Central nervous system high-grade neuroepithelial tumour with MN1 alteration (CNS HGNET-MN1) is a brain tumour methylation class that has recently been identified, based on (epi)genetic profiles of a ...large CNS-PNETs cohort 1. This class is characterized by MN1 gene rearrangements, with BEND2 being the most frequently reported fusion partner 1. Histologically, tumours of this class show pseudopapillary architecture and dense stromal hyalinization 1, features characteristic of astroblastoma. The majority of cases within CNS HGNET-MN1 are represented by the latter, though histopathological aspects resembling ependymomas and not otherwise specified tumours may also be encountered 2. It remains uncertain, however, if MN1 alterations are an exclusive anomaly of CNS HGNET-MN1.
In glioma, TERT promoter mutation and loss of ATRX (ATRX loss) are associated with reactivation of telomerase or alternative lengthening of telomeres (ALT), respectively, i.e. the two telomere ...maintenance mechanisms (TMM). Strangely, 25% of gliomas have been reported to display neither or both of these alterations.
The C-circle (CC) assay was adapted to tumor (formalin-fixed paraffin-embedded and frozen) and blood samples to investigate the TMM.
We constructed a CC-based algorithm able to identify the TMM and reported a sensitivity of 100% and a specificity of 97.3% (n = 284 gliomas). By combining the TMM, the mutational status of the isocitrate dehydrogenase 1/2 (IDH) gene (IDHmt), and the histological grading, we propose a new classification tool: TeloDIAG. This classification defined five subtypes: tOD, tLGA, tGBM_IDHmt, tGBM, and tAIV, corresponding to oligodendroglioma, IDHmt low-grade astrocytoma, IDHmt glioblastoma, and IDHwt glioblastoma (GBM), respectively; the last class gathers ALT+ IDHwt gliomas that tend to be related to longer survival (21.2 months) than tGBM (16.5 months). The TeloDIAG was 99% concordant with the World Health Organization classification (n = 312), and further modified the classification of 55 of 144 (38%) gliomas with atypical molecular characteristics. As an example, 14 of 69 (20%) of TERTwt, ATRXwt, and IDHwt GBM were actually tAIV. Outstandingly, CC in blood sampled from IDHmt astrocytoma patients was detected with a sensitivity of 56% and a specificity of 97% (n = 206 gliomas and 30 healthy donors).
The TeloDIAG is a new, simple, and effective tool helping in glioma diagnosis and a promising option for liquid biopsy.
•CC is a simple and cost-effective assay, able to overcome the misdetection of alterations in TERT and ATRX.•The ‘TeloDIAG’ is a rapid diagnostic tool for glioma based on CC, IDH status, and histological grading.•A third of glioma discordant for histo-molecular markers are classed differently by the TeloDIAG, with prognosis value.•The activation of the ALT mechanism tends to be of good prognosis in IDHwt gliomas.•Outstandingly in glioma, a circulating marker has been retrieved with a sensitivity of 56% and an excellent specificity.
Glioblastoma multiforme (GBM) are highly invasive and angiogenic malignancies with a median survival time from diagnosis of <15 months. Previous work has revealed robust overexpression of fibronectin ...(FN) mRNA in GBM, although immunohistochemical staining of FN in these tumors is typically associated with the angiogenic vasculature. Here we sought to examine the expression of tumor cell FN and address its possible involvement in the invasive phenotype of GBM. We found that FN was expressed and assembled into fibrillar arrays in human tumors and in established GBM lines. Cultured cells spontaneously formed dense cellular networks and spheroid-like domes. Depletion of FN by targeted-short hairpin RNA expression disrupted matrix assembly and multicellular network organization by exerting profound effects on cell adhesion and motility. Although FN depletion enhanced persistent directional migration of single cells, it compromised collective invasion of spheroids through a laminin-rich matrix and sensitized cells to ionizing radiation. In orthotopic grafts, FN depletion significantly reduced tumor growth and angiogenesis. Together our results show that FN produced by the tumor cells has a role in GBM pathophysiology and they provide insights into the implications that targeting FN interactions may have for combating this dreaded disease.
Background
Pilocytic astrocytomas (PAs) are characterized by an excellent prognosis although several factors of adverse outcome have been reported. The mitogen‐activated protein kinase pathway plays ...a major role in their tumorigenesis.
