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Morales-Vargas B, Saad H, Refai D, Schniederjan M, Abdullaev Z, Aldape K, Abedalthagafi M. A case of myxopapillary ependymoma with predominant giant cell morphology: A rare entity with comprehensive genomic profiling and review of literature. Neuropathology 2024. [PMID: 38639066 DOI: 10.1111/neup.12977] [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: 12/01/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
In the evolving landscape of ependymoma classification, which integrates histological, molecular, and anatomical context, we detail a rare case divergent from the usual histopathological spectrum. We present the case of a 37-year-old man with symptomatic spinal cord compression at the L3-L4 level. Neuroradiological evaluation revealed an intradural, encapsulated mass. Histologically, the tumor displayed atypical features: bizarre pleomorphic giant cells, intranuclear inclusions, mitotic activity, and a profusion of eosinophilic cytoplasm with hyalinized vessels, deviating from the characteristic perivascular pseudorosettes or myxopapillary patterns. Immunohistochemical staining bolstered this divergence, marking the tumor cells positive for glial fibrillary acidic protein and epithelial membrane antigen with a characteristic ring-like pattern, and CD99 but negative for Olig-2. These markers, alongside methylation profiling, facilitated its classification as a myxopapillary ependymoma (MPE), despite the atypical histologic features. This profile underscores the necessity of a multifaceted diagnostic process, especially when histological presentation is uncommon, confirming the critical role of immunohistochemistry and molecular diagnostics in classifying morphologically ambiguous ependymomas and exemplifying the histological diversity within MPEs.
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Affiliation(s)
- Bryan Morales-Vargas
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hassan Saad
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Refai
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Schniederjan
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zied Abdullaev
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Malak Abedalthagafi
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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2
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Johnson TS, MacDonald TJ, Pacholczyk R, Aguilera D, Al-Basheer A, Bajaj M, Bandopadhayay P, Berrong Z, Bouffet E, Castellino RC, Dorris K, Eaton BR, Esiashvili N, Fangusaro JR, Foreman N, Fridlyand D, Giller C, Heger IM, Huang C, Kadom N, Kennedy EP, Manoharan N, Martin W, McDonough C, Parker RS, Ramaswamy V, Ring E, Rojiani A, Sadek RF, Satpathy S, Schniederjan M, Smith A, Smith C, Thomas BE, Vaizer R, Yeo KK, Bhasin MK, Munn DH. Indoximod-based chemo-immunotherapy for pediatric brain tumors: A first-in-children phase I trial. Neuro Oncol 2024; 26:348-361. [PMID: 37715730 PMCID: PMC10836763 DOI: 10.1093/neuonc/noad174] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Recurrent brain tumors are the leading cause of cancer death in children. Indoleamine 2,3-dioxygenase (IDO) is a targetable metabolic checkpoint that, in preclinical models, inhibits anti-tumor immunity following chemotherapy. METHODS We conducted a phase I trial (NCT02502708) of the oral IDO-pathway inhibitor indoximod in children with recurrent brain tumors or newly diagnosed diffuse intrinsic pontine glioma (DIPG). Separate dose-finding arms were performed for indoximod in combination with oral temozolomide (200 mg/m2/day x 5 days in 28-day cycles), or with palliative conformal radiation. Blood samples were collected at baseline and monthly for single-cell RNA-sequencing with paired single-cell T cell receptor sequencing. RESULTS Eighty-one patients were treated with indoximod-based combination therapy. Median follow-up was 52 months (range 39-77 months). Maximum tolerated dose was not reached, and the pediatric dose of indoximod was determined as 19.2 mg/kg/dose, twice daily. Median overall survival was 13.3 months (n = 68, range 0.2-62.7) for all patients with recurrent disease and 14.4 months (n = 13, range 4.7-29.7) for DIPG. The subset of n = 26 patients who showed evidence of objective response (even a partial or mixed response) had over 3-fold longer median OS (25.2 months, range 5.4-61.9, p = 0.006) compared to n = 37 nonresponders (7.3 months, range 0.2-62.7). Four patients remain free of active disease longer than 36 months. Single-cell sequencing confirmed emergence of new circulating CD8 T cell clonotypes with late effector phenotype. CONCLUSIONS Indoximod was well tolerated and could be safely combined with chemotherapy and radiation. Encouraging preliminary evidence of efficacy supports advancing to Phase II/III trials for pediatric brain tumors.
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Affiliation(s)
- Theodore S Johnson
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Tobey J MacDonald
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Rafal Pacholczyk
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Dolly Aguilera
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Ahmad Al-Basheer
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Radiation Oncology, Augusta University, Augusta, Georgia, USA
| | - Manish Bajaj
- Department of Radiology, Augusta University, Augusta, Georgia, USA
| | | | - Zuzana Berrong
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Eric Bouffet
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Robert C Castellino
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Kathleen Dorris
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Bree R Eaton
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Natia Esiashvili
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jason R Fangusaro
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Diana Fridlyand
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Cole Giller
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA
| | - Ian M Heger
- Department of Neurosurgery, Augusta University, Augusta, Georgia, USA
| | - Chenbin Huang
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Nadja Kadom
- Department of Radiology and Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Eugene P Kennedy
- Lumos Pharma, Inc. (formerly NewLink Genetics Corporation), Austin, Texas, USA
| | - Neevika Manoharan
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - William Martin
- Department of Radiation Oncology, Augusta University, Augusta, Georgia, USA
| | - Colleen McDonough
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Rebecca S Parker
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Vijay Ramaswamy
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Eric Ring
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Amyn Rojiani
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pathology, Augusta University, Augusta, Georgia, USA
| | - Ramses F Sadek
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Population Health Sciences, Augusta University, Augusta, Georgia, USA
| | - Sarthak Satpathy
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Matthew Schniederjan
- Children’s Healthcare of Atlanta and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Christopher Smith
- Lumos Pharma, Inc. (formerly NewLink Genetics Corporation), Austin, Texas, USA
| | - Beena E Thomas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Rachel Vaizer
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
| | - Kee Kiat Yeo
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Manoj K Bhasin
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - David H Munn
- Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Pediatrics, Augusta University, Augusta, Georgia, USA
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3
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Shahab SW, Patil P, Fangusaro JR, Patteson B, Goldman-Yassen A, Eaton BR, Boydston W, Schniederjan M, Aguilera D. Primary Diffuse Leptomeningeal Melanomatosis in a Child with Extracranial Metastasis: Case Report. Curr Oncol 2024; 31:579-587. [PMID: 38275834 PMCID: PMC10814890 DOI: 10.3390/curroncol31010041] [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: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Primary meningeal melanomatosis is an extremely rare tumor with very few documented responses to treatment. A 3-year-old male with a complex past medical history, including prematurity and shunted hydrocephalus, was diagnosed with primary meningeal melanomatosis with peritoneal implants. Molecular testing revealed an NRAS Q61R mutation. The patient received proton craniospinal radiation followed by immunotherapy with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) IV every 3 weeks and, upon progression, he was switched to a higher dose of nivolumab (3 mg/kg IV every 2 weeks) and binimetinib (24 mg/m2/dose, twice a day). The patient had significant improvement of CNS disease with radiation therapy and initial immunotherapy but progression of extracranial metastatic peritoneal and abdominal disease. Radiation was not administered to the whole abdomen. After two cycles of nivolumab and treatment with the MEK inhibitor binimetinib, he had radiographic and clinical improvement in abdominal metastasis and ascitis. He ultimately died from RSV infection, Klebsiella sepsis, and subdural hemorrhage without evidence of tumor progression. This is the first report of a child with primary meningeal melanomatosis with extracranial metastatic disease with response to a combination of radiation, immunotherapy and MEK inhibitor therapy.
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Affiliation(s)
- Shubin W. Shahab
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Winship Cancer Institute, Atlanta, GA 30322, USA
| | - Prabhumallikarjun Patil
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jason R. Fangusaro
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Winship Cancer Institute, Atlanta, GA 30322, USA
| | - Brooke Patteson
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
| | - Adam Goldman-Yassen
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bree R. Eaton
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Winship Cancer Institute, Atlanta, GA 30322, USA
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - William Boydston
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Matthew Schniederjan
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Dolly Aguilera
- Aflac Cancer and Blood Disorders Center, Atlanta, GA 30342, USA; (J.R.F.); (B.P.); (D.A.)
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (P.P.); (A.G.-Y.); (B.R.E.); (W.B.); (M.S.)
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
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4
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Shahab SW, Roggeveen CM, Sun J, Kunhiraman H, McSwain LF, Juraschka K, Kumar SA, Saulnier O, Taylor MD, Schniederjan M, Schnepp RW, MacDonald TJ, Kenney AM. The LIN28B-let-7-PBK pathway is essential for group 3 medulloblastoma tumor growth and survival. Mol Oncol 2023; 17:1784-1802. [PMID: 37341142 PMCID: PMC10483609 DOI: 10.1002/1878-0261.13477] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Children with Group 3 medulloblastoma (G3 MB) have a very poor prognosis, and many do not survive beyond 5 years after diagnosis. A factor that may contribute to this is the lack of available targeted therapy. Expression of protein lin-28 homolog B (LIN28B), a regulator of developmental timing, is upregulated in several cancers, including G3 MB, and is associated with worse survival in this disease. Here, we investigate the role of the LIN28B pathway in G3 MB and demonstrate that the LIN28B-lethal-7 (let-7; a microRNA that is a tumor suppressor)-lymphokine-activated killer T-cell-originated protein kinase (PBK; also known as PDZ-binding kinase) axis promotes G3 MB proliferation. LIN28B knockdown in G3-MB-patient-derived cell lines leads to a significant reduction in cell viability and proliferation in vitro and in prolonged survival of mice with orthotopic tumors. The LIN28 inhibitor N-methyl-N-[3-(3-methyl-1,2,4-triazolo[4,3-b]pyridazin-6-yl)phenyl]acetamide (1632) significantly reduces G3 MB cell growth and demonstrates efficacy in reducing tumor growth in mouse xenograft models. Inhibiting PBK using HI-TOPK-032 also results in a significant reduction in G3 MB cell viability and proliferation. Together, these results highlight a critical role for the LIN28B-let-7-PBK pathway in G3 MB and provide preliminary preclinical results for drugs targeting this pathway.
