Recent discoveries enabled us to divide medulloblastoma into molecular sub-groups and uncover novel mutations in these tumors. However, except for superior survival of the WNT sub-group, the prognostic and therapeutic implications of these observations remain unclear. TP53 mutations which confer radioresistance revealed conflicting clinical relevance in different studies. We hypothesized that the effect of TP53 mutations on survival is modulated through molecular sub-grouping. This is especially important since therapeutic targeting of WNT can be achieved with administration of lithium. Here we first confirmed that TP53 mutant tumors confers unfavorable outcome only in SHH subgroup, but not in WNT. We demonstrated that while TP53 mutations cause radioresistance, activation of WNT/β-catenin signaling radiosensitizes medulloblastoma cells. We demonstrated that lithium activates the WNT pathway and effectively sensitize medulloblastoma cells to radiation. Furthermore, lithium did not sensitize normal neural stem cells to radiation, suggesting its potential as an effective radiosensitizer for medulloblastoma.

Medulloblastoma (MB) is the most common malignant brain tumor affecting children. The transcription factors MYCN and SOX9 are associated with initiation, maintenance and recurrence of MB and are also connected to more aggressive tumors. In this study, a ChIP was performed to isolate DNA from genes that are transcriptionally regulated by these proteins. Identification of these target genes will reveal new potential drug targets and help us better understand the functions of MYCN and SOX9. The ChIP was not fully optimized during this project and the target genes were not sent for sequencing and identified. To study the connection between SOX9 and recurrence, cells with different levels of SOX9 were treated with drugs, after which cell viability was measured. No significant difference in resistance could be measured. Change in expression level of MYCN, SOX9 and other relevant genes after drug treatment was also studied. The results show an increase in SOX9 and HES1, suggesting that these genes are involved in tumor recurrence.

Aim of the study was to evaluate the influence of clinical characteristics to the prognosis of disease and effectiveness of postoperative radiotherapy and adjuvant chemotherapy using lomustine, cisplatinum and vincristin in the treatment of children with medulloblastoma. This study was performed 2000 – 2005 in the Kaunas University of Medicine Hospital, department of children diseases. The data of patients, treated with medulloblastoma in 1994 - 2003, were used in this study. During ten-years period in Lithuania the medulloblastoma was diagnosed for 32 children. Twenty-seven of them were included in this study. The diagnostic tests made for the patients of the study: preoperative computer tomography or/and magnetic resonance imaging of brain; postoperative control computer tomography of brain; magnetic resonance imaging of spinal cord; bone scintigraphy with radioactive technetium; chest X-ray and ultrasound examination of the abdominal organs The spread of the disease and size of the residual postoperative tumor separates patients of this study into two: standard and high risk groups. Patients depending to the standard risk group were treated with radiotherapy alone. Patients included in the high risk group were treated by 2 different treatment methods: patients diagnosed with medulloblastoma between 1994 and 1998 were treated with craniospinal radiotherapy alone, other patients treated between 1999 and 2003 received radiotherapy with adjuvant chemotherapy with lomustine... [to full text]

Meduloblastoma é o câncer do Sistema Nervoso Central mais comum em crianças entre 0 e 4 anos. Ele é originado de células precursoras neuronais, que falharam em se diferenciar e continuaram a se proliferar. A proteína SAM68 está desregulada em várias linhagens de células de cânceres humanos e é uma proteína que pode estar envolvida em uma ampla gama de vias de sinalização importantes, incluindo metabolismo de RNA, regulação do ciclo celular, apoptose, regulação de splicing e transdução de sinal. Em células-tronco neurais (NSC), níveis elevados de SAM68 levam a uma redução importante na proliferação celular. Contudo, na maioria dos cânceres estudados até o momento, a SAM68 está envolvida com progressão tumoral. Com este trabalho, buscou-se entender o envolvimento de SAM68 na proliferação e morte de células de