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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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Chetty SL, Riemondy K, Donson A, Balaakrishnan I, Venkataraman S, Vibhakar R, Foreman N, Mitra S. IMMU-04. SINGLE-CELL RNA-SEQUENCING IDENTIFIES FUNCTIONAL MACROPHAGE SUBSETS THAT ARE ENRICHED IN RESPONSE TO DIFFERENTIAL PHAGOCYTOSIS INDUCTION AGAINST GLIOMA. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.502] [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] Open
Abstract
Abstract
Pediatric diffuse midline gliomas (DMGs), are fatal brain tumors of childhood arising in the ventral pons. Currently, radiation therapy (RT) is the mainstay treatment for DIPG. However, RT is not a curative treatment and provides only temporary relief for most patients. Recent advances in immunotherapy have yielded some fantastic opportunities to effectively treat patients with high-grade pediatric brain tumors. In this study, we demonstrate that fractionated RT (4Gy X 3) induces immunogenic cell death and activates multiple damage-associated molecular patterns (DAMPs) on DMG/DIPG cells. Furthermore, combining 4Gy X 3 with anti-CD47 therapy enhances the in vitro phagocytosis of DIPG/DMG cells by peripheral blood mononuclear cell-derived macrophages. Next, using single-cell RNA sequencing (scRNA-seq), we investigated the transcriptomic profile of macrophages that were co-cultured with irradiated or non-irradiated DMG cells in the presence of either phosphate-buffered solution (PBS) or anti-CD47 monoclonal antibody for 24 hours. Our findings identified eleven distinct macrophage clusters displaying different gene expression patterns in all the treatment conditions. However, PBS treatment led to a marked increase in macrophages expressing antigen-presentation genes (HLA-DR and HLA-DQB1). 4Gy X 3 treatment led to the enrichment of macrophages expressing genes related to the oxidative phosphorylation pathway, whereas anti-CD47 treatment led to the enrichment of macrophages expressing genes related to interferon-gamma response and ERK-signaling pathway. Lastly, mice intracranially transplanted with DMG/DIPG that received 4Gy X 3 and anti-CD47 therapy showed a significant decrease in tumor growth and an increase in survival rate than those receiving either monotherapy alone. We are currently performing scRNA-seq validation studies on tumors obtained from orthotopic and syngeneic models of DMG. In summary, our results highlight the functional heterogeneity of macrophages and suggest that combining fractionated RT with anti-CD47 therapy has potent anti-tumor effects and may be used as a novel therapeutic approach for treating Glioma patients.
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Affiliation(s)
| | - Kent Riemondy
- University of Colorado, Anschutz Medical Campus , Aurora, CO , USA
| | - Andrew Donson
- University of Colorado, Anschutz Medical Campus , Aurora , USA
| | | | | | | | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO , Aurora , USA
| | - Siddhartha Mitra
- University of Colorado, AMC and Children's Hospital Colorado , Aurora, CO , USA
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Johnson T, Pacholczyk R, Aguilera D, Al-Basheer A, Bajaj M, Bandopadhayay P, Berrong Z, Bouffet E, Castellino R, Dorris K, Eaton B, Esiashvili N, Foreman N, Fridlyand D, Giller C, Heger I, Kadom N, Kennedy E, Manoharan N, Martin W, McDonough C, Parker R, Ramaswamy V, Ring E, Rojiani A, Sadek R, Smith A, Smith C, Vaizer R, Yeo KK, MacDonald T, Munn D. CTIM-32. FIRST-IN-CHILDREN PHASE 1 TRIAL OF INDOXIMOD-BASED CHEMO-IMMUNOTHERAPY FOR PATIENTS WITH PEDIATRIC BRAIN TUMORS: ANALYSIS OF SAFETY, TOLERABILITY, AND 5-YEAR OUTCOME. Neuro Oncol 2022. [PMCID: PMC9660775 DOI: 10.1093/neuonc/noac209.264] [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] Open
Abstract
Abstract
BACKGROUND
Recurrent brain tumors are the leading cause of cancer death in children. We conducted a first-in-children, two-institution, Phase 1 open-label dose-confirmation study using a 3 + 3 design, with expansion cohorts, to determine the recommended pediatric dose of the IDO pathway-inhibitor indoximod (NCT02502708). DESIGN/
METHODS
Eligible patients were 3-22 years old with either recurrent malignant brain tumor or newly-diagnosed diffuse intrinsic pontine glioma (DIPG). Palliative radiation, surgery or dexamethasone were allowed as needed for patient management. Separate dose-finding arms were performed for indoximod plus temozolomide (200 mg/m2/day orally for 5 days of each 28-day cycle) and for indoximod plus conformal radiation (in patients for whom re-irradiation was planned as standard-of-care). At progression, patients who were otherwise clinically stable were offered crossover to indoximod plus a second-line chemotherapy regimen (cyclophosphamide 2.5 mg/kg/day orally and etoposide 50 mg/m2/day orally for 21 days of each 28-day cycle).
RESULTS
Between December 2015 and January 2019, the study enrolled 81 brain tumor patients, including newly-diagnosed DIPG (n = 13) or recurrent ependymoma (n = 27), glioblastoma/high-grade glioma (n = 19), medulloblastoma (n = 13), or other CNS tumors ( n= 9). Median follow-up was 52 months (range 39-77 months). No dose-limiting toxicities were observed, and the pediatric indoximod dose was determined (19.2 mg/kg/dose, given twice daily). Indoximod was well tolerated and did not affect the ability to deliver chemotherapy or radiation as planned. Median overall survival was 13.6 months (n = 81). Median overall survival was 34.7 months for the subset of patients who continued indoximod with second-line chemotherapy after progression on indoximod plus temozolomide (n = 18).
CONCLUSIONS
Indoximod was well tolerated and could be combined with a variety of standard treatments for pediatric brain tumors. Preliminary anti-tumor activity and overall survival suggest that indoximod with standard therapy should be further evaluated in pediatric brain tumors, and potentially other pediatric solid tumors.
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Affiliation(s)
- Theodore Johnson
- Georgia Cancer Center and Department of Pediatrics, Augusta University, Augusta, GA , Augusta, GA , USA
| | - Rafal Pacholczyk
- Georgia Cancer Center, Augusta University, Augusta, GA , Augusta , USA
| | - Dolly Aguilera
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA , Atlanta , USA
| | - Ahmad Al-Basheer
- Georgia Cancer Center and Department of Radiation Oncology, Augusta University, Augusta, GA , Augusta , USA
| | - Manish Bajaj
- Department of Radiology, Augusta University, Augusta, GA (current address: Children’s Healthcare of Atlanta and Department of Radiology, Emory University, Atlanta, GA) , Augusta , USA
| | - Pratiti Bandopadhayay
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston MA , Boston, MA , USA
| | - Zuzana Berrong
- Georgia Cancer Center, Augusta University, Augusta, GA , Augusta , USA
| | - Eric Bouffet
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada , Toronto , Canada
| | - Robert Castellino
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA , Atlanta , USA
| | - Kathleen Dorris
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO , Aurora , USA
| | - Bree Eaton
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, GA , Atlanta, GA , USA
| | - Natia Esiashvili
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, GA , Atlanta , USA
| | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO , Aurora , USA
| | - Diana Fridlyand
- Department of Pediatrics, Augusta University, Augusta, GA (current address: Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA) , Atlanta , USA
| | - Cole Giller
- Department of Neurosurgery, Augusta University, Augusta, GA , Augusta , USA
| | - Ian Heger
- Department of Neurosurgery, Augusta University, Augusta, GA (current address: Pediatric Neurosurgery Program, Medical City Children’s Hospital, Dallas, TX) , Augusta , USA
| | - Nadja Kadom
- Department of Radiology and Winship Cancer Institute of Emory University, Atlanta, GA , Atlanta , USA
| | - Eugene Kennedy
- Lumos Pharma (formerly NewLink Genetics Corporation), Ames, IA , Ames , USA
| | - Neevika Manoharan
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston MA (current address: Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia) , Boston , USA
| | - William Martin
- Department of Radiation Oncology, Augusta University, Augusta, GA , Augusta , USA
| | - Colleen McDonough
- Georgia Cancer Center and Department of Pediatrics, Augusta University, Augusta, GA , Augusta , USA
| | - Rebecca Parker
- Department of Pediatrics, Augusta University, Augusta, GA (current address: Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, Los Angeles, CA) , Augusta , USA
| | - Vijay Ramaswamy
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada , Toronto , Canada
| | - Eric Ring
- Georgia Cancer Center and Department of Pediatrics, Augusta University, Augusta, GA , Augusta , USA
| | - Amyn Rojiani
- Georgia Cancer Center and Department of Pathology, Augusta University, Augusta, GA (current address: Department of Pathology, Penn State Health/College of Medicine, Hershey, PA) , Hershey , USA
| | - Ramses Sadek
- Georgia Cancer Center and Department of Population Health Sciences, Augusta University, Augusta, GA , Augusta , USA
| | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL , Orlando , USA
| | - Chris Smith
- Lumos Pharma (formerly NewLink Genetics Corporation), Ames, IA , Ames , USA
| | - Rachel Vaizer
- Department of Pediatrics, Augusta University, Augusta, GA (current address: Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA) , Augusta , USA
| | - Kee Kiat Yeo
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston MA , Boston , USA
| | - Tobey MacDonald
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA , Atlanta , USA
| | - David Munn
- Georgia Cancer Center and Department of Pediatrics, Augusta University, Augusta, GA , Augusta , USA
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Lindsay H, Massimino M, Avula S, Stivaros S, Grundy R, Metrock K, Bhatia A, Fernández-Teijeiro A, Chiapparini L, Bennett J, Wright K, Hoffman L, Smith A, Pajtler K, Poussaint TY, Warren K, Foreman N, Mirsky D. EPEN-01. Response assessment in pediatric intracranial ependymoma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.138] [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
INTRODUCTION: Ependymomas remain a major cause of cancer-related death in childhood and adolescence, with recurrence occurring in up to 50% of patients. Despite exciting molecular advances in understanding ependymoma tumorigenesis and recurrence, MRI remains the mainstay for assessing objective response to therapy and duration of disease stability. Standardized response assessment criteria for clinical trials studying pediatric intracranial ependymoma are critically needed in order to accurately compare results between studies. METHODS: To generate these standardized response criteria in pediatric intracranial ependymoma, a multidisciplinary team of pediatric neuro-oncologists, neuroradiologists, neurosurgeons, radiation oncologists, and molecular biologists formed the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. The expert members reviewed relevant published literature, assessed current clinical practices, and engaged in iterative discussions to provide consensus recommendations for objective response assessment in pediatric intracranial ependymoma for use in prospective clinical trials. RECOMMENDATIONS AND CONCLUSIONS: The primary sequences for detecting and measuring disease and assessing radiologic response to therapy should be the contrast-enhanced T1-weighted sequence or T2-weighted sequence (T2 or T2-FLAIR) depending on which sequence the tumor is best visualized. When metastatic disease is present, only the three largest lesions will be followed in addition to any residual disease at the primary tumor focus. Importantly, the RAPNO working group notes that radiologic response to therapy is of limited value in clinical trials of patients with ependymoma, since most patients enroll on clinical trials with either no evidence of disease or only minimal disease. In recurrent or progressive disease that cannot be resected, true radiologic disease response to therapy is less clinically meaningful as a study endpoint than event-free and/or overall survival (representing prolonged stable disease) but may provide a signal of efficacy worthy of future exploration in patients with complete to near complete resections.
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Affiliation(s)
| | - Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumouri , Milan , Italy
| | - Shivaram Avula
- Alder Hey Children’s NHS Foundation Trust , Liverpool , United Kingdom
| | - Stavros Stivaros
- Central Manchester University Hospitals NHS Foundation Trust , Manchester , United Kingdom
- University of Manchester , Manchester , United Kingdom
| | | | - Katie Metrock
- University of Alabana at Birmingham , Birmingham, AB , USA
| | - Aashim Bhatia
- Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | | | | | | | - Karen Wright
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
| | | | - Amy Smith
- Orlando Health-Arnold Palmer Hospital , Orlando, FL , USA
| | - Kristian Pajtler
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
- Hopp Children’s Cancer Center Heidelberg (KiTZ) , Heidelberg , Germany
| | | | - Katherine Warren
- Dana-Farber and Boston Children’s Cancer and Blood Disorders Center , Boston, MA , USA
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Alimova I, Wang D, Pierce A, Lakshmanachetty S, Prince E, Danis E, Serkova N, Madhavan K, Balakrishnan I, Yang M, Lin H, Foreman N, Venkataraman S, Vibhakar R. ATRT-23. SIRT2 cooperates with SMARCB1 to induce a differentiation block in ATRT. Neuro Oncol 2022. [PMCID: PMC9165152 DOI: 10.1093/neuonc/noac079.022] [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: 11/25/2022] Open
Abstract
Atypical Teratoid Rhabdoid Tumor is a highly aggressive pediatric brain tumor with poor prognosis driven by loss of the chromatin remodeling factor SMARCB1 that is responsible for determining cellular pluripotency and lineage commitment. The mechanisms by which SMARCB1 deletion results in tumorigenesis remain unclear. We investigated the effect of SIRT2 inhibition in ATRT which was identified as a primary dependency in ATRT. SIRT2 inhibition with shRNA or Thiomyristoyl (TM) decreased ATRT cell growth, inhibited clonogenic potential and leaded to the cell cycle arrest. SIRT2 inhibition effectively suppresses pluripotency-associated genomic programs, significantly changed stem cell frequency, decreased tumor-sphere formation of ATRT cells and attenuated tumor cell self-renewal. In vivo SIRT2 inhibition decreased oncogenic markers and increased accumulation neuronal differentiation markers. Furthermore, SIRT2 induced apoptosis, decreased tumor growth and prolonged survival in orthotopic xenograft models. Single-cell RNA transcriptome analysis of xenoftaft tumors reveals elimination of tumor cells expressing stem cell genes and expansion of tumor cells expressing differentiated genes following TM treatment in ATRT. We demonstrated that SIRT2 inhibition is a molecular vulnerability in SMARCB1-deleted ATRT.
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Affiliation(s)
- Irina Alimova
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | - Dong Wang
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | - Angela Pierce
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | | | - Eric Prince
- Department of Biostatistics and Informatics University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado , USA
- Department of Neurosurgery University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado , USA
| | - Etienne Danis
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | - Natalie Serkova
- Department of Radiology University of Colorado Denver, School of Medicine , Aurora, Colorado , USA
| | - Krishna Madhavan
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | - Ilango Balakrishnan
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
| | - Min Yang
- Department of Chemistry and Chemical Biology, Cornell University , Ithaca, NY , USA
| | - Henning Lin
- Department of Chemistry and Chemical Biology, Cornell University , Ithaca, NY , USA
| | - Nicholas Foreman
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado , Aurora, Colorado , USA
| | - Sujatha Venkataraman
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado , Aurora, Colorado , USA
| | - Rajeev Vibhakar
- Department of Pediatrics University of Colorado Denver, Anschutz Medical Campus , Aurora, Colorado , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado , Aurora, Colorado , USA
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Hemenway M, Foreman N, Kristinsson S. NFB-22. Neurofibromatosis Therapeutics Program: Development of a Program. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.482] [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
Neurofibromatosis (NF) therapeutics is a vital field in the care of children with NF. Recent developments in the treatment of plexiform neurofibromas (PN) have increased the numbers of patients seen for therapy. The Neurofibromatosis Therapeutics Program (NTP) provides high quality care to patients receiving therapy for brain tumors and PNs, as well as tumors related to NF2. The program at Children’s Hospital Colorado (CHCO) includes a physician, nurse practitioner, and nurse care coordinator. The team collaborates with other disciplines in the care of the NF patient with plexiform neurofibromas and/or CNS tumors. As the program grew, key players were identified in each subspecialty and educated about the NTP. We have ongoing regular communication with a large number of subspecialists regarding protocols, clinical care pathways, and mutual patients. In addition, an extensive tissue collection study of plexiform neurofibromas and brain tumors enhances NTPs devotion to both clinical and lab research. Weekly clinical care meetings ensure continuity in the care of the nearly 140 patients with NF1 and NF2 under our program. Monthly strategy and vision meetings focus on grant applications, education of primary care providers and subspecialists in our large catchment area, development of new clinical pathways, treatment roadmaps, and growth of our program. Over the last two years of being a formalized program, we have increased research on the epigenetics of plexiform neurofibromas, opened a Phase 2 clinical trial for a Mek inhibitor, and increased our patient volume. The Covid pandemic has increased our ability to manage treatment side effects virtually through telehealth and online patient portals. Future goals of the NTP include completion of a program website, quarterly patient and provider newsletters, educational offerings, collaboration with other centers on Mek inhibitor side effects, adolescent and young adult education on tumor risk, and transition to adult care.
