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Medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (stPNET) are pediatric embryonic brain tumors, which arise in a brain that is in the process of growth and development. They differ significantly from adult lesions and may involve unique genetic and epigenetic factors. However, the pathogenesis of these tumors is still elusive. My project consisted of four parts, investigating major genetic and epigenetic alterations of these tumors. / Multiple genetic studies have shown high frequency of loss (30--60%) on chromosome 8p in MBs. Microcell-mediated transfer of chromosome 8 suppressed tumorigenesis or the proliferation of colon and breast cancer cell, indicating that chromosome 8p is likely to include several TSGs in human cancers. In previous studies from our laboratory, results showed the frequency of loss on chromosome 8p is also rather high (66.7%). An overlapping HD region was identified in a 1.8cM interval on 8p22-23.1, between markers D8S520 and D8S1130, in two MBs (Yin et al., 2002), indicating that several candidate TSGs are located within or near this region. PinX1 on 8p23.1, a potential inhibitor of telomerase, is most likely the candidate TSG in MBs due to its location and function. To evaluate the genetic alterations of PinX1 and to investigate its role in MBs, the first part of my study is to perform mutation analysis in a series of 52 primary MBs, 3 MB cell lines and 4 primary stPNETs. Transcript expression of PinX1 was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) in microdissected tumors and normal cerebellum. Using the telomeric repeat amplification protocol (TRAP) assay, 19 MBs, 2 stPNETs and all 3 MB cell lines were analyzed for telomerase activity. No somatic point mutations and loss of expression of PinX1 were detected in our series, suggesting that PinX1 is not the target gene on 8p23.1 in MBs. Although we did not find a significant association between PinX1 expression and telomerase activity, the presence of telomerase activity in 16 of 22 MBs and 1 of 2 stPNETs indicate that telomerase activation is associated with the development of this malignant disease. Our study represents the largest series of MB examined by telomerase repeat amplification protocol (TRAP) assay. (Abstract shortened by UMI.) / Chang Qing. / "April 2005." / Adviser: Ho-Keung Ng. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0191. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 201-228). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Background: Medulloblastoma (MB) is the most common pediatric brain tumor. Current treatment regimes consisting of primary surgery followed by radio- and chemotherapy, achieve 5-year overall survival rates of only about 60 %. Therapy-induced endocrine and neurocognitive deficits are common late adverse effects. Thus, improved antitumor strategies are urgently needed. In this study, we combined irradiation (IR) together with epigenetic modifiers and differentiation inducers in a multimodal approach to enhance the efficiency of tumor therapy in MB and also assessed possible late adverse effects on neurogenesis. Methods: In three human MB cell lines (DAOY, MEB-Med8a, D283-Med) short-time survival (trypan blue exclusion assay), apoptosis, autophagy, cell cycle distribution, formation of gH2AX foci, and long-term reproductive survival (clonogenic assay) were analyzed after treatment with 5-aza-2′-deoxycytidine (5-azadC), valproic acid (VPA), suberanilohydroxamic acid (SAHA), abacavir (ABC), all-trans retinoic acid (ATRA) and resveratrol (RES) alone or combined with 5-aza-dC and/or IR. Effects of combinatorial treatments on neurogenesis were evaluated in cultured murine hippocampal slices from transgenic nestin-CFPnuc C57BL/J6 mice. Life imaging of nestin-positive neural stem cells was conducted at distinct time points for up to 28 days after treatment start. Results: All tested drugs showed a radiosynergistic action on overall clonogenic survival at least in two-outof-three MB cell lines. This effect was pronounced in multimodal treatments combining IR, 5-aza-dC and a second drug. Hereby, ABC and RES induced the strongest reduction of clongenic survival in all three MB cell lines and led to the induction of apoptosis (RES, ABC) and/or autophagy (ABC). Additionally, 5-aza-dC, RES, and ABC increased the S phase cell fraction and induced the formation of gH2AX foci at least in oneout-of-three cell lines. Thereby, the multimodal treatment with 5-aza-dC, IR, and RES or ABC did not change the number of normal neural progenitor cells in murine slice cultures. Conclusions: In conclusion, the radiosensitizing capacities of epigenetic and differentiation-inducing drugs presented here suggest that their adjuvant administration might improve MB therapy. Thereby, the combination of 5-aza-dC/IR with ABC and RES seemed to be the most promising to enhance tumor control without affecting the normal neural precursor cells.

