1
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Peshoff MM, Gupta P, Oberai S, Trivedi R, Katayama H, Chakrapani P, Dang M, Migliozzi S, Gumin J, Kadri DB, Lin JK, Milam NK, Maynard ME, Vaillant BD, Parker-Kerrigan B, Lang FF, Huse JT, Iavarone A, Wang L, Clise-Dwyer K, Bhat KP. Triggering receptor expressed on myeloid cells 2 (TREM2) regulates phagocytosis in glioblastoma. Neuro Oncol 2024; 26:826-839. [PMID: 38237157 PMCID: PMC11066944 DOI: 10.1093/neuonc/noad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Glioblastomas (GBMs) are central nervous system tumors that resist standard-of-care interventions and even immune checkpoint blockade. Myeloid cells in the tumor microenvironment can contribute to GBM progression; therefore, emerging immunotherapeutic approaches include reprogramming these cells to achieve desirable antitumor activity. Triggering receptor expressed on myeloid cells 2 (TREM2) is a myeloid signaling regulator that has been implicated in a variety of cancers and neurological diseases with contrasting functions, but its role in GBM immunopathology and progression is still under investigation. METHODS Our reverse translational investigations leveraged single-cell RNA sequencing and cytometry of human gliomas to characterize TREM2 expression across myeloid subpopulations. Using 2 distinct murine glioma models, we examined the role of Trem2 on tumor progression and immune modulation of myeloid cells. Furthermore, we designed a method of tracking phagocytosis of glioma cells in vivo and employed in vitro assays to mechanistically understand the influence of TREM2 signaling on tumor uptake. RESULTS We discovered that TREM2 expression does not correlate with immunosuppressive pathways, but rather showed strong a positive association with the canonical phagocytosis markers lysozyme (LYZ) and macrophage scavenger receptor (CD163) in gliomas. While Trem2 deficiency was found to be dispensable for gliomagenesis, Trem2+ myeloid cells display enhanced tumor uptake compared to Trem2- cells. Mechanistically, we demonstrate that TREM2 mediates phagocytosis via Syk signaling. CONCLUSIONS These results indicate that TREM2 is not associated with immunosuppression in gliomas. Instead, TREM2 is an important regulator of phagocytosis that may be exploited as a potential therapeutic strategy for brain tumors.
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Affiliation(s)
- Mekenzie M Peshoff
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Translational Molecular Pathology, The University of Texas, MD Anderson Cancer Center, UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Pravesh Gupta
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shivangi Oberai
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rakesh Trivedi
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hiroshi Katayama
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prashanth Chakrapani
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minghao Dang
- Department of Genomic Medicine, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simona Migliozzi
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joy Gumin
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Divya B Kadri
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica K Lin
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nancy K Milam
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E Maynard
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas, USA
| | - Brian D Vaillant
- Departments of Translational Molecular Pathology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Brittany Parker-Kerrigan
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Translational Molecular Pathology, The University of Texas, MD Anderson Cancer Center, UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Antonio Iavarone
- Department of Neurological Surgery, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linghua Wang
- Department of Genomic Medicine, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen Clise-Dwyer
- Department of Hematopoietic Biology & Malignancy, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Krishna P Bhat
- Department of Translational Molecular Pathology, Neurosurgery at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Translational Molecular Pathology, The University of Texas, MD Anderson Cancer Center, UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
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2
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Ene CI, Abi Faraj C, Beckham TH, Weinberg JS, Andersen CR, Haider AS, Rao G, Ferguson SD, Alvarez-Brenkenridge CA, Kim BYS, Heimberger AB, McCutcheon IE, Prabhu SS, Wang CM, Ghia AJ, McGovern SL, Chung C, McAleer MF, Tom MC, Perni S, Swanson TA, Yeboa DN, Briere TM, Huse JT, Fuller GN, Lang FF, Li J, Suki D, Sawaya RE. Response of treatment-naive brain metastases to stereotactic radiosurgery. Nat Commun 2024; 15:3728. [PMID: 38697991 PMCID: PMC11066027 DOI: 10.1038/s41467-024-47998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
With improvements in survival for patients with metastatic cancer, long-term local control of brain metastases has become an increasingly important clinical priority. While consensus guidelines recommend surgery followed by stereotactic radiosurgery (SRS) for lesions >3 cm, smaller lesions (≤3 cm) treated with SRS alone elicit variable responses. To determine factors influencing this variable response to SRS, we analyzed outcomes of brain metastases ≤3 cm diameter in patients with no prior systemic therapy treated with frame-based single-fraction SRS. Following SRS, 259 out of 1733 (15%) treated lesions demonstrated MRI findings concerning for local treatment failure (LTF), of which 202 /1733 (12%) demonstrated LTF and 54/1733 (3%) had an adverse radiation effect. Multivariate analysis demonstrated tumor size (>1.5 cm) and melanoma histology were associated with higher LTF rates. Our results demonstrate that brain metastases ≤3 cm are not uniformly responsive to SRS and suggest that prospective studies to evaluate the effect of SRS alone or in combination with surgery on brain metastases ≤3 cm matched by tumor size and histology are warranted. These studies will help establish multi-disciplinary treatment guidelines that improve local control while minimizing radiation necrosis during treatment of brain metastasis ≤3 cm.
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Affiliation(s)
- Chibawanye I Ene
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
| | - Christina Abi Faraj
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Thomas H Beckham
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | | | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Chenyang Michael Wang
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Martin C Tom
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Subha Perni
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Tina M Briere
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jason T Huse
- Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Raymond E Sawaya
- Faculty of Medicine and Medical Affairs, American University of Beirut, Beirut, Lebanon
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Ledbetter D, Gumin J, Phillips L, Ene C, Shimizu Y, Lang FF. Facilitating Repeat Intracarotid Injections in Mouse Models by a Novel Injection Site Repair Technique. J Vis Exp 2024. [PMID: 38557500 DOI: 10.3791/66303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Given recent advances in the delivery of novel antitumor therapeutics using endovascular selective intraarterial delivery methods in neuro-oncology, there is an urgent need to develop methods for intracarotid injections in mouse models, including methods to repair the carotid artery in mice after injection to allow for subsequent injections. We developed a method of intracarotid injection in a mouse model to deliver therapeutics into the internal carotid artery (ICA) with two alternative procedures. During injection, the needle is inserted into the common carotid artery (CCA) after tying a suture around the external carotid artery (ECA) and injected therapeutics are delivered into the ICA. Following injection, the common carotid artery (CCA) can be ligated, which limits the number of intracarotid injections to one. The alternative procedure described in this article includes a modification where intracarotid artery injection is followed by injection site repair of the CCA, which restores blood flow within the CCA and avoids the complication of cerebral ischemia seen in some mouse models. We also compared the delivery of bone marrow-derived human mesenchymal stem cells (BM-hMSCs) to intracranial tumors when delivered through intracarotid injection with and without injection site repair following the injection. Delivery of BM-hMSCs does not differ significantly between the methods. Our results demonstrate that injection site repair of the CCA allows for repeat injections through the same artery and does not impair the delivery and distribution of injected material, thus providing a model with greater flexibility that more closely emulates intracarotid injection in humans.
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Affiliation(s)
- Daniel Ledbetter
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Lynette Phillips
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Yuzaburo Shimizu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center; Department of Neurosurgery, Juntendo University
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center;
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4
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Shin DH, Jiang H, Gillard AG, Kim D, Fan X, Singh SK, Nguyen TT, Sohoni SS, Lopez-Rivas AR, Parthasarathy A, Ene CI, Gumin J, Lang FF, Alonso MM, Gomez-Manzano C, Fueyo J. Chimeric oncolytic adenovirus evades neutralizing antibodies from human patients and exhibits enhanced anti-glioma efficacy in immunized mice. Mol Ther 2024; 32:722-733. [PMID: 38311852 PMCID: PMC10928285 DOI: 10.1016/j.ymthe.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
Oncolytic viruses are a promising treatment for patients with high-grade gliomas, but neutralizing antibodies can limit their efficacy in patients with prior virus exposure or upon repeated virus injections. Data from a previous clinical trial using the oncolytic adenovirus Delta-24-RGD showed that generation of anti-viral neutralizing antibodies may affect the long-term survival of glioma patients. Past studies have examined the effects of neutralizing antibodies during systemic virus injections, but largely overlooked their impact during local virus injections into the brain. We found that immunoglobulins colocalized with viral proteins upon local oncolytic virotherapy of brain tumors, warranting a strategy to prevent virus neutralization and maximize oncolysis. Thus, we generated a chimeric virus, Delta-24-RGD-H43m, by replacing the capsid protein HVRs from the serotype 5-based Delta-24-RGD with those from the rare serotype 43. Delta-24-RGD-H43m evaded neutralizing anti-Ad5 antibodies and conferred a higher rate of long-term survival than Delta-24-RGD in glioma-bearing mice. Importantly, Delta-24-RGD-H43m activity was significantly more resistant to neutralizing antibodies present in sera of glioma patients treated with Delta-24-RGD during a phase 1 clinical trial. These findings provide a framework for a novel treatment of glioma patients that have developed immunity against Delta-24-RGD.
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Affiliation(s)
- Dong Ho Shin
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hong Jiang
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew G Gillard
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Debora Kim
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xuejun Fan
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sanjay K Singh
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Teresa T Nguyen
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sagar S Sohoni
- Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andres R Lopez-Rivas
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Akhila Parthasarathy
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chibawanye I Ene
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joy Gumin
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frederick F Lang
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marta M Alonso
- Department of Pediatrics, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Candelaria Gomez-Manzano
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Juan Fueyo
- MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX 77030, USA; Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA.
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Kumar VA, Perez A, Young AL, Jones J, O'Brien BJ, Lang FF, Huse JT, Fuller GN. Collision tumor: Multinodular and vacuolating neuronal tumor with isocitrate dehydrogenase-mutant diffuse astrocytoma. Neuropathology 2024. [PMID: 38414131 DOI: 10.1111/neup.12968] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
Herein, we report a case of a collision tumor involving a multinodular and vacuolating neuronal tumor (MVNT) and a diffuse astrocytoma. A collision tumor between these two entities has not previously been reported. The patient is a 35-year-old woman who presented with new-onset hearing loss and ringing in her right ear. Magnetic resonance imaging identified a non-enhancing mass involving the gray matter and subcortical white matter of the left middle frontal gyrus. Additionally, tiny clustered nodules were noted along the underlying subcortical ribbon and superficial subcortical white matter of the left superior frontal gyrus. The patient underwent a left frontal craniotomy and complete resection of the mass. Histologic examination of the resected specimen demonstrated a collision tumor consisting of a diffuse astrocytoma (isocitrate dehydrogenase [IDH] mutant, central nervous system [CNS] World Health Organization [WHO] grade 2) and an MVNT, with the latter demonstrating characteristic morphologic and immunohistochemical features.
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Affiliation(s)
- Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alejandro Perez
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angela L Young
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia Jones
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gregory N Fuller
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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McDonald MF, Hossain A, Momin EN, Hasan I, Singh S, Adachi S, Gumin J, Ledbetter D, Yang J, Long L, Daou M, Gopakumar S, Phillips LM, Parker Kerrigan B, Lang FF. Tumor-specific polycistronic miRNA delivered by engineered exosomes for the treatment of glioblastoma. Neuro Oncol 2024; 26:236-250. [PMID: 37847405 PMCID: PMC10836765 DOI: 10.1093/neuonc/noad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) has poor prognosis due to ineffective agents and poor delivery methods. MicroRNAs (miRs) have been explored as novel therapeutics for GBM, but the optimal miRs and the ideal delivery strategy remain unresolved. In this study, we sought to identify the most effective pan-subtype anti-GBM miRs and to develop an improved delivery system for these miRs. METHODS We conducted an unbiased screen of over 600 miRs against 7 glioma stem cell (GSC) lines representing all GBM subtypes to identify a set of pan-subtype-specific anti-GBM miRs and then used available TCGA GBM patient outcomes and miR expression data to hone in on miRs that were most likely to be clinically effective. To enhance delivery and expression of the miRs, we generated a polycistronic plasmid encoding 3 miRs (pPolymiR) and used HEK293T cells as biofactories to package pPolymiR into engineered exosomes (eExos) that incorporate viral proteins (Gag/VSVg) in their structure (eExos+pPolymiR) to enhance function. RESULTS Our stepwise screen identified miR-124-2, miR-135a-2, and let-7i as the most effective miRs across all GBM subtypes with clinical relevance. Delivery of eExos+pPolymiR resulted in high expression of all 3 miRs in GSCs, and significantly decreased GSC proliferation in vitro. eExos+pPolymiR prolonged survival of GSC-bearing mice in vivo when compared with eExos carrying each of the miRs individually or as a cocktail. CONCLUSION eExos+pPolymiR, which includes a pan-subtype anti-glioma-specific miR combination encoded in a polycistronic plasmid and a novel exosome delivery platform, represents a new and potentially powerful anti-GBM therapeutic.
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Affiliation(s)
- Malcolm F McDonald
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anwar Hossain
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eric N Momin
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Irtiza Hasan
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Singh
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Satoshi Adachi
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joy Gumin
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Ledbetter
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Yang
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lihong Long
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marc Daou
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sricharan Gopakumar
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lynette M Phillips
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brittany Parker Kerrigan
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery and The Brain Tumor Research Program, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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7
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Parney IF, Warnick RE, Lang FF, Rutka JT, Kalkanis S, Glick R, Rosenblum ML, Germano IM. The AANS/CNS Section on Tumors: a summary of 40 years of advocacy to advance the care of patients with brain and spine tumors. J Neurosurg 2024:1-7. [PMID: 38277647 DOI: 10.3171/2023.12.jns232781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/28/2024]
Abstract
The AANS/CNS Section on Tumors was founded 40 years ago in 1984 to assist in the education of neurosurgeons interested in neuro-oncology, and serves as a resource for other national organizations regarding the clinical treatment of nervous system tumors. The Section on Tumors was the first national physicians' professional organization dedicated to the study and treatment of patients with brain and spine tumors. Over the past 40 years, the Section on Tumors has built solid foundations, including establishing the tumor section satellite meetings, founding the Journal of Neuro-Oncology (the first medical journal dedicated to brain and spine surgical oncology), advancing surgical neuro-oncology education and research, promoting neurosurgical involvement in neuro-oncology clinical trials, and advocating for patients with brain and spine tumors. This review provides a synopsis of the Section on Tumors' history, its challenges, and its opportunities, drawing on the section's archives and input from the 17 section chairs who led it during its first 40 years.
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Affiliation(s)
- Ian F Parney
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Frederick F Lang
- 3Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - James T Rutka
- 4Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Steven Kalkanis
- 5Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Roberta Glick
- 6Department of Neurosurgery, Rush University, Chicago, Illinois; and
| | - Mark L Rosenblum
- 5Department of Neurosurgery, Henry Ford Health, Detroit, Michigan
| | - Isabelle M Germano
- 7Department of Neurosurgery, Icahn School of Medicine, Mount Sinai, New York, New York
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8
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Wang DH, Fujita Y, Dono A, Rodriguez Armendariz AG, Shah M, Putluri N, Pichardo-Rojas PS, Patel CB, Zhu JJ, Huse JT, Parker Kerrigan BC, Lang FF, Esquenazi Y, Ballester LY. The genomic alterations in glioblastoma influence the levels of CSF metabolites. Acta Neuropathol Commun 2024; 12:13. [PMID: 38243318 PMCID: PMC10799404 DOI: 10.1186/s40478-024-01722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/31/2023] [Indexed: 01/21/2024] Open
Abstract
Cerebrospinal fluid (CSF) analysis is underutilized in patients with glioblastoma (GBM), partly due to a lack of studies demonstrating the clinical utility of CSF biomarkers. While some studies show the utility of CSF cell-free DNA analysis, studies analyzing CSF metabolites in patients with glioblastoma are limited. Diffuse gliomas have altered cellular metabolism. For example, mutations in isocitrate dehydrogenase enzymes (e.g., IDH1 and IDH2) are common in diffuse gliomas and lead to increased levels of D-2-hydroxyglutarate in CSF. However, there is a poor understanding of changes CSF metabolites in GBM patients. In this study, we performed targeted metabolomic analysis of CSF from n = 31 patients with GBM and n = 13 individuals with non-neoplastic conditions (controls), by mass spectrometry. Hierarchical clustering and sparse partial least square-discriminant analysis (sPLS-DA) revealed differences in CSF metabolites between GBM and control CSF, including metabolites associated with fatty acid oxidation and the gut microbiome (i.e., carnitine, 2-methylbutyrylcarnitine, shikimate, aminobutanal, uridine, N-acetylputrescine, and farnesyl diphosphate). In addition, we identified differences in CSF metabolites in GBM patients based on the presence/absence of TP53 or PTEN mutations, consistent with the idea that different mutations have different effects on tumor metabolism. In summary, our results increase the understanding of CSF metabolites in patients with diffuse gliomas and highlight several metabolites that could be informative biomarkers in patients with GBM.
