of Neurosurgery, Asan Medical Center, Seoul, Korea
| | - Jason Fangusaro
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Children's Memorial Hospital, Chicago, USA
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | | | | | - James T Hayden
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Jennifer Chan
- Dept of Pathology & Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Lucie Lafay-Cousin
- Dept of Pediatric Oncology, Alberta Children's Hospital, Calgary, Canada
| | - Ping X Hu
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, Canada
| | - Xing Fan
- Dept of Neurosurgery, University of Michigan Medical School, Ann Arbor, USA
| | - Karin M Muraszko
- Dept of Neurosurgery, University of Michigan Medical School, Ann Arbor, USA
| | | | - Ching C Lau
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, USA
| | - Ho-Keung Ng
- Dept of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Chris Jones
- Dept of Paediatric Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
| | | | - Steven C Clifford
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Charles Eberhart
- Division of Pathology, John Hopkins University School of Medicine, Baltimore, USA
| | - Amar Gajjar
- Neuro-oncology Division, St. Jude Children's Research Hospital, Memphis, USA
| | - Stefan M Pfister
- German Cancer Research Centre, and Paediatric, Haematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Annie Huang
- Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Dept of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Bouffet E, Hawkins CE, Ballourah W, Taylor MD, Bartels UK, Schoenhoff N, Tsangaris E, Huang A, Kulkarni A, Mabbot DJ, Laperriere N, Tabori U. Survival Benefit for Pediatric Patients With Recurrent Ependymoma Treated With Reirradiation. Int J Radiat Oncol Biol Phys 2012; 83:1541-8. [DOI: 10.1016/j.ijrobp.2011.10.039] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/26/2011] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
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Witt H, Mack SC, Bender S, Ryzhova M, Martin S, Isserlin R, Jones DTW, Northcott PA, Till M, Remke M, Benner A, Hielscher T, Gupta N, Garcia L, Weiss WA, Betrand K, van Meter T, von Deimling A, Rutkowski S, Pietsch T, Kulozik AE, Cho YJ, Tabori U, Hawkins CE, Witt O, Bader GD, Rutka JT, Lichter P, Korshunov A, Taylor MD, Pfister SM. Abstract 1432: The heterogeneous genomic landscape of posterior fossa ependymoma. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Brain tumors are the most common cause of cancer-related death in childhood. Ependymomas, are the third most common pediatric brain tumor. The disease remains incurable for about 45% of patients even after gross total resection and radiotherapy. Despite showing a very homogeneous histological picture, ependymomas display distinct molecular behavior, which supports the existence of several independent entities of the disease. We examined two non-overlapping cohorts of 102 and 75 ependymomas by mRNA expression profiling, on two different array platforms (Affymetrix, Agilent). When performing multiple statistical clustering methods (unsupervised consensus NMF and consensus HCL), we could consistently identify three major clusters, including two subgroups of posterior fossa (PF) ependymoma, a variant common in children and associated with heterogeneous clinical outcome. Subgroup-specific chromosome aberrations of PF tumors were detected by aCGH, and biological signaling pathways distinguishing PF subgroups were identified by gene set enrichment analysis and visualized in Cytoscape. We validated the most significantly classifying markers of each subgroup by immunohistochemistry on a tissue microarray containing an independent set of 265 PF ependymomas. Our findings delineate two subgroups of PF ependymoma (groups A and B) which are demographically, transcriptionally, genetically, and clinically distinct. Group A patients are younger, have laterally located tumors with a balanced genome, more frequently develop secondary metastases and are much more likely to have an extremely poor outcome as compared with group B patients. Based on a multi-variate Cox proportional-hazards model, our identified markers have the strongest independent prognostic value among demographic and molecular variables with Hazard ratios of 8.45 (PFS) and 10.55 (OS). Prognostic significance and predictive impact is being validated in the GPOH HIT2000 Ependymoma study. The identification of two distinct subgroups of PF ependymoma, and markers applicable for their clinical distinction, will allow for better prognostication of individual cases, independent of age, level of resection and WHO grade, and also for stratification in future ependymoma clinical trials.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1432. doi:1538-7445.AM2012-1432