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Affiliation(s)
- Molly Hemenway
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Nicholas Foreman
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
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7
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Walker F, Sobral LM, Danis E, Sanford B, Balakrishnan I, Wang D, Pierce A, Karam S, Serkova N, Foreman N, Venkataraman S, Dowell R, Vibhakar R, Dahl N. HGG-12. Rapid PTEFb-dependent transcriptional reorganization underpins the glioma adaptive response to radiotherapy. Neuro Oncol 2022. [PMCID: PMC9164817 DOI: 10.1093/neuonc/noac079.227] [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: 11/15/2022] Open
Abstract
BACKGROUND: Dynamic regulation of gene expression is fundamental for cellular adaptation to exogenous stressors. PTEFb-mediated promoter proximal pause-release of Pol II is a conserved regulatory mechanism for synchronous transcriptional induction best described in response to heat shock, but this pro-survival role has not been examined in the applied context of cancer therapy. DESIGN/METHOD: In order to examine the dynamics of chromatin reorganization following radiotherapy, we performed a combination of ChIP-, ATAC-, and RNA-seq in model systems of diffuse intrinsic pontine glioma (DIPG) and other pediatric high-grade gliomas (pHGG) following IR exposure. We interrogated IR-induced gene expression in the presence or absence of PTEFb blockade, including both mechanistic and functional consequences of concurrent inhibition or genetic depletion. We utilized culture models with live cell imaging to assess the therapeutic synergy of PTEFb inhibition with IR, as well as the therapeutic index of this intervention relative to normal controls. Finally, we employed orthotopic models of pHGG treated with conformal radiotherapy and CNS-penetrant PTEFb inhibitors in order to assess tolerability and anti-tumor effect in vivo. RESULTS: Rapid genome-wide redistribution of active chromatin features and PTEFb facilitates Pol II pause-release to drive nascent transcriptional induction within hours of exposure to therapeutic ionizing radiation. Concurrent inhibition of PTEFb imparts a transcription elongation defect, abrogating canonical adaptive programs such as DNA damage repair and cell cycle regulation. This combination demonstrates a potent, synergistic therapeutic potential agnostic of glioma subtype, leading to a marked induction of tumor cell apoptosis and prolongation of xenograft survival. CONCLUSION: These studies reveal a central role for PTEFb underpinning the early adaptive response to radiotherapy, opening new avenues for combinatorial treatment in these lethal malignancies.
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Affiliation(s)
| | | | | | | | | | - Dong Wang
- University of Colorado , Aurora, CO , USA
| | | | - Sana Karam
- University of Colorado , Aurora, CO , USA
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8
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Grimaldo E, Donson A, Harris F, Amani V, Norris G, Steiner J, Serkova N, Dorris K, Foreman N, Griesinger A. EPEN-30. 5FU with Radiation Followed by Maintenance of 5FU and ATRA Significantly Improves Survival of 1q+/6q- PFA Ependymoma Xenograft Models. Neuro Oncol 2022. [PMCID: PMC9164643 DOI: 10.1093/neuonc/noac079.166] [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
In a screen of over 100 FDA approved drugs on PFA 1q+ EPN cells, 5-fluorouracil (5FU) and All-Trans-Retinoic Acid (ATRA) were identified as inhibitors of EPN cell line growth. We performed in-vitro cell growth assays combining increasing doses of radiation and 5FU and found a significant synergistic effect on cell growth and apoptosis in 1q+ PFA EPN cell lines. Further growth attenuation was seen when ATRA was added 48 hours following radiation and 5FU treatment. This led us to development of preclinical studies in the 1q+ PFA orthotopic xenograft models MAF-811_XF and MAF-928_XF. In the initial cohort, tumors were allowed to establish prior to treatment start confirmed by MRI. In both MAF-811 and MAF-928, chemotherapy improved survival compared to no treatment. As consistent with standard of care, radiation significantly improved survival (p=0.0016) but there was no added benefit to combining 5FU or 5FU+ATRA with radiation. A second cohort was treated using the same treatment approach, however radiation and 5FU were started with minimal to no visible tumors by MRI. Interestingly, we found a significant increase in survival between vehicle control and combination 5FU+ATRA (HR 5.121, 95% CI: 0.2506, 2.409, p=0.048) in MAF-811 mice. However, again with radiation, there was no significant change in survival with only a single cycle of 5FU+ATRA. This led to continued maintenance of 5FU+ATRA cycles of 6 weeks with 2 weeks off for 4 cycles post radiation in mice with minimal tumor. When 5FU with radiation is followed by 5FU+ATRA and is continued in mice with minimal disease, survival significantly improved when compared to radiation alone (HR 9.020, 95% CI: 1.933 to 42.09, p=0.007). These studies highlight the importance of chemotherapy in minimal disease and is the rationale for a Phase I/II study in relapsed PFA EPN and in upfront 1q+ PFA EPN.
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Affiliation(s)
- Enrique Grimaldo
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
| | - Andrew Donson
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
| | - Faith Harris
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
| | - Vladimir Amani
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
| | | | - Jenna Steiner
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
| | - Natalie Serkova
- University of Colorado - Anschutz Medical Campus , Aurora, CO , USA
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9
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Norris G, Donson A, Milgrom S, Gaskell A, Willard N, Foreman N, Gilani A, Dahl N. HGG-17. Novel Fusion in Congenital Brainstem Diffuse High-Grade Glioma. Neuro Oncol 2022. [PMCID: PMC9165180 DOI: 10.1093/neuonc/noac079.232] [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
BACKGROUND: Infant-type hemispheric glioma, previously termed infantile glioblastoma multiforme, is a rare infantile neoplasm with improved survival and distinct molecular features when compared to other pediatric and adult-type high-grade glioma. Infant-type high-grade gliomas are typically located in the cerebral hemispheres and are characterized by ALK, ROS1, MET, and NTRK fusions. Typical brainstem gliomas (diffuse midline glioma, H3 K27-altered or diffuse intrinsic pontine glioma) are comparatively rare in this age group. As a result, the biology of brainstem congenital high-grade gliomas is poorly described. RESULTS: A 3 month old female who initially presented with failure to thrive had an apneic event and was found to have an infiltrative mass in the medulla with expansion into the pons and cervical spine on magnetic resonance imaging. She underwent surgical biopsy with pathology revealing diffuse high-grade glioma, WHO grade 4. Next generation sequencing showed no alterations to H3F3A, IDH, or fusions involving BRAF, ALK, ROS1, MET, or NTRK. Whole-transcriptome sequencing revealed a novel fusion of PDGFRB:APOBEC3C. She received chemotherapy with 2 cycles of carboplatin/etoposide and 2 cycles of carboplatin/etoposide/imatinib before having disease progression. She then underwent palliative radiation (35 Gy in 10 fractions) with near complete regression of her disease. Surprisingly, our patient has not had any progression of disease or new lesions now two years from her last therapy. CONCLUSION: Congenital high-grade glioma is a rare, unique entity that greatly differs from its adult and childhood counterparts. Here, we discuss a previously-unreported fusion of PDGFB:APOBEC3C in a patient with congenital brainstem diffuse high-grade glioma with a favorable clinical course. This highlights the importance of routine molecular characterization, both to better understand the complex biology of this rare disease and to guide prognosis and clinical decision making for individual patients and families.
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Affiliation(s)
| | - Andrew Donson
- Children's Hospital Colorado , Aurora, CO , USA
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | | | | | | | - Nicholas Foreman
- Children's Hospital Colorado , Aurora, CO , USA
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | | | - Nathan Dahl
- Children's Hospital Colorado , Aurora, CO , USA
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
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10
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Willard N, Riemondy K, Griesinger A, Kaufman M, Venkataraman S, Foreman N, Vibhakar R, Donson A. MEDB-44. Transcriptomic resolution of subgroup-specific medulloblastoma architecture. Neuro Oncol 2022. [PMCID: PMC9165111 DOI: 10.1093/neuonc/noac079.418] [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: 11/23/2022] Open
Abstract
Despite a growing understanding and stratification of medulloblastoma, it remains an aggressive childhood brain tumor with high morbidity and mortality. Multimodal genomic and epigenomic analysis has permitted the classification of medulloblastoma into four subgroups with varying biology and clinical behavior: WNT, Sonic-Hedgehog (SHH), Group 3, and Group 4. In our previously published work, Single-cell RNA sequencing (scRNAseq) identified distinct tumor cell subpopulations in specific medulloblastoma groups. However, this technology is limited by its lack of architectural information. Spatial transcriptomics is a relatively new technology that permits the analysis of gene expression as it occurs within organized tissue. In our ongoing study, we utilized Visium spatial transcriptomics, integrated with scRNAseq data and immunohistochemistry, to analyze frozen samples of medulloblastomas (SHH, Group 4, and Group 3 with and without MYC amplification). In SHH in particular, we were able to identify scRNAseq populations within the geographically constricted Visium data, including SHH-C2, a population located in histologic nodules, the predominant neuronal-differentiated population SHH-C1, and progenitor populations (SHH-B1 and B2). In addition, we were able to visualize clusters not detectable by scRNAseq – a cluster lining nodules with expression of vascular endothelium marker, reticulin and M2-macrophage genes, and a novel DNA-repair cluster. In addition, Visium data permits the spatial constraint of proliferating cells, which is frequently problematic in scRNAseq, as dividing cells cluster independently. The proliferation is highest in the SHH-B2 minor progenitor population, absent in the SHH-C1 major differentiated population, and is moderate in other population including the SHH-C2 nodules. Group 3 and 4 medulloblastoma are more complex but show preliminary corroboration with scRNAseq data. In summary, Visium allows us to map subpopulations identified by scRNAseq to tumor architecture more definitively and rapidly than IHC. These novel insights advance our understanding of medulloblastoma, a critical step in improving treatment options for children with this disease.
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11
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Donson A, Fu R, Norris G, Willard N, Griesinger A, Riemondy K, Amani V, Grimaldo E, Harris F, Hankinson T, Mitra S, Ritzmann T, Grundy R, Foreman N. EPEN-29. Spatial transcriptomic analysis of ependymoma implicates unresolved wound healing as a driver of tumor progression. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.165] [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: 11/15/2022] Open
Abstract
Abstract
Ependymoma is a childhood brain tumor that remains incurable in approximately 50 percent of cases, most commonly in posterior fossa subgroup A (PFA). Uncovering how heterogeneous cell types within the tumor microenvironment (TME) interact is crucial to a complete understanding of PFA disease progression. The underlying cellular components of the PFA TME have been revealed by single-cell RNAseq (scRNAseq), identifying divergent epithelial differentiation and epithelial-mesenchymal transition (EMT) lineages. Here, we utilize spatial transcriptomics (Visium) of 14 PFA samples, integrated with scRNAseq, to chart neoplastic and immune cell architecture, with a higher resolution of cellular heterogeneity than scRNAseq alone. At a gross level, all PFA were primarily comprised of neoplastic epithelial and mesenchymal transcriptomic spatial zones, each containing a diversity of hierarchical cellular stages. In all samples we revealed spatially and transcriptomically-distinct mesenchymal zone-associated subclusters, including a quiescent undifferentiated progenitor-like subpopulation and clusters with characteristics of early and late stage EMT. Two early stage EMT clusters were distinguished by signatures of either myeloid cell interaction or hypoxia, and both were demonstrated to be EMT-initiating processes in in-vitro PFA experimental models. Myeloid cell interaction is the predominant initiating stage of EMT in PFA, occurring in zones that are spatially distinct from hypoxia induced EMT. Other mesenchymal clusters represent later EMT stages characterized by wound repair and tissue remodeling. Increased proliferation was a general characteristic of epithelial zone clusters, which included a second undifferentiated progenitor-like population that showed a particularly high mitotic rate and was associated with histologically hypercellular areas. Given the biological parallels with normal wound healing, we propose that mesenchymal and epithelial zones interact to create a cycle of persistent tissue damage response and mitogenic re-epithelialization signals. Unresolved wound repair is therefore a potential driver of PFA progression, a new concept that could provide novel targets for effective therapeutic intervention.
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Affiliation(s)
- Andrew Donson
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Rui Fu
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - gregory Norris
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Nicholas Willard
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | | | - Kent Riemondy
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Vladimir Amani
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Enrique Grimaldo
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Faith Harris
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Todd Hankinson
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Siddhartha Mitra
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - timothy Ritzmann
- University of Nottingham, Nottingham , Nottinghamshire , United Kingdom
| | - Richard Grundy
- University of Nottingham, Nottingham , Nottinghamshire , United Kingdom
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12
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Serkova N, Manalo J, Steiner J, Griesinger A, Pierce A, Foreman N. IMG-17. Advanced MRI On The Cellular and Vascular Phenotype of Mouse Ependymoma Models and Chemo-Radiation Treatment Response. Neuro Oncol 2022. [PMCID: PMC9165129 DOI: 10.1093/neuonc/noac079.293] [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: 11/30/2022] Open
Abstract
Ependymoma (EPN) is an aggressive pediatric brain tumor, for which the benefits of chemotherapy in pediatric patients have not been defined. EPN treated with surgery and radiation recur in 23-66% of patients. Our group has previously established aggressive behaviors of EPN, including high tumor cellularity, cytological anaplasia, high mitotic index, tumor necrosis, and the presence of inflammatory cells such as M2-type myeloid cells. Here we report on an advanced 9.4 Tesla MRI protocol for characterizing the cellular and vascular phenotype and treatment response to chemo-radiation therapy (CRT) in an orthotopic mouse model of patient derived xenografts (PDX) of pediatric EPN . Female severely immune deficient (SCID) mice were used for intracranial inoculation of disaggregated tumors from pediatric EPN patients (n=22). High-resolution T2w-MRI was able to detect cerebellar microlesions as small as 0.2 mm diameter; the median tumor volumes at the baseline were 21±12 mm3. Using diffusion-weighted based cell-size imaging, iron-oxide based vessel-size imaging and quantitative T2-maps, the EPN-specific phenotype was characterized by an increased cell size (S=14 microns), increased vessel density index (Q=0.54), and low ADC values (0.63x10-3). Once the intracranial tumors reached at least 5 mm3, animals were treated with CRT (10 Gy radiation plus 30 mg/kg 5-fluorouracil, n=6). CRT resulted in a tumor shrinkage, tumor necrosis with decreased cell sizes and increased ADC values, and a dramatic vascular-inflammatory response (decreased Q and DT2 values with the injection of iron oxide nanoparticles as macrophage-specific contrast). In summary, orthotopically implanted PDX EPN in mice closely mimic histological features, anatomical location and radiological features of the primary tumors. A significant decrease in vessel size density and an increase in inflammatory cells were seen as soon as 2 days after CRT. The late response (2 weeks post CRT) is characterized by decreased cellularity, cell size, and tumor volumes.