published_or_final_version / abstract / Medical Sciences / Master / Master of Medical Sciences

Medulloblastomas are the most frequent malignant childhood brain tumors, arising in the posterior fossa of children. The overall 5-year survival is 70%, although children often suffer severe long-term side effects from standard medical care. To improve progression-free survival and quality of life for these children, finding new therapeutic targets in medulloblastoma is imperative. Medulloblastoma is divided in to four molecular subgroups (WNT, SHH, Group 3 and Group 4) based on key developmental pathways essential for the initiation and maintenance of tumor development. The MYC family of proto-oncogenes regulates cell proliferation and differentiation in normal brain. Aberrant expression of MYC proteins occurs commonly in medulloblastoma. Our studies on Group 3 medulloblastoma identify the transcription factor SOX9 as a novel target for the E3 ubiquitin ligase FBW7, and show that increased stability of SOX9 confers an increased metastatic potential in medulloblastoma. Moreover, SOX9-positive cells drive distant recurrences in medulloblastoma when combining two regulatable TetON/OFF systems. MYCN depletion leads to increased SOX9 expression in Group 3 medulloblastoma cells, and the recurring tumor cells are more migratory in vitro and in vivo. Segueing to treatment of medulloblastoma, we show that BET bromodomain inhibition specifically targets MYC-amplified medulloblastoma cells by downregulating MYC and MYC-transcriptional targets, and that combining BET bromodomain- and cyclin-dependent kinase- inhibition improves survival in mice compared to single therapy. Combination treatment results in decreased MYC levels and increased apoptosis, and RNA-seq confirms upregulation of apoptotic markers along with downregulated MYC target genes in medulloblastoma cells. This thesis addresses novel findings in transcription factor biology, recurrence and treatment in Group 3 medulloblastoma, the most malignant subgroup of the disease.

Meduloblastoma é um câncer do sistema nervoso central, altamente invasivo, de origem embrionária, localizado no cerebelo. É mais comum em crianças e corresponde a aproximadamente 20% de todos os tumores intracranianos pediátricos. Os tratamentos mais utilizados são cirurgia e quimioterapia, sendo que a radioterapia é aplicada somente em crianças com mais de 3 anos devido aos seus efeitos colaterais. Diversos estudos têm mostrado o papel do NF-B na regulação de genes envolvidos com o processo neoplásico. NF-B é um fator de transcrição chave na regulação da resposta imune e no processo de inflamação e está envolvido na regulação da transcrição de um grande número de genes relacionados ao processo de tumorigênese, além de ser constitutivamente ativo em diversos tipos de câncer, sendo um importante potencial alvo terapêutico. O DHMEQ (Dehidroximetilepoxiquinomicina) é uma droga que inibe a translocação do NF-B do citoplasma para o núcleo, inibindo assim a sua atuação como ativador transcricional. Vários trabalhos tem mostrado os efeitos antineoplásicos do DHMEQ em inúmeros tipos tumorais, entretanto, não há trabalhos que evidenciem esses efeitos em meduloblastoma. Assim, o presente estudo objetivou avaliar os efeitos dessa droga nas linhagens UW402, UW473 e ONS-76 de meduloblastoma pediátrico através de estudos funcionais e moleculares. Os resultados de proliferação demostraram uma significativa diminuição do crescimento celular nas linhagens de meduloblastoma, inibindo cerca de 80, 70 e 60% nas linhagens UW402, UW473 e ONS-76, respectivamente, na dose de 20 g/mL, e apresentou um IC50 de 10g/mL em 48h para as linhagens UW402 e UW473 e em 72h na linhagem ONS-76. Adicionalmente, elevou o nível de apoptose para 50, 17 e 31% nessas linhagens, respectivamente, inibiu fortemente a capacidade clonogênica, a migração e a invasão celular nas três linhagens e foi sinérgico na combinação com outros quimioterápicos em grande parte dos pontos de combinação, além de radiossensibilizar fortemente as três linhagens. Os resultados são congruentes com o potencial efeito antitumoral de DHMEQ. / Medulloblastoma is a cancer of the central nervous system, highly invasive, of embryonic origin, located in the cerebellum. It is more common among children and accounts for approximately 20% of all pediatric intracranial tumors. The most common treatments are surgery and chemotherapy, and radiotherapy is only to children older