meduloblastoma. Por meio da análise de expressão transcricional e proteica, do silenciamento de SAM68, análise de apoptose por citometria de fluxo e análise de proliferação por índice mitótico e incorporação de EdU, observou-se que, em linhagens de meduloblastoma, a SAM68 está envolvida com proliferação, mas não com apoptose. Seu funcionamento em meduloblastoma é similar aos resultados obtidos com NCS do que com outros tipos de câncer, visto que o silenciamento dessa proteína favorece a proliferação das células de meduloblastoma. Em vista dos resultados aparentemente conflitantes, tendo um papel mais semelhante a um supressor tumoral, porém sendo altamente expressa em meduloblasoma, sugeriram-se algumas hipóteses, que foram apenas inicialmente testadas neste trabalho, mas precisam ser aprofundadas em trabalhos futuros / SAM68 is considered a prototype of STAR proteins (Signal Transducers and Activators of RNA protein), that are involved in the signal translation and RNA activation. In cancer, the intracellular levels of Sam68 are crucial to the progression of the disease. Recent observations indicate Sam68 with both pro-oncogenic and tumor suppressor activities, depending on the type of cell. Here, we analyzed SAM68 expression by real time PCR and western blot, proliferation of cell with and without SAM68 by mitotic index and incorporation of EdU and cell death by flux cytometry to define the relevance of the presence of SAM68 to cell proliferation and death. We found that proliferation of medulloblastoma cell lines are affected for absent SAM68, but not apoptosis. Because the contrast of an action similar to a tumor suppressor and a high expression level, we hypothesized that the increase of SAM68 levels is important during the neuronal development, regulating splicing variants. Our results allied to some literature data corroborate this hypothesis

Orientadores: Jose Andres Yunes, Claudia Vianna Maurer Morell, Denise Pontes Cavalcanti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médica / Made available in DSpace on 2018-08-23T14:33:25Z (GMT). No. of bitstreams: 1 Lucon_DanielleRibeiro_D.pdf: 6878652 bytes, checksum: 72be4de1339573c4cea11e28716998c7 (MD5) Previous issue date: 2013 / Resumo: Crianças com anomalias congênitas possuem um risco significativamente aumentado para desenvolver algum tipo de câncer. Anomalias do sistema nervoso central (SNC) estão associadas à maior incidência de tumores também do SNC. A comparação entre tecido 'anômalo', tecido tumoral e tecido normal pode ajudar na identificação dos genes mais importantes na carcinogênese. microRNAs (miRNAs) são pequenas moléculas que atuam negativamente na expressão gênica e têm papel importante no controle do desenvolvimento, diferenciação, apoptose e proliferação celular. Vários miRNAs são expressos no SNC e são conhecidos por serem dinamicamente regulados durante o neurodesenvolvimento. Recentemente, miRNAs foram associados com tumores e malformações do SNC, como o meduloblastoma (MB) e a anencefalia (AN), respectivamente. Ambos tecidos são de origem neuroectodérmica e embrionária. Neste projeto foram estudados os miRNAs diferencialmente expressos no tecido tumoral de MB desmoplástico de pacientes jovens (1-2 anos) versus cerebelo e no tecido cérebro-vascular de fetos com AN versus córtex frontal. Os controles foram obtidos de tecidos normais provenientes de autópsias de fetos e recém-nascidos. As vias gênica-metabólicas importantes na carcinogênese e morfogênese do perfil de miRNAs de MB e AN foram analisados in silico. No primeiro trabalho, apresentado no segundo capítulo, investigamos o perfil de miRNAs de MB que foi predominantemente baixo expresso (64/84 miRNAs) e regulam genes envolvidos com desenvolvimento e/ou câncer. Muitos dos miRNAs baixo expressos (32/64) foram localizados no lócus cromossômico 14q32 (miRNA 14q32). Possíveis mecanismos da baixa expressão de miRNA 14q32 foram investigados por bancos de dados públicos disponíveis. A expressão do gene receptor de estrógeno gama (ESRRG), um regulador transcricional positivo de alguns miRNAs 14q32, foi encontrada baixo expresso em MB desmoplástico. miR-129-5p (11p11.2/7q32.1), miR-206 (6p12.2) e miR-323-3p (14q32.2) foram escolhidos para estudos funcionais em células DAOY. A super expressão do miR-129-5p usando miRNA mimics diminuiu a proliferação das células DAOY. No segundo trabalho, apresentado no terceiro capítulo, analisamos o perfil de expressão de miRNAs em AN que foi predominantemente