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Lester A, McDonald KL. Intracranial ependymomas: molecular insights and translation to treatment. Brain Pathol 2020; 30:3-12. [PMID: 31433520 PMCID: PMC8018002 DOI: 10.1111/bpa.12781] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Ependymomas are primary central nervous system tumors (CNS), arising within the posterior fossa and supratentorial regions of the brain, and in the spine. Over the last decade, research has resulted in substantial insights into the molecular characteristics of ependymomas, and significant advances have been made in the establishment of a molecular classification system. Ependymomas both within and between the three CNS regions in which they arise, have been shown to contain distinct genetic, epigenetic and cytogenic aberrations, with at least three molecularly distinct subgroups identified within each region. However, these advances in molecular characterization have yet to be translated into clinical practice, with the standard treatment for ependymoma patients largely unchanged. This review summarizes the advances made in the molecular characterization of intracranial ependymomas, outlines the progress made in establishing preclinical models and proposes strategies for moving toward subgroup-specific preclinical investigations and treatment.
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Affiliation(s)
- Ashleigh Lester
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSWSydneyAustralia
| | - Kerrie L. McDonald
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSWSydneyAustralia
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Pérez-Ramírez M, García-Méndez A, Siordia-Reyes AG, Chavarría A, Gómez C, García-Hernández N. Pediatric ependymoma: GNAO1, ASAH1, IMMT and IPO7 protein expression and 5-year prognosis correlation. Clin Neurol Neurosurg 2019; 186:105488. [PMID: 31505435 DOI: 10.1016/j.clineuro.2019.105488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/18/2019] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this work was to evaluate a pediatric ependymoma protein expression that may be useful as a molecular biomarker candidate for prognosis, correlated with clinical features such as age, gender, histopathological grade, ependymal tumor recurrence and patient survival. PATIENTS AND METHODS Immunohistochemistry assays were performed for GNAO1, ASAH1, IMMT, IPO7, Cyclin D1, P53 and Ki-67 proteins. Kaplan-Meier and Cox analysis were performed for age, gender, histopathological grade, relapse and survival correlation. RESULTS We found that three proteins correlate with histopathological grade and relapse; two proteins correlate with survival; one protein does not correlate with any clinical feature. CONCLUSION Our results suggest that, out of the proteins analyzed, five may be considered suitable prognostic biomarkers and one may be considered a predictive biomarker for response to treatment of pediatric ependymoma.
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Affiliation(s)
- Monserrat Pérez-Ramírez
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría "Dr. Silvestre Frenk Freud", Centro Médico Nacional Siglo XXI, IMSS. Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhtémoc, 06720, Mexico
| | - Antonio García-Méndez
- Servicio de Neurocirugía Pediátrica, Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional "La Raza", IMSS, Calzada Vallejo y Jacarandas S/N, Col. La Raza, Del. Azcapotzalco, 02980, Ciudad de México, Mexico
| | - Alicia Georgina Siordia-Reyes
- Servicio de Patología, Hospital de Pediatría "Dr. Silvestre Frenk Freud", Centro Médico Nacional Siglo XXI, IMSS. Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhtémoc, 06720, Ciudad de México, Mexico
| | - Anahí Chavarría
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, 04510, Ciudad de México, Mexico
| | - Celedonio Gómez
- Facultad de Química, Universidad Nacional Autónoma de México, Avenida Ciudad Universitaria 3000, Coyoacán, 04360, Ciudad de México, Mexico
| | - Normand García-Hernández
- Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría "Dr. Silvestre Frenk Freud", Centro Médico Nacional Siglo XXI, IMSS. Av. Cuauhtémoc 330, Col. Doctores, Del. Cuauhtémoc, 06720, Mexico.