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Affiliation(s)
- Shubin W. Shahab
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaGAUSA
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | | | - Jiarong Sun
- Emory College of Arts and SciencesEmory UniversityAtlantaGAUSA
| | | | - Leon F. McSwain
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | - Kyle Juraschka
- Department of Neurosurgery, The Hospital for Sick ChildrenUniversity of TorontoONCanada
- Department of Laboratory Medicine and PathologyUniversity of TorontoONCanada
| | - Sachin A. Kumar
- Department of Laboratory Medicine and PathologyUniversity of TorontoONCanada
| | - Olivier Saulnier
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick ChildrenUniversity of TorontoONCanada
- Developmental and Stem Cell Biology Program, The Hospital for Sick ChildrenUniversity of TorontoONCanada
| | - Michael D. Taylor
- Department of Neurosurgery, The Hospital for Sick ChildrenUniversity of TorontoONCanada
- Department of Laboratory Medicine and PathologyUniversity of TorontoONCanada
| | | | - Robert W. Schnepp
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaGAUSA
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
- The Janssen PharmaceuticalAmblerPAUSA
| | - Tobey J MacDonald
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaGAUSA
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
- Winship Cancer InstituteAtlantaGAUSA
| | - Anna Marie Kenney
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
- Winship Cancer InstituteAtlantaGAUSA
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5
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Cleveland AH, Malawsky D, Churiwal M, Rodriguez C, Reed F, Schniederjan M, Velazquez Vega JE, Davis I, Gershon TR. PRC2 disruption in cerebellar progenitors produces cerebellar hypoplasia and aberrant myoid differentiation without blocking medulloblastoma growth. Acta Neuropathol Commun 2023; 11:8. [PMID: 36635771 PMCID: PMC9838053 DOI: 10.1186/s40478-023-01508-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
We show that Polycomb Repressive Complex-2 (PRC2) components EED and EZH2 maintain neural identity in cerebellar granule neuron progenitors (CGNPs) and SHH-driven medulloblastoma, a cancer of CGNPs. Proliferating CGNPs and medulloblastoma cells inherit neural fate commitment through epigenetic mechanisms. The PRC2 is an epigenetic regulator that has been proposed as a therapeutic target in medulloblastoma. To define PRC2 function in cerebellar development and medulloblastoma, we conditionally deleted PRC2 components Eed or Ezh2 in CGNPs and analyzed medulloblastomas induced in Eed-deleted and Ezh2-deleted CGNPs by expressing SmoM2, an oncogenic allele of Smo. Eed deletion destabilized the PRC2, depleting EED and EZH2 proteins, while Ezh2 deletion did not deplete EED. Eed-deleted cerebella were hypoplastic, with reduced proliferation, increased apoptosis, and inappropriate muscle-like differentiation. Ezh2-deleted cerebella showed similar, milder phenotypes, with fewer muscle-like cells and without reduced growth. Eed-deleted and Ezh2-deleted medulloblastomas both demonstrated myoid differentiation and progressed more rapidly than PRC2-intact controls. The PRC2 thus maintains neural commitment in CGNPs and medulloblastoma, but is not required for SHH medulloblastoma progression. Our data define a role for the PRC2 in preventing inappropriate, non-neural fates during postnatal neurogenesis, and caution that targeting the PRC2 in SHH medulloblastoma may not produce durable therapeutic effects.
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Affiliation(s)
- Abigail H. Cleveland
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208Cancer Cell Biology Training Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Daniel Malawsky
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA ,grid.10306.340000 0004 0606 5382Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Mehal Churiwal
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Claudia Rodriguez
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Frances Reed
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Matthew Schniederjan
- grid.189967.80000 0001 0941 6502Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Jose E. Velazquez Vega
- grid.189967.80000 0001 0941 6502Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Ian Davis
- grid.10698.360000000122483208Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Timothy R. Gershon
- grid.10698.360000000122483208Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA ,grid.189967.80000 0001 0941 6502Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322 USA ,grid.189967.80000 0001 0941 6502Children’s Center for Neurosciences Research, Emory University School of Medicine, Atlanta, GA 30322 USA ,grid.189967.80000 0001 0941 6502Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA 30322 USA
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6
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Shahab SW, Schniederjan M, Vega JV, Little S, Reisner A, MacDonald T, Aguilera D. Case report: ATIC-ALK fusion in infant-type hemispheric glioma and response to lorlatinib. Front Oncol 2023; 13:1123378. [PMID: 36910660 PMCID: PMC10004274 DOI: 10.3389/fonc.2023.1123378] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/09/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction Infant type hemispheric gliomas are a rare tumor with unique molecular characteristics. In many cases these harbor mutations in receptor tyrosine kinase pathways and respond to targeted therapy. Here we describe the case of an infant with this type of tumor with a novel ATIC-ALK fusion that has responded dramatically to the ALK inhibitor lorlatinib, despite being refractory to standard chemotherapy. Case description The infant was initially treated with standard chemotherapy and found to have an ATIC-ALK fusion. When surveillance imaging revealed progressive disease, the patient was switched to the ALK-inhibitor lorlatinib at 47 mg/m2/day. The patient demonstrated a significant clinical and radiographic response to the ALK inhibitor lorlatinib after just 3 months of treatment and a near complete response by 6 months of therapy. Conclusion The ALK inhibitor lorlatinib is an effective targeted therapy in infant type hemispheric glioma patients harboring ATIC-ALK fusion.
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Affiliation(s)
- Shubin W Shahab
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Matthew Schniederjan
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, United States.,Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jose Velazquez Vega
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, United States.,Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Stephen Little
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Tobey MacDonald
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Winship Cancer Institute, Atlanta, GA, United States
| | - Dolly Aguilera
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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7
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Newman NJ, Schniederjan M, Mendoza PR, Calkins DJ, Yu-Wai-Man P, Biousse V, Carelli V, Taiel M, Rugiero F, Singh P, Rogue A, Sahel JA, Ancian P. Absence of lenadogene nolparvovec DNA in a brain tumor biopsy from a patient in the REVERSE clinical study, a case report. BMC Neurol 2022; 22:257. [PMID: 35820885 PMCID: PMC9277876 DOI: 10.1186/s12883-022-02787-y] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leber Hereditary Optic Neuropathy (LHON) is a rare, maternally-inherited mitochondrial disease that primarily affects retinal ganglion cells (RGCs) and their axons in the optic nerve, leading to irreversible, bilateral severe vision loss. Lenadogene nolparvovec gene therapy was developed as a treatment for patients with vision loss from LHON caused by the most prevalent m.11778G > A mitochondrial DNA point mutation in the MT-ND4 gene. Lenadogene nolparvovec is a replication-defective recombinant adeno-associated virus vector 2 serotype 2 (AAV2/2), encoding the human wild-type MT-ND4 protein. Lenadogene nolparvovec was administered by intravitreal injection (IVT) in LHON patients harboring the m.11778G > A ND4 mutation in a clinical development program including one phase 1/2 study (REVEAL), three phase 3 pivotal studies (REVERSE, RESCUE, REFLECT), and one long-term follow-up study (RESTORE, the follow-up of REVERSE and RESCUE patients). CASE PRESENTATION A 67-year-old woman with MT-ND4 LHON, included in the REVERSE clinical study, received a unilateral IVT of lenadogene nolparvovec in the right eye and a sham injection in the left eye in May 2016, 11.4 months and 8.8 months after vision loss in her right and left eyes, respectively. The patient had a normal brain magnetic resonance imaging with contrast at the time of diagnosis of LHON. Two years after treatment administration, BCVA had improved in both eyes. The product was well tolerated with mild and resolutive anterior chamber inflammation in the treated eye. In May 2019, the patient was diagnosed with a right temporal lobe glioblastoma, IDH-wildtype, World Health Organization grade 4, based on histological analysis of a tumor excision. The brain tumor was assessed for the presence of vector DNA by using a sensitive validated qPCR assay targeting the ND4 sequence of the vector. CONCLUSION ND4 DNA was not detected (below 15.625 copies/μg of genomic DNA) in DNA extracted from the brain tumor, while a housekeeping gene DNA was detected at high levels. Taken together, this data shows the absence of detection of lenadogene nolparvovec in a brain tumor (glioblastoma) of a treated patient in the REVERSE clinical trial 3 years after gene therapy administration, supporting the long-term favorable safety of lenadogene nolparvovec.
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Affiliation(s)
- Nancy J Newman
- Departments of Ophthalmology, Neurology and Neurological Surgery, Neuro-Ophthalmology Unit, Emory Eye Center, Emory University School of Medicine, 1365-B Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Matthew Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Pia R Mendoza
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - David J Calkins
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Valérie Biousse
- Departments of Ophthalmology, Neurology and Neurological Surgery, Neuro-Ophthalmology Unit, Emory Eye Center, Emory University School of Medicine, 1365-B Clifton Road NE, Atlanta, GA, 30322, USA
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
- Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Magali Taiel
- GenSight Biologics, 74 rue du Faubourg Saint Antoine, 75012, Paris, France
| | | | | | | | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- Fondation Ophtalmologique A. de Rothschild, Paris, France
- Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- CHNO des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC, Paris, France
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8
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Chien F, Schniederjan M, Castellino RC, Janss A, Esiashvili N, Eaton B, Indelicato D, Mazewski C. RARE-31. Radiation induced malignancy associated with pediatric craniopharyngioma: a single institution experience. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.056] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Therapy for pediatric craniopharyngioma, a rare suprasellar tumor, includes surgical resection with consideration for intracranial radiation. Radiation is associated with increased risk of secondary malignancies. Between 2000 and 2021, 81 pediatric patients with craniopharyngioma were treated at our institution; 3 of 54 (5.6%) who received radiation therapy(RT) developed secondary malignancy within the treatment field. CASE DESCRIPTIONS: In all 3 cases, initial imaging demonstrated cystic/solid suprasellar mass and underwent resection; pathology revealed calcifications and wet keratin consistent with craniopharyngioma. None had known cancer predispositions. The first patient (male), presented at 4-years-old with headaches. He underwent subtotal resection (STR) with cyst fenestration(w/CF) and received 55.8Gy photon 3D-Conformal RT. Six-years later, the tumor progressed (edge of RT field). Patient underwent a second STRw/CF and fractionated RT(50.4Gy). Both pathologies were consistent with(c/w) papillary craniopharyngioma. Eight-years from first RT, progression occurred again within the RTfield; pathology revealed an (adeno)squamous carcinoma. The second patient, a 5-year-old female, presented with vision loss, underwent partial resection and received 54Gy focal proton therapy for adamantinonatous craniopharyngioma. Almost 5-years later, an unresectable right basal ganglia/globus pallidus mass was noted in the 30-54Gy field. Pathology was c/w anaplastic astrocytoma(AA). The third, a 9-year-old female was treated with 54Gy photon radiation and 7 years later had evidence of increasing mass. Pathology revealed high-grade-diffuse-glioma(HGDG). Molecular analysis of AA/HGDG both revealed PDGFRA amplification and CDKN2A/B homozygous loss. DISCUSSION/CONCLUSION: Malignant CNS tumors are reported following radiotherapy for a variety of primary CNS lesions. While radiation is a valuable therapy in achieving long-term disease control of pediatric craniopharyngiomas, it is important to understand the risk of developing secondary malignant neoplasms. Our report adds to the body of literature describing secondary malignancies post radiation therapy for the treatment of pediatric craniopharyngioma.