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Affiliation(s)
- Daniel H Wang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W. Holcombe Blvd., Suite 910, Houston, TX, 77030, USA
| | - Yoko Fujita
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin St., Suite 2800, Houston, TX, 77030, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin St., Suite 2800, Houston, TX, 77030, USA
| | - Ana G Rodriguez Armendariz
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Av. Ignacio Morones Prieto 3000, Sertoma, Monterrey, N.L, 64710, Mexico
| | - Mauli Shah
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W. Holcombe Blvd., Suite 910, Houston, TX, 77030, USA
| | - Nagireddy Putluri
- Advanced Technology Core, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Pavel S Pichardo-Rojas
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin St., Suite 2800, Houston, TX, 77030, USA
| | - Chirag B Patel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1002, BSRB S5.8116b, Houston, TX, 77030, USA
| | - Jay-Jiguang Zhu
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin St., Suite 2800, Houston, TX, 77030, USA
- Memorial Hermann Hospital-Texas Medical Center, Houston, TX, 77030, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W. Holcombe Blvd., Suite 910, Houston, TX, 77030, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Brittany C Parker Kerrigan
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Room FC7.2000, Unit 442, Houston, TX, 77030, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Room FC7.2000, Unit 442, Houston, TX, 77030, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6400 Fannin St., Suite 2800, Houston, TX, 77030, USA
- Memorial Hermann Hospital-Texas Medical Center, Houston, TX, 77030, USA
- Center for Precision Health, McGovern Medical School, The University of Texas Health Science Center at Houston, 7000 Fannin St., Suite 600, Houston, TX, 77030, USA
| | - Leomar Y Ballester
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 W. Holcombe Blvd., Suite 910, Houston, TX, 77030, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- Neuropathology and Molecular Genetic Pathology, Department of Pathology, Department of Translational Molecular Pathology, 1515 Holcombe Blvd, Unit 85, Houston, TX, 77030, USA.
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9
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Kan P, Srinivasan VM, Gumin J, Garcia R, Chen SR, Johnson JN, Collins DE, Chen MM, Ledbetter D, Huse J, Evan Luna ZA, Robledo A, Vasandani V, Rao A, Singh SK, Shpall EJ, Fueyo J, Gomez-Manzano C, Lang FF. Development of a rabbit human glioblastoma model for testing of endovascular selective intra-arterial infusion (ESIA) of novel stem cell-based therapeutics. Neuro Oncol 2024; 26:127-136. [PMID: 37603323 PMCID: PMC10768973 DOI: 10.1093/neuonc/noad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Endovascular selective intra-arterial (ESIA) infusion of cellular oncotherapeutics is a rapidly evolving strategy for treating glioblastoma. Evaluation of ESIA infusion requires a unique animal model. Our goal was to create a rabbit human GBM model to test IA infusions of cellular therapies and to test its usefulness by employing clinical-grade microcatheters and infusion methods to deliver mesenchymal stem cells loaded with an oncolytic adenovirus, Delta-24-RGD (MSC-D24). METHODS Rabbits were immunosuppressed with mycophenolate mofetil, dexamethasone, and tacrolimus. They underwent stereotactic xenoimplantation of human GBM cell lines (U87, MDA-GSC-17, and MDA-GSC-8-11) into the right frontal lobe. Tumor formation was confirmed on magnetic resonance imaging, histologic, and immunohistochemistry analysis. Selective microcatheter infusion of MSC-D24 was performed via the ipsilateral internal carotid artery to assess model utility and the efficacy and safety of this approach. RESULTS Twenty-five rabbits were implanted (18 with U87, 2 MDA-GSC-17, and 5 MDA-GSC-8-11). Tumors formed in 68% of rabbits (77.8% for U87, 50.0% for MDA-GSC-17, and 40.0% for MDA-GSC-8-11). On MRI, the tumors were hyperintense on T2-weighted image with variable enhancement (evidence of blood brain barrier breakdown). Histologically, tumors showed phenotypic traits of human GBM including varying levels of vascularity. ESIA infusion into the distal internal carotid artery of 2 ml of MSCs-D24 (107 cells) was safe in the model. Examination of post infusion specimens documented that MSCs-D24 homed to the implanted tumor at 24 hours. CONCLUSIONS The intracranial immunosuppressed rabbit human GBM model allows testing of ESIA infusion of novel therapeutics (eg, MSC-D24) in a clinically relevant fashion.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Joy Gumin
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Roberto Garcia
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Stephen R Chen
- Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, The University of California Los Angeles, Los Angeles, California, USA
| | - Dalis E Collins
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Melissa M Chen
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Ledbetter
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jason Huse
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Zean Aaron Evan Luna
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ariadna Robledo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Viren Vasandani
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Abhijit Rao
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sanjay K Singh
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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10
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Arjuna S, Shah M, Dono A, Nunez-Rubiano L, Pichardo-Rojas PS, Zhu JJ, Riascos RF, Luthra R, Roy-Chowdhuri S, Duose D, Wang DH, Lang FF, Esquenazi Y, Ballester LY. Rapid detection of mutations in CSF-cfTNA with the Genexus Integrated Sequencer. J Neurooncol 2024; 166:39-49. [PMID: 38160230 DOI: 10.1007/s11060-023-04487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Genomic alterations are fundamental for molecular-guided therapy in patients with breast and lung cancer. However, the turn-around time of standard next-generation sequencing assays is a limiting factor in the timely delivery of genomic information for clinical decision-making. METHODS In this study, we evaluated genomic alterations in 54 cerebrospinal fluid samples from 33 patients with metastatic lung cancer and metastatic breast cancer to the brain using the Oncomine Precision Assay on the Genexus sequencer. There were nine patients with samples collected at multiple time points. RESULTS Cell-free total nucleic acids (cfTNA) were extracted from CSF (0.1-11.2 ng/μl). Median base coverage was 31,963× with cfDNA input ranging from 2 to 20 ng. Mutations were detected in 30/54 CSF samples. Nineteen (19/24) samples with no mutations detected had suboptimal DNA input (< 20 ng). The EGFR exon-19 deletion and PIK3CA mutations were detected in two patients with increasing mutant allele fraction over time, highlighting the potential of CSF-cfTNA analysis for monitoring patients. Moreover, the EGFR T790M mutation was detected in one patient with prior EGFR inhibitor treatment. Additionally, ESR1 D538G and ESR1::CCDC170 alterations, associated with endocrine therapy resistance, were detected in 2 mBC patients. The average TAT from cfTNA-to-results was < 24 h. CONCLUSION In summary, our results indicate that CSF-cfTNA analysis with the Genexus-OPA can provide clinically relevant information in patients with brain metastases with short TAT.
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Affiliation(s)
- Srividya Arjuna
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Mauli Shah
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, TX, USA
| | - Luis Nunez-Rubiano
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UT Health, Houston, TX, USA
| | - Pavel S Pichardo-Rojas
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, TX, USA
| | - Jay-Jiguang Zhu
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, TX, USA
- Memorial Hermann Hospital-TMC, Houston, TX, USA
| | - Roy F Riascos
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UT Health, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center at Houston, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Dzifa Duose
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Daniel H Wang
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, TX, USA.
- Memorial Hermann Hospital-TMC, Houston, TX, USA.
- Center for Precision Health, Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Leomar Y Ballester
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA.
- Neuropathology and Molecular Genetic Pathology, Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Houston, TX, USA.
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11
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Leong VWS, Khan S, Sharma P, Wu S, Thomas RR, Li X, Singh SK, Lang FF, Yung AWK, Koul D. MGMT function determines the differential response of ATR inhibitors with DNA-damaging agents in glioma stem cells for GBM therapy. Neurooncol Adv 2024; 6:vdad165. [PMID: 38213834 PMCID: PMC10783493 DOI: 10.1093/noajnl/vdad165] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Background The most prevalent cancer treatments cause cell death through DNA damage. However, DNA damage response (DDR) repair pathways, initiated by tumor cells, can withstand the effects of anticancer drugs, providing justification for combining DDR inhibitors with DNA-damaging anticancer treatments. Methods Cell viability assays were performed with CellTiter-Glo assay. DNA damage was evaluated using Western blotting analysis. RNA-seq and single-cell level expression were used to identify the DDR signatures. In vivo, studies were conducted in mice to determine the effect of ATris on TMZ sensitization. Results We found a subpopulation of glioma sphere-forming cells (GSCs) with substantial synergism with temozolomide (TMZ) using a panel of 3 clinical-grade ataxia-telangiectasia- and Rad3-related kinase inhibitors (ATRis), (elimusertib, berzosertib, and ceralasertib). Interestingly, most synergistic cell lines had O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, indicating that ATRi mainly benefits tumors with no MGMT repair. Further, TMZ activated the ATR-checkpoint kinase 1 (Chk1) axis in an MGMT-dependent way. TMZ caused ATR-dependent Chk1 phosphorylation and DNA double-strand breaks as shown by increased γH2AX. Increased DNA damage and decreased Chk1 phosphorylation were observed upon the addition of ATRis to TMZ in MGMT-methylated (MGMT-) GSCs. TMZ also improved sensitivity to ATRis in vivo, as shown by increased mouse survival with the TMZ and ATRi combination treatment. Conclusions This research provides a rationale for selectively targeting MGMT-methylated cells using ATRis and TMZ combination. Overall, we believe that MGMT methylation status in GBM could serve as a robust biomarker for patient selection for ATRi combined with TMZ.
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Affiliation(s)
- Vincent W S Leong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sabbir Khan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pratibha Sharma
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shaofang Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Riya R Thomas
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiaolong Li
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay K Singh
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alfred W K Yung
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimpy Koul
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Yu KKH, Basu S, Baquer G, Ahn R, Gantchev J, Jindal S, Regan MS, Abou-Mrad Z, Prabhu MC, Williams MJ, D'Souza AD, Malinowski SW, Hopland K, Elhanati Y, Stopka SA, Stortchevoi A, He Z, Sun J, Chen Y, Espejo AB, Chow KH, Yerrum S, Kao PL, Kerrigan BP, Norberg L, Nielsen D, Puduvalli VK, Huse J, Beroukhim R, Kim YSB, Goswami S, Boire A, Frisken S, Cima MJ, Holdhoff M, Lucas CHG, Bettegowda C, Levine SS, Bale TA, Brennan C, Reardon DA, Lang FF, Antonio Chiocca E, Ligon KL, White FM, Sharma P, Tabar V, Agar NYR. Investigative needle core biopsies for multi-omics in Glioblastoma. medRxiv 2023:2023.12.29.23300541. [PMID: 38234840 PMCID: PMC10793534 DOI: 10.1101/2023.12.29.23300541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Glioblastoma (GBM) is a primary brain cancer with an abysmal prognosis and few effective therapies. The ability to investigate the tumor microenvironment before and during treatment would greatly enhance both understanding of disease response and progression, as well as the delivery and impact of therapeutics. Stereotactic biopsies are a routine surgical procedure performed primarily for diagnostic histopathologic purposes. The role of investigative biopsies - tissue sampling for the purpose of understanding tumor microenvironmental responses to treatment using integrated multi-modal molecular analyses ('Multi-omics") has yet to be defined. Secondly, it is unknown whether comparatively small tissue samples from brain biopsies can yield sufficient information with such methods. Here we adapt stereotactic needle core biopsy tissue in two separate patients. In the first patient with recurrent GBM we performed highly resolved multi-omics analysis methods including single cell RNA sequencing, spatial-transcriptomics, metabolomics, proteomics, phosphoproteomics, T-cell clonotype analysis, and MHC Class I immunopeptidomics from biopsy tissue that was obtained from a single procedure. In a second patient we analyzed multi-regional core biopsies to decipher spatial and genomic variance. We also investigated the utility of stereotactic biopsies as a method for generating patient derived xenograft models in a separate patient cohort. Dataset integration across modalities showed good correspondence between spatial modalities, highlighted immune cell associated metabolic pathways and revealed poor correlation between RNA expression and the tumor MHC Class I immunopeptidome. In conclusion, stereotactic needle biopsy cores are of sufficient quality to generate multi-omics data, provide data rich insight into a patient's disease process and tumor immune microenvironment and can be of value in evaluating treatment responses. One sentence summary Integrative multi-omics analysis of stereotactic needle core biopsies in glioblastoma.
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13
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Haider AS, McCutcheon IE, Ene CI, Fuller GN, Schomer DF, Gule-Monroe M, DeMonte F, Ferguson SD, Lang FF, Prabhu SS, Raza SM, Suki D, Weinberg JS, Sawaya R. Subependymomas of the fourth ventricle: To operate or not to operate? J Clin Neurosci 2023; 118:147-152. [PMID: 37944358 DOI: 10.1016/j.jocn.2023.10.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a paucity of literature regarding the clinical characteristics and management of subependymomas of the fourth ventricle due to their rarity. Here, we describe the operative and non-operative management and outcomes of patients with such tumors. METHODS This retrospective single-institution case series was gathered after Institutional Review Board (IRB) approval. Patients diagnosed with a subependymoma of the fourth ventricle between 1993 and 2021 were identified. Clinical, radiology and pathology reports along with magnetic resonance imaging (MRI) images were reviewed. RESULTS Patients identified (n = 20), showed a male predominance (n = 14). They underwent surgery (n = 9) with resection and histopathological confirmation of subependymoma or were followed with imaging surveillance (n = 11). The median age at diagnosis was 51.5 years. Median tumor volume for the operative cohort was 8.64 cm3 and median length of follow-up was 65.8 months. Median tumor volume for the non-operative cohort was 0.96 cm3 and median length of follow-up was 78 months. No tumor recurrence post-resection was noted in the operative group, and no tumor growth from baseline was noted in the non-operative group. Most patients (89 %) in the operative group had symptoms at diagnosis, all of which improved post-resection. No patients were symptomatic in the non-operative group. CONCLUSIONS Surgical resection is safe and is associated with alleviation of presenting symptoms in patients with large tumors. Observation and routine surveillance are warranted for smaller, asymptomatic tumors.