super expressos (34/52 miRNAs) e regulam genes envolvidos com defeito do tubo neural e/ou câncer. Dentre estes miRNAs estão os miR-21, 34a/c, 182, 500 cluster. miRNAs importantes no desenvolvimento do cérebro (miR-124, 128, 137, 139) foram encontrados baixo expressos nas amostras de AN. A prospecção dos genes alvos destes miRNAs mostrou que eles desempenham um papel importante durante o desenvolvimento e a diferenciação neural. Por fim, nós comparamos os miRNAs diferencialmente expressos entre MB e AN e identificamos 19 miRNAs em comum (baixo expressos: miR-124, 128, 129*, 129-5p, 138, 138-1*, 138-2*, 139-3p, 490-5p, 650, 770-5p; super expressos: miR-199a-3p, 199b-3p, 199a-5p, 21, 214, 214*, 34a, 574-3p). A maioria destes miRNAs em comum encontrados nas duas patologias fazem parte dos miRNAs mais descritos em câncer e/ou são importantes no desenvolvimento do cérebro. O fato destes miRNAs estarem desregulados em duas condições diferentes (MB e AN) faz pensar que sejam funcionalmente relevantes nestas patologias. Nossos resultados indicam a correlação de assinatura de miRNAs com cada amostra destacando a heterogeneidade molecular e complexidade na sinalização celular regulada por miRNAs, e também revela que o câncer foi a via de sinalização predominante em MB e AN / Abstract: Children with birth defects have a significantly increased risk for developing some type of cancer. Anomalies of central nervous system (CNS) are associated with increased incidence of tumours also from CNS. The comparison between tissue 'anomalous', tumor tissue and normal tissue can help identify genes important in carcinogenesis. microRNAs (miRNAs) are small non-coding RNA molecules that act negatively on gene expression and play an important role in controlling development, differentiation, apoptosis and cell proliferation. Many miRNAs are expressed in CNS and are known to be dynamically regulated in neurodevelopment. Recently, miRNAs have been associated with CNS tumors and malformations, as meduloblastoma (MB) and anencephaly (AN), respectively. Both tissues are from neuroectodermal and embryonic origins. In this project, we studied the miRNAs differential expressed in tumor tissue of desmoplastic MB of young patients (1-2 years) versus cerebellum and cerebrovascular tissue of fetal with AN versus frontal cortex. The normal tissues were obtained from fetal and newborn autopsy. The gene-metabolic pathways important in carcinogenesis and morphogenesis of miRNAs profile of MB and AN were analyzed in silico. In second chapter, we investigated the MB miRNAs profile that were predominantly downregulated (64/84 miRNAs) and regulates genes involved in development and/or cancer. Most downregulated miRNAs (32/64) were found to belong at the 14q32 locus (14q32 miRNA). Possible mechanisms of 14q32 miRNAs downregulation were investigated by the analysis of publicly available gene expression data sets. The expression of estrogen-related receptor-g (ESRRG), a reported positive transcriptional regulator of some 14q32 miRNAs, was found downregulated in desmoplastic MB. miR-129-5p (11p11.2/7q32.1), miR-206 (6p12.2), and miR-323-3p (14q32.2), were chosen for functional studies in DAOY cells. Overexpression of miR-129-5p using mimics decreased DAOY proliferation. In third chapter we investigated the AN miRNAs profile that were predominantly upregulated (34/52 miRNAs) and regulates genes involved with tube neural defects (DTN) and/or cancer. Between these miRNAs are the miR-21, 34a/c, 182, 500 cluster. miRNAs important in brain development (miR-124, 128, 137, 139) were found downregulated in AN samples. Prospecting for target genes of these miRNAs showed that they play an important role during development and neuronal differentiation. Finally, we compare the miRNAs differential expressed between MB and AN and identified 19 miRNAs in common (underexpression: miR-124, 128, 129 *, 129-5p, 138, 138-1 *, 138-2 *, 139 - 3p, 490-5p, 650, 770-5p; overexpression: miR-199a-3p, 3p-199b, 199a-5p, 21, 214, 214 *, 34a, 574-3p). Most common miRNAs found in MB and AN are known to be involved in cancer and/or are important in brain development. The fact that these miRNAs are deregulated in two different conditions (MB and AN) makes one think that they are functionally relevant in these pathologies. Our results indicate the correlation of miRNAs signature with each sample highlighting the molecular heterogeneity and cellular signaling complexity regulated by miRNAs, and also reveals