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Affiliation(s)
- Hendrik Witt
- 1German Cancer Research Center, Heidelberg, Germany
| | | | | | - Marina Ryzhova
- 3NN Burdenko Neurosurgical Institute, Moscow, Russian Federation
| | - Sill Martin
- 1German Cancer Research Center, Heidelberg, Germany
| | | | | | | | - Milde Till
- 1German Cancer Research Center, Heidelberg, Germany
| | - Marc Remke
- 1German Cancer Research Center, Heidelberg, Germany
| | - Axel Benner
- 1German Cancer Research Center, Heidelberg, Germany
| | | | - Nalin Gupta
- 5University of California, San Francisco, CA
| | - Livia Garcia
- 2Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Uri Tabori
- 2Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Olaf Witt
- 1German Cancer Research Center, Heidelberg, Germany
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Visanji NP, Wong JC, Wang SX, Cappel B, Kleinschmidt-Demasters BK, Handler MH, Ochi A, Otsubo H, Rutka JT, Go C, Weiss S, Vinters HV, Hawkins CE, Desouza LV, Siu KWM, Hazrati LN. A proteomic analysis of pediatric seizure cases associated with astrocytic inclusions. Epilepsia 2012; 53:e50-4. [PMID: 22220588 DOI: 10.1111/j.1528-1167.2011.03369.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cerebral hyaline astrocytic inclusions have been observed in a subset of patients with early onset epilepsy, brain structural anomalies, and developmental delay, which indicates that it may represent a unique clinicopathologic entity. To further characterize this condition we use proteomics to investigate differentially expressed proteins in epileptic brain tissue from three pediatric epileptic patients with cerebral hyaline astrocytic inclusions, ranging in age from 5-13 years, and compare to brain tissue from two normal controls. Catalase and carbonic anhydrase I both exhibited increased expression in epileptic brain tissue compared to controls. These findings were confirmed by Western blot analysis. Furthermore, both proteins were localized to astrocytes and in epileptic brain were located within the cerebral hyaline astrocytic inclusions, suggesting a potential role in the generation of this pathologic feature of early onset epilepsy with cerebral hyaline astrocytic inclusions.
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Affiliation(s)
- Naomi P Visanji
- Tanz Center for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
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Hawkins CE, Bartels U, Bouffet E. Molecular Genetic Approaches and Potential New Therapeutic Strategies for Pediatric Diffuse Intrinsic Pontine Glioma. J Clin Oncol 2011; 29:3956-7. [DOI: 10.1200/jco.2011.37.8661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ute Bartels
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, Ontario, Canada
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41
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Witt H, Mack SC, Ryzhova M, Bender S, Sill M, Isserlin R, Benner A, Hielscher T, Milde T, Remke M, Jones DT, Northcott PA, Garzia L, Bertrand KC, Wittmann A, Yao Y, Roberts SS, Massimi L, Van Meter T, Weiss WA, Gupta N, Grajkowska W, Lach B, Cho YJ, von Deimling A, Kulozik AE, Witt O, Bader GD, Hawkins CE, Tabori U, Guha A, Rutka JT, Lichter P, Korshunov A, Taylor MD, Pfister SM. Delineation of two clinically and molecularly distinct subgroups of posterior fossa ependymoma. Cancer Cell 2011; 20:143-57. [PMID: 21840481 PMCID: PMC4154494 DOI: 10.1016/j.ccr.2011.07.007] [Citation(s) in RCA: 371] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/30/2011] [Accepted: 07/11/2011] [Indexed: 12/18/2022]
Abstract
Despite the histological similarity of ependymomas from throughout the neuroaxis, the disease likely comprises multiple independent entities, each with a distinct molecular pathogenesis. Transcriptional profiling of two large independent cohorts of ependymoma reveals the existence of two demographically, transcriptionally, genetically, and clinically distinct groups of posterior fossa (PF) ependymomas. Group A patients are younger, have laterally located tumors with a balanced genome, and are much more likely to exhibit recurrence, metastasis at recurrence, and death compared with Group B patients. Identification and optimization of immunohistochemical (IHC) markers for PF ependymoma subgroups allowed validation of our findings on a third independent cohort, using a human ependymoma tissue microarray, and provides a tool for prospective prognostication and stratification of PF ependymoma patients.
