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Sonic hedgehog medulloblastoma encompasses a clinically and molecularly diverse group of cancers of the developing central nervous system. Here, we use unbiased sequencing of the transcriptome across a large cohort of 250 tumors to reveal differences among molecular subtypes of the disease, and demonstrate the previously unappreciated importance of non-coding RNA transcripts. We identify alterations within the cAMP dependent pathway (GNAS, PRKAR1A) which converge on GLI2 activity and show that 18% of tumors have a genetic event that directly targets the abundance and/or stability of MYCN. Furthermore, we discover an extensive network of fusions in focally amplified regions encompassing GLI2, and several loss-of-function fusions in tumor suppressor genes PTCH1, SUFU and NCOR1. Molecular convergence on a subset of genes by nucleotide variants, copy number aberrations, and gene fusions highlight the key roles of specific pathways in the pathogenesis of Sonic hedgehog medulloblastoma and open up opportunities for therapeutic intervention.
- MeSH
- dítě MeSH
- dospělí MeSH
- genetická variace MeSH
- genové regulační sítě MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- meduloblastom genetika MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory mozečku genetika MeSH
- předškolní dítě MeSH
- proteiny hedgehog genetika MeSH
- regulace genové exprese u nádorů * MeSH
- signální transdukce genetika MeSH
- transkriptom * MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Názvy látek
- proteiny hedgehog MeSH
- SHH protein, human MeSH Prohlížeč
The short rib polydactyly syndromes (SRPS) are a group of recessively inherited, perinatal-lethal skeletal disorders primarily characterized by short ribs, shortened long bones, varying types of polydactyly and concomitant visceral abnormalities. Mutations in several genes affecting cilia function cause SRPS, revealing a role for cilia function in skeletal development. To identify additional SRPS genes and discover novel ciliary molecules required for normal skeletogenesis, we performed exome sequencing in a cohort of patients and identified homozygosity for a missense mutation, p.E80K, in Intestinal Cell Kinase, ICK, in one SRPS family. The p.E80K mutation abolished serine/threonine kinase activity, resulting in altered ICK subcellular and ciliary localization, increased cilia length, aberrant cartilage growth plate structure, defective Hedgehog and altered ERK signalling. These data identify ICK as an SRPS-associated gene and reveal that abnormalities in signalling pathways contribute to defective skeletogenesis.
- MeSH
- cilie genetika patologie MeSH
- exom genetika MeSH
- kojenec MeSH
- kostra abnormality růst a vývoj MeSH
- lidé MeSH
- MAP kinasový signální systém MeSH
- mnohočetné abnormality genetika patofyziologie MeSH
- protein-serin-threoninkinasy genetika MeSH
- proteiny hedgehog genetika MeSH
- rodokmen MeSH
- sekvenční analýza DNA MeSH
- signální transdukce MeSH
- syndrom krátkého žebra a polydaktylie genetika patologie MeSH
- těhotenství MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- CILK1 protein, human MeSH Prohlížeč
- protein-serin-threoninkinasy MeSH
- proteiny hedgehog MeSH
PURPOSE: Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, Group 3, and Group 4. Current medulloblastoma protocols stratify patients based on clinical features: patient age, metastatic stage, extent of resection, and histologic variant. Stark prognostic and genetic differences among the four subgroups suggest that subgroup-specific molecular biomarkers could improve patient prognostication. PATIENTS AND METHODS: Molecular biomarkers were identified from a discovery set of 673 medulloblastomas from 43 cities around the world. Combined risk stratification models were designed based on clinical and cytogenetic biomarkers identified by multivariable Cox proportional hazards analyses. Identified biomarkers were tested using fluorescent in situ hybridization (FISH) on a nonoverlapping medulloblastoma tissue microarray (n = 453), with subsequent validation of the risk stratification models. RESULTS: Subgroup information improves the predictive accuracy of a multivariable survival model compared with clinical biomarkers alone. Most previously published cytogenetic biomarkers are only prognostic within a single medulloblastoma subgroup. Profiling six FISH biomarkers (GLI2, MYC, chromosome 11 [chr11], chr14, 17p, and 17q) on formalin-fixed paraffin-embedded tissues, we can reliably and reproducibly identify very low-risk and very high-risk patients within SHH, Group 3, and Group 4 medulloblastomas. CONCLUSION: Combining subgroup and cytogenetic biomarkers with established clinical biomarkers substantially improves patient prognostication, even in the context of heterogeneous clinical therapies. The prognostic significance of most molecular biomarkers is restricted to a specific subgroup. We have identified a small panel of cytogenetic biomarkers that reliably identifies very high-risk and very low-risk groups of patients, making it an excellent tool for selecting patients for therapy intensification and therapy de-escalation in future clinical trials.
- MeSH
- čipová analýza tkání MeSH
- cytogenetika MeSH
- dítě MeSH
- hodnocení rizik MeSH
- hybridizace in situ fluorescenční MeSH
- jaderné proteiny genetika MeSH
- kojenec MeSH
- lidé MeSH
- lidské chromozomy, pár 11 MeSH
- lidské chromozomy, pár 14 MeSH
- meduloblastom genetika mortalita patologie terapie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádorové biomarkery genetika MeSH
- prediktivní hodnota testů MeSH
- předškolní dítě MeSH
- prognóza MeSH
- proporcionální rizikové modely MeSH
- protein Gli2 s motivem zinkových prstů MeSH
- proteiny hedgehog * genetika MeSH
- proteiny Wnt * genetika MeSH
- protoonkogenní proteiny c-myc genetika MeSH
- regulace genové exprese u nádorů MeSH
- reprodukovatelnost výsledků MeSH
- rizikové faktory MeSH
- stanovení celkové genové exprese MeSH
- transkripční faktory Krüppel-like genetika MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Názvy látek
- GLI2 protein, human MeSH Prohlížeč
- jaderné proteiny MeSH
- MYC protein, human MeSH Prohlížeč
- nádorové biomarkery MeSH
- protein Gli2 s motivem zinkových prstů MeSH
- proteiny hedgehog * MeSH
- proteiny Wnt * MeSH
- protoonkogenní proteiny c-myc MeSH
- SHH protein, human MeSH Prohlížeč
- transkripční faktory Krüppel-like MeSH