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Affiliation(s)
- Ali S Haider
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Ian E McCutcheon
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chibawanye I Ene
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria Gule-Monroe
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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De A, Lattier JM, Morales JE, Kelly JR, Zheng X, Chen Z, Sebastian S, Nassiri Toosi Z, Huse JT, Lang FF, McCarty JH. Glial Cell Adhesion Molecule (GlialCAM) Determines Proliferative versus Invasive Cell States in Glioblastoma. J Neurosci 2023; 43:8043-8057. [PMID: 37722850 PMCID: PMC10669794 DOI: 10.1523/jneurosci.1401-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
The malignant brain cancer glioblastoma (GBM) contains groups of highly invasive cells that drive tumor progression as well as recurrence after surgery and chemotherapy. The molecular mechanisms that enable these GBM cells to exit the primary mass and disperse throughout the brain remain largely unknown. Here we report using human tumor specimens and primary spheroids from male and female patients that glial cell adhesion molecule (GlialCAM), which has normal roles in brain astrocytes and is mutated in the developmental brain disorder megalencephalic leukoencephalopathy with subcortical cysts (MLC), is differentially expressed in subpopulations of GBM cells. High levels of GlialCAM promote cell-cell adhesion and a proliferative GBM cell state in the tumor core. In contrast, GBM cells with low levels of GlialCAM display diminished proliferation and enhanced invasion into the surrounding brain parenchyma. RNAi-mediated inhibition of GlialCAM expression leads to activation of proinvasive extracellular matrix adhesion and signaling pathways. Profiling GlialCAM-regulated genes combined with cross-referencing to single-cell transcriptomic datasets validates functional links among GlialCAM, Mlc1, and aquaporin-4 in the invasive cell state. Collectively, these results reveal an important adhesion and signaling axis comprised of GlialCAM and associated proteins including Mlc1 and aquaporin-4 that is critical for control of GBM cell proliferation and invasion status in the brain cancer microenvironment.SIGNIFICANCE STATEMENT Glioblastoma (GBM) contains heterogeneous populations of cells that coordinately drive proliferation and invasion. We have discovered that glial cell adhesion molecule (GlialCAM)/hepatocyte cell adhesion molecule (HepaCAM) is highly expressed in proliferative GBM cells within the tumor core. In contrast, GBM cells with low levels of GlialCAM robustly invade into surrounding brain tissue along blood vessels and white matter. Quantitative RNA sequencing identifies various GlialCAM-regulated genes with functions in cell-cell adhesion and signaling. These data reveal that GlialCAM and associated signaling partners, including Mlc1 and aquaporin-4, are key factors that determine proliferative and invasive cell states in GBM.
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Affiliation(s)
- Arpan De
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - John M Lattier
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - John E Morales
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Jack R Kelly
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Xiaofeng Zheng
- Department of Bioinformatics and Computational Biology, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Zhihua Chen
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Sumod Sebastian
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Zahra Nassiri Toosi
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Jason T Huse
- Department of Pathology, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Frederick F Lang
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
| | - Joseph H McCarty
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030
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15
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Goswami S, Raychaudhuri D, Singh P, Natarajan SM, Chen Y, Poon C, Hennessey M, Tannir AJ, Zhang J, Anandhan S, Kerrigan BP, Macaluso MD, He Z, Jindal S, Lang FF, Basu S, Sharma P. Myeloid-specific KDM6B inhibition sensitizes glioblastoma to PD1 blockade. Nat Cancer 2023; 4:1455-1473. [PMID: 37653141 DOI: 10.1038/s43018-023-00620-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Glioblastoma (GBM) tumors are enriched in immune-suppressive myeloid cells and are refractory to immune checkpoint therapy (ICT). Targeting epigenetic pathways to reprogram the functional phenotype of immune-suppressive myeloid cells to overcome resistance to ICT remains unexplored. Single-cell and spatial transcriptomic analyses of human GBM tumors demonstrated high expression of an epigenetic enzyme-histone 3 lysine 27 demethylase (KDM6B)-in intratumoral immune-suppressive myeloid cell subsets. Importantly, myeloid cell-specific Kdm6b deletion enhanced proinflammatory pathways and improved survival in GBM tumor-bearing mice. Mechanistic studies showed that the absence of Kdm6b enhances antigen presentation, interferon response and phagocytosis in myeloid cells by inhibition of mediators of immune suppression including Mafb, Socs3 and Sirpa. Further, pharmacological inhibition of KDM6B mirrored the functional phenotype of Kdm6b-deleted myeloid cells and enhanced anti-PD1 efficacy. This study thus identified KDM6B as an epigenetic regulator of the functional phenotype of myeloid cell subsets and a potential therapeutic target for enhanced response to ICT.
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Affiliation(s)
- Sangeeta Goswami
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- James P. Allison Institute, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Deblina Raychaudhuri
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pratishtha Singh
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seanu Meena Natarajan
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yulong Chen
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Candice Poon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mercedes Hennessey
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aminah J Tannir
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Zhang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Swetha Anandhan
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Marc D Macaluso
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhong He
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonali Jindal
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sreyashi Basu
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Padmanee Sharma
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- James P. Allison Institute, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Immunotherapy Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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16
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Zheng C, Wei Y, Zhang Q, Sun M, Wang Y, Hou J, Zhang P, Lv X, Su D, Jiang Y, Gumin J, Sahni N, Hu B, Wang W, Chen X, McGrail DJ, Zhang C, Huang S, Xu H, Chen J, Lang FF, Hu J, Chen Y. Multiomics analyses reveal DARS1-AS1/YBX1-controlled posttranscriptional circuits promoting glioblastoma tumorigenesis/radioresistance. Sci Adv 2023; 9:eadf3984. [PMID: 37540752 PMCID: PMC10403220 DOI: 10.1126/sciadv.adf3984] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
The glioblastoma (GBM) stem cell-like cells (GSCs) are critical for tumorigenesis/therapeutic resistance of GBM. Mounting evidence supports tumor-promoting function of long noncoding RNAs (lncRNAs), but their role in GSCs remains poorly understood. By combining CRISPRi screen with orthogonal multiomics approaches, we identified a lncRNA DARS1-AS1-controlled posttranscriptional circuitry that promoted the malignant properties of GBM cells/GSCs. Depleting DARS1-AS1 inhibited the proliferation of GBM cells/GSCs and self-renewal of GSCs, prolonging survival in orthotopic GBM models. DARS1-AS1 depletion also impaired the homologous recombination (HR)-mediated double-strand break (DSB) repair and enhanced the radiosensitivity of GBM cells/GSCs. Mechanistically, DARS1-AS1 interacted with YBX1 to promote target mRNA binding and stabilization, forming a mixed transcriptional/posttranscriptional feed-forward loop to up-regulate expression of the key regulators of G1-S transition, including E2F1 and CCND1. DARS1-AS1/YBX1 also stabilized the mRNA of FOXM1, a master transcription factor regulating GSC self-renewal and DSB repair. Our findings suggest DARS1-AS1/YBX1 axis as a potential therapeutic target for sensitizing GBM to radiation/HR deficiency-targeted therapy.
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Affiliation(s)
- Caishang Zheng
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yanjun Wei
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qiang Zhang
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ming Sun
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yunfei Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jiakai Hou
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Peng Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiangdong Lv
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dan Su
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yujie Jiang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Statistics, Rice University, Houston, TX 77005, USA
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nidhi Sahni
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Program in Quantitative and Computational Biosciences (QCB), Baylor College of Medicine, Houston, TX 77030, USA
| | - Baoli Hu
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Pediatric Neurosurgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
- Molecular and Cellular Cancer Biology Program, UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Wenyi Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xi Chen
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniel J. McGrail
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
- Lerner Research Institute, Cleveland, OH 44195, USA
| | - Chaolin Zhang
- Department of Systems Biology, Department of Biochemistry and Molecular Biophysics, and Center for Motor Neuron Biology and Disease, Columbia University, New York, NY 10032, USA
| | - Suyun Huang
- Department of Human and Molecular Genetics, Institute of Molecular Medicine, VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA 23298, USA
| | - Han Xu
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Quantitative Sciences Program, MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- The Center for Cancer Epigenetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Junjie Chen
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jian Hu
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Cancer Biology Program, MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Neuroscience Program, MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Yiwen Chen
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Quantitative Sciences Program, MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
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17
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Nassiri F, Patil V, Yefet LS, Singh O, Liu J, Dang RMA, Yamaguchi TN, Daras M, Cloughesy TF, Colman H, Kumthekar PU, Chen CC, Aiken R, Groves MD, Ong SS, Ramakrishna R, Vogelbaum MA, Khagi S, Kaley T, Melear JM, Peereboom DM, Rodriguez A, Yankelevich M, Nair SG, Puduvalli VK, Aldape K, Gao A, López-Janeiro Á, de Andrea CE, Alonso MM, Boutros P, Robbins J, Mason WP, Sonabend AM, Stupp R, Fueyo J, Gomez-Manzano C, Lang FF, Zadeh G. Oncolytic DNX-2401 virotherapy plus pembrolizumab in recurrent glioblastoma: a phase 1/2 trial. Nat Med 2023; 29:1370-1378. [PMID: 37188783 PMCID: PMC10287560 DOI: 10.1038/s41591-023-02347-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Immune-mediated anti-tumoral responses, elicited by oncolytic viruses and augmented with checkpoint inhibition, may be an effective treatment approach for glioblastoma. Here in this multicenter phase 1/2 study we evaluated the combination of intratumoral delivery of oncolytic virus DNX-2401 followed by intravenous anti-PD-1 antibody pembrolizumab in recurrent glioblastoma, first in a dose-escalation and then in a dose-expansion phase, in 49 patients. The primary endpoints were overall safety and objective response rate. The primary safety endpoint was met, whereas the primary efficacy endpoint was not met. There were no dose-limiting toxicities, and full dose combined treatment was well tolerated. The objective response rate was 10.4% (90% confidence interval (CI) 4.2-20.7%), which was not statistically greater than the prespecified control rate of 5%. The secondary endpoint of overall survival at 12 months was 52.7% (95% CI 40.1-69.2%), which was statistically greater than the prespecified control rate of 20%. Median overall survival was 12.5 months (10.7-13.5 months). Objective responses led to longer survival (hazard ratio 0.20, 95% CI 0.05-0.87). A total of 56.2% (95% CI 41.1-70.5%) of patients had a clinical benefit defined as stable disease or better. Three patients completed treatment with durable responses and remain alive at 45, 48 and 60 months. Exploratory mutational, gene-expression and immunophenotypic analyses revealed that the balance between immune cell infiltration and expression of checkpoint inhibitors may potentially inform on response to treatment and mechanisms of resistance. Overall, the combination of intratumoral DNX-2401 followed by pembrolizumab was safe with notable survival benefit in select patients (ClinicalTrials.gov registration: NCT02798406).
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Affiliation(s)
- Farshad Nassiri
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Vikas Patil
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Leeor S Yefet
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Olivia Singh
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jeff Liu
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Rachel M A Dang
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - Takafumi N Yamaguchi
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariza Daras
- Division of Neuro-oncology, University of California San Francisco, San Francisco, CA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Howard Colman
- Huntsman Cancer Institute and Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Priya U Kumthekar
- Department of Neurology, Division of Neuro-Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MI, USA
| | - Robert Aiken
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - Shirley S Ong
- Division of Neuro-Oncology, Department of Neurology, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, Neuro-Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Simon Khagi
- Division of Medical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason M Melear
- Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - David M Peereboom
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Analiz Rodriguez
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Maxim Yankelevich
- Department of Pediatrics, University of Michigan, Ann Arbor Beaumont Children's Hospital, Royal Oak, MI, USA
| | - Suresh G Nair
- Lehigh Valley Topper Cancer Institute, Allentown, PA, USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Andrew Gao
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Álvaro López-Janeiro
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdISNA), Pamplona, Spain
| | - Carlos E de Andrea
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdISNA), Pamplona, Spain
| | - Marta M Alonso
- Navarra Institute for Health Research (IdISNA), Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
- Program of Solid Tumors, Center for the Applied Medical Research (CIMA), Pamplona, Spain
| | - Paul Boutros
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Warren P Mason
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Adam M Sonabend
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roger Stupp
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern Medicine Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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18
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Jiang H, Shin DH, Yi Y, Fan X, Gumin J, He J, Gillard AG, Lang FF, Gomez-Manzano C, Fueyo J. Adjuvant Therapy with Oncolytic Adenovirus Delta-24-RGDOX After Intratumoral Adoptive T-cell Therapy Promotes Antigen Spread to Sustain Systemic Antitumor Immunity. Cancer Res Commun 2023; 3:1118-1131. [PMID: 37379361 PMCID: PMC10295804 DOI: 10.1158/2767-9764.crc-23-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 06/30/2023]
Abstract
Cancer cell heterogeneity and immunosuppressive tumor microenvironment (TME) pose a challenge in treating solid tumors with adoptive cell therapies targeting limited tumor-associated antigens (TAA), such as chimeric antigen receptor T-cell therapy. We hypothesize that oncolytic adenovirus Delta-24-RGDOX activates the TME and promote antigen spread to potentiate the abscopal effect of adoptive TAA-targeting T cells in localized intratumoral treatment. Herein, we used C57BL/6 mouse models with disseminated tumors derived from B16 melanoma cell lines to assess therapeutic effects and antitumor immunity. gp100-specific pmel-1 or ovalbumin (OVA)-specific OT-I T cells were injected into the first subcutaneous tumor, followed by three injections of Delta-24-RGDOX. We found TAA-targeting T cells injected into one subcutaneous tumor showed tumor tropism. Delta-24-RGDOX sustained the systemic tumor regression mediated by the T cells, leading to improved survival rate. Further analysis revealed that, in mice with disseminated B16-OVA tumors, Delta-24-RGDOX increased CD8+ leukocyte density within treated and untreated tumors. Importantly, Delta-24-RGDOX significantly reduced the immunosuppression of endogenous OVA-specific CTLs while increasing that of CD8+ leukocytes and, to a lesser extent, adoptive pmel-1 T cells. Consequently, Delta-24-RGDOX drastically increased the density of the OVA-specific CTLs in both tumors, and the combination synergistically enhanced the effect. Consistently, the splenocytes from the combination group showed a significantly stronger response against other TAAs (OVA and TRP2) than gp100, resulted in higher activity against tumor cells. Therefore, our data demonstrate that, as an adjuvant therapy followed TAA-targeting T cells in localized treatment, Delta-24-RGDOX activates TME and promotes antigen spread, leading to efficacious systemic antitumor immunity to overcome tumor relapse. Significance Adjuvant therapy with oncolytic viruses promotes antigen spread to potentiate localized intratumoral adoptive T-cell therapy with limited TAA targets, leading to sustainable systemic antitumor immunity to overcome tumor relapse.
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Affiliation(s)
- Hong Jiang
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dong Ho Shin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yanhua Yi
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xuejun Fan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joy Gumin
- Department of Neuro-Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jiasen He
- Pediatric division, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew G. Gillard
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick F. Lang
- Department of Neuro-Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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19
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Stitzlein LM, Gangadharan A, Walsh LM, Nam D, Espejo AB, Singh MM, Patel KH, Lu Y, Su X, Ezhilarasan R, Gumin J, Singh S, Sulman E, Lang FF, Chandra J. Comparison of pharmacological inhibitors of lysine-specific demethylase 1 in glioblastoma stem cells reveals inhibitor-specific efficacy profiles. Front Neurol 2023; 14:1112207. [PMID: 37082446 PMCID: PMC10111022 DOI: 10.3389/fneur.2023.1112207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
IntroductionImproved therapies for glioblastoma (GBM) are desperately needed and require preclinical evaluation in models that capture tumor heterogeneity and intrinsic resistance seen in patients. Epigenetic alterations have been well documented in GBM and lysine-specific demethylase 1 (LSD1/KDM1A) is amongst the chromatin modifiers implicated in stem cell maintenance, growth and differentiation. Pharmacological inhibition of LSD1 is clinically relevant, with numerous compounds in various phases of preclinical and clinical development, but an evaluation and comparison of LSD1 inhibitors in patient-derived GBM models is lacking.MethodsTo assess concordance between knockdown of LSD1 and inhibition of LSD1 using a prototype inhibitor in GBM, we performed RNA-seq to identify genes and biological processes associated with inhibition. Efficacy of various LSD1 inhibitors was assessed in nine patient-derived glioblastoma stem cell (GSC) lines and an orthotopic xenograft mouse model.ResultsLSD1 inhibitors had cytotoxic and selective effects regardless of GSC radiosensitivity or molecular subtype. In vivo, LSD1 inhibition via GSK-LSD1 led to a delayed reduction in tumor burden; however, tumor regrowth occurred. Comparison of GBM lines by RNA-seq was used to identify genes that may predict resistance to LSD1 inhibitors. We identified five genes that correlate with resistance to LSD1 inhibition in treatment resistant GSCs, in GSK-LSD1 treated mice, and in GBM patients with low LSD1 expression.ConclusionCollectively, the growth inhibitory effects of LSD1 inhibition across a panel of GSC models and identification of genes that may predict resistance has potential to guide future combination therapies.