Aim
To report a series of 148 PAs in children to define clinicopathological and biological prognostic factors.
Methods
Clinical data were collected from patient files and mail inquiry. Pathological specimens were centrally reviewed. The three major KIAA1549:BRAF fusion subtypes were analysed by reverse transcription – polymerase chain reaction (RT‐PCR) in a subset of 47 frozen cases and by fluorescence in situ hybridization on formalin‐fixed paraffin‐embedded tissue in 23 cases. Tumour location, age at surgery, extent of surgical removal, histological subtype and KIAA1549:BRAF fusion by RT‐PCR were searched for prognostic significance.
Results
Pilomyxoid astrocytoma (PMA) and the hypothalamo‐chiasmatic (H/C) location were associated with a worse prognosis P < 0.001 for overall survival (OS) and P = 0.001 for progression‐free survival (PFS). Patients who underwent complete surgical excision had a better OS (P = 0.004) and a longer PFS (P < 0.001) than the others. Age was also a strong prognostic factor for OS but not for PFS. Infants (<1 year) and young children (<3 years) had a much worse outcome than the others (P < 0.001 and P = 0.004 respectively). KIAA1549:BRAF fusion status was not predictive of outcome.
Conclusion
This study highlights the good prognostic factors of PAs but H/C PA remains a subgroup with dismal prognosis associated with young age, PMA variant and incomplete surgery. Search for KIAA1549:BRAF fusion in tumours with PA pattern is recommended even though the prognostic impact is still unclear.
Pretherapeutic determination of tumor grade and genotype in grade II and III oligodendroglial tumors is clinically important but is still challenging. Tumor grade and 1p/19q status are currently the ...2 most important factors in therapeutic decision making for patients with these tumors. Histopathology and cMRI studies are still limited in some cases. In the present study, we were interested in determining whether the combination of PWI, DWI, and MR spectroscopy could help distinguish oligodendroglial tumors according to their histopathologic grade and genotype.
We retrospectively reviewed 50 adult patients with grade II and III oligodendrogliomas and oligoastrocytomas who had DWI, PWI, and MR spectroscopy at short and long TE data and known 1p/19q status. Univariate analyses and multivariate random forest models were performed to determine which criteria could differentiate between grades and genotypes.
ADC, rCBV, rCBF, and rK2 were significantly different between grade II and III oligodendroglial tumors. DWI, PWI, and MR spectroscopy showed no significant difference between tumors with and without 1p/19q loss. Separation between tumor grades and genotypes with cMRI alone showed 31% and 48% misclassification rates, respectively. Multimodal MR imaging helps to determine tumor grade and 1p/19q genotype more accurately (misclassification rates of 17% and 40%, respectively).
Although multimodal investigation of oligodendroglial tumors has a lower contribution to 1p/19q genotyping compared with cMRI alone, it greatly improves the accuracy of grading of these neoplasms. Use of multimodal MR imaging could thus provide valuable information that may assist clinicians in patient preoperative management and treatment decision making.
Recently, a broader role of inhibitor of apoptosis (IAP) proteins besides their antiapoptotic functions has been described. Therefore, we investigated the effect of non-toxic concentrations of the ...small-molecule Smac mimetic BV6, which antagonizes IAP proteins, on differentiation of cancer stem-like cells (CSLCs) derived from primary glioblastoma (GBM) specimens. Here, we identify a novel function of BV6 in regulating differentiation of GBM CSLCs by activating NF-κB. BV6 at non-lethal doses stimulates morphological changes associated with the differentiation of GBM CSLCs. BV6 increases transcriptional activity, mRNA and protein levels of the astrocytic marker GFAP without altering expression of the neuronal marker β-III-tubulin, indicating that BV6 induces astrocytic differentiation of GBM CSLCs. Molecular studies reveal that BV6 triggers processing of the NF-κB subunit p100 to p52, nuclear translocation of p52 and p50 and increased NF-κB DNA-binding. Intriguingly, inhibition of NF-κB by overexpression of dominant-negative IκBα super-repressor (IκBα-SR) blocks the BV6-stimulated increase in GFAP and differentiation. Interestingly, this BV6-stimulated differentiation is associated with reduced expression of stemness markers such as CD133, Nanog and Sox2 in GBM CSLCs. In contrast, BV6 does not alter cell morphology, differentiation and expression of stemness markers in non-malignant neural stem cells. Importantly, BV6 treatment reduces clonogenicity of GBM CSLCs in vitro and in vivo, suppresses their tumorigenicity in orthotopic and subcutaneous mouse models and significantly increases the survival of mice. By identifying a novel role of BV6 in promoting differentiation of GBM CSLCs, these findings provide new insights into Smac mimetic-regulated non-apoptotic functions with important implications for targeting GBM CSLCs.