that the cancer was the predominant signaling pathway in MB and AN / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Out of the four molecular subgroups (WNT, SHH, Group 3 and Group 4), Group 3 patients face the highest incidence of leptomeningeal spread and overall patient survival of less than 50%. Current clinical trials for recurrent MB patients based on genomic profiles of primary, treatment-naïve tumors, provide limited clinical benefit since recurrent metastatic MBs are highly genetically divergent from their primary tumors. The paucity of patient matched primary and recurrent MB samples has contributed to the lack of molecular targets specific to medulloblastoma recurrence, limiting relapsing MB patients to palliation. Our previous in silico analyses revealed enriched expression of many stem cell self-renewal regulatory genes in Group 3 MB. In this work, I have set out to investigate whether by identifying genes contributing to self-renewal of Group 3 MB cells, we can characterize a population of cells responsible for therapy evasion and subsequent tumor relapse. Initially, we have adapted the existing COG (Children’s Oncology Group) protocol for children with newly diagnosed high-risk MB for treatment of immuno-deficient mice intracranially xenografted with human MB cells. Cell populations recovered separately from brains and spines mice during the course of tumor development and therapy were comprehensively profiled for gene expression analysis, stem cell and molecular features to generate a global, comparative profile of MB cells through therapy. Additionally, we have investigated therapeutic potential of small molecules targeting BMI1, a known self-renewal regulating gene. In the setting of recurrent Group 3 MB, pharmacological inhibition of BMI1, led to a remarkable decrease in cell proliferation and self-renewal in vitro as well as reduction of local and spinal metastatic disease in vivo. Finally, by combining the established therapy-adapted patient-derived xenograft mouse model and BMI1 inhibitor, PTC-596, we have demonstrated an additive effect of two modalities and provided the pre-clinical data for the upcoming Phase I trial. Biological investigations into the drivers of MB recurrence will lead to development of new therapeutic options for children who are frequently limited to palliation. Clinically relevant mouse models of MB recurrence can serve as platforms for pre-clinical testing and validation of new treatments aimed to provide therapeutic intervention rather than palliation. / Thesis / Doctor of Philosophy (PhD) / Medulloblastoma is the most common type of brain cancer that affects children. Out of the four main subgroups of medulloblastoma, tumors in Groups 3 and 4 are the most aggressive and are associated with a low overall survival in children diagnosed with this type of brain cancer. These two subtypes of medulloblastoma also account for the largest number of patients in which gold standard therapies fail and no additional therapies are available. Several studies have shown the existence of few cells within the tumor that alone can drive tumor growth. The aggressive behavior of these cells has in part been attributed to dysregulation of genes involved in cell replication and division. Further studies that will focus on understanding the significance of genes that regulate cell growth and replication can help discover a population of cells that is capable of evading therapy and contribute to tumor relapse. The identification and characterization of such population can lead to development of novel treatments for the children affected with aggressive medulloblastoma. In my thesis, I have developed a mouse model that replicates the aggressive therapy given to the medulloblastoma patients in order to study cells capable of escaping the harsh treatment and drive tumor comeback. Next, by profiling the gene expression and functional attributes of those cells, we identified genes that contribute to regulation of cell division and growth. The effects of both increasing and decreasing the activity of those genes were then tested in cells grown in the dish. Subsequently, the most promising results were verified in the established mouse models. The main objective of my thesis was to discover new opportunities in treatments the most aggressive type of brain cancer affecting children, and thus not only improve the quality of treatment but also the overall survival of patients with medulloblastoma.