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Affiliation(s)
- Hendrik Witt
- Division Molecular Genetics, German Cancer Research Center
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
| | - Stephen C. Mack
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Marina Ryzhova
- Department of Neuropathology, NN Burdenko Neurosurgical Institute, Moscow 125047, Russia
| | - Sebastian Bender
- Division Molecular Genetics, German Cancer Research Center
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
| | - Martin Sill
- Division Biostatistics, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Ruth Isserlin
- Department of Molecular Genetics, Banting and Best Department of Medical Research, The Donnelly Centre, University of Toronto, Toronto, ON M4N 1X8, Canada
| | - Axel Benner
- Division Biostatistics, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Thomas Hielscher
- Division Biostatistics, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Till Milde
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Marc Remke
- Division Molecular Genetics, German Cancer Research Center
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
| | | | - Paul A. Northcott
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Livia Garzia
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
| | - Kelsey C. Bertrand
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Yuan Yao
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Stephen S. Roberts
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Luca Massimi
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, 00168, Italy
| | - Tim Van Meter
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco San Francisco, California, 94158, USA
| | - Wiesia Grajkowska
- Department of Pathology, Children's Memorial Health Institute, University of Warsaw, 04-730 Warsaw, Poland
| | - Boleslaw Lach
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Yoon-Jae Cho
- Department of Neurology, Children's Hospital Boston, Boston, Massachusetts, 02115, USA
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Andreas E. Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
| | - Olaf Witt
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Gary D. Bader
- Department of Molecular Genetics, Banting and Best Department of Medical Research, The Donnelly Centre, University of Toronto, Toronto, ON M4N 1X8, Canada
| | - Cynthia E. Hawkins
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Uri Tabori
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Abhijit Guha
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
| | - James T. Rutka
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Peter Lichter
- Division Molecular Genetics, German Cancer Research Center
| | - Andrey Korshunov
- Department of Neuropathology, University of Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Michael D. Taylor
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, ON M4N 1X8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Stefan M. Pfister
- Division Molecular Genetics, German Cancer Research Center
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg 69120 Heidelberg, Germany
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Northcott PA, Korshunov A, Witt H, Hielscher T, Eberhart CG, Mack S, Bouffet E, Clifford SC, Hawkins CE, French P, Rutka JT, Pfister S, Taylor MD. Medulloblastoma comprises four distinct molecular variants. J Clin Oncol 2010; 29:1408-14. [PMID: 20823417 DOI: 10.1200/jco.2009.27.4324] [Citation(s) in RCA: 941] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Recent genomic approaches have suggested the existence of multiple distinct subtypes of medulloblastoma. We studied a large cohort of medulloblastomas to determine how many subgroups of the disease exist, how they differ, and the extent of overlap between subgroups. METHODS We determined gene expression profiles and DNA copy number aberrations for 103 primary medulloblastomas. Bioinformatic tools were used for class discovery of medulloblastoma subgroups based on the most informative genes in the data set. Immunohistochemistry for subgroup-specific signature genes was used to determine subgroup affiliation for 294 nonoverlapping medulloblastomas on two independent tissue microarrays. RESULTS Multiple unsupervised analyses of transcriptional profiles identified the following four distinct, nonoverlapping molecular variants: WNT, SHH, group C, and group D. Supervised analysis of these four subgroups revealed significant subgroup-specific demographics, histology, metastatic status, and DNA copy number aberrations. Immunohistochemistry for DKK1 (WNT), SFRP1 (SHH), NPR3 (group C), and KCNA1 (group D) could reliably and uniquely classify formalin-fixed medulloblastomas in approximately 98% of patients. Group C patients (NPR3-positive tumors) exhibited a significantly diminished progression-free and overall survival irrespective of their metastatic status. CONCLUSION Our integrative genomics approach to a large cohort of medulloblastomas has identified four disparate subgroups with distinct demographics, clinical presentation, transcriptional profiles, genetic abnormalities, and clinical outcome. Medulloblastomas can be reliably assigned to subgroups through immunohistochemistry, thereby making medulloblastoma subclassification widely available. Future research on medulloblastoma and the development of clinical trials should take into consideration these four distinct types of medulloblastoma.
