Das Neuroblastom ist der häufigste extrakraniell gelegene solide Tumor der pädiatrischen Onkologie. Der Verlauf der Erkrankung geht von spontaner Regression oder Differenzierung bis hin zu tödlich verlaufenden Erkrankungen. Die Mortalität von Patienten mit Tumoren in fortgeschrittenen Stadien ist immer noch sehr hoch. Die aggressivsten Tumoren sind die, die eine Amplifikation des Protoonkogens MYCN aufweisen. Eine Untergruppe dieser MYCN amplifizierten Tumoren weist eine Coamplifikation von DDX1 auf. Die Prognose dieser Patienten ist besser als die mit allein MYCN amplifizierten Tumoren, wenn auch immer noch schlechter als die von Patienten ohne MYCN Amplifikation. Das DDX1-Protein ist eine putative RNA-Helikase. Über seine genaue Funktion ist noch nicht viel bekannt. Ziel dieser Arbeit war es, potentielle Ziel-mRNAs von DDX1 zu identifizieren, um einen besseren Einblick in die Funktionen von DDX1 und mögliche Wege der Beeinflussung von Tumorverhalten und Prognose zu erhalten. Hierzu wurden eine DDX1 amplifizierte und eine nicht amplifizierte Zelllinie in Kultur genommen und eine Immunopräzipitation mit Zelllysaten der beiden Zelllinien durchgeführt – jeweils mit einem spezifischen Antikörper gegen DDX1 und einem unspezifischen Kontrollantikörper. Die Identifizierung der an DDX1 gebundenen mRNAs erfolgte mittels Microarray. Validiert wurden einige der im Microarray identifizierten RNAs mittels RT-PCR. CDK1, ATM und p18 ließen sich als spezifische Ziel-mRNAs von DDX1 identifizieren.

Eines der charakteristischen Merkmale des Neuroblastoms stellt seine einzigartige biologische Heterogenität dar, die eine genaue Ausage des weiteren klinischen Verlaufes stark erschwert. Bestimmte prognostisch wirksame klinische, molekularbiologische und genetische Faktoren, wie zum Beispiel Alter bei Erstdiagnose, Tumorstadium, MYCN-Amplifikation und 1p Deletion, werden seit längerem zur Risikostratifizierung genutzt. Bereits in anderen Tumorerkrankungen konnte nun der Einfluß einer Telomerlängenveränderung auf das Gesamtüberleben von Patienten nachgewiesen werden. Telomere sichern die genomische Integrität und bestimmen maßgeblich die proliferative Kapazität jeder somatischen Zelle. Aktuelle Forschungsergebnisse legen die Vermutung nahe, dass Veränderungen der Telomerlänge auch in Neuroblastomen einen prognostischen Effekt auf das Gesamtüberleben haben. In diesem Kontext untersucht die vorliegende Arbeit den Zusammenhang zwischen Telomerlänge und Gesamtüberleben in 420 MYCN nicht-amplifizierten primären Neuroblastomen mit Erstdiagnosen von 1983-2001. Hierfür wurden die relativen Telomerlängen mithilfe einer neu etablierten monochromen multiplex q-RT-PCR ermittelt. Anschließend wurden diese sowohl mit ausgesuchten klinischen Variablen (Alter bei Erstdiagnose, Tumorstadium, Primärlokalisation des Tumors, Histologie, Geschlecht und Rezidivauftreten) korreliert als auch auf ihren Einfluß auf das Gesamt- und ereignisfreie Überleben untersucht. In Korrelation mit den klinischen Parametern konnte zwischen Alter bei Erstdiagnose und Telomerlänge ein eindeutiger Zusammenhang nachgewiesen werden. Je älter die Patienten bei Erstdiagnose, desto höher war sowohl der Anteil verlängerter Telomere als auch der extremer Telomerlängenveränderungen. Neuroblastome mit verlängerten Telomeren zeigten in der gleichen Altersgruppe ein verringertes Gesamtüberleben der betroffenen Patienten verglichen mit Neuroblastomen mit verkürzten Telomeren. Somit könnte eine Telomerlängenveränderung, insbesondere verlängerte Telomere, im klinischen Alltag als Hinweis auf einen prognostisch ungünstigen Verlauf genutzt werden.