Medulloblastoma (MB) is the most common malignant pediatric brain tumour. Of its four distinct molecular subgroups (WNT, SHH, Group 3, and Group 4), Group 3 MB patients hold the worst clinical prognosis due to their high incidence of tumour recurrence and metastasis to the spinal leptomeninges. Relapsed Group 3 MB patients, particularly those with MYC amplification (known as Group 3𝛾), carry a mortality rate of nearly 100%, given the paucity of effective therapeutic options currently available. The most common cause of mortality amongst these patients is leptomeningeal metastasis, yet this metastatic disease is poorly characterized. Our understanding of MB tumour recurrence and leptomeningeal metastasis is further encumbered by the rare clinical opportunities at which specimens may be collected from relapsed patients. We were able to circumvent this obstacle by establishing a patient-derived xenograft mouse-adapted therapy model, which mimics the treatments administered in the clinic and in turn, recapitulates both local and metastatic human MB recurrence. This model system enabled the collection of valuable, patient-derived Group 3𝛾 MB tumour cells from the spinal leptomeninges at relapse. It provides an opportunity for chemical screening, with the aim of identifying small molecule inhibitors capable of eradicating these cells. Existing studies on MB leptomeningeal dissemination at diagnosis suggest that effective treatments may target signalling proteins, such as phosphatidylinositol 3-kinases and histone deacetylases (HDACs). Therefore, I hypothesized that selective kinase and HDAC inhibitors would pose as effective therapies against Group 3𝛾 MB metastatic recurrences. In this thesis, I conducted a high-throughput screen of 640 kinase inhibitors and robust testing of novel HDAC6-selective inhibitors against these treatment-refractory, metastatic cells. Here, I showed that metastatic recurrences of Group 3𝛾 MB are therapeutically vulnerable to selective inhibitors of checkpoint kinase 1 (CHK1), platelet-derived growth factor receptor beta (PDGFRβ), and HDAC6. Functional studies demonstrated that these inhibitors selectively target the aggressive, migratory Group 3𝛾 MB cells, while sparing healthy neural stem cells. They also showed effective blood-brain-barrier penetration in silico and in vitro, while significantly reducing MB tumour cell properties that are often associated with treatment failure. Taken together, my thesis highlights specific inhibitors of CHK1, PDGFRβ, and HDAC6 that effectively target MB tumour cells that fuel treatment-refractory leptomeningeal metastases. With additional preclinical validation, these compounds may serve as potent therapeutic options to extend survival and improve the quality of life for patients that are ostensibly limited to palliation. / Thesis / Master of Science (MSc) / Medulloblastoma is an aggressive brain cancer in children. While current standard treatment improves patient survival, 30-40% of all medulloblastoma patients relapse at local (brain) or metastatic (spine) sites. Medulloblastoma metastatic recurrences remain poorly understood, yet they result in an alarmingly high mortality rate amongst patients due to inadequate treatment options currently available. Specific molecular targets are common in both medulloblastoma and metastatic cancer research. These targets are particularly important in governing cell signalling pathways that regulate tumour growth and migration. Therefore, treatment against these targets may be effective at preventing medulloblastoma metastatic recurrences. As the collection of local and metastatic tumour samples at patient relapse are rare, the Singh lab developed an animal model that mimics human medulloblastoma recurrence. In this thesis, recurrent medulloblastoma metastases were isolated from our established animal model and tested against compounds that inhibit the specific molecular targets previously implicated in medulloblastoma and other metastatic tumours. We identified potent compounds that effectively target these metastatic cells. Next, we determined which compounds spared healthy cells and were able to penetrate the brain, given our future objective of targeting these MB cells from their source to ultimately prevent metastasis. The identified compounds substantially reduced the ability of these cells to divide. With further investigation, these compounds may pose as effective therapeutic agents to treat human medulloblastoma patients with metastatic recurrences.