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Hung RM, Yoon G, Hawkins CE, Halliday W, Biggar D, Vajsar J. Erratum to ‘Cap myopathy caused by a mutation of the skeletal alpha-actin gene ACTA1’ [Neuromuscular Disorders 20 (2010) 238–240]. Neuromuscul Disord 2010. [DOI: 10.1016/j.nmd.2010.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li M, Lee K, Lu Y, Clarke I, Shih D, Meter TV, Zhou L, Picard D, Modena P, Pomeroy S, Lau CC, Taylor MD, Bouffet E, Rutka JT, Gajjar A, Dirks PB, Hawkins CE, Huang A. Abstract 4355: The C19MC miRNA polycistron are frequent targets of gene amplification in aggressive primitive neuroectodermal brain tumors and encode oncogenic miRNAs that inhibit normal neural stem cell differentiation. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-4355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Embryonal brain tumors which include medulloblastoma and primitive neuroectodermal brain tumors (CNS-PNET) comprise the largest group of malignant pediatric brain tumors and account for substantial cancer related morbidity and mortality in childhood. Unlike medulloblastoma, a common, cerebellar PNET, few CNS-PNET arising in extracerebellar locations have been characterized. Lack of insight into the molecular pathogenesis of CNS-PNET is a major obstacle towards development of much-needed disease-specific models and treatments for these devastating tumors. In this study, we performed high-resolution DNA copy number analysis on a substantial collection of primary CNS-PNET obtained through an international collaborative group, and discovered a frequent amplicon in 25% (11/46) of CNS-PNET which span 34 protein coding genes and two miRNA clusters, C19MC and miR-371-373, on chr19q13.41. Detailed mapping studies revealed C19MC, which encode 54 primate-specific miRNAs, as the specific target of gene amplification resulting in striking tumor-specific overexpression of a sub-set of miRNAs, including miR-520 g and miR- 517c. Stable expression of miR-520 g and miR-517c promoted in vitro and in vivo oncogenicity and conferred cell survival in tumor cell lines. Strikingly expression of both miR-520g and 517c promoted growth and inhibited differentiation of untransformed normal human neural stem cells. Notably, clinicopathologic analyses revealed that C19MC amplification identifies a distinct group of CNS-PNET with similar gene expression profiles, characteristic histology, and much poorer survival. Our aggregate findings which point to C19MC as an important, new oncogenic locus in a human cancer, have significant implications for the diagnosis and clinical management of embryonal brain tumors in children.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4355.
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Affiliation(s)
- Meihua Li
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyle Lee
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ian Clarke
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | - David Shih
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Limei Zhou
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Picard
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Eric Bouffet
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | - James T. Rutka
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | - Amar Gajjar
- 7St. Jude Children's Research Hospital, Memphis, TN
| | - Peter B. Dirks
- 1The hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Annie Huang
- 1The hospital for Sick Children, Toronto, Ontario, Canada
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45
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Picard DJ, Zhou L, Hu Y, Li M, Shih D, Stearns D, Cohn S, Hawkins CE, Rutka JT, Taylor MD, Huang A. Abstract 3109: Myc confers aggressive medulloblastoma phenotypes by regulating cell migration and adhesion genes. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Mechanisms by which Myc confers aggressive phenotypes and adverse outcomes in medulloblastoma remain largely unknown. In this study, we demonstrate using 2 medulloblastoma cell line models that high Myc expression increases cell migration/invasion and induces metastatic orthotopic tumors which recapitulate the aggressive histology of primary anaplastic medulloblastoma. Using ChIP-chip and expression analysis on Myc transformed medulloblastoma cell lines, we identified a subset of cell migration and adhesion genes as direct Myc repressed transcriptional targets. These include ING4, PVRL3, PPAP2B and Tsp-1/THBS1, a potent tumor suppressor not previously implicated in medulloblastoma. Tsp-1 expression in medulloblastoma cell lines and primary tumors were consistently and significantly diminished in the presence of high Myc (n=101, p=0.032). Using ChIP and reporter assays we confirmed Myc and Max co-localization to a basal Tsp-1 promoter and decreased Tsp-1 transcription in the presence of Myc. Our analyses also revealed that JPO2, a Myc interacting protein linked to metastatic medulloblastoma, directly binds the Tsp-1 promoter and augments Myc-mediated Tsp-1 repression. Interestingly, we observed that stable Tsp-1 expression significantly diminished soft agar growth and drastically decreased cell invasion/migration in high-Myc expressing medulloblastoma cell lines without effects on cellular proliferation. Our collective findings highlight a novel and important role for Tsp-1 in Myc- induced metastatic medulloblastoma phenotypes and suggest Tsp-1 agonists may represent attractive, therapeutics for primary metastatic medulloblastoma.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3109.