The enhanced expression of histone deacetylases (HDACs) in a variety of malignancies drew attention to investigate a new category of anti-cancer drugs that are based on the inhibition of those enzymes. Valproic acid (VPA) is a well-known antiepileptic drug that exhibits antitumor activities through inhibition of HDACs class I and IIa. Cancer stem cells (CSCs) have been recognized to drive the tumor growth and progression hence; attention has been given to target this small subpopulation of CSCs rather than the whole bulk tumor cells. CD133 is considered to be a CSC marker in several tumors and its transcription is strongly influenced by epigenetic changes that will be altered upon administration of histone deacetylase inhibitors (HDACi) in cancer treatment. Therefore, we evaluated the epigenetic and cytotoxic effects of treatment with 1 mM VPA in combination with other chemotherapeutics and its influence on the expression of CD133 in human neuroblastoma (NB) cell lines. Our results revealed that addition of VPA to DNA-damaging chemotherapeutics induced a synergistic anti-tumor effect that was associated with caspase-3 dependent induction of apoptosis in UKF-NB-4 cells. This synergism was related to the increase of the acetylation status of histones H3 and H4 and was only produced either by...

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Cancer is a global health catastrophe, with neuroblastoma, the most common solid childhood tumor, and glioblastoma, a deadly brain tumor, being aggressive and unresponsive to current treatment modalities. These tumors are known to utilize uncontrollable cell proliferative capabilities as a mechanism for tumor survival. Therefore, malignant cell growth can be mitigated by targeting the essential proteins that regulate cell growth, such as receptor tyrosine kinases (RTKs). Under normal physiological conditions, RTKs bind with varying affinity to mitogenic stimuli such as growth factors such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) which, in turn, leads to receptor phosphorylation and activation.

Background: Neuroblastoma (NB) is a pediatric tumor in infants and young children. The survival rate is only around 50 percent for high-risk NB despite advanced and intense multi-modal therapy. Current research aims to find new effective treatment additional to modern therapy to improve prognosis of high-risk NB in children. As such, SU11248 may be a valuable approach for improving treatment and survival as growth factors have crucial roles in tumor growth, angiogenesis, and metastasis. Aim: The aim of this investigation was to examine tissues from SU11248 treated and nontreated tumor-bearing animals on the abundance of tumor-associated macrophages (TAMs) in metastases found on vital organs. Our hypothesis is that if SU11248 could cause “deactivation” or “silencing” of the stroma of metastases particularly by acting on stromal immune cells such as TAMs. Methods: Paraffin-embedded metastases developed in an orthotopic xenograft model in beige SCID mice were stained with a monoclonal rat anti-mouse antibody as a marker of TAMs. Morphological analysis of tissue slides, and macrophage quantification was performed using a microscope. Statistical analysis was achieved using an unpaired two tailed t-test.  Results: Macrophages were stained nicely, but the number of macrophages in the metastases were not statistically different between the vehicle treated controls and SU11248 treated metastases. Conclusion: In patients with high-risk NB, SU11248 may be a useful therapeutic supplement. We believe that further research into mechanisms that target critical factors for angiogenesis and metastasis in NB, such as TAMs, is an important step toward improving patient outcomes in high-risk NB.

Long-term treatment with all trans-retinoic acid (RA) induces neuronal differentiation and apoptosis. However, the effect of short-term RA treatment on cell proliferation, migration and invasion of neuroblastoma cell lines (SH-SY5Y and IMR-32) remains unclear. RA induces expression of tissue-transglutaminase (TGase) and promotes migration and invasion after 24 h of treatment in SH-SY5Y cells, but not in IMR-32 cells. RA receptor (RAR) agonist (4-(E-2-[5,6,7,8- tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl]-1-propenyl) benzoic acid) and RAR/retinoid X receptor (RXR) agonist (9-cis-RA) promote expression of TGase, migration and invasion of SH-SY5Y cells, while RXR agonist has no significant effect. RAR antagonist blocks RA effect on migration and invasion, indicating that RAR receptors are required. Retinoid receptors are expressed and activated by RA in both cell lines. However, only transient activation of RAR is observed in IMR-32 cells. These findings suggest that different responses observed in SH-SY5Y and IMR-32 cells could be due to differential activation of retinoid receptors. Overexpression of TGase has no effect on migration or invasion, while overexpression of antisense TGase blocks RA-induced migration and invasion, indicating that other molecules along with TGase mediate RA effects. In addition to the long-term effects of RA that are coupled with cell differentiation, short-term effects involve migration and invasion of neuroblastoma SH-SY5Y cells.