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Affiliation(s)
- Lea M. Stitzlein
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
| | - Achintyan Gangadharan
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Leslie M. Walsh
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Deokhwa Nam
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexsandra B. Espejo
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Melissa M. Singh
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kareena H. Patel
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yue Lu
- Department of Epigenetics and Molecular Carcinogenesis, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xiaoping Su
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ravesanker Ezhilarasan
- Department of Radiation Oncology, NYU Langone Medical Center, New York, NY, United States
| | - Joy Gumin
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanjay Singh
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erik Sulman
- Department of Radiation Oncology, NYU Langone Medical Center, New York, NY, United States
| | - Frederick F. Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joya Chandra
- Department of Pediatrics Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States
- Department of Epigenetics and Molecular Carcinogenesis, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Joya Chandra,
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20
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Srinivasan VM, Kan P, Gumin J, Collins DE, Chen S, Chen MM, Garcia R, Fueyo J, Lang FF. 893 Development of a Rabbit Human Glioblastoma Model for Testing of Endovascular Selective Intra-Arterial Infusion (ESIA) of Novel Stem Cell-Based Therapeutics. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_893] [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: 03/18/2023] Open
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21
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Hasanov M, Milton DR, Bea Davies A, Sirmans E, Saberian C, Posada EL, Opusunju S, Gershenwald JE, Torres-Cabala CA, Burton EM, Colen R, Huse JT, Glitza Oliva IC, Chung C, McAleer MF, McGovern SL, Yeboa DN, Kim BYS, Prabhu SS, McCutcheon IE, Weinberg J, Lang FF, Tawbi HA, Li J, Haydu LE, Davies MA, Ferguson SD. Changes In Outcomes And Factors Associated With Survival In Melanoma Patients With Brain Metastases. Neuro Oncol 2022:6889653. [PMID: 36510640 DOI: 10.1093/neuonc/noac251] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUD Treatment options for patients with melanoma brain metastasis (MBM) have changed significantly in the last decade. Few studies have evaluated changes in outcomes and factors associated with survival in MBM patients over time. The aim of this study is to evaluate changes in clinical features and overall survival (OS) for MBM patients. METHODS Patients diagnosed with MBMs from 1/1/2009-12/31/2013 (Prior Era; PE) and 1/1/2014-12/31/2018 (Current Era; CE) at The University of Texas MD Anderson Cancer Center were included in this retrospective analysis. The primary outcome measure was OS. Log-rank test assessed differences between groups; multivariable analyses were performed with Cox proportional hazards models and recursive partitioning analysis (RPA). RESULTS 791 MBM patients (PE, n=332; CE, n=459) were included in analysis. Median OS from MBM diagnosis was 10.3 months (95% CI, 8.9 - 12.4) and improved in the CE versus PE (14.4 vs. 10.3 months, P < .001). Elevated serum LDH was the only factor associated with worse OS in both PE and CE patients. Factors associated with survival in CE MBM patients included patient age, primary tumor Breslow thickness, prior immunotherapy, leptomeningeal disease (LMD), symptomatic MBMs, and whole brain radiation therapy (WBRT). Several factors associated with OS in the PE were not significant in the CE. RPA demonstrated that elevated serum LDH and prior immunotherapy treatment are the most important determinants of survival in CE MBM patients. CONCLUSIONS OS and factors associated with OS have changed for MBM patients. This information can inform contemporary patient management and clinical investigations.
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Affiliation(s)
- Merve Hasanov
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alicia Bea Davies
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Sirmans
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chantal Saberian
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eliza L Posada
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sylvia Opusunju
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elizabeth M Burton
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rivka Colen
- Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburg, Pittsburg, PA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Al-Holou WN, Suki D, Hodges TR, Everson RG, Freeman J, Ferguson SD, McCutcheon IE, Prabhu SS, Weinberg JS, Sawaya R, Lang FF. Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas. J Neurosurg 2022; 137:1015-1025. [PMID: 34996044 DOI: 10.3171/2021.9.jns21718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/24/2021] [Accepted: 09/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Many neurosurgeons resect nonenhancing low-grade gliomas (LGGs) by using an inside-out piecemeal resection (PMR) technique. At the authors' institution they have increasingly used a circumferential, perilesional, sulcus-guided resection (SGR) technique. This technique has not been well described and there are limited data on its effectiveness. The authors describe the SGR technique and assess the extent to which SGR correlates with extent of resection and neurological outcome. METHODS The authors identified all patients with newly diagnosed LGGs who underwent resection at their institution over a 22-year period. Demographics, presenting symptoms, intraoperative data, method of resection (SGR or PMR), volumetric imaging data, and postoperative outcomes were obtained. Univariate analyses used ANOVA and Fisher's exact test. Multivariate analyses were performed using multivariate logistic regression. RESULTS Newly diagnosed LGGs were resected in 519 patients, 208 (40%) using an SGR technique and 311 (60%) using a PMR technique. The median extent of resection in the SGR group was 84%, compared with 77% in the PMR group (p = 0.019). In multivariate analysis, SGR was independently associated with a higher rate of complete (100%) resection (27% vs 18%) (OR 1.7, 95% CI 1.1-2.6; p = 0.03). SGR was also associated with a statistical trend toward lower rates of postoperative neurological complications (11% vs 16%, p = 0.09). A subset analysis of tumors located specifically in eloquent brain demonstrated SGR to be as safe as PMR. CONCLUSIONS The authors describe the SGR technique used to resect LGGs and show that SGR is independently associated with statistically significantly higher rates of complete resection, without an increase in neurological complications, than with PMR. SGR technique should be considered when resecting LGGs.
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Affiliation(s)
- Wajd N Al-Holou
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
- 3Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dima Suki
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Tiffany R Hodges
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Richard G Everson
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jacob Freeman
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Sherise D Ferguson
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Ian E McCutcheon
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Sujit S Prabhu
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jeffrey S Weinberg
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Raymond Sawaya
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Frederick F Lang
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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23
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Hasanov E, Yeboa DN, Tucker MD, Swanson TA, Beckham TH, Rini B, Ene CI, Hasanov M, Derks S, Smits M, Dudani S, Heng DYC, Brastianos PK, Bex A, Hanalioglu S, Weinberg JS, Hirsch L, Carlo MI, Aizer A, Brown PD, Bilen MA, Chang EL, Jaboin J, Brugarolas J, Choueiri TK, Atkins MB, McGregor BA, Halasz LM, Patel TR, Soltys SG, McDermott DF, Elder JB, Baskaya MK, Yu JB, Timmerman R, Kim MM, Mut M, Markert J, Beal K, Tannir NM, Samandouras G, Lang FF, Giles R, Jonasch E. An interdisciplinary consensus on the management of brain metastases in patients with renal cell carcinoma. CA Cancer J Clin 2022; 72:454-489. [PMID: 35708940 DOI: 10.3322/caac.21729] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 12/23/2022] Open
Abstract
Brain metastases are a challenging manifestation of renal cell carcinoma. We have a limited understanding of brain metastasis tumor and immune biology, drivers of resistance to systemic treatment, and their overall poor prognosis. Current data support a multimodal treatment strategy with radiation treatment and/or surgery. Nonetheless, the optimal approach for the management of brain metastases from renal cell carcinoma remains unclear. To improve patient care, the authors sought to standardize practical management strategies. They performed an unstructured literature review and elaborated on the current management strategies through an international group of experts from different disciplines assembled via the network of the International Kidney Cancer Coalition. Experts from different disciplines were administered a survey to answer questions related to current challenges and unmet patient needs. On the basis of the integrated approach of literature review and survey study results, the authors built algorithms for the management of single and multiple brain metastases in patients with renal cell carcinoma. The literature review, consensus statements, and algorithms presented in this report can serve as a framework guiding treatment decisions for patients. CA Cancer J Clin. 2022;72:454-489.
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Affiliation(s)
- Elshad Hasanov
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra Nana Yeboa
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mathew D Tucker
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd A Swanson
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas Hendrix Beckham
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian Rini
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chibawanye I Ene
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merve Hasanov
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sophie Derks
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Shaan Dudani
- Division of Oncology/Hematology, William Osler Health System, Brampton, Ontario, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Axel Bex
- The Royal Free London National Health Service Foundation Trust, London, United Kingdom
- University College London Division of Surgery and Interventional Science, London, United Kingdom
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Sahin Hanalioglu
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jeffrey S Weinberg
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laure Hirsch
- Department of Medical Oncology, Cochin University Hospital, Public Assistance Hospital of Paris, Paris, France
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Maria I Carlo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ayal Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Paul David Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Eric Lin Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, California, Los Angeles
| | - Jerry Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Hematology/Oncology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael B Atkins
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Bradley A McGregor
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Toral R Patel
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James Bradley Elder
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - James B Yu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Robert Timmerman
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle Miran Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Melike Mut
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - James Markert
- Department of Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- University College London Queen Square Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Frederick F Lang
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel Giles
- International Kidney Cancer Coalition, Duivendrecht, the Netherlands
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Modrek AS, Eskilsson E, Ezhilarasan R, Wang Q, Goodman LD, Ding Y, Zhang ZY, Bhat KPL, Le TTT, Barthel FP, Tang M, Yang J, Long L, Gumin J, Lang FF, Verhaak RGW, Aldape KD, Sulman EP. PDPN marks a subset of aggressive and radiation-resistant glioblastoma cells. Front Oncol 2022; 12:941657. [PMID: 36059614 PMCID: PMC9434399 DOI: 10.3389/fonc.2022.941657] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment-resistant glioma stem cells are thought to propagate and drive growth of malignant gliomas, but their markers and our ability to target them specifically are not well understood. We demonstrate that podoplanin (PDPN) expression is an independent prognostic marker in gliomas across multiple independent patient cohorts comprising both high- and low-grade gliomas. Knockdown of PDPN radiosensitized glioma cell lines and glioma-stem-like cells (GSCs). Clonogenic assays and xenograft experiments revealed that PDPN expression was associated with radiotherapy resistance and tumor aggressiveness. We further demonstrate that knockdown of PDPN in GSCs in vivo is sufficient to improve overall survival in an intracranial xenograft mouse model. PDPN therefore identifies a subset of aggressive, treatment-resistant glioma cells responsible for radiation resistance and may serve as a novel therapeutic target.
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Affiliation(s)
- Aram S. Modrek
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
| | - Eskil Eskilsson
- Department of Genomic Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Ravesanker Ezhilarasan
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
| | - Qianghu Wang
- Department of Bioinformatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lindsey D. Goodman
- Duncan Neurological Research Institute, Baylor College of Medicine, Houston, TX, United States
| | - Yingwen Ding
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
| | - Ze-Yan Zhang
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
| | - Krishna P. L. Bhat
- Department of Translational Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Thanh-Thuy T. Le
- Department of Anesthesiology, University of Texas Medical School, Houston, TX, United States
| | | | - Ming Tang
- Department of Genomic Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Jie Yang
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
| | - Lihong Long
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | | | - Kenneth D. Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Erik P. Sulman
- Department of Radiation Oncology, New York University (NYU) Langone School of Medicine, New York, NY, United States
- New York University (NYU) Langone Laura and Isaac Perlmutter Cancer Center, New York, NY, United States
- *Correspondence: Erik P. Sulman,
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25
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Nguyen TT, Shin DH, Sohoni S, Singh SK, Rivera-Molina Y, Jiang H, Fan X, Gumin J, Lang FF, Alvarez-Breckenridge C, Godoy-Vitorino F, Zhu L, Zheng WJ, Zhai L, Ladomersky E, Lauing KL, Alonso MM, Wainwright DA, Gomez-Manzano C, Fueyo J. Reshaping the tumor microenvironment with oncolytic viruses, positive regulation of the immune synapse, and blockade of the immunosuppressive oncometabolic circuitry. J Immunother Cancer 2022; 10:e004935. [PMID: 35902132 PMCID: PMC9341188 DOI: 10.1136/jitc-2022-004935] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Oncolytic viruses are considered part of immunotherapy and have shown promise in preclinical experiments and clinical trials. Results from these studies have suggested that tumor microenvironment remodeling is required to achieve an effective response in solid tumors. Here, we assess the extent to which targeting specific mechanisms underlying the immunosuppressive tumor microenvironment optimizes viroimmunotherapy. METHODS We used RNA-seq analyses to analyze the transcriptome, and validated the results using Q-PCR, flow cytometry, and immunofluorescence. Viral activity was analyzed by replication assays and viral titration. Kyn and Trp metabolite levels were quantified using liquid chromatography-mass spectrometry. Aryl hydrocarbon receptor (AhR) activation was analyzed by examination of promoter activity. Therapeutic efficacy was assessed by tumor histopathology and survival in syngeneic murine models of gliomas, including Indoleamine 2,3-dioxygenase (IDO)-/- mice. Flow cytometry was used for immunophenotyping and quantification of cell populations. Immune activation was examined in co-cultures of immune and cancer cells. T-cell depletion was used to identify the role played by specific cell populations. Rechallenge experiments were performed to identify the development of anti-tumor memory. RESULTS Bulk RNA-seq analyses showed the activation of the immunosuppressive IDO-kynurenine-AhR circuitry in response to Delta-24-RGDOX infection of tumors. To overcome the effect of this pivotal pathway, we combined Delta-24-RGDOX with clinically relevant IDO inhibitors. The combination therapy increased the frequency of CD8+ T cells and decreased the rate of myeloid-derived suppressor cell and immunosupressive Treg tumor populations in animal models of solid tumors. Functional studies demonstrated that IDO-blockade-dependent activation of immune cells against tumor antigens could be reversed by the oncometabolite kynurenine. The concurrent targeting of the effectors and suppressors of the tumor immune landscape significantly prolonged the survival in animal models of orthotopic gliomas. CONCLUSIONS Our data identified for the first time the in vivo role of IDO-dependent immunosuppressive pathways in the resistance of solid tumors to oncolytic adenoviruses. Specifically, the IDO-Kyn-AhR activity was responsible for the resurface of local immunosuppression and resistance to therapy, which was ablated through IDO inhibition. Our data indicate that combined molecular and immune therapy may improve outcomes in human gliomas and other cancers treated with virotherapy.
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Affiliation(s)
- Teresa T Nguyen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Dong Ho Shin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Sagar Sohoni
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay K Singh
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisel Rivera-Molina
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hong Jiang
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuejun Fan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Filipa Godoy-Vitorino
- Department of Microbiology and Medical Zoology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Lisha Zhu
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, USA
| | - W Jim Zheng
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marta M Alonso
- Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
- Program of Solid Tumors, CIMA, Pamplona, Spain
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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26
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Gállego Pérez-Larraya J, Garcia-Moure M, Labiano S, Patiño-García A, Dobbs J, Gonzalez-Huarriz M, Zalacain M, Marrodan L, Martinez-Velez N, Puigdelloses M, Laspidea V, Astigarraga I, Lopez-Ibor B, Cruz O, Oscoz Lizarbe M, Hervas-Stubbs S, Alkorta-Aranburu G, Tamayo I, Tavira B, Hernandez-Alcoceba R, Jones C, Dharmadhikari G, Ruiz-Moreno C, Stunnenberg H, Hulleman E, van der Lugt J, Idoate MÁ, Diez-Valle R, Esparragosa Vázquez I, Villalba M, de Andrea C, Núñez-Córdoba JM, Ewald B, Robbins J, Fueyo J, Gomez-Manzano C, Lang FF, Tejada S, Alonso MM. Oncolytic DNX-2401 Virus for Pediatric Diffuse Intrinsic Pontine Glioma. N Engl J Med 2022; 386:2471-2481. [PMID: 35767439 DOI: 10.1056/nejmoa2202028] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pediatric patients with diffuse intrinsic pontine glioma (DIPG) have a poor prognosis, with a median survival of less than 1 year. Oncolytic viral therapy has been evaluated in patients with pediatric gliomas elsewhere in the brain, but data regarding oncolytic viral therapy in patients with DIPG are lacking. METHODS We conducted a single-center, dose-escalation study of DNX-2401, an oncolytic adenovirus that selectively replicates in tumor cells, in patients with newly diagnosed DIPG. The patients received a single virus infusion through a catheter placed in the cerebellar peduncle, followed by radiotherapy. The primary objective was to assess the safety and adverse-event profile of DNX-2401. The secondary objectives were to evaluate the effect of DNX-2401 on overall survival and quality of life, to determine the percentage of patients who have an objective response, and to collect tumor-biopsy and peripheral-blood samples for correlative studies of the molecular features of DIPG and antitumor immune responses. RESULTS A total of 12 patients, 3 to 18 years of age, with newly diagnosed DIPG received 1×1010 (the first 4 patients) or 5×1010 (the subsequent 8 patients) viral particles of DNX-2401, and 11 received subsequent radiotherapy. Adverse events among the patients included headache, nausea, vomiting, and fatigue. Hemiparesis and tetraparesis developed in 1 patient each. Over a median follow-up of 17.8 months (range, 5.9 to 33.5), a reduction in tumor size, as assessed on magnetic resonance imaging, was reported in 9 patients, a partial response in 3 patients, and stable disease in 8 patients. The median survival was 17.8 months. Two patients were alive at the time of preparation of the current report, 1 of whom was free of tumor progression at 38 months. Examination of a tumor sample obtained during autopsy from 1 patient and peripheral-blood studies revealed alteration of the tumor microenvironment and T-cell repertoire. CONCLUSIONS Intratumoral infusion of oncolytic virus DNX-2401 followed by radiotherapy in pediatric patients with DIPG resulted in changes in T-cell activity and a reduction in or stabilization of tumor size in some patients but was associated with adverse events. (Funded by the European Research Council under the European Union's Horizon 2020 Research and Innovation Program and others; EudraCT number, 2016-001577-33; ClinicalTrials.gov number, NCT03178032.).