than 3 years old due to its side effects. Several studies have demonstrated the role of NF-B in the regulation of genes involved in the neoplastic process. NF-B is a key transcription factor in the regulation of immune response and inflammation process, and it is involved in the transcriptional regulation of a large number of genes related to the tumorigenesis process, and constitutively active in many types of cancer, being an important potential therapeutic target. DHMEQ (Dehidroximetilepoxiquinomicina) is a drug that inhibits the translocation of NF-B from the cytoplasm to the nucleus, thus inhibiting its activity as a transcriptional activator. Several studies have shown the antineoplastic effects of DHMEQ in numerous tumor types, however, there is no surveys that have tested their effects in medulloblastoma. Thus, the present study aimed to evaluate the effects of this drug in UW402, UW473 and ONS-76 pediatric medulloblastoma cell lines through functional and molecular studies. The proliferation test results demonstrated a significant decrease in the cell growth in the medulloblastoma cell lines, inhibiting approximately 80, 70 and 60% for UW402, UW473 and ONS-76, respectively, at a dose of 20g/mL, and showed an IC50 of 10g/mL at 48h for UW402 and UW473 and at 72h in ONS-76. Additionally, increased the level of apoptosis to 50, 17 and 31% in these cell lines, respectively, strongly inhibited the clonogenic capacity, the migration and cell invasion in the three lines and it was synergistic in combination with other chemotherapeutic agents in most combination points, and radiosensitization strongly the three cell lines. The results are congruent with the potential antitumor effect of DHMEQ.

O meduloblastoma (MB) é o tumor maligno cerebral mais frequente em crianças e adolescentes. Trata-se de uma doença heterogênea sob o aspecto genético, sendo reconhecido ao menos 12 subgrupos genético-moleculares, com impacto na apresentação clínicopatológica. Pacientes do subgrupo SHH apresentam mutação somática em genes da via Hedgehog, incluindo PTCH1, SUFU, SMO e ativação dos genes GLI1 e GLI2. Mutações no gene TP53 também podem estar presentes, particularmente em crianças acima de 3 anos, e conferem um pior prognóstico. O trióxido de arsênio (ATO) possui ação inibitória sobre os genes da via SHH, mas pouco se sabe sobre sua ação no MB. O presente estudo objetivou avaliar os potenciais efeitos citotóxicos e radiossensibilizantes do ATO sobre as linhagens de MB pediátrico grupo SHH (ONS-76: TP53-selvagem; DAOY: TP53-mutado c.725G>T e UW402, TP53-mutado c.464C>A). Foram comparadas as taxas de proliferação celular, clonogenicidade e apoptose nas linhagem de MB antes e após o tratamento com ATO. Também foi avaliada a clonogenicidade da associação droga e irradiação. Foram investigadas proteínas responsáveis pelo reparo dos danos causados ao DNA (Rad51 e Ku86) através de Western Blot. Foi realizada análise da expressão gênica relativa por QPCR e estudados genes que integram a via SHH, assim como efetores finais desta via de sinalização. A viabilidade celular foi monitorada nos tempos de 24 à 120 horas pelo ensaio de resazurina. A taxa de apoptose foi mensurada por meio de marcação com anexina e iodeto de propídio e avaliada por citometria de fluxo. Os ensaios foram realizados em triplicata e analisados por One Way e Two Way ANOVA, utilizando o pós-teste Bonferroni, e sendo considerados resultados significativos valores de p<0,05. Foi possível observar uma diminuição na viabilidade celular após tratamento com ATO nas três linhagens estudadas. Além disso, houve uma diminuição significativa na capacidade clonogênica. Observou-se também um aumento nas taxas de apoptose nas linhagens, sendo acima de 70% de morte celular para a linhagem DAOY. Foi observado que o tratamento com ATO radiossensibilizou a linhagem UW402, TP53-mutado. Não foi encontrada associação com proteínas de reparo no tempo e dose estudados. O estudo de expressões relativas dos genes estudados demonstrou inibição, principalmente nas linhagens de interesse DAOY e UW402 -(SHH TP53) mutado. Estes achados in vitro apontam para um efeito citotóxico do ATO sobre as linhagens de MB pediátrico, podendo apresentar efeito radiossenssibilizante. O ATO deve ser melhor explorado como droga alvo para MB SHH+, em caráter experimental. / Medulloblastoma (MB) is the most common malignant brain tumor in children and adolescents. It is a heterogeneous disease under the genetic