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Ferguson SD, Zhou S, Xiu J, Hashimoto Y, Sanai N, Kim L, Kesari S, de Groot J, Spetzler D, Heimberger AB. Ependymomas overexpress chemoresistance and DNA repair-related proteins. Oncotarget 2018; 9:7822-7831. [PMID: 29487694 PMCID: PMC5814261 DOI: 10.18632/oncotarget.23288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND After surgery and radiation, treatment options for ependymoma are few making recurrence a challenging issue. Specifically, the efficacy of chemotherapy at recurrence is limited. We performed molecular profiling on a cohort of ependymoma cases in order to uncover therapeutic targets and to elucidate the molecular mechanisms contributing to treatment resistance. RESULTS This ependymoma cohort showed minimal alterations in gene amplifications and mutations but had high expression rates of DNA synthesis and repair enzymes such as RRM1 (47%), ERCC1 (48%), TOPO1 (62%) and class III β-tublin (TUBB3) (57%), which are also all associated with chemoresistance. This cohort also had high expression rates of transporter proteins that mediate multi-drug resistance including BCRP (71%) and MRP1 (43%). Subgroup analyses showed that cranial ependymomas expressed the DNA synthesis enzyme TS significantly more frequently than spinal lesions did (57% versus 15%; p = 0.0328) and that increased TS expression was correlated with increased tumor grade (p = 0.0009). High-grade lesions were also significantly associated with elevated expression of TOP2A (p = 0.0092) and TUBB3 (p = 0.0157). MATERIALS AND METHODS We reviewed the characteristics of 41 ependymomas (21 cranial, 20 spinal; 8 grade I, 11 grade II, 22 grade III) that underwent multiplatform profiling with immunohistochemistry, next-generation sequencing, and in situ hybridization. CONCLUSIONS Ependymomas are enriched with proteins involved in chemoresistance and in DNA synthesis and repair, which is consistent with the meager clinical effectiveness of conventional systemic therapy in ependymoma. Adjuvant therapies that combine conventional chemotherapy with the inhibition of chemoresistance-related proteins may represent a novel treatment paradigm for this difficult disease.
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Affiliation(s)
- Sherise D. Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Yuuri Hashimoto
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nader Sanai
- Division of Neurosurgical Oncology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Lyndon Kim
- Department of Neurological Surgery and Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Santosh Kesari
- Department of Translational Neurosciences and Neurotherapeutics, Pacific Neuroscience Institute and John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Spetzler
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy B. Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lummus SC, Donson AM, Gowan K, Jones KL, Vibhakar R, Foreman NK, Kleinschmidt-DeMasters BK. p16 Loss and E2F/cell cycle deregulation in infant posterior fossa ependymoma. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26656. [PMID: 28548702 PMCID: PMC5647247 DOI: 10.1002/pbc.26656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Posterior fossa (PF) ependymomas (EPNs) in infants less than 1 year of age (iEPN-PF) have a poorer clinical outcome than EPNs in older children. While radiation therapy is the standard of care for the latter, it is withheld in infants to avoid neurotoxicity to immature brain. It is unknown whether the adverse outcome in iEPN-PFs is due to treatment differences or aggressive biology. We examined this question using molecular profiling. METHODS Six anaplastic iEPN-PFs were subjected to transcriptomic analysis and FISH for p16 loss and gains of 1q, and compared with anaplastic PF EPNs from older children. Results were validated by immunohistochemistry (IHC). RESULTS All six iEPN-PFs were grouped within EPN PF subgroup A (PFA). E2F targets and G2M checkpoint were identified as the most enriched gene sets in iEPN-PF, which was validated in a larger independent cohort. Accordingly, MIB-1 IHC demonstrated a higher mitotic rate in iEPN-PFs than noninfant anaplastic EPN PFA. Genetic and protein analyses demonstrated that p16 loss and low p16 protein expression is a hallmark of iEPN-PF, and that none harbored 1q gains. Kaplan-Meier analysis confirmed the poorer clinical outcome of the iEPN-PF cohort. CONCLUSIONS Biological differences, characterized by loss of p16 expression without gains of 1q in iEPN-PFs, as well as deregulated E2F target gene transcription, are indicative of deregulated p16-CDK4/6-pRB-E2F pathway activity. This may underlie the poor clinical outcome seen in this group of iEPN-PFs, rather than the withholding of radiation therapy. Results suggest a potential actionable therapy for iEPN-PF, namely cyclin-dependent kinase 4/6 (CDK4/6) inhibitors.