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Affiliation(s)
- Natalie Serkova
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Jane Manalo
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Jenna Steiner
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | | | - Angela Pierce
- University of Colorado Anschutz Medical Campus , Aurora, CO , USA
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13
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Abstract
INTRODUCTION: Event-free survival of pediatric low-grade glioma (pLGG) is poor, and patients often require multiple treatment strategies. The hallmark of pLGGs are genetic aberrations of the mitogen-activated protein kinase pathway, which lead to constitutive pathway activation. MEK and RAF inhibitors target this pathway and are efficacious in early phase trials in recurrent pLGGs. However, not all patients respond to monotherapy, and many experience progression after completion of therapy. Evaluating combination therapies that may enhance efficacy or prolong disease stabilization is warranted. Lenalidomide is an immunomodulatory agent with an anti-tumor effect demonstrated in phase 1 trials in recurrent pediatric central nervous system (CNS) tumors. OBJECTIVE: To describe our institutional experience using concurrent trametinib and lenalidomide in the treatment of primary pediatric central and peripheral nervous system (PNS) tumors. METHODS: Retrospective review of patients’ medical records. RESULTS: Four patients with locally recurrent primary CNS or PNS tumors, three with WHO grade II pilomyxoid astrocytomas and one with a plexiform neurofibroma, were treated with trametinib and lenalidomide concurrently. Two patients developed severe thromboembolic events. One patient was treated with combination therapy for seven months until trametinib and lenalidomide were held after urgent ventriculoperitoneal shunt revision. Shortly following shunt revision, he experienced near-complete vision loss. MRI of the brain demonstrated a left posterior watershed territory hypoxic-ischemic injury. In a second patient, after four months of combination therapy, surveillance echocardiogram showed an incidental finding of severe biventricular dysfunction with a left ventricular ejection fraction (LVEF) of 17.7% and two mural thrombi in the left ventricular apex. She started losartan and enoxaparin and discontinued trametinib and lenalidomide. Her LVEF normalized four months later, and the mural thrombi resolved. CONCLUSIONS: Given the severe thromboembolic events experienced by these patients treated with concomitant trametinib and lenalidomide, this combination requires further investigation, and we urge caution if used concurrently.
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Affiliation(s)
- Priya Chan
- Department of Pediatrics, University of Utah, Salt Lake City , UT , USA
| | - Ashley Sabus
- Department of Pharmacy, Children's Hospital Colorado , Aurora, CO , USA
| | - Molly Hemenway
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Kathryn Chatfield
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Nathan Dahl
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
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14
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Amani V, Donson A, Riemondy K, Fu R, Willard N, Gilani A, Norris G, Griesinger A, Harris F, Grimaldo E, Foreman N. NFB-18. Integration of single-nuclei RNA-sequencing and spatial transcriptomics to define the complex tumor microenvironment of NF1-associated plexiform neurofibroma and highly-aggressive malignant peripheral nerve sheath tumors. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.479] [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: 11/13/2022] Open
Abstract
Abstract
During formation of plexiform neurofibroma (PN), a complex tumor microenvironment (TME) develops, with recruitment of other cell types being critical for growth and progression. Approximately 10% of PN can undergo transformation into malignant peripheral nerve sheath tumors (MPNST) which is a substantial cause of mortality in older teenagers and young adults. We sought to apply single cell transcriptomic analysis to PN and MPNST to provide a clearer understanding of the complex TME and how this contributes to transformation and disease progression. Due to the cohesive cellularity of PN, single-cell RNA-sequencing is difficult and may result in a loss of detection of critical cellular subpopulations. Single-nuclei RNA-sequencing (snRNA-seq) is an alternative approach that can be applied to fibrous and bulk frozen tissues, such as NF1-associated PN. Our initial snRNA-seq analysis of PN indicates that PN have a TME comprised of a variety of cellular subpopulations, with the predominant fraction being fibroblast-like cells. snRNA-seq analysis of MPNST also shows high cellular heterogeneity, including distinct fibroblast-like subpopulations distinct from PN fibroblast clusters, increased proliferating populations and antigen presenting cells. MPNST cluster separately from PN, suggesting an evolutionary shift in tumor biology. We are currently validating our findings using Visium spatial transcriptomic profiling, allowing us to apply TME architectural context to the PN and MPNST subpopulations identified by snRNA-seq. These techniques provide a deeper understanding of the complex cellular heterogeneity of human PN and MPNST that has not previously been used to describe the TME of these tumors. The mechanisms of tumorigenesis and malignancy described can provide targets for novel therapies ultimately benefitting patients with these devastating tumors of childhood and early adulthood.
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Affiliation(s)
| | | | | | - Rui Fu
- University of Colorado Denver , Aurora, CO , USA
| | - Nicholas Willard
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | | | - Gregory Norris
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | | | - Faith Harris
- University of Colorado Denver , Aurora, CO , USA
| | | | - Nicholas Foreman
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
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15
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Milgrom S, Koo J, Foreman N, Liu A, Campbell K, Dorris K, Green A, Dahl N, Donson A, Vibhakar R, Mulcahy-Levy J. RONC-05. Peri-transplant Radiation Therapy for Young Children Treated with High-Dose Chemotherapy for Primary Brain Tumors. Neuro Oncol 2022. [PMCID: PMC9165012 DOI: 10.1093/neuonc/noac079.659] [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: 11/21/2022] Open
Abstract
PURPOSE: The role of peri-transplant radiation therapy (RT) in young children with primary brain tumors is unclear. We characterized our institutional practice patterns and patient outcomes. MATERIALS AND METHODS: The cohort included all patients treated with high-dose chemotherapy for primary brain tumors at our institution from 2011-2017. Rates of local control (LC), progression-free survival (PFS), overall survival (OS), and radiation-associated injury were assessed. RESULTS: Of 37 eligible patients, 29 (78%) received peri-transplant RT at a median age of 4 years. Patients treated with RT were more likely to have metastatic (p=0.0121) and incompletely resected (p=0.056) disease, and to have high-risk histologies including atypical teratoid rhabdoid tumor, nongerminomatous germ cell tumor, pineoblastoma, primitive neuro-ectodermal tumor, glioneuronal tumor and group 3 medulloblastoma. Of those treated with RT, 13 (45%) received craniospinal irradiation (CSI) and 16 (55%) received focal RT. The median CSI dose was 23.4 Gy (IQR: 18-36; boost median 54 Gy [IQR: 53.7-55.8]) and focal RT dose was 50.4 Gy (IQR: 50.4-54.5). Compared to the focal RT group, patients treated with CSI were older (p=0.0499) and more likely to have metastatic disease (p=0.0004). For the complete cohort, at a median follow-up of 3.8 years, the 2-year rate of LC was 82% (95% CI: 70-96%), PFS was 63% (95% CI: 49-81%), and OS was 65% (95% CI: 51-82%). These rates did not differ significantly between patients treated with and without peri-transplant RT. Two cases of fatal myelopathy were observed after spinal cord doses within the highest tertile (41.4 CGE and 36 Gy); both cases occurred in patients who received RT before high-dose chemotherapy. CONCLUSION: Peri-transplant RT was used for high-risk disease. Oncologic outcomes after RT were encouraging. However, 2 cases of grade 5 myelopathy were observed. If used cautiously, RT may contribute to durable remission in patients at high risk of relapse.
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Affiliation(s)
- Sarah Milgrom
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Jane Koo
- Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
| | | | - Arthur Liu
- University of Colorado Health, Fort Collins , CO , USA
| | | | - Kathleen Dorris
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Adam Green
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Nathan Dahl
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Andrew Donson
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Rajeev Vibhakar
- University of Colorado School of Medicine , Aurora, CO , USA
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16
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Chan P, Hemenway M, McMahon K, Dahl N, Domeshek L, French B, Foreman N. NFB-14. Post-operative use of MEK inhibitors to prevent rebound growth following partial resection of plexiform neurofibromas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.476] [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
BACKGROUND: Plexiform neurofibromas (PNs) can cause significant morbidity leading to functional impairment, pain, and disfigurement. Management of PNs is challenging. Complete surgical resection is often not possible due to tumor growth along vital structures, and rebound growth is frequently experienced with partially resected PNs. The mitogen-activated protein kinase pathway has been implicated in the growth of PNs, and MEK1/2 inhibitors have been shown to be an effective treatment of PNs. OBJECTIVE: To describe our institutional experience using post-operative MEK1/2 inhibitors in the treatment of pediatric patients with PNs following subtotal resection (STR). METHODS: A single-institution retrospective record review. RESULTS: A total of 35 patients had STR of their PN. Fourteen patients underwent resection alone, ten patients received adjuvant mechanistic target of rapamycin (mTOR) inhibitors and eleven patients received adjuvant MEK1/2 inhibitors. The mean follow-up time was 5.1 years, but relatively shorter for patients receiving adjuvant MEK1/2 inhibitors. Mean time from resection to start of adjuvant therapy and mean duration of adjuvant therapy for patients in the mTOR inhibitor group was 3.3 weeks and 3.9 months, respectively, and for patients in the MEK1/2 inhibitor group was 3.1 weeks and 8.5 months, respectively. The number of patients in each group requiring additional treatment with surgical resection or medical therapy, was 11 of 14 patients (78.6%) in the resection only group, 7 of 10 patients (70%) in the adjuvant mTOR inhibitor group and 3 of 11 patients (27.3%) in the adjuvant MEK1/2 inhibitor group. CONCLUSIONS: A short course of MEK1/2 inhibitors following subtotal resection of PNs is effective in the short term in preventing rebound growth when compared to STR alone or adjuvant mTOR inhibitors. Treatment is well tolerated and should be considered as adjuvant therapy in pediatric patients. Long-term follow-up is necessary to judge the effectiveness of this approach.
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Affiliation(s)
- Priya Chan
- Department of Pediatrics, University of Utah, Salt Lake City , UT , USA
| | - Molly Hemenway
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Kathleen McMahon
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Nathan Dahl
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Leahthan Domeshek
- Department of Plastic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus , Aurora, CO , USA
| | - Brooke French
- Department of Plastic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus , Aurora, CO , USA
| | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
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17
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Norris G, Widener M, Amani V, Donson A, Schissel D, Bruno C, Mettetal A, Ramirez D, Gustafson D, Hankinson T, Handler M, Macy M, Foreman N, Dorris K. EPEN-11. Phase 0/I Study of GM-CSF and Intrathecal Trastuzumab In Children With Recurrent Posterior Fossa Ependymoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.148] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Posterior fossa ependymoma (PF EPN) is a pediatric central nervous system malignancy that has a poor outcome to standard therapeutic approaches. The majority of PF EPN have been shown to harbor increased HER2 expression, making it a logical therapeutic target. Trastuzumab is a monoclonal antibody that targets HER2, and sargramostim (GM-CSF) stimulates hematopoietic progenitor cell proliferation. The combination of trastuzumab and GM-CSF has been shown to trigger antibody-dependent cell cytotoxicity in-vitro in patient-derived PF EPN cell lines. METHODS: Children aged 1–21 years with relapsed PF EPN, no ventriculoperitoneal shunt, and no CSF obstruction are eligible for the Phase 0/I single-institution clinical trial at Children’s Hospital Colorado. Stratum 1 involves intrathecal (IT) trastuzumab and subcutaneous (subQ) GM-CSF prior to standard-of-care surgical resection. Stratum 2 involves a 3 + 3 phase I design with serial IT trastuzumab doses, each preceded by three days of GM-CSF, to establish the maximum tolerated dose for IT trastuzumab. RESULTS: Trastuzumab was detected in a sufficient number of tumors after presurgical IT delivery in Stratum 1 to open Stratum 2. Seven patients (3 female) have been enrolled in Stratum 2. Median age at enrollment is 8.1 years (range, 3–20 years). CSF pharmacokinetic analysis demonstrate detectable trastuzumab up to 14 days after IT doses. No dose-limiting toxicities or grade 3 or 4 adverse events have occurred. Four patients completed all planned study therapy and remain progression-free post-therapy (median, 23 months, range, 6-42 months). Three patients progressed on therapy (median, 4 cycles). Biologic correlative studies are in process. CONCLUSIONS: IT trastuzumab penetrates PF EPN tumor tissue and demonstrates an excellent safety profile. Stratum 2 remains open to accrual at Dose Level 2. IT trastuzumab+GM-CSF warrants consideration for a multi-institutional Phase II trial.
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Affiliation(s)
| | - Melissa Widener
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Vladamir Amani
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Andrew Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | | | | | | | - Dominique Ramirez
- Flint Animal Cancer Center Colorado State University, Fort Collins , CO , USA
| | - Daniel Gustafson
- Flint Animal Cancer Center Colorado State University, Fort Collins , CO , USA
| | - Todd Hankinson
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Michael Handler
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Margaret Macy
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Nicholas Foreman
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Kathleen Dorris
- Children's Hospital Colorado , Aurora, CO , USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Denver, CO , USA
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Griesinger A, Lang J, Donson A, Grimaldo E, Pierce A, Knox A, Steiner J, Serkova N, Ritzmann T, Grundy R, Foreman N. MODL-26. Development of humanized immune system, posterior fossa A ependymoma patient-derived xenograft model. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.649] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Cellular interactions between tumor and immune cells are critical in ependymoma biology. We have shown distinct immunobiology phenotypes by ependymoma molecular subgroups, with PFA2 developing an anti-tumor immune phenotype and in contrast PFA1 tumor immune cells being pro-tumor. We recently established two fully characterized pediatric PFA1 intracranial xenograft models in NSG mice. These models, while critical for advancing PFA studies, lack the ability to make lymphocytes. To address this we have established a humanized orthotopic model of PFA1 ependymoma that are grafted to produce functional human lymphocytes. To do this, CD34+ human umbilical cord blood was injected into the cranial facial vein of newborn, irradiation immunodepleted, BRGS mice. Human immune chimerism was determined at 10 weeks by flow cytometry of peripheral blood. Next, we injected existing PDX model MAF-928_XF cells into the 4th ventricle at 12 weeks age and tumors were monitored by MRI. Initial scanning found the tumors were delayed in developing, consistent with other humanized solid tumor mouse models. Mice were euthanized between 32-34 weeks age and necropsies were performed to isolate brain, lymph nodes, blood and spleen. Human chimerism was detectable, by flow cytometry, in spleen, lymph nodes and blood, and most cells were T-cells. Human T-cells were detectable in all tumors, in proportions consistent with human disease (0.05-0.5% of CD45+). Tumors also had 35-50% mouse myeloid infiltration. Tumors were MHC I negative and MHC II positive, and PD-L1 low. Histology was consistent with human ependymoma. We are using spatial proteomics to determine cellular location and phenotype of infiltrating immune cells. Initial studies indicate this model will be usable for modeling the critical tumor-immune interactions and pre-clinically testing the next therapies in PFA ependymoma and can be easily adapted to other pediatric brain tumors in which immune factors have a critical role.