aspect, with at least 12 geneticmolecular subgroups being recognized, with impact on the clinical-pathological presentation. Patients of the SHH subgroup present somatic mutation in genes of the Hedgehog pathway, including PTCH1, SUFU, SMO and activation of the genes GLI1 and GLI2. Mutations in the TP53 gene may also be present, particularly in children over 3 years, and confer a worse prognosis. The arsenic trioxide (ATO) has an inhibitory action on SHH pathway genes, but little is known about its action. The present study aimed to evaluate the potential cytotoxic and radiosensitizing effects of ATO on the pediatric MB cells of SHH group (ONS-76: TP53- wild type; DAOY: TP53-mutated c.725GT and UW402 TP53-mutated c.464C>A). Cell proliferation, clonogenicity and apoptosis were compared in the MB strains following ATO treatment. The clonogenicity assay of ATO combined with irradiation was also evaluated. We investigated proteins responsible for repairing DNA damage and performed Western blotting of the Rad51 and Ku86 proteins. Gene expression analysis was performed using the real-time PCR. Selected genes integrating the SHH pathway as well as final effectors of signaling were also assesed. Cell viability was monitored at endpoints from 24 to 120h by the resazurin assay. The rate of apoptosis was measured by labeling with annexin and propidium iodide, as assessed by flow cytometry. The assays were performed in triplicate and analyzed by One Way and Two Way ANOVA, using the Bonferroni post-test, and being considered significant results a p value less than 0.05. It was possible to observe a decrease in cell viability in the three studied strains. In addition, there was a significant decrease in clonogenic capacity. There was also an increase in the apoptosis rates in the lineages, being above 70% of cell death for the DAOY lineage. It was found that the ATO treatment radiosensitized the UW402 strain - TP53-mutated. No association with time and dose of ATO and irradiation on the repair proteins was found. The study of the relative expressions of the studied genes demonstrated inhibition, mainly in the mutant line of interest DAOY and UW-402, a SHHTP53 mutated cell-line. These in vitro findings point to a cytotoxic effect of ATO on pediatric medulloblastoma lines, with a potential radiosensitizing effect. This study offers rationale for further assesment of ATO on SHH-MB, either alone or along with radiotherapy as a preclinical drug.

INTRODUÇÃO: A combinação de radioterapia e altas doses de cisplatina no tratamento do meduloblastoma tem se mostrado causa de importante ototoxicidade. Com a introdução da técnica de intensidade modulada do feixe (IMRT), tornou-se possível diminuir a dose média de radiação no aparelho auditivo. OBJETIVOS: O objetivo é determinar se com a radioterapia com reforço de dose com IMRT, é possível atingir índices menores de perda auditiva e se há um limite de dose no ouvido para a mesma. Analisar também se o volume de ouvido contornado durante o planejamento inverso influencia o resultado. MÉTODO: Quarenta e um pacientes com meduloblastoma (idade mediana, 10 anos) com audição normal ao início da radioterapia com IMRT foram avaliados retrospectivamente. O último seguimento e a última audiometria realizada após o término da radioterapia foram considerados. A função auditiva foi graduada em uma escala de 0 a 4 de acordo com os critérios de toxicidade do Pediatric Oncology Group (POG). As doses mínima, máxima, média e mediana recebidas pelo aparelho auditivo, bem como o volume contornado no planejamento do IMRT foram correlacionados com o grau de função auditiva. Foi realizada análise univariada e multivariada dos dados. RESULTADOS: O seguimento mediano foi de 41 meses (12,8 a 71) para avaliação audiométrica e 44 meses (14-72) para a sobrevida global. As doses medianas mínima, máxima, média e mediana recebidas pelo aparelho auditivo foram respectivamente de: 3785 (589,4 a 4758,2), 4832,5 (3724 a 5447,9), 4366,5 (2808,5 a 5097,3) e 4360,5 (2878 a 5031,1). Sete pacientes (17%) apresentaram perda auditiva graus 3 e 4. A análise univariada entre as variáveis não mostrou diferença com significância estatística, exceto para a dose de cisplatina (P < 0,03). Na análise multivariada com regressão logística, a dose mediana no aparelho auditivo foi um fator significativo para a perda auditiva graus 3 e 4 (P < 0,01), ao passo que a dose cumulativa de cisplatina apresentou tendência à perda graus 3 e 4 (P = 