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Affiliation(s)
- Seth C. Lummus
- Department of Pathology, The University of Colorado School of Medicine, Aurora, Colorado,Children’s Hospital Colorado, Aurora, Colorado
| | - Andrew M. Donson
- Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, The University of Colorado School of Medicine, Aurora, Colorado
| | - Katherine Gowan
- Department of Pediatrics, The University of Colorado School of Medicine, Aurora, Colorado
| | - Kenneth L. Jones
- Department of Pediatrics, The University of Colorado School of Medicine, Aurora, Colorado
| | - Rajeev Vibhakar
- Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, The University of Colorado School of Medicine, Aurora, Colorado
| | - Nicholas K. Foreman
- Children’s Hospital Colorado, Aurora, Colorado,Department of Pediatrics, The University of Colorado School of Medicine, Aurora, Colorado,Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado
| | - B. K. Kleinschmidt-DeMasters
- Department of Pathology, The University of Colorado School of Medicine, Aurora, Colorado,Department of Neurosurgery, The University of Colorado School of Medicine, Aurora, Colorado,Department of Neurology, The University of Colorado School of Medicine, Aurora, Colorado
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5
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Abstract
Over the past 150 years since Virchow's initial characterization of ependymoma, incredible efforts have been made in the classification of these tumors and in the care of pediatric patients with this disease. While the advent of modern neurosurgery and the optimization of radiation have provided significant gains, a more complex but incomplete picture of pediatric ependymomas has begun to form through a combination of international collaborations and detailed genetic and histologic characterizations. This review includes and synthesizes the clinical understanding of pediatric ependymoma and their developing molecular insight into what is truly a family of malignancies in which distinct members require different surgical approaches, radiation plans, and targeted therapies.
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Affiliation(s)
- Nicholas A Vitanza
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
| | - Sonia Partap
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
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Single-agent erlotinib versus oral etoposide in patients with recurrent or refractory pediatric ependymoma: a randomized open-label study. J Neurooncol 2016; 129:131-8. [DOI: 10.1007/s11060-016-2155-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
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7
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Barszczyk M, Buczkowicz P, Castelo-Branco P, Mack SC, Ramaswamy V, Mangerel J, Agnihotri S, Remke M, Golbourn B, Pajovic S, Elizabeth C, Yu M, Luu B, Morrison A, Adamski J, Nethery-Brokx K, Li XN, Van Meter T, Dirks PB, Rutka JT, Taylor MD, Tabori U, Hawkins C. Telomerase inhibition abolishes the tumorigenicity of pediatric ependymoma tumor-initiating cells. Acta Neuropathol 2014; 128:863-77. [PMID: 25120190 PMCID: PMC4286630 DOI: 10.1007/s00401-014-1327-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/02/2014] [Accepted: 07/23/2014] [Indexed: 12/17/2022]
Abstract
Pediatric ependymomas are highly recurrent tumors resistant to conventional chemotherapy. Telomerase, a ribonucleoprotein critical in permitting limitless replication, has been found to be critically important for the maintenance of tumor-initiating cells (TICs). These TICs are chemoresistant, repopulate the tumor from which they are identified, and are drivers of recurrence in numerous cancers. In this study, telomerase enzymatic activity was directly measured and inhibited to assess the therapeutic potential of targeting telomerase. Telomerase repeat amplification protocol (TRAP) (n = 36) and C-circle assay/telomere FISH/ATRX staining (n = 76) were performed on primary ependymomas to determine the prevalence and prognostic potential of telomerase activity or alternative lengthening of telomeres (ALT) as telomere maintenance mechanisms, respectively. Imetelstat, a phase 2 telomerase inhibitor, was used to elucidate the effect of telomerase inhibition on proliferation and tumorigenicity in established cell lines (BXD-1425EPN, R254), a primary TIC line (E520) and xenograft models of pediatric ependymoma. Over 60 % of pediatric ependymomas were found to rely on telomerase activity to maintain telomeres, while no ependymomas showed evidence of ALT. Children with telomerase-active tumors had reduced 5-year progression-free survival (29 ± 11 vs 64 ± 18 %; p = 0.03) and overall survival (58 ± 12 vs 83 ± 15 %; p = 0.05) rates compared to those with tumors lacking telomerase activity. Imetelstat inhibited proliferation and self-renewal by shortening telomeres and inducing senescence in vitro. In vivo, Imetelstat significantly reduced subcutaneous xenograft growth by 40 % (p = 0.03) and completely abolished the tumorigenicity of pediatric ependymoma TICs in an orthotopic xenograft model. Telomerase inhibition represents a promising therapeutic approach for telomerase-active pediatric ependymomas found to characterize high-risk ependymomas.