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Affiliation(s)
- Andrea Griesinger
- University of Colorado Anschutz , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | - Julie Lang
- University of Colorado Anschutz , Aurora, CO , USA
| | - Andrew Donson
- University of Colorado Anschutz , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | - Enrique Grimaldo
- University of Colorado Anschutz , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | | | - Aaron Knox
- University of Colorado Anschutz , Aurora, CO , USA
| | | | | | | | | | - Nicholas Foreman
- University of Colorado Anschutz , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
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O'Shaughnessy B, Donson A, Amani V, Griesinger A, Grimaldo E, Harris F, Foreman N. EPEN-12. Sunitinib induces apoptosis-mediated cytotoxicity in PFA ependymoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.149] [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
Ependymoma (EPN) has been previously shown to be selectively targeted by three classes of FDA-approved chemotherapy drugs: fluorinated pyrimidines, retinoids, and a subset of small molecule receptor tyrosine kinase inhibitors (RTKIs). We have identified sunitinib malate as an RTKI with ependymoma selectivity, in addition to previously identified ependymoma-selective RTKIs axitinib, imatinib, and pazopanib. Sunitinib—which targets VEGFR, PDGFR and c-kit—elicited unexpectedly high levels of cytotoxic apoptosis (caspase 3/7 cleavage) in EPN PFA cell lines harboring high-risk chromosome 1q gain and 6q loss. In this in-vitro screen of 100+ FDA-approved chemotherapy drugs, sunitinib was the only RTKI in the top five most cytotoxic drugs, a group that included idarubicin HCl, topotecan HCl, daunorubicin HCl, and doxorubicin. Additionally, sunitinib exhibited comparable caspase 3/7 cleavage levels in normoxia and hypoxia, suggesting that this therapy would be as effective in treatment of tumors with potentially resistant hypoxic necrotic cores. The effect of sunitinib on EPN cellular proliferation was tracked visually using Incucyte cell imaging technology, demonstrating consistent dose-dependent inhibition of proliferation. Sunitinib achieved more acute upregulation of apoptosis than axitinib, an EPN-selective RTKI currently being studied in preclinical models. A prior phase II trial of sunitinib in pediatric EPN and high-grade glioma showed that treatment was well tolerated but with no clinical benefit as a monotherapy. However, given encouraging clinical results of combining sunitinib with radiation, our ongoing preclinical studies of sunitinib in EPN are being conducted in the context of radiation which is standard treatment for EPN. Sunitinib presents a promising treatment to an intractable pediatric brain tumor that exhibits high rates of relapse and morbidity in affected individuals.
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Norris G, Fu R, Riemondy K, Willard N, Griesinger A, Amani V, Grimaldi E, Harris F, Gilani A, Hankinson T, Hesselberth J, Foreman N, Donson A. EPEN-16. Epithelial Progenitor Cell Abundance and Copy Number Variant Gains and Losses Impact the Biology of Recurrent Ependymoma. Neuro Oncol 2022. [PMCID: PMC9165014 DOI: 10.1093/neuonc/noac079.153] [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
Ependymoma (EPN) is a common pediatric brain tumor that is fatal in approximately 50% of cases. Posterior fossa A (PFA) EPN has the highest rate of recurrence and the worst prognosis of all EPN subtypes. At relapse, it is typically incurable even with re-resection and re-irradiation. The biology of recurrent ependymoma remains largely unknown, which hinders clinical advances. In this study, we use paired samples of primary and recurrent disease from the same patient to investigate the drivers of recurrence. DNA methylation studies reveal frequent copy number variants at recurrence that were not present at primary presentation. We report a frequent gain of chromosome 1q and loss of 6p at recurrence, which has not been previously reported and may be a driver of recurrent disease. We have previously shown that PFA EPN is comprised of 4 main neoplastic cell populations, two well-differentiated populations termed ciliated and transportive ependymal cells, a mesenchymal cell population, and an undifferentiated population. Using spatial transcriptomics (Visium) integrated with single-nuclei RNA-seq (Chromium), we discovered that a highly proliferative EPN progenitor population of epithelial lineage is significantly upregulated at recurrence which we hypothesize drives refractory disease. Accordingly, we found higher expression of EPN progenitor gene signatures in bulk RNA transcriptomes of primary tumors that later recurred compared to tumors that never recurred. Together, these findings highlight the biologic differences between primary and recurrent disease and add to our understanding of treatment resistance in childhood ependymoma.
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Affiliation(s)
| | - Rui Fu
- University of Colorado , Aurora, CO , USA
| | | | | | - Andrea Griesinger
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Vladamir Amani
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Enrique Grimaldi
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Faith Harris
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | | | - Todd Hankinson
- Children's Hospital Colorado , Aurora, CO , USA
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | | | - Nicholas Foreman
- Children's Hospital Colorado , Aurora, CO , USA
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
| | - Andrew Donson
- The Morgan Adams Pediatric Brain Tumor Research Program , Denver, CO , USA
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21
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Hemenway M, Dorris K, Foreman N, Winzent S, Kissell E, Kasson J. SWK-10. Survivorship: Education, Clinical Guidelines, and Transition to Adult Care. Neuro Oncol 2022. [PMCID: PMC9165175 DOI: 10.1093/neuonc/noac079.682] [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: 11/12/2022] Open
Abstract
Abstract
As the cure rates of patients with pediatric brain tumors increases, the long term care needs of the survivors increase as well. Survivorship includes several facets of multidisciplinary care including education, clinical care guidelines, and transition to adult medical care. The neuro-oncology program at a large tertiary care hospital has developed a team to address survivorship needs. The Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers was utilized as a backbone that was then customized for neuro-oncology patient education including disease type and treatment. The education was compiled into patient handouts as well as electronic medical record (EMR) statements that can easily be added to a clinic note or letter to referring providers. In addition, a diagnosis and treatment summary was placed both in the EMR as well as given to patients at various time points to ensure long term knowledge. Next, follow-up guidelines and roadmaps were developed and customized to tumor type and treatment received (surgery, radiation, chemotherapy). The roadmaps ensure patients are receiving high-quality comprehensive follow-up and screening from a large multidisciplinary team. Finally, patients will transition to adult care. With a large seven state catchment area, the adult care providers vary on local provider availability, knowledge, and medical complexity of the survivor. Each patient is evaluated based on their needs, availability of care locally, and ability to travel. The team developed relationships with the clinical team at the academic center adjacent to the pediatric hospital to support a smooth transition to adult care. The adult neuro-oncology care team can also serve as a consulting service for local adult providers. The survivorship team will continue to address the complex needs of brain tumor survivors and provide education for a smooth transition to adult care.
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Affiliation(s)
- Molly Hemenway
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Kathleen Dorris
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Nicholas Foreman
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Shelby Winzent
- Children's Hospital Colorado , Aurora, CO , USA
- University of Colorado School of Medicine , Aurora, CO , USA
| | - Erin Kissell
- Children's Hospital Colorado , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
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22
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Madhavan K, Walker F, Wang D, Sobral LM, Balakrishnan I, Pierce A, Serkova N, Foreman N, Venkataraman S, Vibhakar R, Dahl N. MEDB-28. CDK9 is a druggable mediator sustaining Myc-driven circuitry in medulloblastoma. Neuro Oncol 2022. [PMCID: PMC9164830 DOI: 10.1093/neuonc/noac079.402] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Though long recognized as a master regulator of cell proliferation across a wide range of cancers, Myc has proven elusive to direct therapeutic targeting. The CDK9-containing PTEFb, complexed with either BRD4 or SEC, facilitates Myc-driven transcriptional programs and is necessary for sustaining expression of Myc itself. Advances in development of clinical-grade CDK9 inhibitors creates an opportunity to examine this as a rational therapy for Myc-driven medulloblastoma. METHODS: We used both RNAi depletion and a panel of pharmacologic agents to characterize the mechanistic and functional consequences of CDK9 inhibition in Myc-driven medulloblastoma. We used a combination of clonogenic assays and live cell imaging to assess the cytotoxic effects of CDK9 activity loss. We then performed a combination of CUT&RUN and RNA-seq to evaluate alterations to Myc binding and downstream Myc-driven transcriptional programs. Finally, we employed orthotopic xenograft models of medulloblastoma to assess CNS penetration, tolerability, and anti-tumor efficacy of lead CDK9i candidate compounds. RESULTS: Genetic or pharmacologic inhibition of CDK9 leads to a loss of Myc expression and downregulation of hallmark Myc-driven transcriptional programs. This corresponds to a loss of cell fitness, as measured by decreased proliferation and clonogenic potential. Clinically relevant CDK9 inhibitors show variable efficacy in vivo, but the CNS-penetrant zotiraciclib achieved a significant prolongation in xenograft survival. CONCLUSION: CDK9 catalytic activity represents a druggable vulnerability underpinning Myc-driven transcriptional programs. The development of CNS-penetrant CDK9 inhibitors may open new avenues for rational therapy in these high-risk medulloblastomas.
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Affiliation(s)
| | | | - Dong Wang
- University of Colorado , Aurora, CO , USA
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23
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Griesinger A, Riemondy K, Eswaran N, Donson A, Willard N, Paine S, Bowes G, Rheaume J, Chapman R, Ramage J, Jackson A, Grundy R, Foreman N, Ritzmann T. IMMU-10. TUMOR ASSOCIATED MYELOID CELLS DRIVE THE IMMUNOBIOLOGY OF HIGH RISK PEDIATRIC EPENDYMOMA. Neuro Oncol 2022. [PMCID: PMC9165116 DOI: 10.1093/neuonc/noac079.303] [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: 11/26/2022] Open
Abstract
Molecular profiling of pediatric ependymoma (EPN) has previously identified discrete neoplastic subpopulations, of which Mesenchymal EPN Cells (MEC) characterize Posterior Fossa A tumors (PFA). MECs are associated with tumor immunosuppression. Here we further characterize the EPN immune environment using single-cell sequencing, spatial phenotyping and cytokine analyses to better define infiltrating myeloid subpopulations. We hypothesize that neoplastic and myeloid cells interact to propagate an immune suppressive environment conferring resistance to traditional therapies. We delineated myeloid cell subpopulations from single-cell RNA-seq of 26 pediatric EPNs and validated them through deconvolution of bulk gene expression profiling (n=299). To define subpopulation spatial distribution, we interrogated a range of tumor and myeloid markers using multiplex immunofluorescence (mIF). Finally, using single-cell cytokine analyses, we gained further insight into myeloid subpopulation function. Eight distinct myeloid subpopulations were identified, relating to macrophages, microglia and monocytes. A subpopulation of cells with wound healing ontologies and characterized by TREM1 expression, demonstrated features of myeloid derived suppressor cells, including IL6/STAT3 pathway activation. We called these hypoxia-M. Like MEC neoplastic cells, hypoxia-M was associated specifically with PFA1 subgroup EPN in both single-cell and bulk tumor gene expression profiling (p<0.001). Additionally, the presence of MEC and hypoxia-M correlated strongly in gene expression (r2=0.92, p<0.001) and IHC analyses, where they co-located to borders between necrosis, blood vessels and viable tumor. Analysis using mIF (n=54) confirmed MEC/hypoxia-M co-location and highlighted that all types of immune cell corralled in significant numbers around areas of vasculature and necrosis. Single cell cytokine analyses demonstrated that hypoxia-M secrete IL-8 which, we hypothesize, amplify the pro-tumor phenotype in PFA1 tumor microenvironment. EPN is characterized by discrete myeloid cell subpopulations which contribute to the tumor microenvironment. Treatment strategies must focus on modifying this pro-tumor, immunosuppressive microenvironment to deliver more effective treatment for childhood ependymoma.
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Affiliation(s)
- Andrea Griesinger
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | | | | | - Andrew Donson
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | - Nicholas Willard
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
| | - Simon Paine
- University of Nottingham , Nottingham , United Kingdom
| | - Georgia Bowes
- University of Nottingham , Nottingham , United Kingdom
| | | | | | - Judith Ramage
- University of Nottingham , Nottingham , United Kingdom
| | | | | | - Nicholas Foreman
- University of Colorado Denver , Aurora, CO , USA
- Children's Hospital Colorado , Aurora, CO , USA
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Blanco-Carmona E, Büllesbach A, Federico A, Liu I, Young MD, Kildisuite G, Behjati S, Vibhakar R, Donson A, Foreman N, Hovestadt V, Shaw M, Chi S, Frühwald M, Drost J, Korshunov A, Hasselblatt M, Pfister SM, Jäger N, Johann P, Filbin M, Kool M. ATRT-10. Single-cell transcriptional profiling of ATRTs reveals heterogeneous signatures of tumor and non-malignant cell populations. Neuro Oncol 2022. [PMCID: PMC9164679 DOI: 10.1093/neuonc/noac079.009] [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: 11/25/2022] Open
Abstract
Atypical Teratoid/Rhabdoid Tumors (ATRTs) are known for exhibiting high inter-tumor heterogeneity, even though they are almost all characterized by a common loss of SMARCB1 (or rarely SMARCA4). Three subgroups have been identified at bulk methylome and transcriptome level: ATRT-TYR, ATRT-SHH, and ATRT-MYC. To better understand the biology underlying each subgroup and potentially unveil their (different) cell(s) of origin, we performed single-cell transcriptomic analyses in 22 ATRTs using fresh frozen samples and both 10X and Smartseq technology. All data, grouped by technology, underwent quality control and normalization, regressing out the biases introduced by each sample. Tumor microenvironment (TME) and tumor bulk (TB) clusters were characterized by a combination of copy number variant analyses, enrichment in literature lists of marker genes for specific cell populations, and in-depth analysis of differentially enriched (DE) genes. Non-negative Matrix Factorization (NMF) was applied to TB to reveal major transcriptional profiles, which were grouped into meta-signatures. A total of 71 gene lists were retrieved from NMF (TB) and DE analyses (TME + TB), that gathered into 11 signature groups by Jaccard similarity, with one extra group accounting for unique signatures. Three groups targeted TME, accounting for either microglia, fibroblasts and endothelial cells, or OPCs, oligodendrocytes, astrocytes and neurons. These signatures are enriched in specific clusters across technologies. The remaining eight groups divide into two types, either enriched in clusters predominantly formed by cells of one or two ATRT subgroups or signatures enriched for a particular phenotype, such as cilial, cycling, axonogenesis or EM transition. While the first type is enriched across clusters in a gradient fashion, the second shows enrichment for selected clusters across technologies. Further analyses on the integrated dataset and additional samples are ongoing to validate and refine these 11 signature groups in ATRTs to see how this may lead to new treatment approaches.