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Affiliation(s)
- Franklin Chien
- Emory University School of Medicine , Atlanta, GA , USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
| | - Matthew Schniederjan
- Emory University School of Medicine , Atlanta, GA , USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
| | - R C Castellino
- Emory University School of Medicine , Atlanta, GA , USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
| | - Anna Janss
- Emory University School of Medicine , Atlanta, GA , USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
| | - Natia Esiashvili
- Emory University, Department of Radiation Oncology , Atlanta, GA , USA
| | - Bree Eaton
- Emory University, Department of Radiation Oncology , Atlanta, GA , USA
| | - Daniel Indelicato
- University of Florida, Department of Radiation Oncology , Gainesville, FL , USA
| | - Claire Mazewski
- Emory University School of Medicine , Atlanta, GA , USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
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9
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Gray R, Chien F, Vega JV, Patteson B, Wrubel D, Eaton B, Schniederjan M, Mazewski C. RARE-30. Novel collision tumor of craniopharyngioma and ependymoma in a pediatric patient: a case study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.055] [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: 11/12/2022] Open
Abstract
Abstract
Collision tumors are rare tumors comprised of two distinct histologies. In this case report, we discuss a suprasellar collision tumor consisting of adamantinomatous craniopharyngioma and supratentorial ependymoma in a pediatric patient. Case Presentation: Our patient was a two-year-old female with progressive craniopharyngioma status post cyst decompression with Ommaya reservoir placement, subcutaneous peginterferon, Ommaya taps, and subtotal resection. An MRI three months post-resection showed progression and treatment was started with subcutaneous interferon alfa. After eight weeks, she presented with new onset headaches and vomiting. MRI demonstrated tumor progression with associated obstructive hydrocephalus. She underwent a subtotal resection. Pathology revealed recurrent adamantinomatous craniopharyngioma and a 0.5cm ependymoma with classic histomorphology lacking anaplasia features. The ependymoma was positive for GFAP immunostain and EMA immunohistochemistry highlighted a ‘dot-like’ reaction. The Ki-67 proliferation index was very low (<1%). The limited diagnostic material precluded further genomic characterization of the ependymoma. The previous pathology was reviewed and no ependymoma was identified. Spine MRI was negative for metastatic disease. CSF cytology was negative for malignant cells. Following recovery from surgery, she received 54Gy (RBE) focal proton radiation. Eight months from completion of therapy, surveillance MRI shows stable residual tumor. Genetic work-up for cancer predisposition syndrome is in process despite no strong family history of cancer. Discussion: Due to the patient’s young age at diagnosis, our initial treatment strategy was to delay radiotherapy and utilize other treatment options. Following diagnosis with a collision tumor, the patient proceeded to radiotherapy to manage both tumor components. The role of interferon in the development of a collision tumor in this patient in unknown, but we suspect it to be unrelated. Conclusion: To our knowledge, this is the first documented case of a suprasellar collision tumor comprised of craniopharyngioma and ependymoma. Discovery of the collision tumor impacted the patient’s treatment plan.
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Affiliation(s)
- Rachel Gray
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine , Atlanta, GA , USA
| | - Franklin Chien
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine , Atlanta, GA , USA
| | - Jose Velazquez Vega
- Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine Department of Pathology , Atlanta, GA , USA
| | - Brooke Patteson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine , Atlanta, GA , USA
| | - David Wrubel
- Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine , Atlanta, GA , USA
| | - Bree Eaton
- Emory University Department of Radiation Oncology , Atlanta, GA , USA
- Emory University Department of Pediatrics , Atlanta, GA , USA
| | - Matthew Schniederjan
- Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University School of Medicine Department of Pathology , Atlanta, GA , USA
| | - Claire Mazewski
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta , Atlanta, GA , USA
- Emory University , Atlanta, GA , USA
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10
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Ross JL, Chen Z, Herting CJ, Grabovska Y, Szulzewsky F, Puigdelloses M, Monterroza L, Switchenko J, Wadhwani NR, Cimino PJ, Mackay A, Jones C, Read RD, MacDonald TJ, Schniederjan M, Becher OJ, Hambardzumyan D. Platelet-derived growth factor beta is a potent inflammatory driver in paediatric high-grade glioma. Brain 2021; 144:53-69. [PMID: 33300045 PMCID: PMC7954387 DOI: 10.1093/brain/awaa382] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 01/18/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Paediatric high-grade gliomas (HGGs) account for the most brain tumour-related deaths in children and have a median survival of 12-15 months. One promising avenue of research is the development of novel therapies targeting the properties of non-neoplastic cell-types within the tumour such as tumour associated macrophages (TAMs). TAMs are immunosuppressive and promote tumour malignancy in adult HGG; however, in paediatric medulloblastoma, TAMs exhibit anti-tumour properties. Much is known about TAMs in adult HGG, yet little is known about them in the paediatric setting. This raises the question of whether paediatric HGGs possess a distinct constituency of TAMs because of their unique genetic landscapes. Using human paediatric HGG tissue samples and murine models of paediatric HGG, we demonstrate diffuse midline gliomas possess a greater inflammatory gene expression profile compared to hemispheric paediatric HGGs. We also show despite possessing sparse T-cell infiltration, human paediatric HGGs possess high infiltration of IBA1+ TAMs. CD31, PDGFRβ, and PDGFB all strongly correlate with IBA1+ TAM infiltration. To investigate the TAM population, we used the RCAS/tv-a system to recapitulate paediatric HGG in newborn immunocompetent mice. Tumours are induced in Nestin-positive brain cells by PDGFA or PDGFB overexpression with Cdkn2a or Tp53 co-mutations. Tumours driven by PDGFB have a significantly lower median survival compared to PDGFA-driven tumours and have increased TAM infiltration. NanoString and quantitative PCR analysis indicates PDGFB-driven tumours have a highly inflammatory microenvironment characterized by high chemokine expression. In vitro bone marrow-derived monocyte and microglial cultures demonstrate bone marrow-derived monocytes are most responsible for the production of inflammatory signals in the tumour microenvironment in response to PDGFB stimulation. Lastly, using knockout mice deficient for individual chemokines, we demonstrate the feasibility of reducing TAM infiltration and prolonging survival in both PDGFA and PDGFB-driven tumours. We identify CCL3 as a potential key chemokine in these processes in both humans and mice. Together, these studies provide evidence for the potent inflammatory effects PDGFB has in paediatric HGGs.
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Affiliation(s)
- James L Ross
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Emory University Department of Microbiology and Immunology, Emory Vaccine Center, Atlanta, GA, USA
| | - Zhihong Chen
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Oncological Sciences, The Tisch Cancer Institute, Mount Sinai Icahn School of Medicine, New York, NY, USA
| | - Cameron J Herting
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Emory University Graduate Division of Molecular and Systems Pharmacology, Atlanta, Georgia, USA
| | - Yura Grabovska
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Frank Szulzewsky
- Department of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Montserrat Puigdelloses
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Program in Solid Tumors, Center for the Applied Medical Research (CIMA), University of Navarra, Pamplona, Navarra, Spain
| | - Lenore Monterroza
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Switchenko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Nitin R Wadhwani
- Department of Pathology, Ann and Robert H. Lurie Children’s Hospital of Chicago, IL, USA
| | - Patrick J Cimino
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Alan Mackay
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Renee D Read
- Department of Pharmacology and Chemical Biology, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Oren J Becher
- Department of Pediatrics, Northwestern University, Chicago, IL, USA
- Department of Biochemistry and Molecular Genetics, Northwestern University, Chicago, IL, USA
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Dolores Hambardzumyan
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
- Department of Oncological Sciences, The Tisch Cancer Institute, Mount Sinai Icahn School of Medicine, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Icahn School of Medicine, New York, NY, USA
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11
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Bornhorst M, Nobre L, Zapotocky M, Barseghyan H, Goecks J, Boue D, Tabori U, Hawkins C, Bouffet E, MacDonald T, Schniederjan M, Bronischer A, Orr B, Solomon D, Mueller S, Opocher E, Vortmeyer A, Marks A, Koschmann C, Leung DL, Mody R, Hwang E, Bhattacharya S, Vilain E, Turner J, Kilburn L, Rood B, Packer R, Nazarian J, Ho CY. PATH-14. GENETIC SUSCEPTIBILITY AND OUTCOMES OF PEDIATRIC, ADOLESCENT AND YOUNG ADULT IDH-MUTANT ASTROCYTOMAS. Neuro Oncol 2020. [PMCID: PMC7715578 DOI: 10.1093/neuonc/noaa222.649] [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: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
Previously thought to be rare, recent case series have shown that IDH mutations in young patients are more common than previously described. In this study, we analyzed IDH-mutant tumors to determine clinical significance of these mutations in children, adolescents and young adults.
METHODS
Through this multi-institution study (10 institutions), we collected 64 IDH1/2-mutant infiltrating astrocytoma specimens from 58 patients aged 4–26 (M:F, 0.4:0.6). Specimens included 46 low-grade (LGG) and 18 high-grade (HGG) astrocytomas. Tumor sequencing data (n=45), germline sequencing data (n=37) and outcome data (n=40) was analyzed.
RESULTS
Similar to adults, most sequenced tumors had a co-mutation in the TP53 gene, while ATRX mutations were less common and primarily seen in HGGs. Approximately 60% (n=21) of patients with germline data available had a mutation in a cancer predisposition gene. Mismatch repair (MMR) mutations were most common (n=12; MSH6 n=9), followed by TP53mutations (n=7). All patients with MMR gene mutations had HGGs and poor progression free (PFS=10% at 2 years, mean TTP=9 months) and overall (OS <30% at 2 years) survival. Despite an OS of 90% at 5 years, many LGG patients had tumor progression/recurrence requiring additional treatment (PFS= 80% at 2 yrs, 40% at 5 yrs, mean TTP=3.5 years). Four LGG tumors (2 with TP53+ATRXloss, 2 with TP53 loss+1p19q co-deletion) underwent malignant transformation.
CONCLUSION
IDH-mutant tumors in pediatric patients are strongly associated with cancer predisposition and increased risk for progression/recurrence or malignant transformation. Routine screening for IDH1/2 mutations in children with grade 2–4 astrocytomas could greatly impact patient management.