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Affiliation(s)
- Mark Barszczyk
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Pawel Buczkowicz
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Pedro Castelo-Branco
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Regenerative Medicine Program, Department of Medicine and Biomedical Sciences, Centre for Molecular and Structural Biomedicine, CBME/IBB, University of Algarve, Faro, Portugal
| | - Stephen C. Mack
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Joshua Mangerel
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Sameer Agnihotri
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Marc Remke
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Brian Golbourn
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sanja Pajovic
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Cynthia Elizabeth
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Man Yu
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Andrew Morrison
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Jennifer Adamski
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON Canada
| | - Kathleen Nethery-Brokx
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Xiao-Nan Li
- Brain Tumor Program, Texas Children’s Cancer Center, Houston, TX USA
| | - Timothy Van Meter
- Division of Pediatric Hematology-Oncology, Virginia Commonwealth University, Richmond, VA USA
| | - Peter B. Dirks
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - James T. Rutka
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - Michael D. Taylor
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON Canada
| | - Cynthia Hawkins
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON Canada
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Rogers HA, Mayne C, Chapman RJ, Kilday JP, Coyle B, Grundy RG. PI3K pathway activation provides a novel therapeutic target for pediatric ependymoma and is an independent marker of progression-free survival. Clin Cancer Res 2013; 19:6450-60. [PMID: 24077346 DOI: 10.1158/1078-0432.ccr-13-0222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Currently, there are few effective adjuvant therapies for pediatric ependymoma outside confocal radiation, and prognosis remains poor. The phosphoinositide 3-kinase (PI3K) pathway is one of the most commonly activated pathways in cancer. PI3Ks transduce signals from growth factors and cytokines, resulting in the phosphorylation and activation of AKT, which in turn induces changes in cell growth, proliferation, and apoptosis. EXPERIMENTAL DESIGN PI3K pathway status was analyzed in ependymoma using gene expression data and immunohistochemical analysis of phosphorylated AKT (P-AKT). The effect of the PI3K pathway on cell proliferation was investigated by immunohistochemical analysis of cyclin D1 and Ki67, plus in vitro functional analysis. To identify a potential mechanism of PI3K pathway activation, PTEN protein expression and the mutation status of PI3K catalytic subunit α-isoform gene (PIK3CA) was investigated. RESULTS Genes in the pathway displayed significantly higher expression in supratentorial than in posterior fossa and spinal ependymomas. P-AKT protein expression, indicating pathway activation, was seen in 72% of tumors (n = 169) and P-AKT expression was found to be an independent marker of a poorer progression-free survival. A significant association between PI3K pathway activation and cell proliferation was identified, suggesting that pathway activation was influencing this process. PTEN protein loss was not associated with P-AKT staining and no mutations were identified in PIK3CA. CONCLUSIONS Our results suggest that the PI3K pathway could act as a biomarker, not only identifying patients with a worse prognosis but also those that could be treated with therapies targeted against the pathway, a strategy potentially effective in a high percentage of ependymoma patients.
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Affiliation(s)
- Hazel A Rogers
- Authors' Affiliation: Children's Brain Tumour Research Centre, D Floor Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
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Holliday EB, Sulman EP. Tumor prognostic factors and the challenge of developing predictive factors. Curr Oncol Rep 2013; 15:33-46. [PMID: 23224629 DOI: 10.1007/s11912-012-0283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Histopathologic classification has been widely used to type and grade primary brain tumors. However, the diverse behavior of primary brain tumors has made prognostic determinations based purely on clinical and histopathologic variables difficult. Recent advances in the molecular genetics of brain tumors have helped to explain the witnessed heterogeneity regarding response to treatment, time to progression, and overall survival. Additionally, there has been interest in identifying predictive factors to help direct patients to therapeutic interventions specific to their tumor and patient biology. Further identification of both prognostic and predictive biomarkers will make possible better patient stratification and individualization of treatment.
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Affiliation(s)
- Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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10
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Tumor profiling: development of prognostic and predictive factors to guide brain tumor treatment. Curr Oncol Rep 2011; 13:26-36. [PMID: 21082294 DOI: 10.1007/s11912-010-0138-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary brain tumors are a heterogeneous group of malignancies with highly variable outcomes, and diagnosis is largely based on the histological appearance of the tumors. However, the diversity of primary brain tumors has made prognostic determinations based purely on clinicopathologic variables difficult. There is an increasing body of data suggesting a significant amount of molecular diversity accounts for the heterogeneity of clinical observations, such as response to treatment and time to progression. The last decade has witnessed an explosive advance in our knowledge of the molecular genetics of brain tumors, due in large part to the availability of high-throughput profiling techniques and to the completion of the human genome sequencing project. The large amount of data generated by these efforts has enabled the identification of prognostic and predictive factors and helping to identify pathways which are driving tumor growth. Identification of biomarkers will enable better patient stratification and individualization of treatment.