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Affiliation(s)
- Enrique Blanco-Carmona
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Annette Büllesbach
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Aniello Federico
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Ilon Liu
- Broad Institute of Harvard and MIT , Cambridge , USA
| | | | | | - Sam Behjati
- Wellcome Sanger Institute , Hinxton , United Kingdom
- Department of Paediatrics , Cambridge , United Kingdom
| | - Rajeev Vibhakar
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Aurora , USA
- Children’s Hospital Colorado , Aurora , USA
| | - Andrew Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Aurora , USA
- Children’s Hospital Colorado , Aurora , USA
| | - Nicholas Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Program , Aurora , USA
- Children’s Hospital Colorado , Aurora , USA
| | - Volker Hovestadt
- Broad Institute of Harvard and MIT , Cambridge , USA
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center , Boston , USA
| | - McKenzie Shaw
- Broad Institute of Harvard and MIT , Cambridge , USA
| | - Susan Chi
- Broad Institute of Harvard and MIT , Cambridge , USA
| | - Michael Frühwald
- Swabian Children’s Cancer Center, University Hospital of Augsburg , Augsburg , Germany
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology , Utrecht , Netherlands
- Oncode Institute , Utrecht , Netherlands
| | - Andrey Korshunov
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital , Heidelberg , Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK) , Heidelberg , Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Natalie Jäger
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg , Germany
| | - Pascal Johann
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Swabian Children’s Cancer Center, University Hospital of Augsburg , Augsburg , Germany
| | - Mariella Filbin
- Broad Institute of Harvard and MIT , Cambridge , USA
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center , Boston , USA
| | - Marcel Kool
- Hopp Children's Cancer Center (KiTZ) , Heidelberg , Germany
- Princess Máxima Center for Pediatric Oncology , Utrecht , Netherlands
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25
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Milgrom SA, Koo J, Foreman N, Liu AK, Campbell K, Dorris K, Green AL, Dahl N, Donson AM, Vibhakar R, Levy JMM. Radiation Therapy for Young Children Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Primary Brain Tumors. Adv Radiat Oncol 2022; 7:100945. [PMID: 35814855 PMCID: PMC9260126 DOI: 10.1016/j.adro.2022.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/09/2022] [Indexed: 10/25/2022] Open
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Foreman N, Hesse A, Lundstrom C. Machine Learning Fails To Improve Marathon Time Prediction Compared To Multiple Linear Regression. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000759656.97049.16] [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: 11/21/2022]
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27
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Fisher M, Jones D, Li Y, Guo X, Sonawane P, Waanders A, Phillips J, Weiss W, Resnick A, Gosline S, Banerjee J, Guinney J, Gnekow A, Kandels D, Foreman N, Korshunov A, Ryzhova M, Massimi L, Gururangan S, Kieran M, Wang Z, Fouladi M, Sato M, Øra I, Holm S, Markham S, Beck P, Jäger N, Wittmann A, Sommerkamp A, Sahm F, Pfister S, Gutmann D. LGG-06. COMPREHENSIVE GENOMIC CHARACTERIZATION AND INTEGRATED CLINICAL ANALYSIS OF LOW-GRADE GLIOMAS IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1. Neuro Oncol 2021. [PMCID: PMC8168145 DOI: 10.1093/neuonc/noab090.130] [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: 11/30/2022] Open
Abstract
Background Low-grade gliomas (LGGs) arising in children with neurofibromatosis type 1 (NF1) are usually not biopsied. To identify secondary genetic alterations or molecular features that may contribute to pathogenesis and correlate with clinical behavior, we initiated a comprehensive molecular and clinical analysis of pediatric NF1-LGGs. Methods NF1-LGGs were analysed by whole-genome sequencing (31), targeted gene panel sequencing (9), RNAseq transcriptomal profiling (33) and genome-wide DNA methylation analysis (67). Clinical annotation was available for 48 subjects. Results Most LGGs harbored bi-allelic NF1 inactivation as the sole genetic abnormality, but 11% had additional alterations (FGFR1 mutation, n=3; PIK3CA mutation, n=2; homozygous 9p21 deletion, n=2; MYB:QKI fusion, n=1; SETD2 mutation, n=1; EGFR amplification, n=1). FGFR1 mutation conferred additional growth advantage in multiple complementary murine Nf1 models. 88% of NF1-LGGs resembled sporadic pilocytic astrocytoma (PA) by methylation, higher than that based on histology. Non-PA methylation patterns included low-grade glial/glioneuronal tumors, rosette-forming glioneuronal tumors, MYB/MYBL1-altered glioma, and high-grade astrocytoma with piloid features (2 tumors histologically diagnosed as LGG). In total, 18% of samples were classified as non-PA and/or harbored an additional non-NF1 mutation. Non-PA methylation class tumors were more likely to harbor an additional non-NF1 mutation (p=0.005). 7.7% of optic pathway hypothalamic gliomas (OPHGs) had other mutations or were not classified by methylation as PA, compared with 20.6% of NF1-LGGs arising elsewhere. There was no difference based on age for the presence of an additional non-NF1 mutation or non-PA methylation class. Conclusions Given the overall low occurrence of non-NF1 mutations or non-PA methylation class tumors in this series, routine clinical biopsy of typically-appearing NF1-LGG may not be indicated, particularly for children with OPHG. Biopsy should be considered for non-OPHG tumors refractory to conventional treatment. As additional agents are developed and treatment strategies evolve, the rationale for biopsy of NF1-LGG may become stronger.
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Affiliation(s)
- Michael Fisher
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Jones
- Hopp Children’s Cancer Center, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yimei Li
- University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaofan Guo
- Washington University School of Medicine, St. Louis, MO, USA
| | - Poonam Sonawane
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Joanna Phillips
- University of California, San Francisco, San Francisco, CA, USA
| | - William Weiss
- University of California, San Francisco, San Francisco, CA, USA
| | - Adam Resnick
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Marina Ryzhova
- NN Burdenko Neurosurgical Research Centre, Moskow, Russian Federation
| | | | | | - Mark Kieran
- Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Zhihong Wang
- Children’s Hospital of Richmond, Richmond, VA, USA
| | | | - Mariko Sato
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
| | | | - Stefan Holm
- Karolinska University Hospital, Stockholm, Sweden
| | - Stephen Markham
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pengbo Beck
- Hopp Children’s Cancer Center, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Natalie Jäger
- Hopp Children’s Cancer Center, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alexander Sommerkamp
- Hopp Children’s Cancer Center, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Heidelberg University, Heidelberg, Germany
| | - Stefan Pfister
- Hopp Children’s Cancer Center, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Gutmann
- Washington University School of Medicine, St. Louis, MO, USA
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Baird-Daniel E, Zahedi S, Morin A, Desmarais M, Williams K, Williams R, Vibhakar R, Foreman N, Mulcahy-Levy J. RARE-18. NF1-MUTATED TUMORS EXHIBIT INCREASED SENSITIVITY TO AUTOPHAGY INHIBITION ALONE AND IN COMBINATION WITH MEK INHIBITION. Neuro Oncol 2021. [PMCID: PMC8168095 DOI: 10.1093/neuonc/noab090.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Autophagy inhibition is a potential treatment for central nervous system (CNS) tumors. Autophagy, a heavily regulated process by which cellular waste is transferred to lysosomes for degradation and processing, is an integral part of tumor cell survival under stressful conditions including nutrient deprivation and chemotherapy. While the efficacy of autophagy inhibition has been demonstrated in CNS tumors with BRAFV600e mutations, it has yet to be explored in other CNS tumor types with MAPK pathway dysregulation including NF1-mutated tumors. Many tumors associated with the NF1 phenotype can be difficult to treat surgically thus development of further pharmacologic interventions is necessary.
Methods
A CRISPR/Cas9 mediated NF1 KO was derived from human immortalized Schwann cells and utilized as a tumor model. Autophagy inhibition was achieved pharmacologically by chloroquine (CQ) and genetically via shRNAi of ATG5 and ATG7. Trametinib was used for MEK inhibition. Cell growth and viability were determined by Incucyte, Cell Titer-Glo luminescent assay, and colony-formation assays. Protein expression was measured by western blot.
Results
We demonstrate increased autophagic activity in NF1 KO cell as compared to control lines both at baseline and in response to cellular stress. Furthermore, we describe that NF1 KO cells exhibit increased sensitivity to CQ alone, CQ in combination with trametinib, and shRNAi-mediated autophagy inhibition in combination with trametinib.
Conclusion
Here, we describe increased autophagic dependence of NF1 mutated tumors and demonstrate increased tumor sensitivity to autophagy inhibition both alone and in combination with MEK inhibition. These findings indicate that autophagy inhibition via CQ may be an effective adjunctive treatment for NF1 mutated tumors and suggests that diverse CNS tumor types with MAPK pathway dysregulation are susceptible to autophagy inhibition. Clinical investigation of combined MEK and autophagy inhibition has the potential to improve outcomes for NF1 patients with CNS tumors.
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Affiliation(s)
| | - Shadi Zahedi
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Andrew Morin
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | | | | | | | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Nicholas Foreman
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
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29
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Donson A, Ritzmann T, Willard N, Griesinger A, Amani V, Harris F, Grimaldo E, Sanford B, Riemondy K, Hankinson T, Grundy R, Foreman N. EPEN-11. TUMOR DIFFERENTIATION IMPACTS THE BIOLOGY OF RECURRENCE IN CHILDHOOD POSTERIOR FOSSA EPENDYMOMA. Neuro Oncol 2021. [PMCID: PMC8168184 DOI: 10.1093/neuonc/noab090.061] [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: 11/13/2022] Open
Abstract
Abstract
Ependymoma (EPN) of childhood is curable in only 50% of cases, with recurrences in the remainder that are refractory to treatment. In recent years significant advances have been made in understanding the molecular and cellular biology of EPN. Recent studies show that PFA subgroup EPN are comprised of multiple neoplastic subpopulations that show undifferentiated, differentiated and mesenchymal characteristics. These studies focused on tumor at presentation, with recurrent EPN being less well understood. In the present longitudinal study we examine changes in neoplastic cell heterogeneity in serial presentations of PFA EPN using deconvolution (Cibersort) of bulk RNAseq data. Analysis of a cohort of 48 PFA EPN presenting at Children’s Colorado showed survival and PFA1/PFA2 subtype assignment was associated with the proportion of individual neoplastic subpopulations as determined by deconvolution. Tumors that subsequently regrew had a significantly higher estimated proportion of undifferentiated EPN cells (UEC) at presentation, than those that were non-recurrent after 5 years follow-up. This outcome association potentially age related, as UEC proportions are significantly higher in PFA arising in children < 1 year old who have a particularly poor prognosis. Changes in PFA neoplastic subpopulations at recurrence was performed in two cohorts of patients from Children’s Colorado (n=23) and Nottingham, UK (n=15). As a whole, no subpopulation proportion was significantly changed at recurrence. However, separation of PFA into subtypes PFA1 and PFA2 revealed an increase in the proportion of the cilia-differentiated EPN cell subpopulation is more frequent event in PFA1 (15/24), and rare in PFA2 (2/11). Changes in other neoplastic subpopulations at recurrence were smaller and only seen in PFA1, both UEC and mesenchymal subpopulations being lower at recurrence. In summary, only PFA1 showed dynamic changes in neoplastic subpopulation proportions at recurrence, with potential impacts on transcriptomic based-subgroup assignment, whereas PFA2 proportions remained largely stable.
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Affiliation(s)
- Andrew Donson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Vladimir Amani
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Faith Harris
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bridget Sanford
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kent Riemondy
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Todd Hankinson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard Grundy
- University of Nottingham, Nottingham, Nottinghamshire, UK
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30
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S. Johnson T, Pacholczyk R, Aguilera D, Al-Basheer A, Bajaj M, Berrong Z, Castellino RC, Eaton BR, Esiashvili N, Foreman N, Heger IM, Kennedy EP, Martin W, Ring E, Sadek RF, Smith A, Smith C, Vaizer R, MacDonald TJ, Munn DH. IMMU-04. FIRST-IN-CHILDREN PHASE 1B STUDY USING THE IDO PATHWAY INHIBITOR INDOXIMOD IN COMBINATION WITH RADIATION AND CHEMOTHERAPY FOR CHILDREN WITH NEWLY DIAGNOSED DIPG (NCT02502708, NLG2105). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab090.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diffuse intrinsic pontine glioma (DIPG) is a uniformly fatal brain tumor with no available cure. Indoximod blocks the IDO (indoleamine 2,3-dioxygenase) pathway, thereby reversing IDO-mediated immune suppression in the tumor microenvironment.
Methods
Patients aged 3 to 21 years with treatment-naive DIPG were eligible for this phase 1b dose-confirmation study of indoximod. The treatment regimen comprised continuous oral indoximod (38.4 mg/kg/day divided twice daily) with conformal photon radiation (54 Gy in 30 fractions), followed by cycles of indoximod with temozolomide (200 mg/m2/day, days 1–5 in 28-day cycles).
Results
Thirteen patients (median age 9 years, range 5 to 20 years) with DIPG were treated. Median OS was 14.5 months (follow-up ranged 4.8 to 29.3 months), 12-month OS was 61.5% (8/13), and 18-month OS was 30.8% (4/13), with 1 patient remaining in follow-up at the data cutoff. This compared favorably to expected median OS of approximately 10.8 months, 12-month OS of 45.3%, and 18-month OS of 16.2% taken from published historical data from the Pediatric Brain Tumor Consortium. Two patients showed near-complete responses lasting until relapsing after 7.6 months and 13.3 months of study therapy, respectively. Many patients had increased circulating non-classical monocytes (nc-Monos, CD16+, CD14neg, CD33+, HLA-DR+) within the first 3 treatment cycles, and elevation of this early pharmacodynamic marker was predictive of subsequent OS. Patients with nc-Monos >10% (n=7) had median OS of 19 months, whereas patients with nc-Monos below 10% (n=5) had median OS of 7 months (p=0.0047). No patients stopped therapy for toxicity. The most common indoximod-attributed adverse events were thrombocytopenia, neutropenia, nausea, vomiting, dizziness, and fatigue.
Conclusions
Adding indoximod immunotherapy to conventional radiation and chemotherapy for front-line treatment of pediatric patients with DIPG was well-tolerated. Improved outcomes were observed in patients having evidence of pharmacodynamic response. A follow-on phase 2 study is in progress (NCT04049669).
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Affiliation(s)
- Theodore S. Johnson
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | | | - Dolly Aguilera
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Ahmad Al-Basheer
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Radiation Oncology, Augusta University, Augusta, GA, USA
| | - Manish Bajaj
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Radiology, Augusta University, Augusta, GA, USA
| | - Zuzana Berrong
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Robert C Castellino
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Bree R Eaton
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Natia Esiashvili
- Department of Radiation Oncology and Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Nicholas Foreman
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ian M Heger
- Pediatric Neurosurgery Program, Medical City Children’s Hospital, Dallas, TX, USA
| | - Eugene P Kennedy
- Lumos Pharma (formerly NewLink Genetics Corporation), Ames, IA, USA
| | - William Martin
- Department of Radiation Oncology, Augusta University, Augusta, GA, USA
| | - Eric Ring
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Ramses F Sadek
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Population Health Sciences, Augusta University, Augusta, GA, USA
| | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Chris Smith
- Lumos Pharma (formerly NewLink Genetics Corporation), Ames, IA, USA
| | - Rachel Vaizer
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Tobey J MacDonald
- Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta and Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - David H Munn
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
- Department of Pediatrics, Augusta University, Augusta, GA, USA
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31
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Willard N, Donson A, Ritzmann T, Grundy R, Jackson A, Hankinson T, Griesinger A, Foreman N. EPEN-08. THE TREM1 POSITIVE HYPOXIC MYELOID SUBPOPULATION IN POSTERIOR FOSSA EPENDYMOMA. Neuro Oncol 2021. [PMCID: PMC8168143 DOI: 10.1093/neuonc/noab090.058] [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
We have previously shown the importance of immune factors in posterior fossa ependymoma (PF EPN). Recently, we found eight transcriptionally unique subpopulations of myeloid cells infiltrating PF EPN with one population particularly enriched in PFA1 tumors. This subpopulation, denoted as hypoxia myeloid subpopulation, is defined by genes associated with angiogenesis, hypoxia response, wound healing, cell migration, neutrophil activation, and response to oxygen levels. TREM1 (Triggering receptor expressed on myeloid cells 1) was found to be expressed almost exclusively within this hypoxia myeloid subpopulation. TREM1 encodes for a receptor belonging to the immunoglobulin superfamily that is expressed on myeloid cells, and stimulates neutrophil and monocyte inflammatory responses. However, single-cell RNAseq give little data suggesting location of cells within the tumor microenvironment. We performed immunohistochemistry (IHC) on our bank of ~90 FFPE PFA EPN samples using TREM1 to characterize and identify the location of the hypoxia myeloid cells. The TREM1 positive cells have an ambiguous cytomorphology reminiscent of a monocyte with modest cytoplasm and a mono-lobated nucleus. IHC also showed that TREM1+ myeloid cells are largely localized to the interface of necrosis and viable tissue, most frequently in a perivascular and intravascular distribution. The latter finding suggests that the TREM1+ cells are derived from the bone marrow and that they may be associated with the mesenchymal tumor population (MEC), which we have previously described as being enriched in PFA1 tumors and localizing to perinecrotic zones. This is supported by parallel IHC analysis of subpopulation-specific markers in the same cohort of PFA EPN which showed the highest TREM1 correlation was with CAIX, a marker of MEC. In PFA matched primary/recurrent pairs, the proportion of TREM1+ cells were increased at recurrence in the majority of cases, suggesting an evolving interaction between this TREM1+ hypoxia myeloid subpopulation and neoplastic cells over the disease course.