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Affiliation(s)
| | - Liana Nobre
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Jeremy Goecks
- Oregon Health and Science University, Portland, OR, USA
| | - Daniel Boue
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Uri Tabori
- Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | | - Brent Orr
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - David Solomon
- University of California San Francisco, San Francisco, CA, USA
| | - Sabine Mueller
- University of California San Francisco, San Francisco, CA, USA
- Children’s Hospital of Zurich, Zurich, Switzerland
| | - Enrico Opocher
- Great Ormond Street Hospital for Children, London, United Kingdom
- Azienda Ospedaliera di Padova, Padova, Italy
| | | | | | - Carl Koschmann
- University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
| | | | - Rajen Mody
- University of Michigan Mott Children’s Hospital, Ann Arbor, MI, USA
| | - Eugene Hwang
- Children’s National Hospital, Washington, DC, USA
| | | | - Eric Vilain
- Children’s National Hospital, Washington, DC, USA
| | - Joyce Turner
- Children’s National Hospital, Washington, DC, USA
| | | | - Brian Rood
- Children’s National Hospital, Washington, DC, USA
| | - Roger Packer
- Children’s National Hospital, Washington, DC, USA
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12
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Malhotra A, Liu J, Zhang H, Ma M, Vega JV, Schniederjan M, Prabhu V, Allen J, MacDonald T. MODL-06. PRECLINICAL EFFICACY OF THE IMIPRIDONE ONC-206 AGAINST MEDULLOBLASTOMA. Neuro Oncol 2020. [PMCID: PMC7715948 DOI: 10.1093/neuonc/noaa222.582] [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: 12/03/2022] Open
Abstract
Treatment for medulloblastoma (MB) is typically ineffective for MYC amplified or metastatic SHH, Group 3 and 4 subgroups. Promising preclinical and clinical results have been obtained in brain cancers treated with ONC-201, a selective antagonist of DRD2, a G-protein coupled receptor that regulates prosurvival pathways. Herein, we report the activity of ONC-201 and ONC-206, which has increased non-competitive antagonism of DRD2, against MB. We treated three different MB cell types representative of SHH- and Group 3-like cells, with varied levels of DRD2 expression, and consistently observed increased cell death in a dose-dependent manner at lower doses of ONC-206 compared to ONC-201. We also evaluated ClpP as an additional drug target in MB. ClpP is a mitochondrial protease that has been shown to directly bind and be activated by ONC 201, and is highly expressed at the protein level across pediatric MB, malignant glioma and ATRT, but not normal brain. We observed that similar to ONC-201, ONC-206 treatment of MB cells induces the restoration of mitochondrial membrane potential to the non-proliferative state, degradation of the mitochondrial substrate SDHB, reduction in survivin and elevation in ATF4 (integrated stress response). Importantly, ONC-206 treatment induced significant cell death of patient-derived SHH, WNT, and Group 3 tumors ex vivo and Group 4 cells in vitro, while having no observable toxicity in normal brain. Efficacy studies of ONC-206 against MB in vivo will be reported in preparation for a planned Phase I study of ONC-206 in children with malignant brain tumors.
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Affiliation(s)
| | | | | | - Minhui Ma
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
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13
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Robinson MH, Vasquez J, Kaushal A, MacDonald TJ, Velázquez Vega JE, Schniederjan M, Dhodapkar K. Subtype and grade-dependent spatial heterogeneity of T-cell infiltration in pediatric glioma. J Immunother Cancer 2020; 8:e001066. [PMID: 32788236 PMCID: PMC7422651 DOI: 10.1136/jitc-2020-001066] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Brain tumors are the leading cause of cancer-related mortality in children and have distinct genomic and molecular features compared with adult glioma. However, the properties of immune cells in these tumors has been vastly understudied compared with their adult counterparts. We combined multiplex immunofluorescence immunohistochemistry coupled with machine learning and single-cell mass cytometry to evaluate T-cells infiltrating pediatric glial tumors. We show that low-grade tumors are characterized by greater T-cell density compared with high-grade glioma (HGG). However, even among low-grade tumors, T-cell infiltration can be highly variable and subtype-dependent, with greater T-cell density in pleomorphic xanthoastrocytoma and ganglioglioma. CD3+ T-cell infiltration correlates inversely with the expression of SOX2, an embryonal stem cell marker commonly expressed by glial tumors. T-cells within both HGG and low-grade glioma (LGG) exhibit phenotypic heterogeneity and tissue-resident memory T-cells consist of distinct subsets of CD103+ and TCF1+ cells that exhibit distinct spatial localization patterns. TCF1+ T-cells are located closer to the vessels while CD103+ resident T-cells reside within the tumor further away from the vasculature. Recurrent tumors are characterized by a decline in CD103+ tumor-infiltrating T-cells. BRAFV600E mutation is immunogenic in children with LGG and may serve as a target for immune therapy. These data provide several novel insights into the subtype-dependent and grade-dependent changes in immune architecture in pediatric gliomas and suggest that harnessing tumor-resident T-cells may be essential to improve immune control in glioma.
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Affiliation(s)
- M Hope Robinson
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Juan Vasquez
- Pediatric Oncology, Yale University, New Haven, Connecticut, USA
| | - Akhilesh Kaushal
- Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tobey J MacDonald
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | | | | | - Kavita Dhodapkar
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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14
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Pomeranz Krummel DA, Nasti TH, Izar B, Press RH, Xu M, Lowder L, Kallay L, Rupji M, Rosen H, Su J, Curran W, Olson J, Weinberg B, Schniederjan M, Neill S, Lawson D, Kowalski J, Khan MK, Sengupta S. Impact of Sequencing Radiation Therapy and Immune Checkpoint Inhibitors in the Treatment of Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2020; 108:157-163. [PMID: 32057994 DOI: 10.1016/j.ijrobp.2020.01.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Melanoma brain metastases (MBM) occur in ∼50% of melanoma patients. Although both radiation therapy (RT) and immune checkpoint inhibitor (ICI) are used alone or in combination for MBM treatment, the role of this combination and how these treatments could best be sequenced remains unclear. METHODS AND MATERIALS We conducted a retrospective analysis of patients with resected MBM who underwent treatment with RT, ICI, or a combination of RT and ICI. Among the latter, we specifically investigated the differential gene expression via RNA-sequencing between patients who received RT first then ICI (RT → ICI) versus ICI first then RT (ICI → RT). We used a glycoprotein-transduced syngeneic melanoma mouse model for validation experiments. RESULTS We found that for patients with resected MBM, a combination of RT and ICI confers superior survival compared with RT alone. Specifically, we found that RT → ICI was superior compared with ICI → RT. Transcriptome analysis of resected MBM revealed that the RT → ICI cohort demonstrated deregulation of genes involved in apoptotic signaling and key modulators of inflammation that are most implicated in nuclear factor kappa-light-chain-enhancer of activated B cells signaling. In a preclinical model, we showed that RT followed by anti-programmed death-ligand 1 therapy was superior to the reverse sequence of therapy, supporting the observations we made in patients with MBM. CONCLUSIONS Our study provides initial insights into the optimal sequence of RT and ICI in the treatment of MBM after surgical resection. Prospective studies examining the best sequence of RT and ICI are necessary, and our study contributes to the rationale to pursue these.
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Affiliation(s)
| | - Tahseen H Nasti
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia
| | - Benjamin Izar
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York City, New York
| | - Robert H Press
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Maxwell Xu
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lindsey Lowder
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Kallay
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Manali Rupji
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Havi Rosen
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jing Su
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Walter Curran
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey Olson
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Brent Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Stewart Neill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David Lawson
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Jeanne Kowalski
- Department of Oncology, LIVESTRONG Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
| | - Soma Sengupta
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio; University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio.
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15
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Pomeranz Krummel D, Nasti T, Izar B, Xu M, Lowder L, Press R, Kaluzova M, Kallay L, Rupji M, Burnham A, Li G, Ahmed T, Rosen H, Connolly E, Keskin H, Ben Thomas M, Curran W, Kudchadkar R, Weinberg B, Olson J, Schniederjan M, Neil S, Su J, Lawson D, Cook J, Jenkins A, Kowalski J, Khan M, Sengupta S. EXTH-12. RADIATION ENHANCES MELANOMA RESPONSE TO IMMUNOTHERAPY AND SYNERGIZES WITH BENZODIAZEPINES TO PROMOTE ANTI-TUMOR ACTIVITY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Melanoma brain metastases (MBM) occur in ~50% of advanced melanoma patients. It is unclear if systemic therapies synergize with radiotherapy (RT) and what the impact of RT timing has on efficacy. We find that RT followed by ICI (immune checkpoint inhibitors) (RTàICI) improves MBM patient survival compared to other combination strategies, also shown here in a murine melanoma model. RNA-seq of MBM tumors in the RTàICI group exhibit overrepresentation of genes implicated in NFKB signaling. There is also expression of GABAA receptor subunits across both treatment groups. We show that melanoma cells express functional GABAA receptors and that benzodiazepines impair tumor growth. Combination of sub-lethal RT doses with benzodiazepine results in significant ipsilateral and out of field abscopal anti-tumor activity, which is associated with enhanced tumor infiltration with poly-functional CD8 T-cells. This study provides evidence that RT enhances MBM response to ICI and synergizes with benzodiazepines to promote anti-tumor activity.
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Affiliation(s)
| | | | | | - Maxwell Xu
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Walter Curran
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | | | | | | | | | - Jing Su
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - James Cook
- University Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Soma Sengupta
- University of Cincinnati College of Medicine; Gardner Neuroscience Institute, Cincinnati, OH, USA
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16
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Ross J, Chen Z, Herting C, Szulzewsky F, Becher O, MacDonald T, Schniederjan M, Hambardzumyan D. PDTM-11. GAINING INSIGHTS INTO THE INFLAMMATORY MICROENVIRONMENT OF PEDIATRIC HIGH-GRADE GLIOMAS USING GEMMs AND PATIENT SAMPLES. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.787] [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: 11/12/2022] Open
Abstract
Abstract
Pediatric high-grade gliomas (pHGG) account for the most cancer-related deaths in children, as there are no effective therapies available. It is known tumor associated macrophages (TAM) can make up 30–40% of the total tumor cell mass in adult high-grade gliomas, promoting tumor growth and immune evasion. This raises the question of whether pHGGs possess a distinct constituency of TAMs due to their unique genetic and epigenetic landscapes. To uncover the composition and behavior of TAMs in pHGG we utilize RCAS/tva, a somatic cell-type specific gene transfer system which allows us to recapitulate all major subtypes of pHGG in newborn immunocompetent mice, including histone wild-type and histone-mutant tumors. We combine RCAS-H3.3K27M, RCAS-H3.3G34R/V, or RCAS-H3.3WT along with their driver mutations such as RCAS-shp53 and RCAS-PDGFA or RCAS-PDGFB. These tumors are induced in Nestin-positive cells, each in their respective locations found in the human population. Tumors driven by PDGFB have a significantly lower median survival compared to PDGFA-driven tumors and have increased infiltration of lymphocytes and TAMs, specifically inflammatory monocytes. In vitro bone marrow derived monocyte and microglial cultures demonstrate the BMDM population is most responsible for the production of inflammatory chemokines and angiogenic factors in the tumor microenvironment. We performed histological analyses on over 40 human patient samples to determine the role of the stromal population in TAM infiltration. Matched human samples were also utilized for pan-cancer immune profiling with NanoString to further characterize the innate and adaptive immune microenvironments. These analyses indicate DIPG/K27M tumors have a higher immune cell infiltrate compared to G34R/V and histone wildtype tumors. Further, we observe higher infiltration of T-cell populations in pHGGs compared to adult HGGs, suggesting these tumors may be amenable to immunotherapy despite being considered “immune cold.” These studies provide the critical foundation needed for the development of novel therapeutics targeting these tumors.