0,075). Não houve correlação entre o volume contornado no planejamento a perda auditiva. Perda auditiva graus 3 e 4 foi incomum com dose mediana no aparelho auditivo menor que 42 Gy (P = 0,063) e dose cumulativa de cisplatina abaixo de 375 mg/m² (P < 0,01). Nenhum paciente que recebeu carboplatina em substituição à cisplatina apresentou perda auditiva grave. Não houve associação, com significância estatística, entre as variáveis analisadas e a ototoxicidade, quando estes pacientes foram excluídos da análise. Quatro pacientes morreram e dois apresentaram recidiva no momento do estudo, levando a uma sobrevida global de 90% e uma sobrevida livre de doença de 85% em 44 meses. CONCLUSÕES: Os resultados mostram que o tratamento com IMRT leva a uma baixa taxa de perda auditiva grave, mesmo com um seguimento maior, o que é consistente com outros estudos. Acreditamos ser seguro contornar somente a cóclea e que uma dose mediana para a mesma deve ser mantida abaixo de 42 Gy. A quimioterapia com cisplatina continua a ter um papel importante no tratamento, no entanto a dose cumulativa não deve exceder 375 mg/m². A sobrevida foi impressionante neste estudo, uma vez que 21 (51,2%) foram classificados como alto risco / INTRODUCTION: The combination of radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma is a known cause of important ototoxicity. With the introduction of intensity-modulated radiation therapy (IMRT), it became possible to deliver less radiation to the auditory apparatus. PURPOSE: To determine if boost radiotherapy with IMRT can achieve a lower rate of hearing loss and if theres a cutoff dose for it. Also, to analyze whether the auditory apparatus volume contoured in inverse planning influences the outcome. METHODS: Forty-one pediatric medulloblastoma patients (median age, 10 years) with normal hearing at the time of radiation with IMRT were retrospectively evaluated. The last audiogram and follow-up from the completion of radiation were considered. Hearing function was graded on a scale 0 to 4 according to Pediatric Oncology groups toxicity criteria. Minimum, maximum, mean and median doses to the inner ear and its volume contoured in IMRT planning, as well the cisplatin dose were recorded and correlated with hearing function. Univariate and multivariate data analysis were performed. RESULTS: The median follow-up was 41 months (range 12.8-71.0 months) for audiometric evaluation and 44 months (range 14-72 months) for survival. Median doses for minimum, maximum, mean and median in the inner ear were respectively: 3785 (range, 589.4 to 4758.2), 4832.5 (range 3724 to 5447.9), 4366.5 (range 2808.5 to 5097,3) and 4360,5 (range 2878 to 5031,1). Seven patients (17%) have experienced Grade 3 or 4 hearing loss. Univariate analysis showed no difference among the variables with statistical significance, except for cisplatin dose (P < 0.03). In multivariate analysis with logistic regression, median dose in inner ear was a significant factor for hearing loss grade 3 or 4 (P < 0,01), meanwhile cisplatin dose had a trend to hearing loss grade 3 or 4 (P = 0.075). There was no relationship between the auditory apparatus volume contoured in planning and hearing loss. Grade 3 or 4 hearing loss were uncommon with median dose to the inner ear bellow 42 Gy (P = 0.063) and cisplatin dose less than 375 mg/m² (P < 0.01). None of the patients who received carboplatin in lieu of cisplatin had severe hearing loss. There was no statistically significant association between ototoxicity and the variables, when these patients were excluded from the analysis. Four patients died and two have recurred at the time of the study with a 90% overall survival rate and 85% disease free survival in 44 months. CONCLUSIONS: Our findings shows that IMRT treatment leads to a low rate of serious hearing loss even with a longer follow-up, which is consistent with others trials. We believe that is safe to contour only the cochlea and that a median dose to it should be kept below 42Gy. Cisplatin chemotherapy continues to have an important role in treatment, however doses should not exceed 375 mg/m². Survival rates were impressing in this trial given the fact that 21 (51.2%) patients were classified as high risk

