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The anti-disialoganglioside (GD2) monoclonal antibody dinutuximab beta is approved for the maintenance treatment of high-risk neuroblastoma. Dinutuximab beta combined with different chemotherapy regimens is being investigated in various clinical settings. We conducted a retrospective clinical chart review of 25 patients with relapsed/refractory neuroblastoma who had failed ≥1 second-line therapy and received compassionate use treatment with dinutuximab beta long-term infusion combined with the induction chemotherapy regimens N5 (cisplatin, etoposide, vindesine) and N6 (vincristine, dacarbazine, ifosfamide, doxorubicin) recommended by the German Pediatric Oncology and Hematology Group [GPOH] guidelines. The treatment did not result in any unexpected severe toxicities or in any major treatment delays. Grade 3/4 pain was reported by 4/25 patients in cycle 1, decreasing to 0/9 patients in cycles 3 and 4. The median follow-up was 0.6 years. The best response in this group was 48% (12/25 patients), which included three patients with minor responses. At 1 year, the estimated event-free survival was 27% (95% confidence interval [CI] 8–47) and overall survival was 44% (95% CI 24–65). Combining long-term infusion of dinutuximab beta with N5 and N6 chemotherapy demonstrated an acceptable safety profile and encouraging objective response rates in heavily pretreated patients with high-risk neuroblastoma, warranting further evaluation in clinical trials.

PDF file - 2.6MB, Effects of LBW242 or XIAP silencing on apoptosis induction and caspase activation in SH-EP neuroblastoma cells.

PDF file - 298K, Effect of LBW242 and etoposide treatment on TNF-� expression.

PDF file - 656K, Induction of apoptosis in NXS2 neuroblastoma cells by LBW242 in combination with etoposide or vincristine.

PDF file - 1.7MB, Effect of XIAP silencing by specific antisense oligonucleotide on apoptosis induction in neuroblastoma cells.

PDF file - 1.9MB, Effects of LBW242 or XIAP silencing on apoptosis induction and caspase activation in SK-N-SH neuroblastoma cells.

PDF file - 31K

BACKGROUND: Inborn errors of immunity (IEI) are rare diseases, which makes diagnosis a challenge. A better description of the initial presenting manifestations should improve awareness and avoid diagnostic delay. Although increased infection susceptibility is a well-known initial IEI manifestation, less is known about the frequency of other presenting manifestations.OBJECTIVE: We sought to analyze age-related initial presenting manifestations of IEI including different IEI disease cohorts.METHODS: We analyzed data on 16,486 patients of the European Society for Immunodeficiencies Registry. Patients with autoinflammatory diseases were excluded because of the limited number registered.RESULTS: Overall, 68% of patients initially presented with infections only, 9% with immune dysregulation only, and 9% with a combination of both. Syndromic features were the presenting feature in 12%, 4% had laboratory abnormalities only, 1.5% were diagnosed because of family history only, and 0.8% presented with malignancy. Two-third of patients with IEI presented before the age of 6 years, but a quarter of patients developed initial symptoms only as adults. Immune dysregulation was most frequently recognized as an initial IEI manifestation between age 6 and 25 years, with male predominance until age 10 years, shifting to female predominance after age 40 years. Infections were most prevalent as a first manifestation in patients presenting after age 30 years.CONCLUSIONS: An exclusive focus on infection-centered warning signs would have missed around 25% of patients with IEI who initially present with other manifestations.

Acute lymphoblastic leukemia (ALL) represents the most frequent malignancy in children, and relapse/refractory (r/r) disease is difficult to treat, both in children and adults. In search for novel treatment options against r/r ALL, we studied inhibitor of apoptosis proteins (IAP) and Smac mimetics (SM). SM-sensitized r/r ALL cells towards conventional chemotherapy, even upon resistance against SM alone. The combination of SM and chemotherapy-induced cell death via caspases and PARP, but independent from cIAP-1/2, RIPK1, TNFα or NF-κB. Instead, XIAP was identified to mediate SM effects. Molecular manipulation of XIAP invivo using microRNA-30 flanked shRNA expression in cell lines and patient-derived xenograft (PDX) models of r/r ALL mimicked SM effects and intermediate XIAP knockdown-sensitized r/r ALL cells towards chemotherapy-induced apoptosis. Interestingly, upon strong XIAP knockdown, PDX r/r ALL cells were outcompeted invivo, even in the absence of chemotherapy. Our results indicate a yet unknown essential function of XIAP in r/r ALL and reveal XIAP as a promising therapeutic target for r/r ALL.