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Affiliation(s)
- Nicholas Willard
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Hospital, Aurora, CO, USA
| | - Andrew Donson
- Children’s Hospital Colorado, Aurora, CO, USA
- CU Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | - Todd Hankinson
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Hospital, Aurora, CO, USA
| | - Andrea Griesinger
- Children’s Hospital Colorado, Aurora, CO, USA
- CU Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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32
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Donson A, Riemondy K, Venkataraman S, Willard N, Nellan A, Sanford B, Griesinger A, Amani V, Mitra S, Hankinson T, Handler M, Sill M, Ocasio J, Weir S, Malawsky D, Gershon T, Garancher A, Wechsler-Reya R, Hesselberg J, Foreman N, Vibhakar R. EMBR-27. NEOPLASTIC AND IMMUNE SINGLE CELL TRANSCRIPTOMICS DEFINE SUBGROUP-SPECIFIC INTRA-TUMORAL HETEROGENEITY OF CHILDHOOD MEDULLOBLASTOMA. Neuro Oncol 2021. [PMCID: PMC8168088 DOI: 10.1093/neuonc/noab090.044] [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: 11/21/2022] Open
Abstract
Medulloblastoma (MB) is a heterogeneous disease in which neoplastic cells and associated immune cells contribute to disease progression. To better understand cellular heterogeneity in MB we used single-cell RNA sequencing, immunohistochemistry and deconvolution of transcriptomic data to profile neoplastic and immune populations in childhood MB samples and MB genetically engineered mouse models (GEMM). Neoplastic cells clustered primarily according to individual sample of origin which is in part due to the effect of chromosomal copy number gains and losses. Harmony alignment of single cell transcriptomic data revealed novel MB subgroup/subtype-associated subpopulations that recapitulate neurodevelopmental processes and are associated with clinical outcomes. This includes photoreceptor-like cells and glutamatergic lineage unipolar brush cells in both GP3 and GP4 subgroups of MB, and a SHH subgroup nodule-associated neuronally-differentiated cell subpopulation. We definitively chart the spectrum of MB immune cell infiltrates, which reveals unexpected degree of myeloid cell diversity. Myeloid subpopulations include subgroup/subtype-associated developmentally-related neuron-pruning as well as antigen presenting myeloid cells. Human MB cellular diversity is recapitulated in subgroup-specific MB GEMM, supporting the fidelity of these models. These findings provide a clearer understanding of both the neoplastic and immune cell heterogeneity in MB and how these impact subgroup/subtype classification and clinical outcome.
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Affiliation(s)
- Andrew Donson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kent Riemondy
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Anandani Nellan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bridget Sanford
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Vladimir Amani
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Todd Hankinson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Handler
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | - Seth Weir
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Jay Hesselberg
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Rajeev Vibhakar
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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33
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Prince E, Trudeau T, Chatain O, Chee K, Vijmasi T, Staulcup S, Donson A, Foreman N, Hankinson T. RARE-19. NETWORK AND DEEP LEARNING INFERENCE IN SINGLE CELL RNA SEQUENCING REVEAL DETAILED TRANSCRIPTIONAL SIGNATURES CONGRUENT WITH MOLECULAR UNDERSTANDING OF ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2021. [PMCID: PMC8168248 DOI: 10.1093/neuonc/noab090.180] [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: 11/12/2022] Open
Abstract
Adamantinomatous Craniopharyngioma (ACP) is a highly morbid, cellularly heterogeneous pediatric tumor arising in the sellar/suprasellar region of the brain. This cellular heterogeneity makes ACP an ideal candidate for study using single-cell RNA-sequencing (scRNA-seq). We collected a 10,000 cell scRNA-seq dataset on the 10X v3 platform, from 6 unique patients. Using the industry standard Seurat software package, we identified 34 unique cell clusters. By crossing the results of two separate expert curated cellular reference atlases (Azimuth and scHCL), we determined that 33 of these cell types were immune-related (e.g., T cells, monocytes, etc.) or histologically related (e.g., glial cells). The remaining 2,048 cells were inferred to be ACP driver cells. Rigorous statistical testing of third-generation graph topology-based network enrichment methods utilizing the Reactome database supported this conclusion. In order to identify effective antitumor therapies, it is critical to understand the temporal evolution of tumor cell behavior. Computational solutions that describe the potential lifecycle of tumor cells have been derived using scRNA-seq datasets. Using a well-established method, Monocle3, we generated a potential model of temporal evolution of the ACP driver cell population. To identify a specific transcriptional “point-of-no-return” for ACP driver cells, which may help define a rational target for intervention, we created a custom probabilistic Deep Learning framework in the form of a Convolutional Variational Autoencoder (CVAE). By applying this CVAE to our data, we identified 31 anomalous transcripts, each of which was aberrantly active at all times or demonstrated a temporal pattern of anomalous activity. Strikingly, this small list – representing roughly 0.15% of the protein coding genome – aligns closely with extant data describing the molecular behavior of ACP. This work provides a novel transcriptome benchmark for comparison of in vitromodels, a deeper understanding of ACP heterogeneity, as well as a generalizable approach for scRNA-seq analysis.
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Affiliation(s)
- Eric Prince
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tammy Trudeau
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Oscar Chatain
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keanu Chee
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Trinka Vijmasi
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Staulcup
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Donson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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34
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Griesinger A, Riemondy K, Donson A, Willard N, Prince E, Harris F, Amani V, Grimaldo E, Hankinson T, Grundy R, Jackson A, Foreman N, Ritzmann T. EPEN-07. SINGLE-CELL RNA SEQUENCING IDENTIFIES A UNIQUE MYELOID SUBPOPULATION ASSOCIATED WITH MESENCHYMAL TUMOR SUBPOPULATION IN POOR OUTCOME PEDIATRIC EPENDYMOMA. Neuro Oncol 2021. [PMCID: PMC8168243 DOI: 10.1093/neuonc/noab090.057] [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: 11/26/2022] Open
Abstract
We have previously shown immune gene phenotype variations between posterior fossa ependymoma subgroups. PFA1 tumors chronically secrete IL-6, which induces secretion of myeloid cell IL-8 and pushes the infiltrating myeloid cells to an immune suppressive function. In contrast, PFA2 tumors have a more immune activated phenotype associated with a better prognosis. The objective of this study was to use single-cell(sc) RNAseq to descriptively characterize the infiltrating myeloid cells. We analyzed approximately 8500 cells from 21 PFA patient samples. Using advanced machine learning, we identified eight myeloid cell subpopulations with unique gene expression profiles. Interestingly, only one subpopulation was significantly enriched in PFA1 tumors. This subpopulation, denoted as the hypoxia myeloid subpopulation, was defined by genes associated with angiogenesis, response to hypoxia, wound healing, cell migration, neutrophil activation and response to oxygen levels. These myeloid cells also share similar gene expression profile to a mesenchymal tumor subpopulation (MEC) enriched in PFA1 and associated with poor outcome in EPN patients. This tumor subpopulation was the only population expressing IL-6. Using immunohistochemistry, we found the hypoxia myeloid located in regions of tumor necrosis and perivascular niches. The MEC cells were also more abundant in these regions. In an independent single-cell cytokine release assay, we identified eight subpopulations of functional myeloid cells. One subpopulation significantly secreted IL-8, which represented the hypoxia subpopulation based on IL-8 gene expression in the scRNAseq dataset. This data suggests the tumor necrosis resulting in the development of MEC tumor subpopulation is driving the immune suppressive myeloid phenotype in PFA1 tumors through polarization of myeloid cells to the hypoxia subpopulation. Further studies are needed to determine how these myeloid cells interact with the lymphocyte subpopulations and whether they contribute to the progression of PFA1 EPN.
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Affiliation(s)
- Andrea Griesinger
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Andrew Donson
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Nicholas Willard
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Eric Prince
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Faith Harris
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Vladimir Amani
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Enrique Grimaldo
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Todd Hankinson
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | - Nicholas Foreman
- CU Anschutz Medical Campus, Aurora, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
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35
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Kais L, Roesser K, Kleman M, Wilkening G, Liu A, Hankinson T, Foreman N, Hutaff-Lee C. QOL-37. USE OF COMPUTERIZED NEUROPSYCHOLOGICAL MEASURES TO ASSESS COGNITIVE MORBIDITY IN CHILDREN UNDERGOING ACTIVE RADIATION THERAPY. Neuro Oncol 2020. [PMCID: PMC7715818 DOI: 10.1093/neuonc/noaa222.696] [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: 11/12/2022] Open
Abstract
Abstract
Cognitive late effects of brain tumors and related treatments are well-established; however, limited information regarding changes in cognition during radiation therapy (RT) is available. Recent advances in computerized neuropsychological assessments for monitoring of acute and late treatment effects have been developed, though the feasibility of using these tools in a population undergoing active RT has limited empirical evidence. This study investigated performance of pediatric patients with brain tumors actively undergoing RT on the NIH Toolbox (N = 10; M age = 11.29 ± 3.35 years; 86% Caucasian; 86% female). Given significant individual variability, one-sample proportion tests were calculated to assess whether the proportion of patients with performances >1 standard deviation below the mean significantly differed from normative expectations. Of the 12 participants that were enrolled in the study, 10 completed the NIH Toolbox during active RT. Compared to normative expectations, a greater proportion of participants undergoing active RT exhibited deficits on measures of processing speed, working memory, and response inhibition (p=<.01). Differences between participants and normative expectations were not seen on measures of visual memory and vocabulary (p=>.05). Seventy-seven percent of recruited participants completed computerized assessment during active RT, suggesting reasonable feasibility within the small cohort recruited. Consistent with the literature regarding late effects of RT, performance on computerized measures of cognitive functioning mediated by processing speed and aspects of executive functioning were lower for patients undergoing active RT. Further investigation will focus on clarifying the trajectory of deficits across treatment course and comparing computerized measures to traditional neuropsychological measures.
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Affiliation(s)
- Lorri Kais
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Greta Wilkening
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Liu
- UCHealth, Fort Collins, CO, USA
- University of Colorado, Aurora, CO, USA
| | - Todd Hankinson
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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36
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Nellan A, Donson A, Calhoun J, Griesinger A, Fry T, Foreman N. IMMU-20. EVALUATION OF CAR T CELLS IN EPENDYMOMA. Neuro Oncol 2020. [PMCID: PMC7715269 DOI: 10.1093/neuonc/noaa222.376] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Ependymoma is the third most common pediatric brain tumor and current treatment still results in a 10-year relapse rate of over 70% in the highest risk groups. The treatment refractory nature of ependymoma to standard therapies strongly supports the development of novel interventions. Ependymoma tumor cells express HER2 and there are active clinical trials treating children with ependymoma using local delivery of second-generation HER2 CAR T cells.
METHODS
Two high-risk patient-derived ependymoma cell lines, MAF811 and MAF928, that display HER2 surface expression are used for testing. We tested second-generation HER2-BBz CAR T cells in vitro and in vivo.
RESULTS
HER2 CAR T cells effectively kill ependymoma tumor cells in culture, but this strategy cannot eradicate the same tumor cells in mice when implanted in the fourth ventricle of the brain. HER2 CAR T cells proliferate and traffic into the tumor, but this causes a dramatic influx of immune cells, tumor swelling and lethal toxicity in a subset of mice. Mice that survive this initial tumor swelling, display significant tumor shrinkage but all tumors eventually start growing again. Ependymoma tumor cells release high amounts of inflammatory chemokines that strongly attract neutrophils and monocytes to the tumor, compared to other brain tumors, and can downregulate HER2 expression to escape recognition by CAR T cells.
CONCLUSION
The immunosuppressive microenvironment as well as tumor heterogeneity make HER2 CAR T cells ineffective in ependymoma. Studying these two hurdles in CAR T cell therapy is critical to effectively treat brain tumors with CAR T cells.
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Affiliation(s)
| | | | | | | | - Terry Fry
- University of Colorado, Denver, CO, USA
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Serkova N, Stukova M, Henehan S, Steiner J, Pierce A, Griesinger A, Veo B, Alimova I, Venkataraman S, Green A, Dahl N, Foreman N, Vibhakar R. IMG-17. RADIOMICS CHARACTERIZATION OF FOUR PEDIATRIC BRAIN TUMOR SUBTYPES IN PDX MOUSE MODELS. Neuro Oncol 2020. [PMCID: PMC7715626 DOI: 10.1093/neuonc/noaa222.352] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Previously, we have reported on the development of advanced magnetic resonance imaging (MRI) protocols for mouse brain tumors. The goal of this follow-up pre-clinical study was to develop a machine-learning MRI classifier (radiomics) for four subtypes of childhood brain tumor in patient-derived xenograft (PDX) mice.
METHODS
MRI scans on orthotopic medulloblastoma, ependymoma, ATRT and DIPG PDX (each n=12 animals) were performed on the animal 9.4 Tesla scanner with an in-plane resolution of 47 microns. Image segmentation, as well as shape and texture based radiomics descriptors were modeled using a modified COLIAGE software for tumor classification and to characterize tumor habitat of each tumor subtype.
RESULTS
The mean tumor volumes were 11.2 mm3. Each MRI scan was segmented into three regions: (i) well defined tumor (including distant metastases); (ii) peritumoral edema; (iii) tumor necrosis. 360 radiomics features (capturing co-occurrence, grey-level dependence and directional gradients) were obtained for each region. The model classified four subtypes with high accuracy while achieving sufficient segmentation accuracy despite the small lesion size. A subset of fourteen tumoral, six peritumoral and five distant MRI radiomics features were found to be predictive of the tumor sub-type (p=0.0017) independently of tumor anatomical location.
CONCLUSIONS
MRI protocols followed by radiomics feature analysis discriminated among specific radiological features for four distinct orthotopic PDX models: medulloblastomas exhibit low ADC values, high angiogenesis and cortical metastases as compared to ependymomas (high levels of edema and olfactory bulb metastases), ATRT (the highest level of necrosis) and DIPG (highest T2 signal intensities and spinal metastases).
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Affiliation(s)
- Natalie Serkova
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marina Stukova
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Samuel Henehan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenna Steiner
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela Pierce
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bethany Veo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Irina Alimova
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Adam Green
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathan Dahl
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Rajeev Vibhakar
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Dorris K, Channell J, Mettetal A, Hemenway M, Briones N, Tran A, Griesinger A, Donson A, Vibhakar R, Green A, Nellan A, Levy JM, Ambruso D, Foreman N. QOL-36. USE OF CANNABINOIDS IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM TUMOR POPULATION. Neuro Oncol 2020. [PMCID: PMC7715372 DOI: 10.1093/neuonc/noaa222.695] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Cannabinoids, including cannabidiol (CBD) and tetrahydrocannabinol (THC), are a class of compounds found in marijuana. Numerous studies in adults have examined cannabinoid use in management of cancer-related symptoms such as nausea, anorexia, and pain. Less is known about the use in the pediatric oncology population.
METHODS
A prospective observational study has been ongoing since 2016 at Children’s Hospital Colorado to evaluate cannabinoids’ impact using PedsQL™ modules on quality of life of pediatric patients with central nervous system (CNS) tumors who are 2–18 years old. Laboratory assessments of T-cell activity and pharmacokinetics of CBD, THC and associated metabolites are in process. Diaries with exploratory information on cannabinoid use patterns are being collected.