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Affiliation(s)
| | | | | | | | | | - Tobey MacDonald
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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17
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Lowder L, Hauenstein J, Woods A, Chen HR, Rupji M, Kowalski J, Olson JJ, Saxe D, Schniederjan M, Neill S, Weinberg B, Sengupta S. Gliosarcoma: distinct molecular pathways and genomic alterations identified by DNA copy number/SNP microarray analysis. J Neurooncol 2019; 143:381-392. [PMID: 31073965 PMCID: PMC6591191 DOI: 10.1007/s11060-019-03184-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 03/25/2019] [Accepted: 04/26/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Gliosarcoma is a histologic variant of glioblastoma (GBM), and like GBM carries a poor prognosis. Median survival is less than one (1) year with less than 5% of patients alive after 5 years. Although there is no cure, standard treatment includes surgery, radiation and chemotherapy. While very similar to GBM, gliosarcoma exhibits several distinct differences, morphologically and molecularly. Therefore, we report a comprehensive analysis of DNA copy number changes in gliosarcoma using a cytogenomic DNA copy number (CN) microarray (OncoScan®). METHODS Cytogenomic DNA copy number microarray (OncoScan®) was performed on 18 cases of gliosarcoma. MetaCore™ enrichment was applied to the array results to detect associated molecular pathways. RESULTS The most frequent alteration was copy number loss, comprising 57% of total copy number changes. The number of losses far exceeded the number of amplifications (***, < 0.001) and loss of heterozygosity events (***, < 0.001). Amplifications were infrequent (4.6%), particularly for EGFR. Chromosomes 9 and 10 had the highest number of losses; a large portion of which correlated to CDKN2A/B loss. Copy number gains were the second most common alteration (26.2%), with the majority occurring on chromosome 7. MetaCore™ enrichment detected notable pathways for copy number gains including: HOXA, Rho family of GTPases, and EGFR; copy number loss including: WNT, NF-kß, and CDKN2A; and copy number loss of heterozygosity including: WNT and p53. CONCLUSIONS The pathways and copy number alterations detected in this study may represent key drivers in gliosarcoma oncogenesis and may provide a starting point toward targeted oncologic analysis with therapeutic potential.
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Affiliation(s)
- Lindsey Lowder
- Department of Pathology & Laboratory Medicine, Emory University Hospital, H185D, 1364 Clifton Road, NE, Atlanta, GA 30322 USA
| | - Jennifer Hauenstein
- Department of Oncology Cytogenetics, Emory University Hospital, F143A, 1364 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Ashley Woods
- Department of Hematology/Oncology, Winship Cancer Institute, 1365 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Hsiao-Rong Chen
- Bioinformatics & Biostatistics, Winship Cancer Institute, 1365 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Manali Rupji
- Bioinformatics & Biostatistics, Winship Cancer Institute, 1365 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Jeanne Kowalski
- Department of Oncology, Dell Medical School, LIVESTRONG Cancer Institutes, The University of Texas At Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX 78712 USA
| | - Jeffrey J. Olson
- Department of Neurosurgery, Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322 USA
| | - Debra Saxe
- Department of Oncology Cytogenetics, Emory University Hospital, 1364 Clifton Rd. NE, Atlanta, GA 143A USA
| | - Matthew Schniederjan
- Department of Pathology & Laboratory Medicine, Children’s Healthcare of Atlanta, Emory University Hospital, H185D, 1364 Clifton Road, NE, Atlanta, GA 30322 USA
| | - Stewart Neill
- Department of Pathology & Laboratory Medicine, Emory University Hospital, H185D, 1364 Clifton Road, NE, Atlanta, GA 30322 USA
| | - Brent Weinberg
- Department of Neuroradiology, Emory University Hospital, BG20, 1364 Clifton Road, NE, Atlanta, GA 30322 USA
| | - Soma Sengupta
- Departments Neurology, Hematology & Medical Oncology, Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322 USA
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18
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Kaluzova M, Nasti T, Chen HR, Lowder L, Press R, Rosen H, Rupji M, Kallay L, Patel R, Burnham A, Xu M, Ross A, Keskin H, Connelly E, Izar B, Adamson C, Olson J, Su J, Curran W, Kudchadkar R, Schniederjan M, Neill S, Lawson D, Chan M, Kowalski J, Khan M, Krummel DP, Sengupta S. Abstract 247: Identification of the GABAA receptor in melanoma brain metastases patient tumors and demonstration that it is a viable drug target using benzodiazepine-derivatives. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-247] [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
Primary cutaneous melanoma is often successfully treated in early stages in patients with regional disease. While distant metastatic disease, including brain metastasis, that develops in most stage IV melanoma patients, carries a particularly poor prognosis with median overall survival of only 4-5 months. Standard-of-care treatment of brain metastases includes surgery, radiation, and chemotherapy. The fact that melanoma is a radio-resistant cancer, significantly limits treatment options for melanoma that has metastasized to the brain. There is clearly a significant demand for new therapeutic approaches. We have conducted a whole transcriptomic analysis of melanoma brain metastases to provide insight into molecular changes that may contribute to metastasis as well as to identify potential therapeutic targets in the metastasized cancer. Total RNA was extracted from 29 formalin-fixed paraffin-embedded (FFPE) melanoma brain metastatic samples, libraries constructed and enriched for transcript fragments with coding regions. Libraries were subjected to Transcriptome Capture (TCap) targeting 21,415 genes, which represents more than 98% of the total RefSeq exome. Sequencing was performed on the Illumina HiSeq platform. Gene expression analysis of melanoma brain metastatic samples reveals high expression levels of ion channels, including subunits of the ligand-gated neurotransmitter GABAA receptors. We will present differential expression analysis between recent melanoma transcriptomic studies [1, 2] and melanoma brain metastases samples. More than 20% of FDA approved drugs target ion channels. We report that repurposing of one such class of drugs targeting GABAA receptors can impair melanoma cell viability in vitro and reduce tumor volume in vivo. GABAA receptors can serve as a potential therapeutic target for treatment brain metastasis.
References 1. Akbani, et al. (The Cancer Genome Atlas Network, TCGA). Genome classification of cutaneous melanoma. Cell 2015; 161(7): 1681-1696. 2. Tirosh, et al. Dissecting the multicellular ecosystem of metastatic melanoma by single-cell RNA-seq. Science 2016; 352 (6282): 189-196.
Citation Format: Milota Kaluzova, Tahseen Nasti, Hiao-Rong Chen, Lindsey Lowder, Robert Press, Havi Rosen, Manali Rupji, Laura Kallay, Rikesh Patel, Andre Burnham, Maxwell Xu, Alexandra Ross, Havva Keskin, Erin Connelly, Benjamin Izar, Cory Adamson, Jeffrey Olson, Jing Su, Walter Curran, Ragini Kudchadkar, Matthew Schniederjan, Stewart Neill, David Lawson, Michael Chan, Jeanne Kowalski, Mohammad Khan, Daniel Pomeranz Krummel, Soma Sengupta. Identification of the GABAA receptor in melanoma brain metastases patient tumors and demonstration that it is a viable drug target using benzodiazepine-derivatives [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 247.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jing Su
- 3Wake Forest, School of Medicine, Wake Forest, NC
| | | | | | | | | | | | - Michael Chan
- 3Wake Forest, School of Medicine, Wake Forest, NC
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19
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Ferris SP, Velazquez Vega J, Aboian M, Lee JC, Van Ziffle J, Onodera C, Grenert JP, Saunders T, Chen YY, Banerjee A, Kline CN, Gupta N, Raffel C, Samuel D, Ruiz-Diaz I, Magaki S, Wilson D, Neltner J, Al-Hajri Z, Phillips JJ, Pekmezci M, Bollen AW, Tihan T, Schniederjan M, Cha S, Perry A, Solomon DA. High-grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication-a comprehensive clinical, radiographic, pathologic, and genomic analysis. Brain Pathol 2019; 30:46-62. [PMID: 31104347 DOI: 10.1111/bpa.12747] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 04/16/2019] [Accepted: 05/14/2019] [Indexed: 12/30/2022] Open
Abstract
High-grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication (HGNET BCOR ex15 ITD) is a recently proposed tumor entity of the central nervous system (CNS) with a distinct methylation profile and characteristic genetic alteration. The complete spectrum of histologic features, accompanying genetic alterations, clinical outcomes, and optimal treatment for this new tumor entity are largely unknown. Here, we performed a comprehensive assessment of 10 new cases of HGNET BCOR ex15 ITD. The tumors mostly occurred in young children and were located in the cerebral or cerebellar hemispheres. On imaging all tumors were large, well-circumscribed, heterogeneous masses with variable enhancement and reduced diffusion. They were histologically characterized by predominantly solid growth, glioma-like fibrillarity, perivascular pseudorosettes, and palisading necrosis, but absence of microvascular proliferation. They demonstrated sparse to absent GFAP expression, no synaptophysin expression, variable OLIG2 and NeuN positivity, and diffuse strong BCOR nuclear positivity. While BCOR exon 15 internal tandem duplication was the solitary pathogenic alteration identified in six cases, four cases contained additional alterations including CDKN2A/B homozygous deletion, TERT amplification or promoter hotspot mutation, and damaging mutations in TP53, BCORL1, EP300, SMARCA2 and STAG2. While the limited clinical follow-up in prior reports had indicated a uniformly dismal prognosis for this tumor entity, this cohort includes multiple long-term survivors. Our study further supports inclusion of HGNET BCOR ex15 ITD as a distinct CNS tumor entity and expands the known clinicopathologic, radiographic, and genetic features.
