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Genome sequencing of SHH medulloblastoma predicts genotype-related response to smoothened inhibition.

ABSTRACT: Smoothened (SMO) inhibitors recently entered clinical trials for sonic-hedgehog-driven medulloblastoma (SHH-MB). Clinical response is highly variable. To understand the mechanism(s) of primary resistance and identify pathways cooperating with aberrant SHH signaling, we sequenced and profiled a large cohort of SHH-MBs (n = 133). SHH pathway mutations involved PTCH1 (across all age groups), SUFU (infants, including germline), and SMO (adults). Children >3 years old harbored an excess of downstream MYCN and GLI2 amplifications and frequent TP53 mutations, often in the germline, all of which were rare in infants and adults. Functional assays in different SHH-MB xenograft models demonstrated that SHH-MBs harboring a PTCH1 mutation were responsive to SMO inhibition, whereas tumors harboring an SUFU mutation or MYCN amplification were primarily resistant.

SUBMITTER: Kool M

PROVIDER: S-EPMC4493053 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Genome sequencing of SHH medulloblastoma predicts genotype-related response to smoothened inhibition.

Kool Marcel M Jones David T W DT Jäger Natalie N Northcott Paul A PA Pugh Trevor J TJ Hovestadt Volker V Piro Rosario M RM Esparza L Adriana LA Markant Shirley L SL Remke Marc M Milde Till T Bourdeaut Franck F Ryzhova Marina M Sturm Dominik D Pfaff Elke E Stark Sebastian S Hutter Sonja S Seker-Cin Huriye H Johann Pascal P Bender Sebastian S Schmidt Christin C Rausch Tobias T Shih David D Reimand Jüri J Sieber Laura L Wittmann Andrea A Linke Linda L Witt Hendrik H Weber Ursula D UD Zapatka Marc M König Rainer R Beroukhim Rameen R Bergthold Guillaume G van Sluis Peter P Volckmann Richard R Koster Jan J Versteeg Rogier R Schmidt Sabine S Wolf Stephan S Lawerenz Chris C Bartholomae Cynthia C CC von Kalle Christof C Unterberg Andreas A Herold-Mende Christel C Hofer Silvia S Kulozik Andreas E AE von Deimling Andreas A Scheurlen Wolfram W Felsberg Jörg J Reifenberger Guido G Hasselblatt Martin M Crawford John R JR Grant Gerald A GA Jabado Nada N Perry Arie A Cowdrey Cynthia C Croul Sydney S Zadeh Gelareh G Korbel Jan O JO Doz Francois F Delattre Olivier O Bader Gary D GD McCabe Martin G MG Collins V Peter VP Kieran Mark W MW Cho Yoon-Jae YJ Pomeroy Scott L SL Witt Olaf O Brors Benedikt B Taylor Michael D MD Schüller Ulrich U Korshunov Andrey A Eils Roland R Wechsler-Reya Robert J RJ Lichter Peter P Pfister Stefan M SM

Cancer cell 20140301 3

Smoothened (SMO) inhibitors recently entered clinical trials for sonic-hedgehog-driven medulloblastoma (SHH-MB). Clinical response is highly variable. To understand the mechanism(s) of primary resistance and identify pathways cooperating with aberrant SHH signaling, we sequenced and profiled a large cohort of SHH-MBs (n = 133). SHH pathway mutations involved PTCH1 (across all age groups), SUFU (infants, including germline), and SMO (adults). Children >3 years old harbored an excess of downstream ...[more]

PMID: 24651015

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Project description:Medulloblastoma is heterogeneous, being characterized by molecular subgroups that demonstrate distinct gene expression profiles. Activation of the WNT or SHH signaling pathway characterizes two of these molecular subgroups, the former associated with low-risk disease and the latter potentially targeted by novel SHH pathway inhibitors. This manuscript reports the validation of a novel diagnostic immunohistochemical method to distinguish SHH, WNT, and non-SHH/WNT tumors and details their associations with clinical, pathological and cytogenetic variables. A cohort (n = 235) of medulloblastomas from patients aged 0.4-52 years was studied for expression of four immunohistochemical markers: GAB1, β-catenin, filamin A, and YAP1. Immunoreactivity (IR) for GAB1 characterizes only SHH tumors and nuclear IR for β-catenin only WNT tumors. IRs for filamin A and YAP1 identify SHH and WNT tumors. SHH, WNT, and non-SHH/WNT tumors contributed 31, 14, and 55% to the series. All desmoplastic/nodular (D/N) medulloblastomas were SHH tumors, while most WNT tumors (94%) had a classic phenotype. Monosomy 6 was strongly associated with WNT tumors, while PTCH1 loss occurred almost exclusively among SHH tumors. MYC or MYCN amplification and chromosome 17 imbalance occurred predominantly among non-SHH/WNT tumors. Among patients aged 3-16 years and entered onto the SIOP PNET3 trial, outcome was significantly better for children with WNT tumors, when compared to SHH or non-SHH/WNT tumors, which showed similar survival curves. However, high-risk factors (M+ disease, LC/A pathology, MYC amplification) significantly influenced survival in both SHH and non-SHH/WNT groups. We describe a robust method for detecting SHH, WNT, and non-SHH/WNT molecular subgroups in formalin-fixed medulloblastoma samples. In corroborating other studies that indicate the value of combining clinical, pathological, and molecular variables in therapeutic stratification schemes for medulloblastoma, we also provide the first outcome data based on a clinical trial cohort and novel data on how molecular subgroups are distributed across the range of disease.

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Genome sequencing of SHH medulloblastoma predicts genotype-related response to smoothened inhibition.

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Genome sequencing of SHH medulloblastoma predicts genotype-related response to smoothened inhibition.

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