Le neuroblastome pédiatrique est un des cancers extra-crâniens des plus fréquents chez les enfants. Malgré une amélioration du taux de survie avec les thérapies actuellement disponibles, les stades avancés de neuroblastome ou en rechute présentent un très mauvais pronostic. De nouvelles approches thérapeutiques doivent donc être développées afin d'augmenter la survie des patients. Une de ces approches est la thérapie épigénétique. Le neuroblastome, comme plusieurs autres cancers pédiatriques, contient plusieurs altérations épigénétiques au niveau de la méthylation de l'ADN et des modifications des histones. Lors d'un criblage de médicaments déjà approuvés par la FDA, nous avons découvert quelques molécules ayant des caractéristiques de médicaments épigénétiques jusqu’alors jamais découvertes. Notre étude cherche donc à démontrer l'efficacité de ces molécules dans le traitement de lignées cellulaires de neuroblastome. Suite à des tests préliminaires, une des molécules approuvées par la FDA s'est démarquée : le disulfirame, un médicament approuvé pour le traitement de l’alcoolisme chronique. Nous avons donc traité des lignées cellulaires de neuroblastomes (IMR-32, N91, SK-N-DZ, SK-N-SH et SK-N-AS ) pendant 48 heures avec du disulfirame à des concentrations pertinentes sur le plan clinique (10nM à 50 µM). Nos résultats démontrent une inhibition de croissance de 50 % (IC50) d'environ 80 nM pour les lignées cellulaires testées. De plus, après analyse par cytométrie de flux, on observe un blocage du cycle cellulaire en G2/M. Nous avons également observé une diminution du facteur de transcription MYCN ainsi qu’une baisse d’acétylation de plusieurs marques d’histones (H3K9ac, H3K14ac, H3K27ac). Une analyse par séquençage d'ARN a confirmé le bloc en G2/M par une baisse d'expression de gènes associés à cette phase ainsi que la diminution de MYCN par une baisse de gènes cible de MYC. Des travaux sont en cours afin de déterminer le mécanisme d’action du disulfirame. Cette recherche permettra d’évaluer l’efficacité du disulfirame dans le traitement du neuroblastome / Pediatric neuroblastoma is one of the most common extracranial cancer in children. Despite an improvement in survival with the currently available therapies, neuroblastoma with an amplification of the transcription factor MYCN has a very poor prognosis. New therapeutic approaches must be developed to increase the survival of patients. One such approach is epigenetic drug therapy. Neuroblastoma, like many other pediatric cancers, contains several epigenetic alterations at the level of DNA methylation and histone modifications. In a screening of FDA-approved drugs, we discovered some molecules having characteristics of epigenetic drugs that were unknown until now. Our study seeks to demonstrate the efficacy of these molecules in the treatment of neuroblastoma cell lines. Following preliminary tests, one of the molecules approved by the FDA stood out: disulfiram, a medication approved for the treatment of chronic alcoholism. We treated neuroblastoma cell lines (MYCN amplified: IMR-32, N91 and SK-N-DZ; MYCN non-amplified: SK-N-AS and SK-N-SH) for 48 hours with disulfiram at clinically relevant concentrations (from 10 nM to 20 µM). Our results demonstrate a 50% growth inhibition (IC50) of 80nM for the cell lines tested. In addition, after analysis by flow cytometry, we found a cell cycle block in G2/M. RNA sequencing also revealed that disulfiram affects a many genes (downregulated n=508, upregulated n=207). We also observed a decrease in the transcription factor MYCN and a reduction in acetylation of several histone marks by Western blot’s analysis. Further studies are underway to determine the mechanism of action of disulfiram. This study shows the potential of disulfiram in the treatment of neuroblastoma.

Neuroblastoma is a highly metastatic and invasive tumour with poor prognosis. Despite recent advances in the treatment of neuroblastoma, mortality is still high due to uncontrolled metastatic disease, and novel therapeutic approaches for the treatment of neuroblastoma are therefore desperately needed. A potential novel approach for therapy of neuroblastoma relates to the polysialic acid decoration of the neural cell adhesion molecule (PSANCAM). PSA-NCAM is selectively re-expressed in a number of tumours including neuroblastoma, where it is thought to modulate tumour dissemination. Expression is strongly associated with poor clinical prognosis and an aggressive tumour phenotype. Inhibition of the enzymes responsible for synthesis of PSA, the polysialyltransferases (polySTs) presents a novel and selective therapeutic opportunity. The aims of the studies described in this thesis are to evaluate PSANCAM expression and function in neuroblastoma, and to develop and utilise cell-based models to pharmacologically investigate novel polyST inhibitors. PSA-NCAM was seen to be highly expressed in neuroblastoma clinical specimens and associated with phenotypes of tumour aggressiveness. A screening panel consisting of cell lines with a range of PSA-NCAM expression types was established and utilised to develop assays for pharmacologically assessing novel polyST inhibitors. Using cytidine monophosphate (CMP), a naturally-occurring inhibitor of polySTs, the robustness of the assays was confirmed before progression to evaluate novel molecules. From 16 compounds identified in an in vitro screen of polyST inhibition, three promising polyST inhibitors were identified. These promising polyST inhibitors modulated PSA-NCAM expression on the tumour cell surface and led to a significant reduction in cell migration. Therefore the work presented in this thesis suggests that targeting polySTs is a promising novel therapeutic strategy for neuroblastoma and further research in this area is warranted. / Mu'tah University and Jordan Armed Forces, Hashemite Kingdom of Jordan. / The full text will be available at the end of the extended embargo period: 5th March 2027