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Affiliation(s)
- Sean P Ferris
- Department of Pathology, University of California, San Francisco, CA
| | | | - Mariam Aboian
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Julieann C Lee
- Department of Pathology, University of California, San Francisco, CA
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
| | - Tara Saunders
- Department of Pathology, University of California, San Francisco, CA
| | - Yunn-Yi Chen
- Department of Pathology, University of California, San Francisco, CA
| | - Anu Banerjee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA
| | - Cassie N Kline
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Corey Raffel
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - David Samuel
- Department of Hematology-Oncology, Valley Children's Hospital, Madera, CA
| | - Irune Ruiz-Diaz
- Department of Pathology, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - Shino Magaki
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA
| | - Dianne Wilson
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
| | - Janna Neltner
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
| | - Zahra Al-Hajri
- Department of Histopathology, Khoula Hospital, Muscat, Sultanate of Oman
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA
| | | | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA.,Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA
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20
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Ross J, Chen Z, Szulzewsky F, Monterroza L, Schniederjan M, Becher O, Hambardzumyan D. TMOD-09. TUMOR ASSOCIATED MACROPHAGE DYNAMICS IN PEDIATRIC HIGH-GRADE GLIOMAS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Felker J, Dey A, Malhotra A, Liu J, Schniederjan M, Kenney A, MacDonald T. PDTM-11. A NOVEL EX VIVO MODEL FOR HUMAN MEDULLOBLASTOMA: A NEW PERSONALIZED MEDICINE TOOL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- James Felker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Abhinev Dey
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anshu Malhotra
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jingbo Liu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Anna Kenney
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Tobey MacDonald
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
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22
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Ross J, Chen Z, Szulzewsky F, Schniederjan M, Becher O, Hambardzumyan D. PDTM-43. THE ROLE OF TUMOR ASSOCIATED MACROPHAGES IN PEDIATRIC HIGH-GRADE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James Ross
- Emory University, Department of Pediatrics, Atlanta, GA, USA
| | - Zhihong Chen
- Emory University, Department of Pediatrics, Atlanta, GA, USA
| | - Frank Szulzewsky
- Fred Hutch Cancer Center, Department of Human Biology, Seattle, WA, USA
| | - Matthew Schniederjan
- Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA
| | - Oren Becher
- Northwestern University, Department of Pediatrics, Chicago, IL, USA
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23
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Kowalski J, Krummel DP, Rupji M, Dwivedi B, Keskin H, Kallay L, Xu M, Ross A, Press R, Rosen H, Connelly E, Patel R, Izar B, Adamson C, Olson J, Su J, Kudchadkar R, Schniederjan M, Lowder L, Neill S, Curran W, Lawson D, Chan M, Khan M, Sengupta S. COMP-22. LARGE SCALE TRANSCRIPTOMIC ANALYSIS OF MELANOMA BRAIN METASTASES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Maxwell Xu
- Johns Hopkins University, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Jing Su
- Wake Forest University, Atlanta, GA, USA
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24
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Morgan T, Chandora K, Switchenko J, Schreibmann E, Abugideiri M, Schniederjan M, MacDonald T, Esiashvili N, Eaton B. RTHP-20. PEDIATRIC HIGH GRADE GLIOMAS: PATTERNS OF FAILURE AND OUTCOMES WITH LIMITED MARGIN RADIOTHERAPY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tiffany Morgan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Kapil Chandora
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey Switchenko
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mustafa Abugideiri
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Tobey MacDonald
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Bree Eaton
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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25
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Calligaris D, Clark A, Kallay L, Krummel DP, Agar J, Schniederjan M, Pomeroy S, Agar NY, Sengupta S. PATH-04. DISTINGUISHING PINEOBLASTOMA FROM MEDULLOBLASTOMAS USING TISSUE MASS SPECTROMETRY IMAGING. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Oh SY, Vigneswaran K, Schniederjan M, Horbinski C, Hambardzumyan D, Becher O, Kenney A, Read R. PDTM-35. THERAPEUTIC RELEVANCE OF YAP/TAZ ACTIVITY IN PEDIATRIC HIGH-GRADE GLIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Read R, Oh SY, Schniederjan M, Kenney A, Becher O, Olson J. TMOD-12. YAP/TAZ FUNCTION IN PEDIATRIC GLIOBLASTOMAS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Read R, Kenney A, Schniederjan M, Olson JJ. PDTB-25. YAP FUNCTION IN PEDIATRIC GLIOBLASTOMAS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Aguilera D, Janss A, Mazewski C, Castellino RC, Schniederjan M, Hayes L, Brahma B, Fogelgren L, MacDonald TJ. Successful Retreatment of a Child with a Refractory Brainstem Ganglioglioma with Vemurafenib. Pediatr Blood Cancer 2016; 63:541-3. [PMID: 26579623 DOI: 10.1002/pbc.25787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/01/2015] [Indexed: 02/05/2023]
Abstract
A child with brainstem ganglioglioma underwent subtotal resection and focal radiation. Magnetic resonance imaging confirmed tumor progression 6 months later. Another partial resection revealed viable BRAF V600E-positive residual tumor. Vemurafenib (660 mg/m(2) /dose) was administered twice daily, resulting in >70% tumor reduction with sustained clinical improvement for 1 year. Vemurafenib was then terminated, but significant tumor progression occurred 3 months later. Vemurafenib was restarted, resulting in partial response. Toxicities included Grade I pruritus and Grade II rash. Vemurafenib was effectively crushed and administered in solution via nasogastric tube. We demonstrate benefit from restarting vemurafenib therapy.
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Affiliation(s)
- Dolly Aguilera
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Janss
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Claire Mazewski
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Craig Castellino
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Laura Hayes
- Department of Radiology, Children's HealthCare of Atlanta at Scottish Rite, Atlanta, Georgia
| | - Barunashish Brahma
- Department of Neurosurgery, Children's Health Care of Atlanta, Emory University, School of Medicine, Atlanta, Georgia
| | - Lauren Fogelgren
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tobey J MacDonald
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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McKinney N, Yuan L, Zhang H, Liu J, Cho YJ, Rushing E, Schniederjan M, MacDonald TJ. EphrinB1 expression is dysregulated and promotes oncogenic signaling in medulloblastoma. J Neurooncol 2014; 121:109-18. [PMID: 25258252 DOI: 10.1007/s11060-014-1618-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
Eph receptors and ephrin ligands are master regulators of oncogenic signaling required for proliferation, migration, and metastasis. Yet, Eph/ephrin expression and activity in medulloblastoma (MB), the most common malignant brain tumor of childhood, remains poorly defined. We hypothesized that Eph/ephrins are differentially expressed by sonic hedgehog (SHH) and non-SHH MB and that specific members contribute to the aggressive phenotype. Affymetrix gene expression profiling of 29 childhood MB, separated into SHH (N = 11) and non-SHH (N = 18), was performed followed by protein validation of selected Eph/ephrins in another 60 MB and two MB cell lines (DAOY, D556). Functional assays were performed using MB cells overexpressing or deleted for selected ephrins. We found EPHB4 and EFNA4 almost exclusively expressed by SHH MB, whereas EPHA2, EPHA8, EFNA1 and EFNA3 are predominantly expressed by non-SHH MB. The remaining family members, except EFNB1, are ubiquitously expressed by over 70-90 % MB, irrespective of subgroup. EFNB1 is the only member differentially expressed by 28 % of SHH and non-SHH MB. Corresponding protein expression for EphB/ephrinB1 and B2 was validated in MB. Only ephrinB2 was also detected in fetal cerebellum, indicating that EphB/ephrinB1 expression is MB-specific. EphrinB1 immunopositivity localizes to tumor cells within MB with the highest proliferative index. EphrinB1 overexpression promotes EphB activation, alters F-actin distribution and morphology, decreases adhesion, and significantly promotes proliferation. Either silencing or overexpression of ephrinB1 impairs migration. These results indicate that EphrinB1 is uniquely dysregulated in MB and promotes oncogenic responses in MB cells, implicating ephrinB1 as a potential target.
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Affiliation(s)
- Nicole McKinney
- Department of Pediatrics, Emory Children's Center, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, 2015 Uppergate Drive NE, 4th Floor, Atlanta, GA, 30322, USA
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Shofty B, Bokstein F, Ram Z, Ben-Sira L, Freedman S, Kesler A, Constantini S, Shofty B, Mauda-Havakuk M, Ben-Bashat D, Dvir R, Pratt LT, Weizman L, Joskowicz L, Tal M, Ravid L, Ben-Sira L, Constantini S, Dodgshun A, Maixner W, Sullivan M, Hansford J, Ma J, Wang B, Toledano H, Muhsinoglu O, Luckman J, Michowiz S, Goldenberg-Cohen N, Schroeder K, Rosenfeld A, Grant G, McLendon R, Cummings T, Becher O, Gururangan S, Aguilera D, Mazewski C, Janss A, Castellino RC, Schniederjan M, Hayes L, Brahma B, MacDonald T, Osugi Y, Kiyotani C, Sakamoto H, Yanagisawa T, Kanno M, Kamimura S, Kosaka Y, Hirado J, Takimoto T, Nakazawa A, Hara J, Hwang E, Mun A, Kilburn L, Chi S, Knipstein J, Oren M, Dvir R, Hardy K, Rood B, Packer R, Kandels D, Schmidt R, Geh M, Breitmoser-Greiner S, Gnekow AK, Bergthold G, Bandopadhayay P, Rich B, Chan J, Santagata S, Hoshida Y, Ramkissoon S, Ramkissoon L, Golub T, Tabak B, Ferrer-Luna R, Weng PY, Stiles C, Grill J, Kieran MW, Ligon KL, Beroukhim R, Fisher MJ, Levin MH, Armstrong GT, Broad JH, Zimmerman R, Bilaniuk LT, Feygin T, Liu GT, Gan HW, Phipps K, Spoudeas HA, Kohorst M, Warad D, Keating G, Childs S, Giannini C, Wetjen N, Rao; AN, Nakamura H, Makino K, Hide T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Rush S, Madden J, Hemenway M, Foreman N, Sie M, den Dunnen WFA, Lourens HJ, Meeuwsen-de Boer TGJ, Scherpen FJG, Kampen KR, Hoving EW, de Bont ESJM, Gnekow AK, Kandels D, Walker DA, Perilongo G, Grill J, Stokland T, Sehested AM, van Schouten AYN, de Paoli A, de Salvo GL, Pache-Leschhorn S, Geh M, Schmidt R, Gnekow AK, Gass D, Rupani K, Tsankova N, Stark E, Anderson R, Feldstein N, Garvin J, Deel M, McLendon R, Becher O, Karajannis M, Wisoff J, Muh C, Schroeder K, Gururangan S, del Bufalo F, Carai A, Macchiaiolo M, Messina R, Cacchione A, Palmiero M, Cambiaso P, Mastronuzzi A, Anderson M, Leary S, Sun Y, Buhrlage S, Pilarz C, Alberta J, Stiles C, Gray N, Mason G, Packer R, Hwang E, Biassoni V, Schiavello E, Bergamaschi L, Chiaravalli S, Spreafico F, Massimino M, Krishnatry R, Kroupnik T, Zhukova N, Mistry M, Zhang C, Bartels U, Huang A, Adamski J, Dirks P, Laperriere N, Silber J, Hawkins C, Bouffet E, Tabori U, Riccardi R, Rizzo D, Chiaretti A, Piccardi M, Dickmann A, Lazzareschi I, Ruggiero A, Guglielmi G, Salerni A, Manni L, Colosimo C, Falsini B, Rosenfeld A, Etzl M, Miller J, Carpenteri D, Kaplan A, Sieow N, Hoe R, Tan AM, Chan MY, Soh SY, Orphanidou-Vlachou E, MacPherson L, English M, Auer D, Jaspan T, Arvanitis T, Grundy R, Peet A, Bandopadhayay P, Bergthold G, Sauer N, Green A, Malkin H, Dabscheck G, Marcus K, Ullrich N, Goumnerova L, Chi S, Beroukhim R, Kieran M, Manley P, Donson A, Kleinschmidt-DeMasters B, Aisner D, Bemis L, Birks D, Mulcahy-Levy J, Smith A, Handler M, Rush S, Foreman N, Davidson A, Figaji A, Pillay K, Kilborn T, Padayachy L, Hendricks M, van Eyssen A, Parkes J, Gass D, Dewire M, Chow L, Rose SR, Lawson S, Stevenson C, Jones B, Pai A, Sutton M, Pruitt D, Fouladi M, Hummel T, Cruz O, de Torres C, Sunol M, Morales A, Santiago C, Alamar M, Rebollo M, Mora J, Sauer N, Dodgshun A, Malkin H, Bergthold G, Manley P, Chi S, Ramkissoon S, MacGregor D, Beroukhim R, Kieran M, Sullivan M, Ligon K, Bandopadhayay P, Hansford J, Messina R, De Benedictis A, Carai A, Mastronuzzi A, Rebessi E, Palma P, Procaccini E, Marras CE, Aguilera D, Castellino RC, Janss A, Schniederjan M, McNall R, Kim S, MacDOnald T, Mazewski C, Zhukova N, Pole J, Mistry M, Fried I, Krishnatry R, Stucklin AG, Bartels U, Huang A, Laperriere N, Dirks P, Zelcer S, Sylva M, Johnston D, Scheinemann K, An J, Hawkins C, Nathan P, Greenberg M, Bouffet E, Malkin D, Tabori U, Kiehna E, Da Silva S, Margol A, Robison N, Finlay J, McComb JG, Krieger M, Wong K, Bluml S, Dhall G, Ayyanar K, Moriarty T, Moeller K, Farber D. LOW GRADE GLIOMAS. Neuro Oncol 2014; 16:i60-i70. [PMCID: PMC4046289 DOI: 10.1093/neuonc/nou073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
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Jactel SN, Abramowsky CR, Schniederjan M, Durham MM, Ricketts RR, Clifton MS, Langberg KM, Elawabdeh N, Pandya S, Talebagha S, Shehata BM. Noniatrogenic neonatal gastric perforation: the role of interstitial cells of Cajal. Fetal Pediatr Pathol 2013; 32:422-8. [PMID: 23742621 DOI: 10.3109/15513815.2013.799248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Noniatrogenic neonatal gastric perforation is a rare and life-threatening condition whose etiology is often unclear. Interstitial cells of Cajal act as gastrointestinal pacemaker cells and express the proto-oncogene c-Kit. Six new cases were identified at our institution which presented with no mechanical, pharmacologic, or otherwise medical-related intervention prior to rupture. The number of interstitial cells of Cajal in nonnecrotic muscularis propria from five random high-power fields per specimen was compared using immunohistochemical stains for c-Kit. The authors show that a lack of interstitial cells of Cajal in the stomach musculature may be implicated in the development of noniatrogenic gastric perforation (p = 0.008). Further large-scale studies, including molecular and genetic analysis, may help to better understand this phenomenon.