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Koos B, Bender S, Witt H, Mertsch S, Felsberg J, Beschorner R, Korshunov A, Riesmeier B, Pfister S, Paulus W, Hasselblatt M. The Transcription Factor Evi-1 Is Overexpressed, Promotes Proliferation, and Is Prognostically Unfavorable in Infratentorial Ependymomas. Clin Cancer Res 2011; 17:3631-7. [DOI: 10.1158/1078-0432.ccr-11-0175] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Peyre M, Commo F, Dantas-Barbosa C, Andreiuolo F, Puget S, Lacroix L, Drusch F, Scott V, Varlet P, Mauguen A, Dessen P, Lazar V, Vassal G, Grill J. Portrait of ependymoma recurrence in children: biomarkers of tumor progression identified by dual-color microarray-based gene expression analysis. PLoS One 2010; 5:e12932. [PMID: 20885975 PMCID: PMC2945762 DOI: 10.1371/journal.pone.0012932] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 07/14/2010] [Indexed: 01/06/2023] Open
Abstract
Background Children with ependymoma may experience a relapse in up to 50% of cases depending on the extent of resection. Key biological events associated with recurrence are unknown. Methodology/Principal Findings To discover the biology behind the recurrence of ependymomas, we performed CGHarray and a dual-color gene expression microarray analysis of 17 tumors at diagnosis co-hybridized with the corresponding 27 first or subsequent relapses from the same patient. As treatment and location had only limited influence on specific gene expression changes at relapse, we established a common signature for relapse. Eighty-seven genes showed an absolute fold change ≥2 in at least 50% of relapses and were defined as the gene expression signature of ependymoma recurrence. The most frequently upregulated genes are involved in the kinetochore (ASPM, KIF11) or in neural development (CD133, Wnt and Notch pathways). Metallothionein (MT) genes were downregulated in up to 80% of the recurrences. Quantitative PCR for ASPM, KIF11 and MT3 plus immunohistochemistry for ASPM and MT3 confirmed the microarray results. Immunohistochemistry on an independent series of 24 tumor pairs at diagnosis and at relapse confirmed the decrease of MT3 expression at recurrence in 17/24 tumor pairs (p = 0.002). Conversely, ASPM expression was more frequently positive at relapse (87.5% vs 37.5%, p = 0.03). Loss or deletion of the MT genes cluster was never observed at relapse. Promoter sequencing after bisulfite treatment of DNA from primary tumors and recurrences as well as treatment of short-term ependymoma cells cultures with a demethylating agent showed that methylation was not involved in MT3 downregulation. However, in vitro treatment with a histone deacetylase inhibitor or zinc restored MT3 expression. Conclusions/Significance The most frequent molecular events associated with ependymoma recurrence were over-expression of kinetochore proteins and down-regulation of metallothioneins. Metallothionein-3 expression is epigenetically controlled and can be restored in vitro by histone deacetylase inhibitors.
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Affiliation(s)
- Matthieu Peyre
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
| | - Frédéric Commo
- CNRS FRE 2939, Bioinformatics Group, Gustave Roussy Institute, Villejuif, France
| | - Carmela Dantas-Barbosa
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
| | - Felipe Andreiuolo
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
- Translational Research Laboratory, Gustave Roussy Institute, Villejuif, France
| | - Stéphanie Puget
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
- Department of Neurosurgery, Necker Sick Children's Hospital, Université Paris V Descartes, Paris, France
| | - Ludovic Lacroix
- Translational Research Laboratory, Gustave Roussy Institute, Villejuif, France
| | - Françoise Drusch
- Translational Research Laboratory, Gustave Roussy Institute, Villejuif, France
| | - Véronique Scott
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France
| | - Audrey Mauguen
- Department of Biostatistics, Gustave Roussy Institute, Villejuif, France
| | - Philippe Dessen
- CNRS FRE 2939, Bioinformatics Group, Gustave Roussy Institute, Villejuif, France
| | - Vladimir Lazar
- Functional Genomics Unit, Gustave Roussy Institute, Villejuif, France
| | - Gilles Vassal
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Jacques Grill
- Université Paris-Sud, CNRS UMR 8203 “Vectorology and Anticancer Treatments”, Gustave Roussy Institute, Villejuif, France
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
- * E-mail:
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Donson AM, Birks DK, Barton VN, Wei Q, Kleinschmidt-DeMasters BK, Handler MH, Waziri AE, Wang M, Foreman NK. Immune Gene and Cell Enrichment Is Associated with a Good Prognosis in Ependymoma. THE JOURNAL OF IMMUNOLOGY 2009; 183:7428-40. [DOI: 10.4049/jimmunol.0902811] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Ependymomas represent a heterogeneous group of glial tumors whose biological behavior depends on various histological, molecular, and clinical variables. The scope of this chapter is to review the clinical and histo-logical features as well as the molecular genetics of ependymomas with special emphasis on their influence on tumor recurrence and prognosis. Furthermore, potential molecular targets for therapy are outlined.