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Affiliation(s)
- Jaime Gállego Pérez-Larraya
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Marc Garcia-Moure
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Sara Labiano
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Ana Patiño-García
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Jessica Dobbs
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Marisol Gonzalez-Huarriz
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Marta Zalacain
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Lucia Marrodan
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Naiara Martinez-Velez
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Montserrat Puigdelloses
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Virginia Laspidea
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Itziar Astigarraga
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Blanca Lopez-Ibor
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Ofelia Cruz
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Miren Oscoz Lizarbe
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Sandra Hervas-Stubbs
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Gorka Alkorta-Aranburu
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Ibon Tamayo
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Beatriz Tavira
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Ruben Hernandez-Alcoceba
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Chris Jones
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Gitanjali Dharmadhikari
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Cristian Ruiz-Moreno
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Henk Stunnenberg
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Esther Hulleman
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Jasper van der Lugt
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Miguel Á Idoate
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Ricardo Diez-Valle
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Inés Esparragosa Vázquez
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Maria Villalba
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Carlos de Andrea
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Jorge M Núñez-Córdoba
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Brett Ewald
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Joan Robbins
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Juan Fueyo
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Candelaria Gomez-Manzano
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Frederick F Lang
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Sonia Tejada
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
| | - Marta M Alonso
- From the Health Research Institute of Navarra (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., S.H.-S., I.T., B.T., R.H.-A., M.V., C.A., S.T., M.M.A.), the Program in Solid Tumors (J.G.P.-L., M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., B.T., S.T., M.M.A.), the Program in Immunology (S.H.-S.), and the Program in Gene Therapy and Regulation of Gene Expression (R.H.-A.), Foundation for the Applied Medical Research, the Departments of Neurology (J.G.P.-L., I.E.V.), Pediatrics (M.G.-M., S.L., A.P.-G., M.G.-H., M.Z., L.M., N.M.-V., M.P., V.L., M.M.A.), Pathology (M.V., C.A.), and Neurosurgery (S.T.) and the Division of Biostatistics, Research Support Service, Central Clinical Trials Unit (J.M.N.-C.), Clínica Universidad de Navarra, the Service of Pediatric Hemato-Oncology, Hospital Universitario de Navarra (M.O.L.), Center for Applied Medical Research (CIMA) LAB Diagnostics, University of Navarra and Healthcare Research Institute of Navarra (G.A.-A.), and the Bioinformatics Platform, CIMA, University of Navarra (I.T.), Pamplona, the Department of Pediatric Oncology, Biocruces Bizkaia Health Research Institute, Barakaldo (I.A.), the Pediatric Department, Faculty of Medicine and Nursing, University of the Basque Country, Leioa (I.A.), the Department of Pediatric Oncology, Montepríncipe Hospital (B.L.-I.), the Department of Neurosurgery, Quirón Hospitals (R.D.-V., S.T.), and Centro de Investigación Biomédica en Red de Cáncer (M.V.), Madrid, the Department of Pediatric Oncology, Neuro-Oncology Unit, Hospital Sant Joan de Deu, Barcelona (O.C.), and the Department of Pathology, University Hospital Virgen Macarena and School of Medicine, University of Seville, Seville (M.Á.I.) - all in Spain; DNAtrix, Carlsbad, CA (J.D., B.E., J.R.); the Division of Molecular Pathology, Institute of Cancer Research, London (C.J.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (G.D., C.R.-M., H.S., E.H., J.L.); and the Departments of Neuro-Oncology (J.F., C.G.-M.) and Neurosurgery (F.F.L.), University of Texas M.D. Anderson Cancer Center, Houston
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Nguyen TT, Shin DH, Sohoni S, Singh SK, Rivera-Molina Y, Jiang H, Fan X, Gumin J, Lang FF, Alvarez-Breckenridge C, Alonso MM, Godoy-Vitorino F, Zhai L, Ladomersky E, Lauing KL, Wainwright DA, Fueyo J, Gomez-Manzano C. Abstract 4184: RNA-seq analyses reveal remodeling of tumor microenvironment and reversal of glioma resistance to oncolytic viruses by targeting immunometabolism. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4184] [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
Viroimmunotherapy aims to infect cancer cells to elicit anti-tumor immune responses. In clinical trials, glioma treatment with oncolytic viruses induced durable clinical responses in a small fraction of patients. To improve the percentage of responders, it is necessary to reshape the tumor microenvironment that shields the tumor from the immune system of the patient. Thus, we engineered Delta-24-RGDOX (DNX-2440), an oncolytic adenovirus that carries the cDNA of the T-cell activator, OX40L. In this work, we observed that Delta-24-RGDOX triggered a dramatic reshaping of the tumor microenvironment dominated by strong changes in immune processes as indicated by RNA-sequencing via ingenuity pathway analyses in a murine glioblastoma model. Paradoxically, network analyses revealed that Delta-24-RGDOX also induced robust activation of the cytokine-driven immunosuppressive IDO-Kynurenine-AhR circuitry, indicating a potential mechanism of resistance of the cancer cells to oncolytic virotherapy. To reverse this immunosuppression, we combined Delta-24-RGDOX with clinically relevant IDO inhibitors to treat glioma bearing mice. Importantly, addition of the IDO inhibitor to Delta-24-RGDOX decreased the activation of the IDO network. IDO inhibition did not affect virus infection or replication in human or murine glioma cells. Flow cytometry assays revealed that the combination therapy increased the frequency of activated CD8+ T cells and decreased the presence of the immunosuppressive cell populations, MDSCs and Tregs. Gene set enrichment analyses confirmed the decrease of MDSCs and Tregs in the combination treated glioma-bearing mice compared to the virus alone. Functional co-culture studies showed that the combined therapy activated splenocytes against tumor antigens, and that this activation was reversed by kynurenine. Importantly, the combination treatment eradicated the tumors in a CD4-dependent manner and significantly prolonged the survival of glioma-bearing mice. Altogether, these studies indicate that the combination treatment promotes an adaptive immune response while decreasing immunosuppression caused by virus-induced IDO activation. Furthermore, our data identified the striking role of immunosuppressive pathways in the resistance of gliomas to oncolytic virotherapy. Specifically, the activity of the tumor microenvironment IDO circuitry was responsible, at least partially, for the remodeling of local immunosuppression after tumor infection. Combining molecular and immune-related therapies may improve outcomes in human gliomas treated with virotherapy.
Citation Format: Teresa T. Nguyen, Dong Ho Shin, Sagar Sohoni, Sanjay K. Singh, Yisel Rivera-Molina, Hong Jiang, Xuejun Fan, Joy Gumin, Frederick F. Lang, Christopher Alvarez-Breckenridge, Marta M. Alonso, Filipa Godoy-Vitorino, Lijie Zhai, Erik Ladomersky, Kristen L. Lauing, Derek A. Wainwright, Juan Fueyo, Candelaria Gomez-Manzano. RNA-seq analyses reveal remodeling of tumor microenvironment and reversal of glioma resistance to oncolytic viruses by targeting immunometabolism [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4184.
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Affiliation(s)
| | | | | | | | | | | | | | - Joy Gumin
- 1MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Lijie Zhai
- 5Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erik Ladomersky
- 5Northwestern University Feinberg School of Medicine, Chicago, IL
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Van Wieren AC, Sahoni S, Nguyen T, Ossimetha A, Rivera-Molina Y, Jiang H, Shin DH, Kim D, Fan X, Yi Y, Melendez-Vazquez NM, Godoy-Vitorino F, Gumin J, Lang FF, Alonso MM, Fueyo J, Gomez-Manzano C. Abstract 3565: Viroimmunotherapy for solid tumors results in local and abscopal anti-cancer effects and the remodeling of tumor microenvironment. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3565] [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
Oncolytic viruses are a promising experimental treatment for solid tumors. Recently, several phase 1 clinical trials have reported encouraging therapeutic effects of oncolytic viruses in adult and pediatric patients with malignant gliomas. To further improve the therapeutic outcome of viroimmunotherapy, we have developed Delta-24-RGDOX (DNX-2440), a replication competent adenovirus encompassing the T-cell activator OX40L in the genetic backbone of Delta-24-RGD. We have previously reported the effect of Delta-24-RGDOX in murine brain tumors supporting the translation of this new agent to treat patients with recurrent malignant gliomas (NCT03714334). In the work presented here, we have tested the therapeutic effect of Delta-24-RGDOX in murine syngeneic models of breast (4T1), gastric (M12) and lung cancer (LLC and CMT 167). We found that Delta-24-RGDOX infected all cancer cell lines efficiently. In addition, infection of cells was followed by the expression of the ectopic ligand in vitro and in vivo. Because the elicitation of an anti-tumor immunity is part of the mechanisms underlying the therapeutic effect of oncolytic viruses, we examined whether infection of tumors led to the reshaping of the tumor microenvironment. We observed that Delta-24-RGDOX infection was followed by increased frequencies of tumor infiltrating lymphocytes, particularly CD8+ T cells and NK cells. In addition, the CD8+/CD4+ ratio was increased in Delta-24-RGDOX-treated tumor versus PBS-treated tumors. Interestingly, abscopal modifications were observed in breast cancer brain metastases with increased frequency of CD8+ T cells at the distal, untreated site. Delta-24-RGDOX treatment induced an anti-cancer effect in orthotopically implanted breast cancer and subcutaneously implanted lung and gastric tumors, as well as in metastatic niches. In summary, our data showed that treatment of solid tumors with Delta-24-RGDOX induces robust remodeling of the tumor microenvironment and produces anti-tumor effects leading to decrease in tumor volume, along with a delay in the development and in the reduction of the number of metastases. These data suggest that Delta-24-RGDOX should be tested in the clinical setting in patients with metastatic breast, gastric and lung cancers.
Citation Format: Arie C. Van Wieren, Sagar Sahoni, Teresa Nguyen, Ashley Ossimetha, Yisel Rivera-Molina, Hong Jiang, Dong Ho Shin, Debora Kim, Xuejun Fan, Yanhua Yi, Natalie M. Melendez-Vazquez, Filipa Godoy-Vitorino, Joy Gumin, Frederick F. Lang, Marta M. Alonso, Juan Fueyo, Candelaria Gomez-Manzano. Viroimmunotherapy for solid tumors results in local and abscopal anti-cancer effects and the remodeling of tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3565.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yanhua Yi
- 1MD Anderson Cancer Center, Houston, TX
| | | | | | - Joy Gumin
- 1MD Anderson Cancer Center, Houston, TX
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Jiang H, Shin DH, Yi Y, Fan X, Gumin J, Alonso MM, Lang FF, Gomez-Manzano C, Fueyo J. Abstract 3569: Combining oncolytic adenovirus Delta-24-RGDOX with adoptive T cell therapy in localized treatment induces sustainable regression of disseminated solid tumors through antigen spreading. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3569] [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
CAR T therapy greatly improves the survival of patients with hematological malignancies. But its effect in solid tumors is suboptimal. Intratumoral injections of oncolytic viruses, including Delta-24-RGDOX (DNX-2440) from our group, directly lyse cancer cells and activate tumor microenvironment, leading to adaptive antitumor immunity. To take advantage of instant antitumor activity of T cells and virus-mediated in situ autovaccination against heterogeneous cancer cells, we hypothesize that intratumorally injections of tumor-targeting T cells followed by Delta-24-RGDOX overcome antigen escape of CAR T therapy, leading to more sustainable systemic anti-cancer immunity. Thus, we used subcutaneous (s.c.)/s.c. B16 melanoma mouse models to assess the effect of localized treatment in disseminated tumors. OVA (or gp100)-specific CD8+ T cells or CD19 CAR T cells were injected into the first tumor, followed by three injections of Delta-24-RGDOX into the same tumor. T cells and tumor cells from the mice were profiled for surface markers with flow cytometry and immune staining. Activity of splenocytes against tumor cells and specific tumor-associated-antigens (TAAs) was measured with ELISA. Tumor growth was monitored through measuring tumor size. The animal survival curves were plotted according to the Kaplan-Meier method. We found TAA-specific T cells injected into the first s.c. tumor showed tropism for disseminated s.c. and intracranial tumors, tumor draining lymph nodes, but not for spleen, peripheral blood and normal brain. Unlike untreated and Delta-24-RGDOX-treated tumor, T cell-treated tumor showed decreased expression of the target TAA which was depleted in the recurrent tumor. Moreover, Delta-24-RGDOX increased total T cell presence within the tumors, and the activity of the splenocytes against the tumor cells and other antigens than the one targeted by injected T cells. Consequentially, the combination of OVA-specific T cells and Delta-24-RGDOX was more potent to inhibit the injected and untreated disseminated tumor growth and caused improved survival rate than either of the agent alone (p < 0.05). Importantly, we observed relapse of the regressed tumors in the group treated by T cells alone, but not in the combination group. The survivors from the combination therapy were protected from rechallenging with B16-OVA cells but not lung carcinoma cells, suggesting the development of immune memory. In summary, our study indicates the virus induces antigen spread, resulting in expansion of antitumor T cell repertoire to prevent cancer relapse in adoptive T cell therapy (ACT). Our data demonstrate that Delta-24-RGDOX collaborates with ACT to induce more potent systemic immunity against the tumors, leading to sustainable tumor regression.
Citation Format: Hong Jiang, Dong Ho Shin, Yanhua Yi, Xuejun Fan, Joy Gumin, Marta M. Alonso, Frederick F. Lang, Candelaria Gomez-Manzano, Juan Fueyo. Combining oncolytic adenovirus Delta-24-RGDOX with adoptive T cell therapy in localized treatment induces sustainable regression of disseminated solid tumors through antigen spreading [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3569.