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Overall survival is about 70% and in cases where current treatment fails, the disease recurs and most often is fatal. At the molecular level, MB can be divided into four defined subgroups: WNT, SHH, Group 3 and Group 4. Amplification of MYC family genes is common in MB and correlates with poor prognosis and tumor relapse. In this thesis we showed how MYCN initiates brain tumors when transduced in neural stem cells (NSCs). Prior to transduction, NSCs were isolated from different brain regions and at various time points. While overexpression of wild-type MYCN did not generate any tumors, orthotopic transplantation of MYCNT58A-expressing forebrain, brain stem and cerebellar NSCs induced diffuse malignant glioma, PNET-like tumors and MB, respectively. Interestingly, MYCNT58A-expressing cerebellar NSCs induced SHH-dependent MB from embryonic cells but SHH-independent MB from postnatal cells. We further showed that cerebellar NSCs transduced with both MYCNT58A and transcription factor SOX9 developed tumors faster and promoted distant migration into the forebrain. The function and regulation of SOX9 in MB cells is poorly understood. We identified SOX9 protein as target of FBW7 ubiquitin ligase and demonstrated the effects of SOX9 on MB cells migration, metastasis and drug resistance. We further blocked PI3K pathway to destabilize SOX9 which sensitized cells to cytostatic treatment. We used a (TetOFF) transgenic mouse model of MYCN-induced MB (GTML) and crossed it with a (TetON) transgene which allowed us to specifically target rare SOX9-positive cells in the tumor. In this system, MB develops spontaneously and SOX9-negative tumor cells can be killed off by doxycycline. The few remaining SOX9-positive cancer cells were able to promote distant MB recurrences. Such a pattern of relapse was recently shown for Group 3 and 4 human MB where about 90% of the recurrences were distant. In summary, this thesis demonstrates that MYCN can generate various types of brain tumors depending on the timing and location of its expression. It further defines the existence of a rare population of SOX9-expressing MB cells that are involved in causing distant MB recurrences. Finally, it describes how SOX9 is stabilized in MB cells and increases MB migration and therapy resistance.

According to the cancer stem cell hypothesis a subpopulation of cells within a tumour has the capacity to sustain its growth. These cells are termed cancer stem cells, and are most simply defined as the cells within a primary tumour that can self-renew, differentiate and regenerate a phenocopy of that cancer when transplanted in vivo. Cancer stem cells have now been prospectively identified from numerous human tumours and are actively sought in many cancer types, both clinical and experimental. The cancer stem cell hypothesis remains controversial, with evidence both supporting and challenging its existence in human tumours and in animal models of disease. Here we prospectively identify and study brain cancer stem cells in clinically representative mouse models of the medulloblastoma and glioma. Cancer stem cells from both mouse brain tumour types are prospectively enriched by fluorescent activated cell sorting freshly dissociated cells for the surface antigen CD15, display a neural precursor phenotype, exhibit the hallmark stem cell characteristics of self-renewal and multilineage differentiation, and regenerate a phenocopy of the original tumour after orthotopic transplantation. Additionally, novel mouse medulloblastoma and glioma cancer stem cell lines were established and studied in vitro as adherent cultures in the same serum-free media conditions that support the growth of normal neural stem cells. When mouse and human glioma stem cell lines were compared, many novel molecular mediators of the tumour phenotype were identified, as were chemical compounds that selectively inhibit their growth. Our results have important implications regarding the cancer stem cell hypothesis, the mechanisms that drive brain tumour stem cell growth and the therapeutic strategies that may prove effective for the treatment of glioma and medulloblastoma.