La définition de myopathie nécrosante (MN) est histologique montrant des lésions de nécrose-régénération associées à peu ou pas d’infiltrat inflammatoire. Les causes de MN sont variées, pouvant se ...rencontrer aussi bien dans des affections musculaires acquises que dans certaines dystrophies musculaires de formule histologique inhabituelle. Parmi les formes acquises, les myopathies nécrosantes auto-immunes (MNAI) constituent une entité récemment individualisée au sein des myopathies dites inflammatoires (MI). Elles présentent une grande hétérogénéité sur le plan clinique, sérologique et évolutif. Initialement, elles étaient considérées comme des myopathies sévères, de début subaigu, associées à une hyperCKémie supérieure à 10 fois la normale. Cependant, des formes plus insidieuses ont été rapportées. Plusieurs tableaux clinico-sérologiques de MNAI sont distingués : les MNAI associées aux auto-anticorps anti-SRP, les MNAI associées aux anticorps anti-HMG-CoA réductase, les MNAI associées à des maladies de système et les MNAI paranéoplasiques. Pour porter le diagnostic de MNAI, il est nécessaire d’exclure les diagnostics différentiels que sont les MN toxiques, certaines affections musculaires héréditaires et les autres myopathies inflammatoires pour lesquelles l’histologie peut être trompeuse. Actuellement, les MNAI sont rares mais probablement sous-diagnostiquées. L’enjeu d’un diagnostic précoce est majeur. Bien que ces formes soient fréquemment cortico-résistantes, le recours à plusieurs thérapeutiques peut permettre une bonne réponse thérapeutique. Le développement de nouvelles classifications des MI prenant en compte à la fois les critères clinico-sérologiques et anatomopathologiques devrait permettre d’améliorer leur diagnostic. Nous proposons à la fin de cette revue un arbre décisionnel diagnostique des MNAI en fonction du mode évolutif.
Necrotizing myopathies (NM) are defined by histological features. Muscle biopsy demonstrates marked muscle necrosis with regeneration, with little or an absence of inflammatory infiltrate. Histological pattern of NM is unspecific and can be encountered in diverse conditions as acquired myopathies and muscular dystrophies. Among acquired forms of NM, necrotizing autoimmune myopathy (NAM) is a recently recognized sub-group of the idiopathic inflammatory myopathies. Classically, patients present with a subacute severe proximal myopathy, associated with a markedly elevated creatine kinase level, usually greater than 10 times the upper limit of normal. Nevertheless, the clinical presentation can be misleading, with chronic course mimicking muscular dystrophy. Different forms of NAM can be distinguished with various underlying inciting conditions, including autoantibodies to the SRP, autoantibodies to the HMG-CoA reductase, association to connective tissue disease or underlying malignancy. Other associated conditions need yet to be identified. To confirm a diagnosis of NAM, other causes of NM should be excluded as toxic myopathies, muscular dystrophies and other inflammatory myopathies with a misleading histological pattern. NAM is a rare condition but is probably underdiagnosed. Both clinicoserologic and pathologic data must be taken into account to improve this diagnosis. We propose guidelines for diagnosis of NAM according to clinical course, to be used in clinical practice.
Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular ...heterogeneity.
To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data.
Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The ‘immune-hot’ CS4 group, enriched with mutations increasing the Janus kinase (JAK)–signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue.
The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
•Multi-omic data consensus clustering reveals four molecular subtypes of PCNSL with prognostic relevance.•RNA-seq data alone and a publicly accessible algorithm can be used to assign the multi-omic defined PCNSL subtypes.•PCNSL molecular subtyping can improve future clinical stratification and suggest rational subtype-based targeted therapies.
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