O meduloblastoma é o tumor cerebral maligno mais comum em crianças de zero a quatro anos e uma das principais causas de morbidade e mortalidade infantil. Diversos estudos têm suportado a hipótese de que a ativação de genes tipicamente expressos em células-tronco confere características mais primitivas e agressivas a células tumorais, frequentemente associadas a prognóstico clínico desfavorável. Nesse contexto, tanto fatores proteicos quanto miRNAs poderiam estimular uma reprogramação em células cancerosas, induzindo um fenótipo semelhantes ao de células-tronco. Estudos recentes apontam o envolvimento do miR-367 na reprogramação de fibroblastos ao estado pluripotente e sua expressão aberrante foi correlacionada com prognóstico desfavorável em alguns tipos de câncer. Neste trabalho, verificou-se um possível papel funcional do miR-367 na agressividade de meduloblastoma. Células de meduloblastoma de quatro diferentes linhagens, Daoy, D283-Med, CHLA-01-Med e USP-13-Med apresentaram níveis baixos de expressão de pri-miR-367 e miR-367 maduro, em relação aos níveis encontrados em células-tronco embrionárias humanas. Uma superexpressão transiente do miR-367 em células das linhagens CHLA-01-Med e USP-13-Med resultaram em uma redução significativa dos níveis proteicos de RYR3, bem como dos transcritos preditos de ITGAV e RAB23, respectivos alvos do miR-367, envolvidos em câncer. Além disso, a superexpressão de miR-367 aumentou significativamente a proliferação celular, indicada pela cinética de crescimento in vitro e pela maior porcentagem de células presentes nas fases S+G2/M do ciclo celular. Embora a sensibilidade ao tratamento com cisplatina não tenha sido alterada após superexpressão de miR-367, a capacidade de geração de neuroesferas in vitro foi significativamente aumentada. Este último resultado é interessante do ponto de vista clínico, uma vez que a capacidade de geração de neuroesferas está significativamente correlacionada com menor sobrevida de pacientes com meduloblastoma. Portanto, esses achados sugerem uma função pró-oncogênica ao miR-367, a qual pode afetar a agressividade de meduloblastoma por meio de efeitos positivos sobre a proliferação celular e propriedades de células-tronco neurais / Medulloblastoma is the most common malignant brain tumor in children aged four and younger, and is the leading cause of infant morbidity and mortality. Several studies have reported the activation of stem cell genes leading to more primitive and aggressive characteristics in tumor cell often associated with unfavorable clinical prognosis. Cell reprogramming, stimulated by tumor microenvironment factors, might induce tumor stem cells phenotype. Recent researches suggest an involvement of miR-367 in fibroblasts reprogramming into pluripotent state, as well as a correlation with poor prognosis in some cancers. In this study, we observed a possible functional role of miR-367 in medulloblastoma aggressiveness. Four different medulloblastoma cell lines, Daoy, D283-Med, CHLA-01-Med and USP-13-Med showed low rates of pri-miR-367 and mature miR-367 expression. Overexpression of miR-367 down-regulated the protein levels of its target RYR3 and of two bioinformatically predicted transcript targets encoding ITGAV and RAB23, which are involved in cancer in CHLA-01-Med and USP-13 Med cell lines. Furthermore, transfection with the miRNA mimic significantly increased cell proliferation and the percentage of cells observed in S + G2 / M phase of the cell cycle. Although the sensitivity to cisplatin treatment was not changed after overexpression of miR-367, the ability to generate neurospheres in vitro was significantly increased. This last result can be related to clinical ones because cells from medulloblastoma patients with low survival show great ability to generate neurospheres. In sum, these findings suggest a pro-oncogenic role to miR-367, which can affect medulloblastoma aggressiveness by cell proliferation and neural stem cells positive modifications

O meduloblastoma (MB) é o tumor maligno cerebral mais frequente em crianças e adolescentes. Trata-se de uma doença heterogênea sob o aspecto genético, sendo reconhecido ao menos 12 subgrupos genético-moleculares, com impacto na apresentação clínicopatológica. Pacientes do subgrupo SHH apresentam mutação somática em genes da via Hedgehog, incluindo PTCH1, SUFU, SMO e ativação dos genes GLI1 e GLI2. Mutações no gene TP53 também podem estar presentes, particularmente em crianças acima de 3 anos, e conferem um pior prognóstico. O trióxido de arsênio (ATO) possui ação inibitória sobre os genes da via SHH, mas pouco se sabe sobre sua ação no MB. O presente estudo objetivou avaliar os potenciais efeitos citotóxicos e radiossensibilizantes do