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Affiliation(s)
- Martin Hasselblatt
- Institute of Neuropathology, University of Münster, Domagkstr. 19, Münster, 48129, Germany.
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Kilday JP, Rahman R, Dyer S, Ridley L, Lowe J, Coyle B, Grundy R. Pediatric ependymoma: biological perspectives. Mol Cancer Res 2009; 7:765-86. [PMID: 19531565 DOI: 10.1158/1541-7786.mcr-08-0584] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric ependymomas are enigmatic tumors that continue to present a clinical management challenge despite advances in neurosurgery, neuroimaging techniques, and radiation therapy. Difficulty in predicting tumor behavior from clinical and histological factors has shifted the focus to the molecular and cellular biology of ependymoma in order to identify new correlates of disease outcome and novel therapeutic targets. This article reviews our current understanding of pediatric ependymoma biology and includes a meta-analysis of all comparative genomic hybridization (CGH) studies done on primary ependymomas to date, examining more than 300 tumors. From this meta-analysis and a review of the literature, we show that ependymomas in children exhibit a different genomic profile to those in adults and reinforce the evidence that ependymomas from different locations within the central nervous system (CNS) are distinguishable at a genomic level. Potential biological markers of prognosis in pediatric ependymoma are assessed and the ependymoma cancer stem cell hypothesis is highlighted with respect to tumor resistance and recurrence. We also discuss the shifting paradigm for treatment modalities in ependymoma that target molecular alterations in tumor-initiating cell populations.
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Affiliation(s)
- John-Paul Kilday
- The Children's Brain Tumour Research Centre, University of Nottingham, United Kingdom
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16
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Puget S, Grill J, Valent A, Bieche I, Dantas-Barbosa C, Kauffmann A, Dessen P, Lacroix L, Geoerger B, Job B, Dirven C, Varlet P, Peyre M, Dirks PB, Sainte-Rose C, Vassal G. Candidate Genes on Chromosome 9q33-34 Involved in the Progression of Childhood Ependymomas. J Clin Oncol 2009; 27:1884-92. [DOI: 10.1200/jco.2007.15.4195] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The molecular pathogenesis of pediatric ependymoma remains unclear. Our study was designed to identify genetic changes implicated in ependymoma progression. Patients and Methods We characterized 59 ependymoma samples (33 at diagnosis and 26 at relapse) using array-comparative genomic hybridization (aCGH). Specific chromosomal imbalances were confirmed by fluorescent in situ hybridization, and candidate genes were assessed by real-time quantitative polymerase chain reaction (qPCR), immunohistochemistry, sequencing, and in vitro functional studies. Results aCGH analysis revealed a significant increase in genomic imbalances on relapse compared with diagnosis, such as gain of 9qter and 1q (54% v 21% and 12% v 0%, respectively) and loss of 6q (27% v 6%). Supervised tumor classification showed that gain of 9qter was associated with tumor recurrence, age older than 3 years, and posterior fossa location. Using a candidate-gene strategy, we found an overexpression of two potential oncogenes at the locus 9qter: Tenascin-C and Notch1. Moreover, Notch pathway analysis (qPCR) revealed overexpression of Notch ligands, receptors, and target genes (Hes-1, Hey2, and c-Myc), and downregulation of Notch repressor Fbxw7. We confirmed by immunohistochemistry the overexpression of Tenascin-C and Hes-1. We detected Notch1 missense mutations in 8.3% of the tumors (only in the posterior fossa location and in case of 9q33-34 gain). Furthermore, inhibition of Notch pathway with a γ-secretase inhibitor impaired the growth of ependymoma stem cell cultures. Conclusion The activation of the Notch pathway and Tenascin-C seem to be important events in ependymoma progression and may represent future targets for therapy. We report, to our knowledge for the first time, recurrent oncogenic mutations in pediatric posterior fossa ependymomas.