RESULTS
Thirty-three patients (14:19; male:female) have been enrolled with a median age of 6.4 years (range, 2.9–17.7 years). The most common tumor type in enrolled patients is embryonal tumors (13/33; 39%). Nine (27%) patients have low-grade glial/glioneuronal tumors, and eight (24%) had high-grade/diffuse midline gliomas. The remaining patients had ependymoma or craniopharyngioma. The median time on cannabinoids is 9 months. Most (n=20) patients have used oral products with CBD and THC. One patient continues on cannabinoid therapy in follow up. Preliminary immune function analyses identified impaired neutrophil superoxide anion production and chemotaxis in patients taking cannabinoids at early time points on therapy.
CONCLUSIONS
Families of children with various CNS tumors are pursuing cannabinoid therapy for both antitumor and supportive care purposes. Analysis of the impact of cannabinoids on patients’ quality of life is ongoing.
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Affiliation(s)
- Kathleen Dorris
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | | | | | - Molly Hemenway
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | | | | | - Andrea Griesinger
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Andrew Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Rajeev Vibhakar
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Adam Green
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Anandani Nellan
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Jean Mulcahy Levy
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Daniel Ambruso
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
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Nguyen T, McMahon K, Hemenway M, Levy JM, Foreman N, Dorris K. LGG-27. TARGETED THERAPY FOR PEDIATRIC LOW-GRADE GLIOMAS AND PLEXIFORM NEUROFIBROMAS WITH TRAMETINIB. Neuro Oncol 2020. [PMCID: PMC7715454 DOI: 10.1093/neuonc/noaa222.409] [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
BACKGROUND
Targeted therapy aimed at modulating the RAS/RAF/MEK/ERK pathway is of increasing interest for patients with plexiform neurofibromas and low-grade gliomas. Trametinib is an FDA-approved MEK inhibitor that has little published pediatric experience to date.
METHODS
A retrospective chart review of patients treated with trametinib for low-grade gliomas (LGG) and/or plexiform neurofibromas (PN) between 2015–2018 was conducted at Children’s Hospital Colorado. Data collected included patient demographics, lesion location, Neurofibromatosis type 1 (NF1) status, best response of PN/LGG to trametinib, duration of trametinib therapy, and reported toxicities at least possibly attributed to trametinib.
RESULTS
Thirty (57% male; 73% NF1) patients were identified. Sixteen (53%) patients had PN only, 12 (40%) had LGG only, and two (7%) patients had both PN and LGG. The most common LGG location was the optic pathway/hypothalamus (72%). The most common location of PN was the face (63%). Two-thirds (8/12) of patients with LGG had a BRAF alteration or NF1 mutation. The median age at start of trametinib therapy was 9.9 years (range, 2.0 – 18.8 years). The median duration of trametinib therapy was 0.8 years (range 0.1 – 2.9 years). The most commonly reported adverse event was rash. No patients developed retinal toxicity or cardiotoxicity. Only two (7%) patients discontinued for toxicity and one (3%) for progressive disease.
CONCLUSIONS
Trametinib can be administered without significant toxicity to children with PN or LGG. Clinical benefit is noted in this cohort; however, prospective clinical trials are necessary to characterize efficacy formally.
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Affiliation(s)
- Tiffany Nguyen
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Molly Hemenway
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Jean Mulcahy Levy
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Kathleen Dorris
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
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40
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Hemenway M, Nellan A, McMahon K, Foreman N, Reddy K, Nellan A, Suttman A. NFB-02. TREATMENT OF PAIN AND TUMOR GROWTH IN NF2. Neuro Oncol 2020. [PMCID: PMC7715678 DOI: 10.1093/neuonc/noaa222.606] [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: 12/02/2022] Open
Abstract
BACKGROUND Neurofibromatosis Type 2 (NF2) is an autosomal dominant disorder characterized by multiple nervous system tumors. Chronic pain affects the majority of patients with NF2 and is the primary factor that contributes to decreased quality of life. There are limited therapies that effectively reduce pain in NF2, but intravenous (IV) bevacizumab has been reported to provide significant relief to patients suffering from debilitating pain. CASE STUDY James is a 24-year-old who initially presented with manifestations of NF2 at age 10, and by 15 years old had developed daily pain affecting his neck, back, and lower extremity. He has multiple CNS schwannomas, meningiomas, neurofibromas, and meets clinical NF2 criteria. While genetic testing did not reveal a mutation in his gDNA, low level skipping of exon 4 via RNA supports (likely mosaic) NF2. James’s pain was poorly controlled with multiple oral medications, including opioids. James started IV bevacizumab at age 16 that improved his pain. He was critically dependent on bevacizumab for pain control and required continuous IV pain medication when bevacizumab was held for a surgical procedure. Following five years of bevacizumab he developed worsening toxicities including hypertension, proteinuria, and elevated hemoglobin. James transitioned to therapy with trametinib, a MEK inhibitor, and was able to wean off bevacizumab six months later. Treatment of NF2 related pain with trametinib instead of bevacizumab has improved his QOL with decreased medical visits, improved pain management, and decreased side effects. FUTURE IMPLICATIONS: Treatment of NF2 tumor related pain can be managed with MEK inhibitors.
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Affiliation(s)
- Molly Hemenway
- Univ of CO, Children’s Hospital Colorado, Aurora, CO, USA
| | - Anan Nellan
- Univ of CO, Children’s Hospital Colorado, Aurora, CO, USA
| | - Kate McMahon
- Univ of CO, Children’s Hospital Colorado, Aurora, CO, USA
| | | | - Kartik Reddy
- Univ of CO, Children’s Hospital Colorado, Aurora, CO, USA
| | - Anan Nellan
- Univ of CO, Children’s Hospital Colorado, Aurora, CO, USA
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41
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Sabus A, Winzent S, Hemenway M, Levy JM, Foreman N. DDEL-06. DRUG INTERACTION BETWEEN EVEROLIMUS AND CANNABIDIOL IN PEDIATRIC PATIENTS WITH SUBEPENDYMAL GIANT CELL ASTROCYTOMAS: A SINGLE INSTITUTION EXPERIENCE. Neuro Oncol 2020. [PMCID: PMC7715614 DOI: 10.1093/neuonc/noaa222.041] [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: 11/12/2022] Open
Abstract
Abstract
Tuberous sclerosis complex (TSC) is an autosomal recessive genetic disorder associated with clinical manifestations including subependymal giant cell astrocytomas (SEGA) and seizures. The combination of everolimus and Epidiolex, a purified form of cannabidiol, has become an increasingly common treatment regimen in this population. Everolimus is primarily metabolized via CYP3A4, which may be inhibited by cannabidiol. We seek to describe our institution’s experience with this drug interaction. METHODS: Investigators conducted a retrospective review of neuro-oncology patients with TSC and SEGA who were treated concurrently with everolimus and cannabidiol. Data collected included demographics, body surface area, everolimus dose, everolimus troughs, date of cannabidiol initiation, documented symptoms, liver and renal function tests, and reason for discontinuing therapy. RESULTS: Three patients (ages 11–17 years) met inclusion criteria. All patients were stable on everolimus doses ranging from 6.5 to 9.5 mg/m2/day and achieving trough goals of 5–10 ng/mL. Two to four weeks after initiating cannabidiol, everolimus trough concentrations rose 200–860% above goal. One patient reported new-onset involuntary movements, but no other toxicities were noted. Cannabidiol was discontinued in all cases due to caregiver concerns regarding drug interactions. All patients were able to achieve goal trough concentrations on previously stable doses of everolimus after discontinuing cannabidiol. CONCLUSIONS: Cannabidiol appears to modulate everolimus metabolism leading to significantly elevated serum concentrations. Additional research is required to determine the need for empiric dose adjustments upon cannabidiol initiation. Patient counseling, frequent trough monitoring, and surveillance for adverse effects are crucial for optimizing outcomes in patients prescribed this regimen.
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Affiliation(s)
| | - Shelby Winzent
- University of Colorado, Denver, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Molly Hemenway
- University of Colorado, Denver, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Jean Mulcahy Levy
- University of Colorado, Denver, CO, USA
- Children’s Hospital Colorado, Aurora, CO, USA
| | - Nicholas Foreman
- University of Colorado, Denver, CO, USA
- Children’s Hospital Colorado, Denver, CO, USA
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Prince E, Vijmasi T, McWilliams J, Hengartner A, Staulcup S, Foreman N, Jordan K, Dorris K, Hoffman L, Hankinson T. RARE-10. ADAMANTINOMATOUS CRANIOPHARYNGIOMA RESIDES OUTSIDE THE BLOOD BRAIN BARRIER. Neuro Oncol 2020. [PMCID: PMC7715731 DOI: 10.1093/neuonc/noaa222.721] [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
BACKGROUND Adamantinomatous craniopharyngioma (ACP) is a devastating skull-base tumor believed to derive from epithelial remnants of the primordial craniopharyngeal duct (Rathke’s pouch), which gives rise to the anterior pituitary gland. Genetically engineered mouse models of ACP demonstrate that perturbation of the fetal anterior pituitary can generate tumors analogous to ACP. Clinical and preclinical data indicate that IL-6 blockade may contribute to ACP tumor control, with the most common agent being the humanized monoclonal antibody, tocilizumab. This agent demonstrated poor blood-brain barrier (BBB) penetration in primates. We present findings from two children enrolled on a phase 0 clinical trial (NCT03970226) of a single dose of preoperative intravenous tocilizumab prior to resection of newly diagnosed ACP. METHODS Blood samples were obtained at multiple timepoints. Serum was isolated via ficoll separation. Tumor tissue and cyst fluid were obtained 4–6 hours following the single IV dose of tocilizumab. Tissue was snap-frozen. Tumor was homogenized in RIPA buffer. Free tocilizumab in serum, cyst fluid, and tumor tissue was measured using enzyme-linked immunosorbent assay (ELISA) against a standard curve. RESULTS Both patients in this trial demonstrated clinically relevant levels of tocilizumab (≥ 4µg/mL) in serum, cyst fluid, and tumor tissue, compared to undetectable levels in control samples. CONCLUSION ACP resides outside BBB protection. In addition to demonstrating the feasibility of systemic delivery of tocilizumab, these findings indicate that other large molecules, including those known to have poor BBB penetration, may be systemically delivered as part of an antitumor regimen in the treatment of ACP.
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Affiliation(s)
- Eric Prince
- Children’s Hospital Colorado, Aurora, CO, USA
| | | | | | | | | | | | - Kimberly Jordan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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43
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Vijmasi T, Prince E, Hengartner A, Staulcup S, Griesinger A, Donson A, Gilani A, Foreman N, Hankinson T. MODL-24. AN ORGANOTYPIC CHUNK CULTURE TECHNIQUE TO STUDY DISEASE MECHANISM AND DEVELOP TARGETED THERAPEUTICS FOR PEDIATRIC ADAMANTINOMATOUS CRANIOPHARYNGIOMA. Neuro Oncol 2020. [PMCID: PMC7715791 DOI: 10.1093/neuonc/noaa222.597] [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
BACKGROUND
Advances in the treatment of Adamantinomatous Craniopharyngioma (ACP) face challenges with translation to clinical study due to the absence of robust culture models of the disease. We developed a technique for culturing human ACP tissue in an organotypic chunk culture format that retains the tumor microenvironment for a duration sufficient to evaluate potential targeted therapeutics.
METHODS
Intraoperatively collected tumor tissue from pediatric ACP was cut into volumes of approximately 3 mm3 and rested over a semi-permeable insert placed in the wells of a 6-well plate. Specimens were cultured in (1) Control media, media containing (2) Tocilizumab, (3) Trametinib, and (4) combination of Tocilizumab and Trametinib, for 24 and 96 hours. Specimens were harvested for paraffin embedding, protein and gene expression assays. Supernatants were collected to assay secreted components. Paraffin embedded specimens were sectioned and stained for H&E, Pan-CK, Beta-Catenin, cleaved Caspase-3, Ki-67, and Phospho-ERK.
RESULTS
H&E staining revealed characteristic histologic features of ACP with epithelial cells with palisading nuclei, wet keratin and ghost cells. Tumor sections were markedly positive for epithelial cell markers, Pan-CK and Beta-Catenin. Ki-67 and cleaved Caspase-3 were restricted to a small fraction of cells, indicating low index of proliferation and apoptosis under the culture conditions. The response to drug treatments shall be determined using gene expression assays and evaluation of the secreted components.
CONCLUSION
The organotypic chunk culture technique appears to maintain the viability and integrity of ACP tumors for several days and may serve as an appropriate model for pre-clinical studies to develop targeted therapeutics for pediatric ACP.
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Affiliation(s)
- Trinka Vijmasi
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eric Prince
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Astrid Hengartner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Susan Staulcup
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, USA
| | - Andrea Griesinger
- Deparment of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Andrew Donson
- Deparment of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ahmed Gilani
- Department of Pathology, Children’s Hospital Colorado, Aurora, CO, USA
| | - Nicholas Foreman
- Deparment of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Todd Hankinson
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, USA
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Lucas J, DeSisto J, Xu K, Donson A, Lin T, Sanford B, Wu G, Tran Q, Hedges D, Hsu CY, Armstrong G, Arnold M, Bhatia S, Flannery P, Lemma R, Hardie L, Schuller U, Hoffman L, Dorris K, Levy J, Hankinson T, Handler M, Liu A, Foreman N, Vibhakar R, Jones K, Allen S, Zhang J, Baker S, Merchant T, Orr B, Green A. HGG-57. WHOLE-GENOME SEQUENCING, METHYLATION ANALYSIS, AND SINGLE-CELL RNA-SEQ DEFINE UNIQUE CHARACTERISTICS OF PEDIATRIC TREATMENT-INDUCED HIGH-GRADE GLIOMA AND SUGGEST ONCOGENIC MECHANISMS. Neuro Oncol 2020. [PMCID: PMC7715357 DOI: 10.1093/neuonc/noaa222.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric treatment-induced high-grade glioma (TIHGG) is among the most severe late effects observed in childhood cancer survivors and is uniformly fatal. We previously showed that TIHGG are divergent from de novo pediatric high-grade glioma (pHGG) and cluster into two gene expression subgroups, one stemlike and the other inflammatory. Here we systematically compared TIHGG molecular profiles to pHGG and evaluated expression and single cell sequencing profiles in order to identify oncogenic mechanisms and the cellular basis for the observed TIHGG gene expression subgroups. MATERIALS/ METHODS 450/850K methylation and mutational signature analysis was conducted in 36 TIHGG samples. Resultant data were analyzed for the presence of chromothripsis, distinct molecular alterations, and mutational signatures in a subset of 10 samples with whole genome sequencing data. Five TIHGGs underwent single-cell RNA-Seq analysis (scRNAseq). RESULTS 26/36 TIHGG clustered with the pedRTK1 methylation class. TIHGG were characterized by an increased frequency of chromothripsis relative to pHGG (67% vs. 31%, p=0.036). FISH and WGS revealed frequent PDGFRA amplification secondary to enrichment in ecDNA. TIHGG were enriched for COSMIC mutational signatures 5 and 19 (p=0.0003) relative to pHGG. scRNAseq data showed that TIHGG tumors are composed of stem-like, neuronal, and inflammatory cell populations which may contribute to the previously described dominant expression profiles. CONCLUSIONS TIHGG represents a distinct molecular subtype of pHGG. Chromothripsis, leading to enriched expression of genes in extrachromosomal DNA, likely contribute to TIHGG oncogenesis. The dominant cell type (stem-like vs. inflammatory) may define the expression subgroup derived from bulk RNA-seq in heterogeneous tumors.