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Affiliation(s)
- Daniel J. Picard
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Limei Zhou
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yaqi Hu
- 2University Health Network, Toronto, Ontario, Canada
| | - Meihua Li
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Shih
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Duncan Stearns
- 3John Hopkins University School of Medicine, Baltimore, MD
| | - Susan Cohn
- 4University of Chicago Hospitals, Chicago, IL
| | | | - James T. Rutka
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michal D. Taylor
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- 1Univ. of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
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Hung RM, Yoon G, Hawkins CE, Halliday W, Biggar D, Vajsar J. Cap myopathy caused by a mutation of the skeletal alpha-actin gene ACTA1. Neuromuscul Disord 2010; 20:238-40. [PMID: 20303757 DOI: 10.1016/j.nmd.2010.01.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/04/2010] [Accepted: 01/18/2010] [Indexed: 11/25/2022]
Abstract
Cap myopathy is a congenital myopathy with cap-like structures under the sarcolemma. Mutations in TPM2 and TPM3 genes have been reported in cap myopathy so far. We report a newborn boy with persistent profound weakness who required gastro-jejunal tube feeding, tracheostomy and life-long ventilation until he died at 5 years of age. Muscle biopsy at 5 weeks of age was uninformative. Repeat biopsy at 4.5 years revealed subsarcolemmally located caps that were immunopositive for alpha-actinin, actin and to some extent, desmin. EM confirmed loosely arranged thin filaments and paucity of thick filaments. Molecular analysis of ACTA1 gene identified a novel de novo Met49Val [corrected] mutation. In addition to a new ACTA1 gene mutation, our case emphasizes the genetic heterogeneity of cap myopathy and its association with ACTA1 gene as well as the importance of repeat muscle biopsy in patients with undiagnosed muscle weakness.
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Affiliation(s)
- Ryan M Hung
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
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Abstract
Ependymomas are the third most common pediatric brain tumor with an overall survival of approximately 50%. Recently, we showed that telomerase [human telomerase reverse transcriptase (hTERT)] expression is a predictor of poor outcome in pediatric ependymoma. Thus, we hypothesized that ependymomas with functional telomerase may behave more aggressively and that these patients may benefit from anti-telomerase therapy. To address our hypothesis, we investigated the effect of telomerase inhibition on primary ependymoma cells harvested at the time of surgery, as no animal models or established cell lines are readily available for this tumor. The cells were characterized for glial fibrillary acidic protein (GFAP) and hTERT expression, initial telomere length and telomerase activity. They were then subjected to telomerase inhibition (MST-312, 1 microM) and tested for effects on cell viability (MTT assay), proliferation (MIB-1), apoptosis (cleaved caspase 3) and DNA damage (gammaH2AX). After 72 h of telomerase inhibition, primary ependymoma cells showed a significant decrease in cell number (P < 0.001), accompanied by increased DNA damage (gammaH2AX expression) (P < 0.01) and decreased proliferative index (MIB-1) (P < 0.01). Half showed an increase in apoptosis (cleaved caspase 3). These data suggest that telomerase inhibition may be an effective adjuvant therapy in pediatric ependymoma, potentially inducing tumor growth arrest in the short term, independent of telomere shortening.