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Affiliation(s)
- Stéphanie Puget
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Jacques Grill
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Alexander Valent
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Ivan Bieche
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Carmela Dantas-Barbosa
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Audrey Kauffmann
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Philippe Dessen
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Ludovic Lacroix
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Birgit Geoerger
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Bastien Job
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Clemens Dirven
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Pascale Varlet
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Mathieu Peyre
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Peter B. Dirks
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Christian Sainte-Rose
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
| | - Gilles Vassal
- From the Department of Neurosurgery, Hôpital Necker Enfants Malades, Université Paris Descartes; Department of Pediatric Oncology; Centre National de la Recherche Scientifique – Formation de Recherche en Evolution 2939; Unité Propre de Recherche de I'Enseignement Supérieur Equipe d'Accueil 3535; Laboratory of Translational Research, Institut Gustave Roussy, Villejuif; INSERM (L'Institut National de la Santé et de la Recherche Médicale) U745; Department of Pathology, Hôpital Sainte-Anne, Université Paris
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Genomic deletions correlate with underexpression of novel candidate genes at six loci in pediatric pilocytic astrocytoma. Neoplasia 2008; 10:757-72. [PMID: 18670637 DOI: 10.1593/neo.07914] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 05/09/2008] [Accepted: 05/11/2008] [Indexed: 01/24/2023] Open
Abstract
The molecular pathogenesis of pediatric pilocytic astrocytoma (PA) is not well defined. Previous cytogenetic and molecular studies have not identified nonrandom genetic aberrations. To correlate differential gene expression and genomic copy number aberrations (CNAs) in PA, we have used Affymetrix GeneChip HG_U133A to generate gene expression profiles of 19 pediatric patients and the SpectralChip 2600 to investigate CNAs in 11 of these tumors. Hierarchical clustering according to expression profile similarity grouped tumors and controls separately. We identified 1844 genes that showed significant differential expression between tumor and normal controls, with a large number clearly influencing phosphatidylinositol and mitogen-activated protein kinase signaling in PA. Most CNAs identified in this study were single-clone alterations. However, a small region of loss involving up to seven adjacent clones at 7q11.23 was observed in seven tumors and correlated with the underexpression of BCL7B. Loss of four individual clones was also associated with reduced gene expression including SH3GL2 at 9p21.2-p23, BCL7A (which shares 90% sequence homology with BCL7B) at 12q24.33, DRD1IP at 10q26.3, and TUBG2 and CNTNAP1 at 17q21.31. Moreover, the down-regulation of FOXG1B at 14q12 correlated with loss within the gene promoter region in most tumors. This is the first study to correlate differential gene expression with CNAs in PA.
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Rand V, Prebble E, Ridley L, Howard M, Wei W, Brundler MA, Fee BE, Riggins GJ, Coyle B, Grundy RG. Investigation of chromosome 1q reveals differential expression of members of the S100 family in clinical subgroups of intracranial paediatric ependymoma. Br J Cancer 2008; 99:1136-43. [PMID: 18781180 PMCID: PMC2567087 DOI: 10.1038/sj.bjc.6604651] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Gain of 1q is one of the most common alterations in cancer and has been associated with adverse clinical behaviour in ependymoma. The aim of this study was to investigate this region to gain insight into the role of 1q genes in intracranial paediatric ependymoma. To address this issue we generated profiles of eleven ependymoma, including two relapse pairs and seven primary tumours, using comparative genome hybridisation and serial analysis of gene expression. Analysis of 656 SAGE tags mapping to 1q identified CHI3L1 and S100A10 as the most upregulated genes in the relapse pair with de novo 1q gain upon recurrence. Moreover, three more members of the S100 family had distinct gene expression profiles in ependymoma. Candidates (CHI3L1, S100A10, S100A4, S100A6 and S100A2) were validated using immunohistochemistry on a tissue microarray of 74 paediatric ependymoma. In necrotic cases, CHI3L1 demonstrated a distinct staining pattern in tumour cells adjacent to the areas of necrosis. S100A6 significantly correlated with supratentorial tumours (P<0.001) and S100A4 with patients under the age of 3 years at diagnosis (P=0.038). In conclusion, this study provides evidence that S100A6 and S100A4 are differentially expressed in clinically relevant subgroups, and also demonstrates a link between CHI3L1 protein expression and necrosis in intracranial paediatric ependymoma.