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Affiliation(s)
- Samuel Noah Jactel
- 1Pathology, Childrens Hospital of Atlanta -Egleston, Emory University School of Medicine, Atlanta, Georgia, USA
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Adachi JI, Totake K, Shirahata M, Mishima K, Suzuki T, Yanagisawa T, Fukuoka K, Nishikawa R, Arimappamagan A, Manoj N, Mahadevan A, Bhat D, Arvinda H, Indiradevi B, Somanna S, Chandramouli B, Petterson SA, Hermansen SK, Dahlrot RH, Hansen S, Kristensen BW, Carvalho F, Jalali S, Singh S, Croul S, Aldape K, Zadeh G, Choi J, Park SH, Khang SK, Suh YL, Kim SP, Lee YS, Kim SH, Coberly S, Samayoa K, Liu Y, Kiaei P, Hill J, Patterson S, Damore M, Dahiya S, Emnett R, Phillips J, Haydon D, Leonard J, Perry A, Gutmann D, Epari S, Ahmed S, Gurav M, Raikar S, Moiyadi A, Shetty P, Gupta T, Jalali R, Georges J, Zehri A, Carlson E, Martirosyan N, Elhadi A, Nichols J, Ighaffari L, Eschbacher J, Feuerstein B, Anderson T, Preul M, Jensen K, Nakaji P, Girardi H, Monville F, Carpentier S, Giry M, Voss J, Jenkins R, Boisselier B, Frayssinet V, Poggionovo C, Catteau A, Mokhtari K, Sanson M, Peyro-Saint-Paul H, Giannini C, Hide T, Nakamura H, Makino K, Yano S, Anai S, Shinojima N, Kuroda JI, Takezaki T, Kuratsu JI, Higuchi F, Matsuda H, Iwata K, Ueki K, Kim P, Kong J, Cooper L, Wang F, Gao J, Teodoro G, Scarpace L, Mikkelsen T, Schniederjan M, Moreno C, Saltz J, Brat D, Cho U, Hong YK, Lee YS, Lober R, Lu L, Gephart MH, Fisher P, Miyazaki M, Nishihara H, Itoh T, Kato M, Fujimoto S, Kimura T, Tanino M, Tanaka S, Nguyen N, Moes G, Villano JL, Nishihara H, Kanno H, Kato Y, Tanaka S, Ohnishi T, Harada H, Ohue S, Kouno S, Inoue A, Yamashita D, Okamoto S, Nitta M, Muragaki Y, Maruyama T, Sawada T, Komori T, Saito T, Okada Y, Omay SB, Gunel JM, Clark VE, Li J, Omay EZE, Serin A, Kolb LE, Hebert RM, Bilguvar K, Ozduman K, Pamir MN, Kilic T, Baehring J, Piepmeier JM, Brennan CW, Huse J, Gutin PH, Yasuno K, Vortmeyer A, Gunel M, Perry A, Pugh S, Rogers CL, Brachman D, McMillan W, Jenrette J, Barani I, Shrieve D, Sloan A, Mehta M, Prabowo A, Iyer A, Veersema T, Anink J, Meeteren ASV, Spliet W, van Rijen P, Ferrier T, Capper D, Thom M, Aronica E, Chharchhodawala T, Sable M, Sharma MC, Sarkar C, Suri V, Singh M, Santosh V, Thota B, Srividya M, Sravani K, Shwetha S, Arivazhagan A, Thennarasu K, Chandramouli B, Hegde A, Kondaiah P, Somasundaram K, Rao M, Santosh V, Kumar VP, Thota B, Shastry A, Arivazhagan A, Thennarasu K, Kondaiah P, Shastry A, Narayan R, Thota B, Somanna S, Thennarasu K, Arivazhagan A, Santosh V, Shastry A, Naz S, Thota B, Thennarasu K, Arivazhagan A, Somanna S, Santosh V, Kondaiah P, Venneti S, Garimella M, Sullivan L, Martinez D, Huse J, Heguy A, Santi M, Thompson C, Judkins A, Voronovich Z, Chen L, Clark K, Walsh M, Mannas J, Horbinski C, Wiestler B, Capper D, Holland-Letz T, Korshunov A, von Deimling A, Pfister SM, Platten M, Weller M, Wick W, Zieman G, Dardis C, Ashby L, Eschbacher J. PATHOLOGY. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yuan L, Zhang H, Liu J, Rubin JB, Cho YJ, Shu HK, Schniederjan M, MacDonald TJ. Growth factor receptor-Src-mediated suppression of GRK6 dysregulates CXCR4 signaling and promotes medulloblastoma migration. Mol Cancer 2013; 12:18. [PMID: 23497290 PMCID: PMC3599655 DOI: 10.1186/1476-4598-12-18] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 10/01/2012] [Accepted: 02/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastasis in medulloblastoma (MB) is associated with poor survival. Recent genetic studies revealed MB to comprise distinct molecular subgroups, including the sonic hedgehog (SHH) subgroup that exhibits a relatively high rate of progression. To identify targeted therapeutics against metastasis, a better understanding of the regulation of MB cell migration is needed. G protein-coupled receptor kinases (GRKs) have been implicated in cancer metastasis through their regulation of G-protein coupled receptors (GPCRs) involved in growth factor (GF)-mediated cell migration. However, the specific roles and regulation of GRKs in MB have not been investigated. METHODS Microarray mRNA analysis was performed for GRKs, GPCRs, and GFs in 29 human MB, and real time RT-PCR was used to detect GRK6 expression in MB cells. Lenti- or retro-virus infection, and siRNA or shRNA transfection, of MB cells was used to overexpress and knockdown target genes, respectively. Western blot was used to confirm altered expression of proteins. The effect of altered target protein on cell migration was determined by Boyden chamber assay and xCELLigence migration assays. RESULTS We observed co-overexpression of PDGFRA, CXCR4, and CXCL12 in the SHH MB subtype compared to non-SHH MB (5, 7, and 5-fold higher, respectively). GRK6, which typically acts as a negative regulator of CXCR4 signaling, is downregulated in MB, relative to other GRKs, while the percentage of GRK6 expression is lower in MB tumors with metastasis (22%), compared to those without metastasis (43%). In SHH-responsive MB cells, functional blockade of PDGFR abolished CXCR4-mediated signaling. shPDGFR transfected MB cells demonstrated increased GRK6 expression, while PDGF or 10% FBS treatment of native MB cells reduced the stability of GRK6 by inducing its proteosomal degradation. Overexpression or downregulation of Src, a key mediator of GF receptor/PDGFR signaling, similarly inhibited or induced GRK6 expression, respectively. siRNA downregulation of GRK6 enhanced CXCR4 signaling and promoted MB migration, while lentiviral-GRK6 overexpression suppressed CXCR4 signaling, potentiated the effect of AMD3100, a CXCR4 antagonist, and impaired migration. CONCLUSIONS Our findings demonstrate a novel mechanism of GF receptor/PDGFR-Src-mediated dysregulation of CXCR4 signaling that promotes MB cell migration, which could potentially be exploited for therapeutic targeting in SHH MB.