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Affiliation(s)
- Vincent C H Wong
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
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Li M, Lee KF, Lu Y, Clarke I, Shih D, Eberhart C, Collins VP, Van Meter T, Picard D, Zhou L, Boutros PC, Modena P, Liang ML, Scherer SW, Bouffet E, Rutka JT, Pomeroy SL, Lau CC, Taylor MD, Gajjar A, Dirks PB, Hawkins CE, Huang A. Frequent amplification of a chr19q13.41 microRNA polycistron in aggressive primitive neuroectodermal brain tumors. Cancer Cell 2009; 16:533-46. [PMID: 19962671 PMCID: PMC3431561 DOI: 10.1016/j.ccr.2009.10.025] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 08/03/2009] [Accepted: 10/23/2009] [Indexed: 12/19/2022]
Abstract
We discovered a high-level amplicon involving the chr19q13.41 microRNA (miRNA) cluster (C19MC) in 11/45 ( approximately 25%) primary CNS-PNET, which results in striking overexpression of miR-517c and 520g. Constitutive expression of miR-517c or 520g promotes in vitro and in vivo oncogenicity, modulates cell survival, and robustly enhances growth of untransformed human neural stem cells (hNSCs) in part by upregulating WNT pathway signaling and restricting differentiation of hNSCs. Remarkably, the C19MC amplicon, which is very rare in other brain tumors (1/263), identifies an aggressive subgroup of CNS-PNET with distinct gene-expression profiles, characteristic histology, and dismal survival. Our data implicate miR-517c and 520g as oncogenes and promising biological markers for CNS-PNET and provide important insights into oncogenic properties of the C19MC locus.
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Affiliation(s)
- Meihua Li
- Division of Hematology-Oncology, Hospital for Sick Children, Toronto, ON M5G 0A3, Canada
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Wong VCH, Ma J, Hawkins CE. Telomerase inhibition induces acute ATM-dependent growth arrest in human astrocytomas. Cancer Lett 2008; 274:151-9. [PMID: 18945545 DOI: 10.1016/j.canlet.2008.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 07/15/2008] [Revised: 07/15/2008] [Accepted: 09/09/2008] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to examine the degree of hTERT, the catalytic subunit of telomerase, expression in paediatric high-grade astrocytoma and to explore the potential of telomerase inhibition as a therapy for these tumours. hTERT was expressed at high levels in 36 of 44 paediatric astrocytomas. Telomerase inhibition induced acute DNA damage and ATM-pathway-dependent G2/M cell cycle arrest in astrocytomas in vitro, both occurring prior to telomere shortening itself. Our data suggest that telomerase inhibition could be a useful adjuvant therapy for high-grade astrocytomas, potentially inducing tumour growth arrest following short-term treatment.
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Affiliation(s)
- Vincent C H Wong
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M5G 1X8
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50
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Abstract
The authors report on 2 newborn infants with the unusual presentation of intrinsic brainstem tumors. Both nondysmorphic, full-term neonates had cranial nerve palsies and hypotonia. Diagnoses of diffuse intrinsic brainstem gliomas were made on the basis of magnetic resonance imaging, which showed large expansive, nonenhancing intrinsic pontine masses. Intrinsic pontine tumors, characteristically seen in school-age children, are most often high-grade gliomas that are almost invariably fatal. However, the microanatomy and natural history of pontine tumors in neonates are unknown. With parental consent, both newborns were treated expectantly with supportive care but died of progressive disease by 2 weeks of age. In one child, postmortem examination revealed a primary brainstem primitive neuroectodermal tumor. The authors conclude that, as in older children, neonatal intrinsic brainstem tumors may be of a highly malignant nature. The rapid tumor progression in both cases indicates that where a diagnostic procedure may pose significant risks, supportive observation can aid in distinguishing malignant from benign tumor growth.
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Affiliation(s)
- Niketa C Shah
- Division of Hematology and Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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