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Affiliation(s)
| | | | - Yanhua Yi
- 1MD Anderson Cancer Center, Houston, TX
| | | | - Joy Gumin
- 1MD Anderson Cancer Center, Houston, TX
| | - Marta M. Alonso
- 2Clínica Clínica Universidad de Navarra-CIMA-CIMA, PAMPLONA, Spain
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Abdelfattah N, Kumar P, Wang C, Leu JS, Flynn WW, Gao R, Baskin DS, Pichumani K, Ijare OB, Wood S, Powell S, Haviland D, Lang FF, Prabhu S, Huntoon K, Kerrigan BCP, Jiang WJ, Kim BY, George J, Yun K. Abstract 2540: A multi-dimensional analysis of human gliomas at the single cell level identifies immune suppressive macrophage molecular signatures and a novel immunotherapy target for GBM. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2540] [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
Glioblastoma (GBM) is the most prevalent primary brain malignancy in adults. The current standard of care includes maximal surgical resection followed by radio- and chemotherapy with temozolomide. Yet <5% of GBM patients survive more than five years. This indicates a desperate need for more effective treatments, such as immunotherapy for GBM patients. Unfortunately, most immunotherapy trials, including vaccines, adoptive cellular therapy, CAR-T cells, and checkpoint blockade, showed only modest benefits in GBM patients. A major barrier to immunotherapy efficacy is GBM’s immunosuppressive microenvironment composed of few tumor infiltrating lymphocytes (TILs; <5%) but abundant myeloid cells, making it an immune cold tumor. By contrast, immune hot tumors, characterized by abundant tumoricidal effector T cells necessary to mount a meaningful attack, have consistently responded better to immunotherapy. Hence, a better definition of the heterogeneous cell types in the GBM microenvironment and their function is urgently needed. Fortunately, single cell transcriptomics approaches provide comprehensive and high-resolution cellular and molecular understanding to resolve this heterogeneity. Here we report an integrated, multiregional and -dimensional single cell transcriptomic analysis of 201,986 human glioma and immune cells derived from 44 tissue fragments from 18 human glioma patients. In doing so, we map GBM cellular heterotypia and spatial, molecular, and functional heterogeneity of glioma associated immune cells. We report extensive spatial and molecular heterogeneity of glioma cells, microglia, macrophages, and T cells within the same tumor samples in low grade gliomas, primary GBMs, and recurrent GBMs. Importantly, our analysis of 83,479 glioma infiltrating myeloid cells identifies 9 molecularly distinct myeloid subtypes: 4 microglial, 4 bone marrow derived macrophage and dendritic cells subtypes. Importantly, in multiple independent glioma patient cohorts, 5 of these myeloid cell subtype gene signatures were independent predictors of patient survival. We also provide evidence that cell:cell communication between glioma and immune cells is more robust than glioma:Tcells, indicating that myeloid cells form a communication hub in vivo. Additionally, we identified S100A4 as highly expressed in immunosuppressive macrophages and T cells, and provide in vitro and in vivo evidence that S100a4 plays a critical role in promoting immunosuppressive phenotypes in glioma associated leukocytes. This study not only provides the first comprehensive single cell atlas of GBM to include both glioma and immune cells from same samples but also demonstrates its utility in elucidating cell:cell communication among different cell types in vivo and discovering new therapeutic targets for this poorly immunogenic cancer.
Citation Format: Nourhan Abdelfattah, Parveen Kumar, Caiyi Wang, Jia-Shiun Leu, William W. Flynn, Ruli Gao, David S. Baskin, Kumar Pichumani, Omkar B. Ijare, Stephanie Wood, Suzanne Powell, David Haviland, Frederick F. Lang, Sujit Prabhu, Kristin Huntoon, Brittany C. Parker Kerrigan, Wen Jiang Jiang, Betty Y. Kim, Joshy George, Kyuson Yun. A multi-dimensional analysis of human gliomas at the single cell level identifies immune suppressive macrophage molecular signatures and a novel immunotherapy target for GBM [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2540.
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Affiliation(s)
| | | | - Caiyi Wang
- 1Houston Methodist Research Institute, Houston, TX
| | | | | | - Ruli Gao
- 1Houston Methodist Research Institute, Houston, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kyuson Yun
- 1Houston Methodist Research Institute, Houston, TX
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Vogelbaum MA, Li G, Heimberger AB, Lang FF, Fueyo J, Gomez-Manzano C, Sanai N. A Window of Opportunity to Overcome Therapeutic Failure in Neuro-Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35580289 DOI: 10.1200/edbk_349175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Glioblastoma is the most common primary malignant brain neoplasm and it remains one of the most difficult-to-treat human cancers despite decades of discovery and translational and clinical research. Many advances have been made in our understanding of the genetics and epigenetics of gliomas in general; yet, there remains an urgent need to develop novel agents that will improve the survival of patients with this deadly disease. What sets glioblastoma apart from all other cancers is that it develops and spreads within an organ that renders tumor cells inaccessible to most systemically administered agents because of the presence of the blood-brain barrier. Inadequate drug penetration into the central nervous system is often cited as the most common cause of trial failure in neuro-oncology, and even so-called brain-penetrant therapeutics may not reach biologically relevant concentrations in tumor cells. Evaluation of the pharmacokinetics and pharmacodynamics of a novel therapy is a cornerstone of drug development, but few trials for glioma therapeutics have incorporated these basic elements in an organ-specific manner. Window-of-opportunity clinical trial designs can provide early insight into the biological plausibility of a novel therapeutic strategy in the clinical setting. A variety of window-of-opportunity trial designs, which take into account the limited access to treated tissue and the challenges with obtaining pretreatment control tissues, have been used for the initial development of traditional and targeted small-molecule drugs and biologic therapies, including immunotherapies and oncolytic viral therapies. Early-stage development of glioma therapeutics should include a window-of-opportunity component whenever feasible.
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Affiliation(s)
- Michael A Vogelbaum
- Department of NeuroOncology and NeuroOncology Program, Moffitt Cancer Center, Tampa, FL
| | - Gongbo Li
- Department of Neurosurgery, Northwestern University School of Medicine, Chicago, IL
| | - Amy B Heimberger
- Department of Neurosurgery, Northwestern University School of Medicine, Chicago, IL
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nader Sanai
- Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, AZ
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Chen SR, Lang FF, Kan P. Preclinical animal brain tumor models for interventional neuro-oncology. J Neurointerv Surg 2022; 14:neurintsurg-2022-018968. [PMID: 35414632 DOI: 10.1136/neurintsurg-2022-018968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Stephen R Chen
- Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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van Putten EH, Kleijn A, van Beusechem VW, Noske D, Lamers CH, de Goede AL, Idema S, Hoefnagel D, Kloezeman JJ, Fueyo J, Lang FF, Teunissen CE, Vernhout RM, Bakker C, Gerritsen W, Curiel DT, Vulto A, Lamfers ML, Dirven CM. Convection Enhanced Delivery of the Oncolytic Adenovirus Delta24-RGD in Patients with Recurrent GBM: A Phase I Clinical Trial Including Correlative Studies. Clin Cancer Res 2022; 28:1572-1585. [PMID: 35176144 PMCID: PMC9365362 DOI: 10.1158/1078-0432.ccr-21-3324] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/04/2021] [Accepted: 02/10/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Testing safety of Delta24-RGD (DNX-2401), an oncolytic adenovirus, locally delivered by convection enhanced delivery (CED) in tumor and surrounding brain of patients with recurrent glioblastoma. PATIENTS AND METHODS Dose-escalation phase I study with 3+3 cohorts, dosing 107 to 1 × 1011 viral particles (vp) in 20 patients. Besides clinical parameters, adverse events, and radiologic findings, blood, cerebrospinal fluid (CSF), brain interstitial fluid, and excreta were sampled over time and analyzed for presence of immune response, viral replication, distribution, and shedding. RESULTS Of 20 enrolled patients, 19 received the oncolytic adenovirus Delta24-RGD, which was found to be safe and feasible. Four patients demonstrated tumor response on MRI, one with complete regression and still alive after 8 years. Most serious adverse events were attributed to increased intracranial pressure caused by either an inflammatory reaction responding to steroid treatment or viral meningitis being transient and self-limiting. Often viral DNA concentrations in CSF increased over time, peaking after 2 to 4 weeks and remaining up to 3 months. Concomitantly Th1- and Th2-associated cytokine levels and numbers of CD3+ T and natural killer cells increased. Posttreatment tumor specimens revealed increased numbers of macrophages and CD4+ and CD8+ T cells. No evidence of viral shedding in excreta was observed. CONCLUSIONS CED of Delta24-RGD not only in the tumor but also in surrounding brain is safe, induces a local inflammatory reaction, and shows promising clinical responses.
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Affiliation(s)
- Erik H.P. van Putten
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands.,Corresponding Author: Erik H.P. van Putten, Neurosurgery, Erasmus MC, Rotterdam, 3000 CA, the Netherlands
| | - Anne Kleijn
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Victor W. van Beusechem
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - David Noske
- Department of Neurosurgery, Brain Tumor Center/Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Cor H.J. Lamers
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC-Cancer Institute, Rotterdam, the Netherlands
| | - Anna L. de Goede
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sander Idema
- Department of Neurosurgery, Brain Tumor Center/Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Daphna Hoefnagel
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jenneke J. Kloezeman
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Vrije Universiteit Amsterdam, the Netherlands
| | - René M. Vernhout
- Clinical Trial Center, Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cathy Bakker
- Team Biosafety, Division of Safety & Environment, Support Service, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winald Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - David T. Curiel
- Division of Cancer Biology and Biologic Therapeutics Center, Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Arnold Vulto
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martine L.M. Lamfers
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Clemens M.F. Dirven
- Department of Neurosurgery, Brain Tumor Center, Erasmus University Medical Center, Rotterdam, the Netherlands
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Li T, Mehraein-Ghomi F, Forbes ME, Namjoshi SV, Ballard EA, Song Q, Chou PC, Wang X, Parker Kerrigan BC, Lang FF, Lesser G, Debinski W, Yang X, Zhang W. HSP90-CDC37 functions as a chaperone for the oncogenic FGFR3-TACC3 fusion. Mol Ther 2022; 30:1610-1627. [PMID: 35151844 PMCID: PMC9077375 DOI: 10.1016/j.ymthe.2022.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
The FGFR3-TACC3 (F3-T3) fusion gene was discovered as an oncogenic molecule in glioblastoma and bladder cancers, and has subsequently been found in many cancer types. Notably, F3-T3 was found to be highly expressed in both untreated and matched recurrence glioblastoma under the concurrent radiotherapy and temozolomide (TMZ) treatment, suggesting that targeting F3-T3 is a valid strategy for treatment. Here, we show that the F3-T3 protein is a client of heat shock protein 90 (HSP90), forming a ternary complex with the cell division cycle 37 (CDC37). Deprivation of HSP90 or CDC37 disrupts the formation of the ternary complex, which destabilizes glycosylated F3-T3, and thereby suppresses F3-T3 oncogenic activity. Gliomas harboring F3-T3 are resistant to TMZ chemotherapy. HSP90 inhibitors sensitized F3-T3 glioma cells to TMZ via the inhibition of F3-T3 activation and potentiated TMZ-induced DNA damage. These results demonstrate that F3-T3 oncogenic function is dependent on the HSP90 chaperone system and suggests a new clinical option for targeting this genetic aberration in cancer.
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Affiliation(s)
- Tao Li
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China
| | - Farideh Mehraein-Ghomi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - M Elizabeth Forbes
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Sanjeev V Namjoshi
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - E Ashley Ballard
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Qianqian Song
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Ping-Chieh Chou
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Xuya Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China
| | | | - Frederick F Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Glenn Lesser
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Waldemar Debinski
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Xuejun Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China; Laboratory of Neuro-Oncology, Tianjin Neurological Institute, Tianjin 300052, China; Department of Neurosurgery, Tsinghua University Beijing Tsinghua Changgung Hospital, Beijing 102218, China.
| | - Wei Zhang
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
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Abdelfattah N, Kumar P, Wang C, Leu JS, Flynn WF, Gao R, Baskin DS, Pichumani K, Ijare OB, Wood SL, Powell SZ, Haviland DL, Parker Kerrigan BC, Lang FF, Prabhu SS, Huntoon KM, Jiang W, Kim BYS, George J, Yun K. Single-cell analysis of human glioma and immune cells identifies S100A4 as an immunotherapy target. Nat Commun 2022; 13:767. [PMID: 35140215 PMCID: PMC8828877 DOI: 10.1038/s41467-022-28372-y] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
A major rate-limiting step in developing more effective immunotherapies for GBM is our inadequate understanding of the cellular complexity and the molecular heterogeneity of immune infiltrates in gliomas. Here, we report an integrated analysis of 201,986 human glioma, immune, and other stromal cells at the single cell level. In doing so, we discover extensive spatial and molecular heterogeneity in immune infiltrates. We identify molecular signatures for nine distinct myeloid cell subtypes, of which five are independent prognostic indicators of glioma patient survival. Furthermore, we identify S100A4 as a regulator of immune suppressive T and myeloid cells in GBM and demonstrate that deleting S100a4 in non-cancer cells is sufficient to reprogram the immune landscape and significantly improve survival. This study provides insights into spatial, molecular, and functional heterogeneity of glioma and glioma-associated immune cells and demonstrates the utility of this dataset for discovering therapeutic targets for this poorly immunogenic cancer.
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Affiliation(s)
- Nourhan Abdelfattah
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - Parveen Kumar
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Caiyi Wang
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
- Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jia-Shiun Leu
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - William F Flynn
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Ruli Gao
- Center for Bioinformatics and Computational Biology. Houston Methodist Research Institute Houston, Houston, TX, USA
| | - David S Baskin
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Kumar Pichumani
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Omkar B Ijare
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Stephanie L Wood
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Suzanne Z Powell
- Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David L Haviland
- Flow Cytometry Core, Houston Methodist Research Institute, Houston, TX, USA
| | - Brittany C Parker Kerrigan
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristin M Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Joshy George
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Kyuson Yun
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA.
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
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Xu J, Wu PJ, Lai TH, Sharma P, Canella A, Welker AM, Beattie C, Timmers CD, Lang FF, Jacob NK, Elder JB, Lonser R, Easley M, Pietrzak M, Sampath D, Puduvalli VK. Disruption of DNA Repair and Survival Pathways through Heat Shock Protein inhibition by Onalespib to Sensitize Malignant Gliomas to Chemoradiation therapy. Clin Cancer Res 2022; 28:1979-1990. [PMID: 35140124 PMCID: PMC9064967 DOI: 10.1158/1078-0432.ccr-20-0468] [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] [Received: 02/10/2020] [Revised: 07/10/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Proficient DNA repair by homologous recombination (HR) facilitates resistance to chemo-radiation in glioma stem cells (GSCs). We evaluated whether compromising HR by targeting HSP90, a molecular chaperone required for the function of key HR proteins, using onalespib, a long-acting, brain-penetrant HSP90 inhibitor, would sensitize high-grade gliomas to chemo-radiation in vitro and in vivo Experimental Design: The ability of onalespib to deplete HR client proteins, impair HR repair capacity, and sensitize GBM to chemo-radiation was evaluated in vitro in GSCs, and in vivo using zebrafish and mouse intracranial glioma xenograft models. The effects of HSP90 inhibition on the transcriptome and cytoplasmic proteins was assessed in GSCs and in ex vivo organotypic human glioma slice cultures. RESULTS Treatment with onalespib depleted CHK1 and RAD51, two key proteins of the HR pathway, and attenuated HR repair, sensitizing GSCs to the combination of radiation and temozolomide (TMZ). HSP90 inhibition reprogrammed the transcriptome of GSCs and broadly altered expression of cytoplasmic proteins including known and novel client proteins relevant to GSCs. The combination of onalespib with radiation and TMZ extended survival in a zebra fish and a mouse xenograft model of GBM compared to the standard of care (radiation and TMZ) or onalespib with radiation. CONCLUSIONS The results of this study demonstrate that targeting HR by HSP90 inhibition sensitizes GSCs to radiation and chemotherapy and extends survival in zebrafish and mouse intracranial models of GBM. These results provide a preclinical rationale for assessment of HSP90 inhibitors in combination with chemoradiation in GBM patients.