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Affiliation(s)
- Liangping Yuan
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA
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Kiyotani C, Uno T, Ogiwara H, Morota N, Nakazawa A, Tsutsumi Y, Masaki H, Mori T, Sanz JAS, Guibelalde M, Tavera A, Herandez I, Ibanez J, Brell M, Mas A, Muller HL, Gebhardt U, Warmuth-Metz M, Pietsch T, Sorensen N, Kortmann RD, Stapleton S, Gonzalez I, Steinbrueck S, Rodriguez L, Tuite G, Krzyzankova M, Mertsch S, Jeibmann A, Kordes U, Wolff J, Paulus W, Hasselblatt M, Nonaka Y, Hara S, Fukazawa S, Shimizu K, Ben-Arush M, Postovsky S, Toledano H, Peretz-Nahum M, Fujimura J, Sakaguchi S, Kondo A, Saito Y, Shimoji K, Ohara Y, Arakawa A, Saito M, Shimizu T, Benesch M, von Bueren AO, Dantonello T, von Hoff K, Pietsch T, Leuschner I, Claviez A, Bierbach U, Kropshofer G, Korinthenberg R, Graf N, Suttorp M, Kortmann RD, Friedrich C, Klingebiel T, Koscielniak E, Rutkowski S, Mesa M, Sanchez M, Mejia J, Pena G, Dussan R, Cabeza M, Storino A, Dincer F, Roffidal T, Powell M, Berrak S, Wolff JE, Fouyssac F, Delaunay C, Vignaud JM, Schmitt E, Klein O, Mansuy L, Chastagner P, Cruz O, Guillen A, Garcia G, Alamar M, Candela S, Roussos I, Garzon M, Sunol M, Muchart J, Rebollo M, Mora J, Wolff J, Diez B, Muggeri A, Arakaki N, Meli F, Sevlever G, Tsitouras V, Pettorini B, Fellows G, Blair J, Didi M, Daousi C, Steele C, Javadpour M, Sinha A, Hishii M, Kondo A, Fujimura J, Sakaguchi S, Ishii H, Shimoji K, Miyajima M, Arai H, Dvir R, Sayar D, Levin D, Ben-Sirah L, Constantini S, Elhasid R, Gertsch E, Foreman N, Valera ET, Brassesco MS, Machado HR, Oliveira RS, Santos AC, Terra VC, Barros MV, Scrideli CA, Tone LG, Merino D, Pienkowska M, Shlien A, Tabori U, Gilbertson R, Malkin D, Jeeva I, Chang B, Long V, Picton S, Burton D, Clark S, Kwok C, Mokete B, Rafiq O, Simmons I, Shing MMK, Li CK, Chan GCF, Ha SY, Yuen HL, Luk CW, Li CK, Ling SC, Li RCH, Yoon JH, Park HJ, Shin HJ, Park BK, Kim JY, Jung HL, Ra YS, Ghim TT, Wolff J, Hasselblatt M, Hartung S, Powell M, Garami M, Traunecker H, Thall P, Mahajan A, Kordes U, Sumerauer D, Grillner P, Orrego A, Mosskin M, Gustavsson B, Holm S, Peters N, Rogers M, Chowdry S, Selman W, Mitchell A, Bangert B, Ahuja S, Laschinger K, Gold D, Stearns D, Wright K, Gupta K, Klimo P, Ellison D, Keating G, Eckel L, Giannini C, Wetjen N, Patton A, Zaky W, McComb G, Finlay J, Grimm J, Wong K, Dhall G, Zaky W, Gilles F, Grimm J, Dhall G, Finlay J, Ormandy D, Alston R, Estlin E, Gattamaneni R, Birch J, Kamaly-Asl I, Hemenway M, Foreman N, Rush S, Reginald YA, Nicolin G, Bartel U, Buncic JR, Aguilera D, Flamini R, Mazewski C, Schniederjan M, Hayes L, Boydston W, MacDonald T, Fleming A, Jabado N, Saint-Martin C, Albrecht S, Ramsay DA, Farmer JP, Bendel A, Hansen M, Dugan S, Mendelsohn N. RARE TUMORS. Neuro Oncol 2012; 14:i148-i156. [PMCID: PMC3483354 DOI: 10.1093/neuonc/nos108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
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Raore B, Schniederjan M, Prabhu R, Brat DJ, Shu HK, Olson JJ. Metastasis Infiltration: An Investigation of the Postoperative Brain–Tumor Interface. Int J Radiat Oncol Biol Phys 2011; 81:1075-80. [DOI: 10.1016/j.ijrobp.2010.07.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 07/10/2010] [Accepted: 07/13/2010] [Indexed: 12/01/2022]
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Affiliation(s)
- Reshma Shah
- Department of Medicine, Division of Endocrinology, Diabetes and Lipids, Emory University, Atlanta, Georgia, USA
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Ilhan A, Wagner L, Maj M, Woehrer A, Czech T, Heinzl H, Marosi C, Base W, Preusser M, Jeuken JW, Navis AC, Sijben A, Boots-Sprenger SH, Bleeker FE, Gijtenbeek JM, Wesseling P, Seyed Sadr E, Tessier A, Seyed Sadr M, Alshami J, Anan M, Sabau C, Del Maestro R, Agnihotri S, Gajadhar A, Wolf A, Mischel PM, Hawkins C, Guha A, Guan X, Chance MR, Barnholtz-Sloan JS, Larson JD, Rodriguez FJ, Demer AM, Sarver AL, Dubac A, Jenkins RB, Dupuy AJ, Copeland NG, Jenkins NA, Taylor MD, Largaespada DA, Lusis EA, Stuart JE, Scheck AC, Coons SW, Lal A, Perry A, Gutmann DH, Barnholtz-Sloan JS, Adams MD, Cohen M, Devine K, Wolinsky Y, Bambakidis N, Selman W, Miller R, Sloan AE, Suchorska B, Mehrkens JH, Eigenbrod S, Eroes CA, Tonn JC, Kretzschmar HA, Kreth FW, Buczkowicz P, Bartels U, Morrison A, Zarghooni M, Bouffet E, Hawkins C, Kollmeyer TM, Wrensch M, Decker PA, Xiao Y, Rynearson AL, Fink S, Kosel ML, Johnson DR, Lachance DH, Yang P, Fridley BL, Wiemels J, Wiencke J, Jenkins RB, Zhou YH, Hess KR, Yu L, Raj VR, Liu L, Alfred Yung WK, Hutchins LF, Linskey ME, Roldan G, Kachra R, McIntyre JB, Magliocco A, Easaw J, Hamilton M, Northcott PA, Van Meter T, Eberhart C, Weiss W, Rutka JT, Gupta N, Korshunov A, French P, Kros J, Michiels E, Kloosterhof N, Hauser P, Montange MF, Jouvet A, Bouffet E, Jung S, Kim SK, Wang KC, Cho BK, Di Rocco C, Massimi L, Leonard J, Scheurlen W, Pfister S, Robinson S, Yang SH, Yoo JY, Cho DG, Kim HK, Kim SW, Lee SW, Fink S, Kollmeyer T, Rynearson A, Decker P, Sicotte H, Yang P, Jenkins R, Lai A, Kharbanda S, Tran A, Pope W, Solis O, Peale F, Forrest W, Purjara K, Carrillo J, Pandita A, Ellingson B, Bowers C, Soriano R, Mohan S, Yong W, Aldape K, Mischel P, Liau L, Nghiemphu P, James CD, Prados M, Westphal M, Lamszus K, Cloughesy T, Phillips H, Thon N, Kreth S, Eigenbrod S, Lutz J, Ledderose C, Tonn JC, Kretzschmar H, Kreth FW, Mokhtari K, Ducray F, Kros JM, Gorlia T, Idbaih A, Marie Y, Taphoorn M, Wesseling P, Brandes AA, Hoang-Xuan K, Delattre JY, Van den Bent M, Sanson M, Lavon I, Shahar T, Granit A, Smith Y, Nossek E, Siegal T, Ram Z, Marko NF, Quackenbush J, Weil RJ, Ducray F, Criniere E, Idbaih A, Paris S, Marie Y, Carpentier C, Houillier C, Dieme M, Adam C, Hoang-Xuan K, Delattre JY, Duyckaerts C, Sanson M, Mokhtari K, Zinn PO, Kozono D, Kasper EM, Warnke PC, Chin L, Chen CC, Saito K, Mukasa A, Saito N, Stieber D, Lenkiewicz E, Evers L, Vallar L, Bjerkvig R, Barrett M, Niclou SP, Gorlia T, Brandes A, Stupp R, Rampling R, Fumoleau P, Dittrich C, Campone M, Twelves C, Raymond E, Lacombe D, van den Bent MJ, Potter N, Ashmore S, Karakoula K, Ward S, Suarez-Merino B, Luxsuwong M, Thomas DG, Darling J, Warr T, Gutman DA, Cooper L, Kong J, Chisolm C, Van Meir EG, Saltz JH, Moreno CS, Brat DJ, Brennan CW, Brat DJ, Aldape KD, Cohen M, Lehman NL, McLendon RE, Miller R, Schniederjan M, Vandenberg SR, Weaver K, Phillips S, Pierce L, Christensen B, Smith A, Zheng S, Koestler D, Houseman EA, Marsit CJ, Wiemels JL, Nelson HH, Karagas MR, Wrensch MR, Kelsey KT, Wiencke JK, Al-Nedawi K, Meehan B, Micallef J, Guha A, Rak J. -Omics and Prognostic Markers. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Castellino RC, Barwick BG, Schniederjan M, Buss MC, Becher O, Hambardzumyan D, Macdonald TJ, Brat DJ, Durden DL. Heterozygosity for Pten promotes tumorigenesis in a mouse model of medulloblastoma. PLoS One 2010; 5:e10849. [PMID: 20520772 PMCID: PMC2877103 DOI: 10.1371/journal.pone.0010849] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 05/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent publications have described an important role for cross talk between PI-3 kinase and sonic hedgehog signaling pathways in the pathogenesis of medulloblastoma. METHODOLOGY/PRINCIPAL FINDINGS We crossed mice with constitutive activation of Smoothened, SmoA1, with Pten deficient mice. Both constitutive and conditional Pten deficiency doubled the incidence of mice with symptoms of medulloblastoma and resulted in decreased survival. Analysis revealed a clear separation of gene signatures, with up-regulation of genes in the PI-3 kinase signaling pathway, including downstream activation of angiogenesis in SmoA1+/-; Pten +/- medulloblastomas. Western blotting and immunohistochemistry confirmed reduced or absent Pten, Akt activation, and increased angiogenesis in Pten deficient tumors. Down-regulated genes included genes in the sonic hedgehog pathway and tumor suppressor genes. SmoA1+/-; Pten +/+ medulloblastomas appeared classic in histology with increased proliferation and diffuse staining for apoptosis. In contrast, Pten deficient tumors exhibited extensive nodularity with neuronal differentiation separated by focal areas of intense staining for proliferation and virtually absent apoptosis. Examination of human medulloblastomas revealed low to absent PTEN expression in over half of the tumors. Kaplan-Meier analysis confirmed worse overall survival in patients whose tumor exhibited low to absent PTEN expression. CONCLUSIONS/SIGNIFICANCE This suggests that PTEN expression is a marker of favorable prognosis and mouse models with activation of PI-3 kinase pathways may be important tools for preclinical evaluation of promising agents for the treatment of medulloblastoma.
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Affiliation(s)
- Robert C Castellino
- Department of Pediatrics, Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA.
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Rizzo M, Lund MJ, Oprea G, Schniederjan M, Wood WC, Mosunjac M. Surgical Follow-Up and Clinical Presentation of 142 Breast Papillary Lesions Diagnosed by Ultrasound-Guided Core-Needle Biopsy. Ann Surg Oncol 2008; 15:1040-7. [DOI: 10.1245/s10434-007-9780-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/29/2007] [Accepted: 11/29/2007] [Indexed: 11/18/2022]
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