Background: Adrenalectomies are rare procedures especially in childhood. So far, no large cohort study on this topic has been published with data on to age distribution, operative procedures, hospital volume and operative outcome. Methods: This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes) of patients between the age 0 and 21 years in Germany were included. Results: A total of 523 patient records were identified. The mean age was 8.6 ± 7.7 years and 262 patients were female (50.1%). The majority of patients were between 0 and 5 years old (52% overall), while 11.1% were between 6 and 11 and 38.8% older than 12 years. The most common diagnoses were malignant neoplasms of the adrenal gland (56%, mostly neuroblastoma) with the majority being younger than 5 years. Benign neoplasms in the adrenal gland (D350) account for 29% of all cases with the majority of affected patients being 12 years or older. 15% were not defined regarding tumor behavior. Overall complication rate was 27% with a clear higher complication rate in resection for malignant neoplasia of the adrenal gland. Bleeding occurrence and transfusions are the main complications, followed by the necessary of relaparotomy. There was an uneven patient distribution between hospital tertiles (low volume, medium and high volume tertile). While 164 patients received surgery in 85 different “low volume” hospitals (0.2 cases per hospital per year), 205 patients received surgery in 8 different “high volume” hospitals (2.8 cases per hospital per year; p<0.001). Patients in high volume centers were significant younger, had more extended resections and more often malignant neoplasia. In multivariable analysis younger age, extended resections and open procedures were independent predictors for occurrence of postoperative complications. Conclusion: Overall complication rate of adrenalectomies in the pediatric population in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a very uneven distribution of patient volume among hospitals.

Neuroblastoma (NB) is a very heterogeneous tumour derived from undifferentiated cells of the neural crest. It is the most common extracranial solid tumour in children, characterised by a large variability of the clinical outcome. The clinically aggressive form of the disease, the high-risk neuroblastoma, affects about 50% of patients, which, unfortunately, despite the intensity of therapies, have a survival rate of less than 50%. Although the introduction of two new therapeutic solutions based on the use of 13-cis-retinoic acid and the immunotherapy with a chimeric monoclonal antibody against the GD2 ganglioside, 20% of patients affected by the high-risk disease are still entirely refractory to treatments, and 60% will relapse. In this panorama, identifying new strategies specific for critical NB targets is endowed with great potential to improve the survival rate and long-term quality of life and reduce the elevated toxicity of current treatments. LIN28B is an RNA binding protein extensively overexpressed in NB. Its exogenous expression in mouse sympatho-adrenergic lineage is able to reproduce the human disease, underlying the importance of LIN28B in NB pathogenesis. LIN28B prevents the maturation of let-7 miRNA family members, an important group of tumour suppressors that induce differentiation and, at the same time, decrease cell proliferation. We hypothesised that interfering with the LIN28B/let-7 miRNA interaction could lead to an increase in let-7 miRNA levels and, consequently, to a decrease in cell proliferation and an induction of cell differentiation, ultimately reducing NB aggressiveness. First, we created NB cell lines with stable LIN28B down-regulation, and we observed an expected increase in let-7 miRNA levels. We then verified if the rise in the let-7 miRNAs could induce the cells' differentiation by analysing a panel of stemness and differentiation markers such as SOX2, SOX9 and β-III-tubulin, detecting a decrease in the stemness markers and an increase in the differentiation-related markers. Following a high-throughput screening, performed and validated with two orthogonal biochemical techniques, the Alpha screen and the REMSA, we identified molecule A as the molecule with the best inhibitory activity on the LIN28B/let-7 miRNA interaction. After the biochemical validation, we proceeded to assess molecule A activity in vitro on NB cell lines. Molecule A resulted to be very unstable in cell culture conditions, therefore we decided to include the molecule in PLGA-PEG nanoparticles to preserve its stability in solution and improve its activity. Upon encapsulation, we observed a substantial increase in molecule A effects, leading to a strong increment in mature let-7 miRNAs and a consequent inhibition of cellular growth. Finally, we tested if the let-7 miRNAs increment caused by molecule A treatment was sufficient to induce NB cells differentiation, as observed with stable LIN28B-downregulation. We detected an increase in differentiation marker levels suggesting that the treatment with Molecule A nanoparticles is able to lead to the induction of neuronal differentiation processes in NB cells. Although these last results need to be confirmed with further experiments, they clearly show that the LIN28B/let-7 miRNA axis represents a good therapeutic target and that molecule A and/or other molecules able to interfere with this interaction deserve further preclinical and clinical evaluation.