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Affiliation(s)
- Jihong Xu
- Neuro-Oncology, The University of Texas MD Anderson Cancer Center
| | - Pei-Jung Wu
- Division of Neuro-oncology, The Ohio State University
| | - Tzung-Huei Lai
- Division of Hematology, Department of Medicine, The Ohio State University
| | - Pratibha Sharma
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center
| | | | | | | | | | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Naduparambil K Jacob
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center
| | - J Bradley Elder
- Dardinger Neuro-Oncology Center, Department of Neurosurgery, The Ohio State University
| | - Russell Lonser
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke
| | | | | | - Deepa Sampath
- Hematopoeitic Biology and Malignancy, The University of Texas MD Anderson Cancer Center
| | - Vinay K Puduvalli
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center
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37
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Shepard MJ, Haider AS, Prabhu SS, Sawaya R, DeMonte F, McCutcheon IE, Weinberg JS, Ferguson SD, Suki D, Fuller GN, Lang FF. Long term outcomes following surgery for pineal region tumors. J Neurooncol 2022; 156:491-498. [PMID: 35083579 DOI: 10.1007/s11060-021-03919-z] [Citation(s) in RCA: 8] [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: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pineal region tumors are surgically demanding tumors to resect. Long term neuro-oncologic outcomes following surgical excision of tumors from this region have been underreported. We sought to define the long term outcomes of patients undergoing resection of pineal region tumors. METHODS A retrospective analysis of a prospectively maintained database was performed on patients who underwent intended surgical excision of pineal region tumors. Overall survival (OS) and progression free survival (PFS) were the primary endpoints of this study. Factors associated with OS, PFS and the degree of resection were analyzed, along with 30-day complication rates and dependence on CSF diversion. RESULTS Sixty-eight patients with a mean age of 30.9 ± 15.3 years were analyzed. The median clinical and radiographic follow-up was 95.7 and 48.2 months, respectively. The supracerebellar infratentorial and the occipital transtentorial corridors were utilized in the majority of cases (80.9%). The gross total resection (GTR) rate was 52.9% (n=36). The 5-year OS and PFS rates were 70.2% and 58.5%, respectively. Achieving GTR was associated with improved OS (HR 0.39, p = 0.03) and PFS (HR 0.4, p = 0.006). The 30-day mortality rate was 5.9%. The need for CSF diversion was high with 77.9% of patients requiring a shunt or ETV by last follow-up. CONCLUSIONS This is the first modern surgical series providing long term follow-up for patients undergoing surgical resection of pineal region tumors. Obtaining a GTR of these challenging tumors is beneficial with regards to PFS/OS. Higher grade tumors have diminished PFS/OS and are treated with adjuvant chemotherapy and/or radiotherapy.
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Affiliation(s)
- Matthew J Shepard
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. .,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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38
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Danussi C, Bose P, Parthasarathy PT, Silberman PC, Van Arnam JS, Vitucci M, Tang OY, Heguy A, Wang Y, Chan TA, Riggins GJ, Sulman EP, Lang FF, Creighton CJ, Deneen B, Miller CR, Picketts DJ, Kannan K, Huse JT. Author Correction: Atrx inactivation drives disease-defining phenotypes in glioma cells of origin through global epigenomic remodeling. Nat Commun 2022; 13:190. [PMID: 34987156 PMCID: PMC8733027 DOI: 10.1038/s41467-021-27820-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Carla Danussi
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Promita Bose
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Prasanna T Parthasarathy
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Pedro C Silberman
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - John S Van Arnam
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mark Vitucci
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA
| | - Oliver Y Tang
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA
| | - Yuxiang Wang
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Timothy A Chan
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.,Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Gregory J Riggins
- Departments of Neurosurgery, Oncology, and Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Erik P Sulman
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Frederick F Lang
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chad J Creighton
- Department of Medicine and Dan L. Duncan Comprehensive Cancer Center Division of Biostatistics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Benjamin Deneen
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, 77030, USA
| | - C Ryan Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA.,Departments of Pharmacology and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27516, USA
| | - David J Picketts
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Kasthuri Kannan
- Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. .,Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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Chen SR, Chen MM, Ene C, Lang FF, Kan P. Perfusion-guided endovascular super-selective intra-arterial infusion for treatment of malignant brain tumors. J Neurointerv Surg 2021; 14:533-538. [PMID: 34824133 DOI: 10.1136/neurintsurg-2021-018190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Survival for glioblastoma remains very poor despite decades of research, with a 5-year survival of only 5%. The technological improvements that have revolutionized treatment of ischemic stroke and brain aneurysms have great potential in providing more precise and selective delivery of cancer therapeutic agents to brain tumors. METHODS We describe for the first time the use of perfusion guidance to enhance the precision of endovascular super-selective intra-arterial (ESIA) infusions of mesenchymal stem cells loaded with Delta-24 (MSC-D24) in the treatment of glioblastoma (NCT03896568). RESULTS MRI imaging, which best defines the location of the tumor, is co-registered and fused with the patient's position using cone beam CT, resulting in optimal vessel selection and confirmation of targeted delivery through volumetric perfusion imaging. CONCLUSIONS This technique of perfusion guided-ESIA injections (PG-ESIA) enhances our ability to perform targeted super-selective delivery of therapeutic agents for brain tumors.
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Affiliation(s)
- Stephen R Chen
- Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa M Chen
- Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chibawanye Ene
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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40
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Khan S, Mahalingam R, Sen S, Martinez-Ledesma E, Khan A, Gandy K, Lang FF, Sulman EP, Alfaro-Munoz KD, Majd NK, Balasubramaniyan V, de Groot JF. Intrinsic Interferon Signaling Regulates the Cell Death and Mesenchymal Phenotype of Glioblastoma Stem Cells. Cancers (Basel) 2021; 13:cancers13215284. [PMID: 34771447 PMCID: PMC8582372 DOI: 10.3390/cancers13215284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Interferon signaling is mostly studied in the context of immune cells. However, its role in glioma cancer cells is unclear. This study aimed to investigate the role of cancer-cell-intrinsic IFN signaling in tumorigenesis in glioblastoma (GBM). We found that GSCs and GBM tumors exhibited differential cell-intrinsic type I and type II IFN signaling, and the high IFN/STAT1 signaling was associated with mesenchymal phenotype and poor survival in glioma patients. IFN-β exposure induced cell death in GSCs with intrinsically high IFN/STAT1 signaling, and this effect was abolished by inhibition of IFN/STAT1 signaling. A subset of GBM patients with high IFN/STAT1 may benefit from the IFN-β therapy. Abstract Interferon (IFN) signaling contributes to stemness, cell proliferation, cell death, and cytokine signaling in cancer and immune cells; however, the role of IFN signaling in glioblastoma (GBM) and GBM stem-like cells (GSCs) is unclear. Here, we investigated the role of cancer-cell-intrinsic IFN signaling in tumorigenesis in GBM. We report here that GSCs and GBM tumors exhibited differential cell-intrinsic type I and type II IFN signaling, and high IFN/STAT1 signaling was associated with mesenchymal phenotype and poor survival outcomes. In addition, chronic inhibition of IFN/STAT1 signaling decreased cell proliferation and mesenchymal signatures in GSCs with intrinsically high IFN/STAT1 signaling. IFN-β exposure induced apoptosis in GSCs with intrinsically high IFN/STAT1 signaling, and this effect was abolished by the pharmacological inhibitor ruxolitinib and STAT1 knockdown. We provide evidence for targeting IFN signaling in a specific sub-group of GBM patients. IFN-β may be a promising candidate for adjuvant GBM therapy.
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Affiliation(s)
- Sabbir Khan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
| | - Rajasekaran Mahalingam
- Department of Symptom Research, MD Anderson Cancer Center, The University of Texas, Houston, TX 770030, USA;
| | - Shayak Sen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
| | - Emmanuel Martinez-Ledesma
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, Monterrey 64710, Mexico
| | - Arshad Khan
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Kaitlin Gandy
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Erik P. Sulman
- Department of Radiation Oncology, New York University, New York, NY 10016, USA;
| | - Kristin D. Alfaro-Munoz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
| | - Nazanin K. Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
| | - Veerakumar Balasubramaniyan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
- Correspondence: (V.B.); (J.F.d.G.)
| | - John F. de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (S.K.); (S.S.); (E.M.-L.); (K.G.); (K.D.A.-M.); (N.K.M.)
- Department of Neuro-Oncology, University of California, San Francisco, CA 94143, USA
- Correspondence: (V.B.); (J.F.d.G.)
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41
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Pudakalakatti S, Audia A, Mukhopadhyay A, Enriquez JS, Bourgeois D, Tayob N, Zacharias NM, Millward SW, Carson D, Farach-Carson MC, Lang FF, Heimberger AB, Bhat KP, Bhattacharya PK. NMR Spectroscopy-Based Metabolomics of Platelets to Analyze Brain Tumors. Reports 2021; 4. [PMID: 35937580 PMCID: PMC9352435 DOI: 10.3390/reports4040032] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
“Tumor-educated platelets” have recently generated substantial interest for the diagnosis of cancer. We hypothesized that tumor educated platelets from patients with brain tumors will reflect altered metabolism compared to platelets from healthy volunteers. Here, in a pilot study, we have employed nuclear magnetic resonance (NMR) spectroscopy in platelets from brain tumor patients to demonstrate altered metabolism compared to the platelets obtained from healthy volunteers.
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Affiliation(s)
- Shivanand Pudakalakatti
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Alessandra Audia
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Center Center, Houston, TX 77030, USA
| | - Anirudh Mukhopadhyay
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - José S. Enriquez
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
| | | | - Nabihah Tayob
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Niki M. Zacharias
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Steven W. Millward
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
| | - Daniel Carson
- Department of BioSciences, Rice University, Houston, TX 77005, USA
| | - Mary C. Farach-Carson
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center, Houston, TX 77054, USA
| | - Frederick F. Lang
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amy B. Heimberger
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Krishna P. Bhat
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Center Center, Houston, TX 77030, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
| | - Pratip K. Bhattacharya
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77054, USA
- Correspondence:
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Salzillo TC, Mawoneke V, Weygand J, Shetty A, Gumin J, Zacharias NM, Gammon ST, Piwnica-Worms D, Fuller GN, Logothetis CJ, Lang FF, Bhattacharya PK. Measuring the Metabolic Evolution of Glioblastoma throughout Tumor Development, Regression, and Recurrence with Hyperpolarized Magnetic Resonance. Cells 2021; 10:cells10102621. [PMID: 34685601 PMCID: PMC8534002 DOI: 10.3390/cells10102621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022] Open
Abstract
Rapid diagnosis and therapeutic monitoring of aggressive diseases such as glioblastoma can improve patient survival by providing physicians the time to optimally deliver treatment. This research tested whether metabolic imaging with hyperpolarized MRI could detect changes in tumor progression faster than conventional anatomic MRI in patient-derived glioblastoma murine models. To capture the dynamic nature of cancer metabolism, hyperpolarized MRI, NMR spectroscopy, and immunohistochemistry were performed at several time-points during tumor development, regression, and recurrence. Hyperpolarized MRI detected significant changes of metabolism throughout tumor progression whereas conventional MRI was less sensitive. This was accompanied by aberrations in amino acid and phospholipid lipid metabolism and MCT1 expression. Hyperpolarized MRI can help address clinical challenges such as identifying malignant disease prior to aggressive growth, differentiating pseudoprogression from true progression, and predicting relapse. The individual evolution of these metabolic assays as well as their correlations with one another provides context for further academic research.
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Affiliation(s)
- Travis C. Salzillo
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
| | - Vimbai Mawoneke
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
| | - Joseph Weygand
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Akaanksh Shetty
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.G.); (F.F.L.)
| | - Niki M. Zacharias
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA;
| | - Seth T. Gammon
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
| | - David Piwnica-Worms
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA;
| | - Christopher J. Logothetis
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA;
| | - Frederick F. Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (J.G.); (F.F.L.)
| | - Pratip K. Bhattacharya
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA; (T.C.S.); (V.M.); (A.S.); (S.T.G.); (D.P.-W.)
- Correspondence: ; Tel.: +1-713-454-9887
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Shimizu Y, Gumin J, Gao F, Hossain A, Shpall EJ, Kondo A, Parker Kerrigan BC, Yang J, Ledbetter D, Fueyo J, Gomez-Manzano C, Lang FF. Characterization of patient-derived bone marrow human mesenchymal stem cells as oncolytic virus carriers for the treatment of glioblastoma. J Neurosurg 2021; 136:757-767. [PMID: 34450587 DOI: 10.3171/2021.3.jns203045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delta-24-RGD is an oncolytic adenovirus that is capable of replicating in and killing human glioma cells. Although intratumoral delivery of Delta-24-RGD can be effective, systemic delivery would improve its clinical application. Bone marrow-derived human mesenchymal stem cells (BM-hMSCs) obtained from healthy donors have been investigated as virus carriers. However, it is unclear whether BM-hMSCs can be derived from glioma patients previously treated with marrow-toxic chemotherapy or whether such BM-hMSCs can deliver oncolytic viruses effectively. Herein, the authors undertook a prospective clinical trial to determine the feasibility of obtaining BM-hMSCs from patients with recurrent malignant glioma who were previously exposed to marrow-toxic chemotherapy. METHODS The authors enrolled 5 consecutive patients who had been treated with radiation therapy and chemotherapy. BM aspirates were obtained from the iliac crest and were cultured to obtain BM-hMSCs. RESULTS The patient-derived BM-hMSCs (PD-BM-hMSCs) had a morphology similar to that of healthy donor-derived BM-hMSCs (HD-BM-hMSCs). Flow cytometry revealed that all 5 cell lines expressed canonical MSC surface markers. Importantly, these cultures could be made to differentiate into osteocytes, adipocytes, and chondrocytes. In all cases, the PD-BM-hMSCs homed to intracranial glioma xenografts in mice after intracarotid delivery as effectively as HD-BM-hMSCs. The PD-BM-hMSCs loaded with Delta-24-RGD (PD-BM-MSC-D24) effectively eradicated human gliomas in vitro. In in vivo studies, intravascular administration of PD-BM-MSC-D24 increased the survival of mice harboring U87MG gliomas. CONCLUSIONS The authors conclude that BM-hMSCs can be acquired from patients previously treated with marrow-toxic chemotherapy and that these PD-BM-hMSCs are effective carriers for oncolytic viruses.
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Affiliation(s)
- Yuzaburo Shimizu
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and.,5Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Joy Gumin
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Feng Gao
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Anwar Hossain
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | | | - Akihide Kondo
- 5Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Brittany C Parker Kerrigan
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jing Yang
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Daniel Ledbetter
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Juan Fueyo
- 3Neuro-Oncology, and.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Candelaria Gomez-Manzano
- 3Neuro-Oncology, and.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Frederick F Lang
- Departments of1Neurosurgery.,4Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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Shaim H, Shanley M, Basar R, Daher M, Gumin J, Zamler DB, Uprety N, Wang F, Huang Y, Gabrusiewicz K, Miao Q, Dou J, Alsuliman A, Kerbauy LN, Acharya S, Mohanty V, Mendt M, Li S, Lu J, Wei J, Fowlkes NW, Gokdemir E, Ensley EL, Kaplan M, Kassab C, Li L, Ozcan G, Banerjee PP, Shen Y, Gilbert AL, Jones CM, Bdiwi M, Nunez-Cortes AK, Liu E, Yu J, Imahashi N, Muniz-Feliciano L, Li Y, Hu J, Draetta G, Marin D, Yu D, Mielke S, Eyrich M, Champlin RE, Chen K, Lang FF, Shpall EJ, Heimberger AB, Rezvani K. Targeting the αv integrin/TGF-β axis improves natural killer cell function against glioblastoma stem cells. J Clin Invest 2021; 131:e142116. [PMID: 34138753 DOI: 10.1172/jci142116] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [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: 07/09/2020] [Accepted: 06/03/2021] [Indexed: 12/29/2022] Open
Abstract
Glioblastoma multiforme (GBM), the most aggressive brain cancer, recurs because glioblastoma stem cells (GSCs) are resistant to all standard therapies. We showed that GSCs, but not normal astrocytes, are sensitive to lysis by healthy allogeneic natural killer (NK) cells in vitro. Mass cytometry and single-cell RNA sequencing of primary tumor samples revealed that GBM tumor-infiltrating NK cells acquired an altered phenotype associated with impaired lytic function relative to matched peripheral blood NK cells from patients with GBM or healthy donors. We attributed this immune evasion tactic to direct cell-to-cell contact between GSCs and NK cells via αv integrin-mediated TGF-β activation. Treatment of GSC-engrafted mice with allogeneic NK cells in combination with inhibitors of integrin or TGF-β signaling or with TGFBR2 gene-edited allogeneic NK cells prevented GSC-induced NK cell dysfunction and tumor growth. These findings reveal an important mechanism of NK cell immune evasion by GSCs and suggest the αv integrin/TGF-β axis as a potentially useful therapeutic target in GBM.