ATO sobre as linhagens de MB pediátrico grupo SHH (ONS-76: TP53-selvagem; DAOY: TP53-mutado c.725G>T e UW402, TP53-mutado c.464C>A). Foram comparadas as taxas de proliferação celular, clonogenicidade e apoptose nas linhagem de MB antes e após o tratamento com ATO. Também foi avaliada a clonogenicidade da associação droga e irradiação. Foram investigadas proteínas responsáveis pelo reparo dos danos causados ao DNA (Rad51 e Ku86) através de Western Blot. Foi realizada análise da expressão gênica relativa por QPCR e estudados genes que integram a via SHH, assim como efetores finais desta via de sinalização. A viabilidade celular foi monitorada nos tempos de 24 à 120 horas pelo ensaio de resazurina. A taxa de apoptose foi mensurada por meio de marcação com anexina e iodeto de propídio e avaliada por citometria de fluxo. Os ensaios foram realizados em triplicata e analisados por One Way e Two Way ANOVA, utilizando o pós-teste Bonferroni, e sendo considerados resultados significativos valores de p<0,05. Foi possível observar uma diminuição na viabilidade celular após tratamento com ATO nas três linhagens estudadas. Além disso, houve uma diminuição significativa na capacidade clonogênica. Observou-se também um aumento nas taxas de apoptose nas linhagens, sendo acima de 70% de morte celular para a linhagem DAOY. Foi observado que o tratamento com ATO radiossensibilizou a linhagem UW402, TP53-mutado. Não foi encontrada associação com proteínas de reparo no tempo e dose estudados. O estudo de expressões relativas dos genes estudados demonstrou inibição, principalmente nas linhagens de interesse DAOY e UW402 -(SHH TP53) mutado. Estes achados in vitro apontam para um efeito citotóxico do ATO sobre as linhagens de MB pediátrico, podendo apresentar efeito radiossenssibilizante. O ATO deve ser melhor explorado como droga alvo para MB SHH+, em caráter experimental. / Medulloblastoma (MB) is the most common malignant brain tumor in children and adolescents. It is a heterogeneous disease under the genetic aspect, with at least 12 geneticmolecular subgroups being recognized, with impact on the clinical-pathological presentation. Patients of the SHH subgroup present somatic mutation in genes of the Hedgehog pathway, including PTCH1, SUFU, SMO and activation of the genes GLI1 and GLI2. Mutations in the TP53 gene may also be present, particularly in children over 3 years, and confer a worse prognosis. The arsenic trioxide (ATO) has an inhibitory action on SHH pathway genes, but little is known about its action. The present study aimed to evaluate the potential cytotoxic and radiosensitizing effects of ATO on the pediatric MB cells of SHH group (ONS-76: TP53- wild type; DAOY: TP53-mutated c.725GT and UW402 TP53-mutated c.464C>A). Cell proliferation, clonogenicity and apoptosis were compared in the MB strains following ATO treatment. The clonogenicity assay of ATO combined with irradiation was also evaluated. We investigated proteins responsible for repairing DNA damage and performed Western blotting of the Rad51 and Ku86 proteins. Gene expression analysis was performed using the real-time PCR. Selected genes integrating the SHH pathway as well as final effectors of signaling were also assesed. Cell viability was monitored at endpoints from 24 to 120h by the resazurin assay. The rate of apoptosis was measured by labeling with annexin and propidium iodide, as assessed by flow cytometry. The assays were performed in triplicate and analyzed by One Way and Two Way ANOVA, using the Bonferroni post-test, and being considered significant results a p value less than 0.05. It was possible to observe a decrease in cell viability in the three studied strains. In addition, there was a significant decrease in clonogenic capacity. There was also an increase in the apoptosis rates in the lineages, being above 70% of cell death for the DAOY lineage. It was found that the ATO treatment radiosensitized the UW402 strain - TP53-mutated. No association with time and dose of ATO and irradiation on the repair proteins was found. The study of the relative expressions of the studied genes demonstrated inhibition, mainly in the mutant line of interest DAOY and UW-402, a SHHTP53 mutated cell-line. These in vitro findings point to a cytotoxic effect of ATO on pediatric medulloblastoma lines, with a potential radiosensitizing effect. This study offers rationale for further assesment of ATO on SHH-MB, either alone or along with radiotherapy as a preclinical drug.