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Affiliation(s)
- John Lucas
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - John DeSisto
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Ke Xu
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew Donson
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Tong Lin
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Gang Wu
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Quynh Tran
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Dale Hedges
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Chih-Yang Hsu
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory Armstrong
- St. Jude Children’s Research Hospital, Memphis, TN, USA
- Childhood Cancer Survivor Study, Memphis, TN, USA
| | | | - Smita Bhatia
- University of Alabama, Birmingham, AL, USA
- Childhood Cancer Survivor Study, Memphis, TN, USA
| | | | - Rakeb Lemma
- Childhood Cancer Survivor Study, Memphis, TN, USA
| | | | | | | | | | - Jean Levy
- Childhood Cancer Survivor Study, Memphis, TN, USA
| | | | | | - Arthur Liu
- Childhood Cancer Survivor Study, Memphis, TN, USA
| | | | | | | | - Sariah Allen
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Jinghui Zhang
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Suzanne Baker
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Brent Orr
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Adam Green
- Childhood Cancer Survivor Study, Memphis, TN, USA
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45
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Griesinger A, Harris F, Donson A, Gillen A, Riemondy K, Venkataraman S, Amani V, Handler M, Hankinson T, Foreman N. EPEN-26. NON-CANONICAL NF-κB SIGNALING DRIVES MESENCHYMAL EPENDYMAL CELL SUBPOPULATION IN PFA EPENDYMOMA. Neuro Oncol 2020. [PMCID: PMC7715852 DOI: 10.1093/neuonc/noaa222.163] [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: 12/02/2022] Open
Abstract
NF-κB signaling is a hallmark of PFA1 ependymoma. Loss of LDOC1, through epigenetic silencing, leads to constitutively active NF-κB signaling and chronic IL-6 secretion. In this study, we investigate the loss of LDOC1 within the PFA tumor clusters. Using our PFA scRNAseq database, in which there are 5 clusters within the tumor cell compartment: mesenchymal (MEC), ciliated (CEC), transportive (TEC), and undifferentiated (UEC). LDOC1 expression was significantly reduced and had an inverse correlation with genes defining the unfavorable MEC subpopulation, predominate in PFA1. This is consistent with our findings that MEC was defined by an NF-κB2 signaling profile. In contrast, LDOC1 expression was higher and positively correlated with genes defining the favorable CEC subpopulation, mostly seen in PFA2. RELA expression, which we studied as a target of LDOC1, was not localized to MEC and was wide-spread throughout the PFA compartment. RELB, part of non-conical NF-κB signaling, was expressed only the MEC subpopulation correlating with IL-6 gene expression found only in this subpopulation. In MAF-811, a PFA cell line with more CEC-like gene phenotype, RELB co-immunoprecipates with the active form of NF-κB2 in both the nucleus and cytoplasm. IL-6 gene expression is almost completely lost when NF-κB2 is knock-down using shRNA. Additionally, loss of LDOC1 leads to over 3 fold increase in NF-κB2 expression. Combined with our previous work, this would suggest that NF-κB2 drives IL-6 expression by binding with RELB in MEC subpopulation and targeting loss of LDOC1 may shift the MEC subpopulation toward the more favorable CEC subpopulation.
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Affiliation(s)
- Andrea Griesinger
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Faith Harris
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Andrew Donson
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Austin Gillen
- RNA Biosciences Initiative, University of Colorado, Aurora, CO, USA
| | - Kent Riemondy
- RNA Biosciences Initiative, University of Colorado, Aurora, CO, USA
| | - Sujatha Venkataraman
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Vladimir Amani
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Michael Handler
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Todd Hankinson
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Nicholas Foreman
- The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics-Hematology and Oncology, University of Colorado Anschutz, Aurora, CO, USA
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Dorris K, Widener M, Amani V, Donson A, Schissel D, Carson J, Mettetal A, Ramirez D, Gustafson D, Hankinson T, Handler M, Macy M, Foreman N. EPCT-18. PHASE 0/I STUDY OF GM-CSF AND INTRATHECAL TRASTUZUMAB IN CHILDREN WITH RECURRENT POSTERIOR FOSSA EPENDYMOMA. Neuro Oncol 2020. [PMCID: PMC7715093 DOI: 10.1093/neuonc/noaa222.140] [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: 11/25/2022] Open
Abstract
BACKGROUND Posterior fossa ependymoma (PF EPN) is a pediatric central nervous system malignancy that has a poor outcome to standard therapeutic approaches. The majority of PF EPN tumors have increased HER2 expression. Trastuzumab is a monoclonal antibody that targets HER2, and sargramostim (GM-CSF) stimulates hematopoietic progenitor cell proliferation. The combination of trastuzumab and GM-CSF has been shown to trigger antibody-dependent cell cytotoxicity in vitro in PF EPN cell lines. METHODS Children aged 1–21 years with relapsed PF EPN and no ventriculoperitoneal shunt or CSF obstruction are eligible for the Phase 0/I institutional trial at Children’s Hospital Colorado. Stratum 1 involves IT trastuzumab and subcutaneous (subQ) GM-CSF prior to standard-of-care surgical resection. Stratum 2 involves a 3 + 3 phase I design with serial IT trastuzumab doses, each preceded by three days of GM-CSF, to establish the MTD for IT trastuzumab. RESULTS Trastuzumab was detected in a sufficient number of tumors after presurgical IT delivery in Stratum 1 to open Stratum 2. Four patients (75% female) have been enrolled in Stratum 2 at trastuzumab Dose Level 1. Median age at enrollment is 9.8 years (range, 3.5–20.2 years). Preliminary CSF pharmacokinetic analysis demonstrated detectable trastuzumab up to 14 days after IT doses. No dose-limiting toxicities have occurred. Two patients progressed on therapy (median, 4 cycles). One patient is progression-free at 18 months off therapy. One patient remains on study therapy. CONCLUSIONS IT trastuzumab penetrates PF EPN tumor tissue. Stratum 2 remains open to accrual at Dose Level 2.
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Affiliation(s)
- Kathleen Dorris
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Melissa Widener
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Vladimir Amani
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Andrew Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | | | | | | | - Dominique Ramirez
- Flint Animal Cancer Center, Colorado State University, Fort Collins, CO, USA
| | - Daniel Gustafson
- Flint Animal Cancer Center, Colorado State University, Fort Collins, CO, USA
| | - Todd Hankinson
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Michael Handler
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Margaret Macy
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, CO, USA
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Hemenway M, Nellan A, Foreman N, Suttman A, Schneider K. RARE-27. DOUBLE MUTATIONS: DIFFERENT GERMLINE AND TUMOR MUTATIONS LEAD TO POOR OUTCOMES. Neuro Oncol 2020. [PMCID: PMC7715213 DOI: 10.1093/neuonc/noaa222.738] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
As genetic testing for both germline and tumor mutations has increased in completeness, complexity, and availability, more mutations and their impact on patient outcomes have been identified.
METHODS
A retrospective review of pediatric patients who have identified germline mutations and a different tumor mutation was conducted. Data collected included demographics, tumor type, germline mutation status, tumor mutation status, relapse status, and patient outcome.
RESULTS
Six patients aged 8–13 years old (median age 10 years) were identified for analysis. Four patients had pilocytic astrocytoma and two had pilomyxoid astrocytoma. One of the patients with pilocytic astrocytoma also had MPNST diagnosed very early at age 9. The combination of germline/tumor mutations is as follows: Neurofibromatosis Type I (NF1)/BRAF v600e, NF1, CHEK2/MYB-QKI, NF1, Klinefelter, ATM, MUTYH, GPC3/BRAF-KIAA fusion, NF1/BRAF-KIAA (2 patients), and Marfan’s/BRAF-KIAA. The number of relapses per patient following initial diagnosis range from 3–7 with an average of 3.3. Four of the patients are alive and on therapy, which two are deceased. The two deceased patients both had NF1/BRAF-KIAA fusions and pilocytic astrocytomas.
CONCLUSIONS
Patients with differing and compounded germline and tumor molecular genetic mutations have worse outcomes. These patients have more relapses and death when compared to those patients with one mutation, either germline or tumor. Broad molecular testing and germline testing for mutations is crucial in determining patient risk for poor outcomes.
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Affiliation(s)
- Molly Hemenway
- Univ of Colorado, SOM, Children’s Hospital Colorado, Aurora, CO, USA
| | - Anan Nellan
- Univ of Colorado, SOM, Children’s Hospital Colorado, Aurora, CO, USA
| | - Nicholas Foreman
- Univ of Colorado, SOM, Children’s Hospital Colorado, Aurora, CO, USA
| | - Alexandra Suttman
- Univ of Colorado, SOM, Children’s Hospital Colorado, Aurora, CO, USA
| | - Kami Schneider
- Univ of Colorado, SOM, Children’s Hospital Colorado, Aurora, CO, USA
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Ritzmann T, Lourdusamy A, Jackson A, Storer L, Donson A, Griesinger A, Foreman N, Rogers H, Grundy R. EPEN-23. A COMPUTATIONAL ANALYSIS OF THE TUMOUR IMMUNE MICROENVIRONMENT IN PAEDIATRIC EPENDYMOMA. Neuro Oncol 2020. [PMCID: PMC7715220 DOI: 10.1093/neuonc/noaa222.160] [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: 11/12/2022] Open
Abstract
Abstract
Ependymoma is the third commonest childhood brain tumour. Relapse is frequent, often fatal and current therapeutic strategies are inadequate. Previous ependymoma research describes an immunosuppressive environment with T-cell exhaustion, indicating a lack of response to T-cell directed immunotherapy. Understanding the immune microenvironment is therefore critical. We present a computational analysis of ependymoma, gene expression derived, immune profiles. Using 465 ependymoma samples from gene expression datasets (GSE64415, GSE50385, GSE100240) and two RNA-seq databases from UK ependymomas, we applied bulk tumour deconvolution methods (CIBERSORT and xCell) to infer immune cell populations. Additionally, we measured checkpoint blockade related mRNAs and used immunohistochemistry to investigate cell populations in ependymoma sections. CIBERSORT indicated high proportions of M2-like macrophages and smaller proportions of activated natural killer (NK) cells, T follicular helper cells, CD4+ memory T-cells and B-cells. xCell overlapped with the M2-like macrophage and CD4+ memory T-cell signatures seen in CIBERSORT. On immunohistochemistry, T and B cells were scarce, with small numbers of CD8+, CD4+ and CD20+ cells in the parenchyma but greater numbers in surrounding regions. CD68 was more highly expressed in the parenchyma. Analysis of nine checkpoint ligands and receptors demonstrated only the TIM3/GAL9 combination was reliably detectable. GAL9 is implicated in tumour interactions with T-cells and macrophages elsewhere, possibly contributing to poorer outcomes. Our study supports the presence of myeloid cells being leading contributors to the ependymoma immune microenvironment. Further work will delineate the extent of myeloid contribution to immunosuppression across molecular subtypes. Modulation of tumour immunity may contribute to better clinical outcomes.
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Affiliation(s)
- Timothy Ritzmann
- The Children’s Brain Tumour Research Centre, Nottingham, United Kingdom
| | | | - Andrew Jackson
- Host Tumour Interactions Group, University of Nottingham, Nottingham, United Kingdom
| | - Lisa Storer
- The Children’s Brain Tumour Research Centre, Nottingham, United Kingdom
| | - Andrew Donson
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea Griesinger
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hazel Rogers
- The Children’s Brain Tumour Research Centre, Nottingham, United Kingdom
| | - Richard Grundy
- The Children’s Brain Tumour Research Centre, Nottingham, United Kingdom
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49
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Dickson D, Channell J, Mettetal A, Chick E, Wilkening G, Liu A, Hankinson T, Foreman N, Hutaff-Lee C. QOL-38. USE OF COMPUTERIZED NEUROPSYCHOLOGICAL MEASURES TO ASSESS COGNITIVE MORBIDITY IN SURVIVORS OF CHILDHOOD BRAIN TUMORS. Neuro Oncol 2020. [PMCID: PMC7715277 DOI: 10.1093/neuonc/noaa222.697] [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: 11/25/2022] Open
Abstract
Treatment of central nervous system (CNS) tumors in pediatric populations is associated with significant cognitive morbidity. Documentation of neuropsychological deficits is vital to treatment and educational planning. We investigated the feasibility and utility of a computerized neuropsychological measure (NIH Toolbox Cognitive Battery) in differentiating individuals who received tumor treatment from healthy controls. Participants included pediatric CNS tumor survivors (N = 85; Mean Age = 13.47; SD = 4.76) at least 1-year post-completion of treatment and healthy sibling controls (N = 20; Mean Age = 10.2; SD = 3.21) who completed the NIH Toolbox. Ninety-eight percent of the participants enrolled completed the computerized tasks. The overall logistical regression model, with NIH Toolbox tests as predictors, was statistically significant [χ2 (7, N = 105) = 26.176; p < .001] and improved correct group classification from 81% to 82.9%. Picture Sequencing (β = -0.059; Wald = 6.942; p = .008) and Flanker (β = -0.083; Wald = 7.473; p = .006) were both statistically significant and negatively predictive of membership in the treatment group. For each 1 unit increase in standard score on measures of working memory and inhibition, odds of membership in the treatment group decreased by 6.2% and 8.7%, respectively. Consistent with the literature, worse performance on computerized measures of cognitive functioning mediated by executive functioning was correlated with a history of brain tumor treatment. Further investigation will focus on comparing computerized neuropsychological tools to traditional comprehensive neuropsychological evaluations and clarifying the trajectory of these deficits across recovery.
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Affiliation(s)
| | | | | | | | - Greta Wilkening
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Liu
- UCHealth, Fort Collins, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Todd Hankinson
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas Foreman
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Dahl N, Danis E, Balakrishnan I, Wang D, Pierce A, Walker F, Gilani A, Serkova N, Madhaven K, Fosmire S, Green A, Foreman N, Venkataraman S, Vibhakar R. DIPG-34. SUPER ELONGATION COMPLEX AS A TARGETABLE DEPENDENCY IN H3K27M+ DIFFUSE MIDLINE GLIOMA. Neuro Oncol 2020. [PMCID: PMC7715266 DOI: 10.1093/neuonc/noaa222.082] [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: 11/13/2022] Open
Abstract
Abstract
Mutations in the histone 3 gene (H3K27M) are the eponymous driver in diffuse intrinsic pontine gliomas (DIPGs) and other diffuse midline gliomas (DMGs), aggressive pediatric brain tumors for which no curative therapy currently exists. To identify specific epigenetic dependencies within the context of the H3K27M mutation, we performed an shRNA screen targeting 408 genes classified as epigenetic/chromatin-associated molecules in patient-derived DMG cultures. This identified AFF4, a component of the super elongation complex (SEC), as necessary for DMG cells to maintain growth and self-renewal. We hypothesized that aberrant SEC expression occurs as a consequence of the H3K27M mutation and that this dysregulated SEC signaling overcomes repressive transcriptional regulation in order to suppresses differentiation and promote self-renewal of DMG tumor stem cells. We interrogated the role of AFF4 in DMG using an shRNA lentiviral approach. We demonstrate a significant decrease in in vitro clonogenicity and stem cell maintenance following AFF4 depletion. We employed RNA-seq-based gene set enrichment analysis to delineate differentiation programs under SEC regulatory control. Finally, we sought to determine whether CDK9, the catalytic subunit of the SEC, represents a therapeutic vulnerability in DMG. Using RNA polymerase II ChIP-seq, we demonstrate that CDK9 pharmacologic inhibition restores regulatory Pol II pausing, promotes cellular differentiation, and leads to potent anti-tumor effect both in vitro and in patient-derived xenograft models. These studies present a biologic rationale for the translational exploration of CDK9 inhibition as a promising therapeutic approach.
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Affiliation(s)
| | | | | | - Dong Wang
- University of Colorado, Aurora, CO, USA
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