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Affiliation(s)
- Hila Shaim
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Internal Medicine II, University Medical Center Würzburg, Würzburg, Germany
| | - Mayra Shanley
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rafet Basar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - May Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Nadima Uprety
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fang Wang
- Department of Bioinformatics and Computational Biology
| | - Yuefan Huang
- Department of Bioinformatics and Computational Biology
| | | | - Qi Miao
- Department of Bioinformatics and Computational Biology
| | - Jinzhuang Dou
- Department of Bioinformatics and Computational Biology
| | - Abdullah Alsuliman
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lucila N Kerbauy
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sunil Acharya
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vakul Mohanty
- Department of Bioinformatics and Computational Biology
| | - Mayela Mendt
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sufang Li
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - JunJun Lu
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Elif Gokdemir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily L Ensley
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mecit Kaplan
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Li Li
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gonca Ozcan
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pinaki P Banerjee
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yifei Shen
- Department of Bioinformatics and Computational Biology
| | - April L Gilbert
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Corry M Jones
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mustafa Bdiwi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ana K Nunez-Cortes
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Enli Liu
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jun Yu
- Department of Neurosurgery
| | - Nobuhiko Imahashi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Luis Muniz-Feliciano
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ye Li
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jian Hu
- Department of Cancer Biology, and
| | | | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephan Mielke
- Department of Internal Medicine II, University Medical Center Würzburg, Würzburg, Germany.,Department of Hematology, Karolinska Institute, Stockholm, Sweden
| | - Matthias Eyrich
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Medical Center Würzburg, Würzburg, Germany
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ken Chen
- Department of Bioinformatics and Computational Biology
| | | | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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45
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Sharma P, Xu J, Williams K, Easley M, Elder JB, Lonser R, Lang FF, Lapalombella R, Sampath D, Puduvalli VK. Inhibition of nicotinamide phosphoribosyltransferase, the rate-limiting enzyme of the nicotinamide adenine dinucleotide salvage pathway, to target glioma heterogeneity through mitochondrial oxidative stress. Neuro Oncol 2021; 24:229-244. [PMID: 34260721 PMCID: PMC8804900 DOI: 10.1093/neuonc/noab175] [Citation(s) in RCA: 12] [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] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Tumor-specific metabolic processes essential for cell survival are promising targets to potentially circumvent intratumoral heterogeneity, a major resistance factor in gliomas. Tumor cells preferentially using nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in the salvage pathway for synthesis of NAD, a critical cofactor for diverse biological processes including cellular redox reactions, energy metabolism and biosynthesis. NAMPT is overexpressed in most malignancies, including gliomas, and can serve as a tumor-specific target. METHODS Effects of pharmacological inhibition of NAMPT on cellular oxygen consumption rate, extracellular acidification, mitochondrial respiration, cell proliferation, invasion and survival were assessed through in vitro and ex vivo studies on genetically heterogeneous glioma cell lines, glioma stem-like cells (GSCs) and mouse and human ex vivo organotypic glioma slice culture models. RESULTS Pharmacological inhibition of the NAD salvage biosynthesis pathway using a highly specific inhibitor, KPT-9274, resulted in reduction of NAD levels and related downstream metabolites, inhibited proliferation, and induced apoptosis in vitro in cell lines and ex vivo in human glioma tissue. These effects were mediated by mitochondrial dysfunction, DNA damage and increased oxidative stress leading to apoptosis in GSCs independent of genotype, IDH status or MGMT promoter methylation status. Conversely, NAMPT inhibition had minimal in vitro effects on normal human astrocytes (NHA) and no apparent in vivo toxicity in non-tumor-bearing mice. CONCLUSIONS Pharmacological NAMPT inhibition by KPT9274 potently targeted genetically heterogeneous gliomas by activating mitochondrial dysfunction. Our preclinical results provide a rationale for targeting the NAMPT-dependent alternative NAD biosynthesis pathway as a novel clinical strategy against gliomas.
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Affiliation(s)
- Pratibha Sharma
- Division of Neurooncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Xu
- Division of Neurooncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katie Williams
- Division of Hematology Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michelle Easley
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Brad Elder
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Russell Lonser
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosa Lapalombella
- Division of Hematology Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Deepa Sampath
- Division of Hematology Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Hematopoietic Biology and Malignancy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinay K Puduvalli
- Division of Neurooncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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46
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Gupta P, Dang M, Hao D, Bojja K, Tran TM, Shehwana H, Kamiya-Matsuoka C, Li J, Audia A, Kassab C, Ott M, Gumin J, Alenazy S, Goldman A, Seth SA, Maheshwari A, Balasubramaniyan V, Vaillant B, de Groot JF, Lang FF, Iavarone A, Navin NE, Heimberger AB, Wang L, Bhat KP. OTME-23. Single-cell transcriptomic and epigenomic immune landscape of isocitrate dehydrogenase stratified human gliomas. Neurooncol Adv 2021. [PMCID: PMC8264920 DOI: 10.1093/noajnl/vdab070.074] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The brain tumor immune microenvironment (TIME) continuously evolves during glioma progression, but a comprehensive characterization of the glioma-centric immune cell repertoire beyond a priori cell states is uncharted. In this study, we performed single-cell RNA-sequencing (scRNA-seq) and single cell- Assay for Transposase-Accessible Chromatin using sequencing (sc-ATAC-seq) on ~100,000 tumor-associated immune cells from seventeen isocitrate dehydrogenase (IDH) mutation classified primary and recurrent human gliomas and non-glioma brains (NGBs). Our analyses revealed sixty-two transcriptionally distinct myeloid and lymphoid cell states within and across glioma subtypes and we noted microglial attrition with increasing disease severity concomitant with invading monocyte-derived cells and lymphocytes. Specifically, certain microglial and monocyte-derived subpopulations were associated with antigen presentation gene modules, akin to cross-presenting dendritic cells (DCs). We identified cytotoxic T cells with poly-functional cytolytic states mostly in recurrent IDH-wt gliomas. Furthermore, ligand-receptor interactome analyses showed a preponderance of antigen presentation and phagocytosis over the checkpoint axis in IDH-wt compared to IDH-mut gliomas. Additionally, our sc-ATAC-seq analyses revealed differences in regulatory networks in NGBs, IDH-mut and IDH-wt glioma associated immune cells. In particular, we noted abundant usage of inflammatory transcription factors (TFs) as exemplified by Nuclear factor kappa B and Activator Protein-1 TF family in IDH-wt microglia when compared with microglia from IDH-mut and NGBs. Unique features such as amplification of 11- Zinc Finger Protein accessibility were restricted to monocyte derived cells and were not observed in microglia. Finally, sc-ATAC-seq profiles of CD8+ exhausted T cells from IDH-wt showed strong enhancer accessibility on Cytotoxic T-lymphocyte-associated protein 4, Layilin and Hepatitis A Virus Cellular Receptor 2 but no enrichment on PDCD1 (gene encoding Programmed cell death protein 1) was seen. In summary, our study provides unprecedented granular detail of transcriptionally defined glioma- specific immune contexture that can be exploited for immunotherapy applications. This study in K.B. laboratory was supported by the generous philanthropic contributions to The University of Texas (UT) MD Anderson Cancer Center (MDACC) Moon Shots Program™, Marnie Rose Foundation, NIH grants: R21 CA222992 and R01CA225963. This study was partly supported by the UT MDACC start-up research fund to L.W. and CPRIT Single Core grant RP180684 to N. E. N.
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Affiliation(s)
- Pravesh Gupta
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Minghao Dang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dapeng Hao
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Krishna Bojja
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tuan M Tran
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Huma Shehwana
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianzhuo Li
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Audia
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cynthia Kassab
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Martina Ott
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanaalarab Alenazy
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alicia Goldman
- Department of Neurology and Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Sahil A Seth
- Department of Neurology and Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Atul Maheshwari
- Department of Neurology and Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | | | - Brian Vaillant
- Department of Neurology, University of Texas at Austin, TX, USA
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Antonio Iavarone
- Institute for Cancer Genetics, Department of Pathology and Cell Biology, Department of Neurology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Nicholas E Navin
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy B Heimberger
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Krishna P Bhat
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neurology and Neuroscience, Baylor College of Medicine, Houston, TX, USA
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Fueyo J, Gomez-Manzano C, Lang FF, Alonso MM. Hitchhiking to brain tumours: stem cell delivery of oncolytic viruses. Lancet Oncol 2021; 22:1049-1051. [PMID: 34214494 DOI: 10.1016/s1470-2045(21)00296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marta M Alonso
- Department of Pediatrics, University Clinic of Navarra, Pamplona, Spain; Program of Solid Tumors, Center for the Applied Medical Research, Pamplona, Spain; Institute for the Medical Research of Navarra, Pamplona, Spain.
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48
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Quirarte JA, Kumar VA, Liu HL, Noll KR, Wefel JS, Lang FF. Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report. J Neurosurg 2021; 134:1738-1742. [DOI: 10.3171/2020.4.jns193250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/03/2020] [Indexed: 11/06/2022]
Abstract
Supplementary motor area (SMA) syndrome is well known; however, the mechanism underlying recovery from language SMA syndrome is unclear. Herein the authors report the case of a right-handed woman with speech aphasia following resection of an oligodendroglioma located in the anterior aspect of the left superior frontal gyrus. The patient exhibited language SMA syndrome, and functional MRI (fMRI) findings 12 days postoperatively demonstrated a complete shift of blood oxygen level–dependent (BOLD) activation to the contralateral right language SMA/pre-SMA as well as coequal activation and an increased volume of activation in the left Broca’s area and the right Broca’s homolog. The authors provide, to the best of their knowledge, the first description of dynamic changes in task-based hemispheric language BOLD fMRI activations across the preoperative, immediate postoperative, and more distant postoperative settings associated with the development and subsequent complete resolution of the clinical language SMA syndrome.
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Affiliation(s)
| | | | - Ho-Ling Liu
- Imaging Physics, University of Texas MD Anderson Cancer Center; and
| | - Kyle R. Noll
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S. Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
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49
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Garcia-Moure M, Pérez-Larraya JG, Patiño A, Gonzalez-Huarriz M, Jones C, MacKay A, Van der Lugt J, Hulleman E, de Andrea C, Astigarraga I, García-Ariza M, Lopez-Ibor B, Villalba M, Lang FF, Fueyo J, Gomez-Manzano C, Dobbs J, Diez-Valle R, Alonso MM, Tejada S. EPCT-04. RESULTS OF A PHASE 1 STUDY OF THE ONCOLYTIC ADENOVIRUS DNX-2401 WITH RADIOTHERAPY FOR NEWLY DIAGNOSED DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2021. [PMCID: PMC8263199 DOI: 10.1093/neuonc/noab090.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A Phase 1, single center study is ongoing to evaluate the conditionally replicative oncolytic adenovirus, DNX-2401 (tasadenoturev), followed by radiotherapy (RT) in pediatric patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Methods Patients 1–18 years with newly diagnosed DIPG with no prior treatment, Lansky/Karnofsky performance score ≥ 70, and adequate organ function were enrolled. A tumor biopsy was performed followed by a single intratumoral injection of 1e10-5e10 virus particles (vp) DNX-2401. Conventional radiotherapy was initiated within 1 month of DNX-2401 administration. Results Enrolled subjects (n=12) had a median age of 9 (range 3–18) and performance scores of 90–100 (n=4; 33%) or 70–80 (n=8; 67%). As part of a dose escalation design, subjects were treated with 1e10 vp (n=4) or 5e10 vp DNX-2401 (n=8), which was then followed by standard RT in 11 of 12 subjects (92%). No dose-limiting toxicities were observed and the treatment regimen was well-tolerated. Adverse events (AEs) have been primarily mild to moderate and consistent with underlying disease. The most commonly reported AEs (≥ 5 subjects), regardless of study drug relationship, include headache, asthenia, vomiting, anemia, leukocytosis, and fever. Two SAEs have been reported including grade 3 lymphopenia and grade 3 abdominal pain. Tumor reductions have been observed and efficacy evaluations are ongoing. As of 09Dec2020, 12-month survival (OS-12) was 71% and 4 of 12 patients had survived > 20 months. Four subjects continue to be followed for survival. Correlative analysis of tumor biopsy and peripheral samples is ongoing. Conclusions DNX-2401 followed by RT can be safely administered to pediatric subjects with newly diagnosed DIPG; clinical activity and preliminary survival are encouraging.
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Affiliation(s)
- Marc Garcia-Moure
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jaime Gállego Pérez-Larraya
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Patiño
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marisol Gonzalez-Huarriz
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Alan MacKay
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | | | - Esther Hulleman
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Oncology/Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carlos de Andrea
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IdiSNA), Pamplona, Spain
| | - Itziar Astigarraga
- Department of Pediatrics, Hospital Universitario Cruces, IIS Biocruces-Bizkaia, UPV/EHU, Barakaldo, Spain
| | | | - Blanca Lopez-Ibor
- Department of Pediatric Hematology and Oncology, HM Montepríncipe Hospital, Boadilla del Monte, Spain
| | - Maria Villalba
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Frederick F Lang
- Department of Neurosurgery and Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Fueyo
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Candelaria Gomez-Manzano
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of NeuroOncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Houston, TX, USA
| | | | - Ricardo Diez-Valle
- Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Marta M Alonso
- Program in Solid Tumors, Foundation for the Applied Medical Research, Pamplona, Spain
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sonia Tejada
- Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Phillips LM, Li S, Gumin J, Daou M, Ledbetter D, Yang J, Singh S, Parker Kerrigan BC, Hossain A, Yuan Y, Gomez-Manzano C, Fueyo J, Lang FF. An immune-competent, replication-permissive Syrian Hamster glioma model for evaluating Delta-24-RGD oncolytic adenovirus. Neuro Oncol 2021; 23:1911-1921. [PMID: 34059921 DOI: 10.1093/neuonc/noab128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Oncolytic adenoviruses are promising new treatments against solid tumors, particularly for glioblastoma (GBM), and preclinical models are required to evaluate the mechanisms of efficacy. However, due to the species selectivity of adenovirus, there is currently no single animal model that supports viral replication, tumor oncolysis, and a virus-mediated immune response. To address this gap, we took advantage of the Syrian hamster to develop the first intracranial glioma model that is both adenovirus replication-permissive and immunocompetent. METHODS We generated hamster glioma stem-like cells (hamGSCs) by transforming hamster neural stem cells with hTERT, simian virus 40 large T antigen, and h-RasV12. Using a guide-screw system, we generated an intracranial tumor model in the hamster. The efficacy of the oncolytic adenovirus Delta-24-RGD was assessed by survival studies, and tumor-infiltrating lymphocytes were evaluated by flow cytometry. RESULTS In vitro, hamster GSCs supported viral replication and were susceptible to Delta-24-RGD mediated cell death. In vivo, hamster GSCs consistently developed into highly proliferative tumors resembling high-grade glioma. Flow cytometric analysis of hamster gliomas revealed significantly increased T cell infiltration in Delta-24-RGD infected tumors, indicative of immune activation. Treating tumor-bearing hamsters with Delta-24-RGD led to significantly increased survival compared to hamsters treated with PBS. CONCLUSIONS This adenovirus-permissive, immunocompetent hamster glioma model overcomes the limitations of previous model systems and provides a novel platform in which to study the interactions between tumor cells, the host immune system, and oncolytic adenoviral therapy; understanding of which will be critical to implementing oncolytic adenovirus in the clinic.
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Affiliation(s)
- Lynette M Phillips
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shoudong Li
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marc Daou
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Ledbetter
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jing Yang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanjay Singh
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brittany C Parker Kerrigan
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anwar Hossain
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Candelaria Gomez-Manzano
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Juan Fueyo
- The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, TX
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