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Affiliation(s)
- V Rand
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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de Bont JM, Packer RJ, Michiels EM, den Boer ML, Pieters R. Biological background of pediatric medulloblastoma and ependymoma: a review from a translational research perspective. Neuro Oncol 2008; 10:1040-60. [PMID: 18676356 DOI: 10.1215/15228517-2008-059] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Survival rates of pediatric brain tumor patients have significantly improved over the years due to developments in diagnostic techniques, neurosurgery, chemotherapy, radiotherapy, and supportive care. However, brain tumors are still an important cause of cancer-related deaths in children. Prognosis is still highly dependent on clinical characteristics, such as the age of the patient, tumor type, stage, and localization, but increased knowledge about the genetic and biological features of these tumors is being obtained and might be useful to further improve outcome for these patients. It has become clear that the deregulation of signaling pathways essential in brain development, for example, sonic hedgehog (SHH), Wnt, and Notch pathways, plays an important role in pathogenesis and biological behavior, especially for medulloblastomas. More recently, data have become available about the cells of origin of brain tumors and the possible existence of brain tumor stem cells. Newly developed array-based techniques for studying gene expression, protein expression, copy number aberrations, and epigenetic events have led to the identification of other potentially important biological abnormalities in pediatric medulloblastomas and ependymomas.
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Affiliation(s)
- Judith M de Bont
- Department of Pediatric Oncology and Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Childhood primary central nervous system tumors remain a therapeutic conundrum. As the second most common pediatric cancer, brain tumors lead to significantly worse survival and long-term effects compared with those seen with hematologic malignancies and other solid tumors. This review discusses current management strategies in three pediatric brain tumors, the long-term effects of therapy, as well as novel laboratory findings that may alter future treatment strategies. RECENT FINDINGS The current literature focuses on tactics to predict those at risk of treatment failure and long-term effects. By analyzing tumors at a molecular genetics level rather than traditional histology, new data have begun to emerge on methods to begin to consider targeted therapies, tailored to the individual child. Furthermore, as survivorship has improved with current radiation and chemotherapy regimens, long-term effects have been identified and merit clinical attention. SUMMARY Even though long-term survival for children with a brain tumor approaches 70%, the need for improved treatment regimens is striking. Secondary malignancies, neurocognitive deficits and treatment failure continue to afflict these children and young adults. The current review will inform clinicians of the challenges faced by basic scientists and clinicians when treating brain tumors, and point to future research directions.
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Modena P, Lualdi E, Facchinetti F, Veltman J, Reid JF, Minardi S, Janssen I, Giangaspero F, Forni M, Finocchiaro G, Genitori L, Giordano F, Riccardi R, Schoenmakers EFPM, Massimino M, Sozzi G. Identification of tumor-specific molecular signatures in intracranial ependymoma and association with clinical characteristics. J Clin Oncol 2006; 24:5223-33. [PMID: 17114655 DOI: 10.1200/jco.2006.06.3701] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To delineate clinically relevant molecular signatures of intracranial ependymoma. MATERIALS AND METHODS We analyzed 24 primary intracranial ependymomas. For genomic profiling, microarray-based comparative genomic hybridization (CGH) was used and results were validated by fluorescent in situ hybridization and loss of heterozygosity mapping. We performed gene expression profiling using microarrays, real-time quantitative reverse transcriptase polymerase chain reaction, and methylation analysis of selected genes. We applied class comparison analyses to compare both genomic and expression profiling data with clinical characteristics. RESULTS A variable number of genomic imbalances were detected by array CGH, revealing multiple regions of recurrent gain (including 2q23, 7p21, 12p, 13q21.1, and 20p12) and loss (including 5q31, 6q26, 7q36, 15q21.1, 16q24, 17p13.3, 19p13.2, and 22q13.3). An ependymoma-specific gene expression signature was characterized by the concurrent abnormal expression of developmental and differentiation pathways, including NOTCH and sonic hedgehog signaling. We identified specific differentially imbalanced genomic clones and gene expression signatures significantly associated with tumor location, patient age at disease onset, and retrospective risk for relapse. Integrated genomic and expression profiling allowed us to identify genes of which the expression is deregulated in intracranial ependymoma, such as overexpression of the putative proto-oncogene YAP1 (located at 11q22) and downregulation of the SULT4A1 gene (at 22q13.3). CONCLUSION The present exploratory molecular profiling study allowed us to refine previously reported intervals of genomic imbalance, to identify novel restricted regions of gain and loss, and to identify molecular signatures correlating with various clinical variables. Validation of these results on independent data sets represents the next step before translation into the clinical setting.
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Affiliation(s)
- Piergiorgio Modena
- Unit of Molecular Cytogenetics, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
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