Simple Summary The childhood tumor, neuroblastoma, has a broad clinical presentation. Risk assessment at diagnosis is particularly difficult in molecularly heterogeneous high-risk cases. Here we investigate the potential of imaging mass spectrometry to directly detect intratumor heterogeneity on the protein level in tissue sections. We show that this approach can produce discriminatory peptide signatures separating high- from low- and intermediate-risk tumors, identify 8 proteins aassociated with these signatures and validate two marker proteins using tissue immunostaining that have promise for further basic and translational research in neuroblastoma. We provide proof-of-concept that mass spectrometry-based technology could assist early risk assessment in neuroblastoma and provide insights into peptide signature-based detection of intratumor heterogeneity. Abstract Risk classification plays a crucial role in clinical management and therapy decisions in children with neuroblastoma. Risk assessment is currently based on patient criteria and molecular factors in single tumor biopsies at diagnosis. Growing evidence of extensive neuroblastoma intratumor heterogeneity drives the need for novel diagnostics to assess molecular profiles more comprehensively in spatial resolution to better predict risk for tumor progression and therapy resistance. We present a pilot study investigating the feasibility and potential of matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) to identify spatial peptide heterogeneity in neuroblastoma tissues of divergent current risk classification: high versus low/intermediate risk. Univariate (receiver operating characteristic analysis) and multivariate (segmentation, principal component analysis) statistical strategies identified spatially discriminative risk-associated MALDI-based peptide signatures. The AHNAK nucleoprotein and collapsin response mediator protein 1 (CRMP1) were identified as proteins associated with these peptide signatures, and their differential expression in the neuroblastomas of divergent risk was immunohistochemically validated. This proof-of-concept study demonstrates that MALDI-MSI combined with univariate and multivariate analysis strategies can identify spatially discriminative risk-associated peptide signatures in neuroblastoma tissues. These results suggest a promising new analytical strategy improving risk classification and providing new biological insights into neuroblastoma intratumor heterogeneity.

HSCT is curative in SCD. Patients with HLA-identical sibling donor have an excellent outcome ranging from 90%-100% overall and event-free survival. However, due to the lack of matched sibling donors this option is out of reach for 70% of patients with SCD. The pool of potential donors needs to be extended. Transplantations from HLA-matched unrelated donors were reported to be less successful with shorter event-free survival and higher incidences of complications including graft-vs-host disease, especially in patients with advanced stage SCD. Here we report transplantation outcomes for 25 children with SCD transplanted using HLA-matched grafts from related or unrelated donors. Overall survival was 100% with no severe (grade III-IV) graft-vs-host disease and a 12% rejection rate. Mixed donor chimerisms only occurred in transplantations from siblings, while transplantations from unrelated donors resulted in either complete donor chimerism or rejection. Despite the small patient number, overall and disease-free survival for unrelated donor transplantations is excellent in this cohort. The advanced disease state, higher alloreactive effect and stronger immunosuppression in unrelated donor transplantations raises patient risk, for which possible solutions could be found in optimization of transplant preparation, graft manipulation or haploidentical transplantation using T cell receptor ��/��-depleted grafts.

Purpose In spite of good initial therapy response neuroblastomas often spread to distant organs or relapse after periods of remission. Dysregulation of apoptosis, a hallmark of cancer, is often effected by elevated levels of antiapoptotic signals leading to resistance against chemotherapeutic drugs. Inhibitors of apoptosis proteins (IAPs) are crucial cellular apoptosis regulators. Targeting IAPs with Smac mimetics has been demonstrated as a promising strategy for treatment of neuroblastoma and other tumors. Methods In paired neuroblastoma cell lines, obtained from the same patient at time of diagnosis (CHLA-15) and postchemotherapy during progressive disease (CHLA-20), expression of crucial IAPs was determined. Furthermore, effects of vincristine on viability, cytotoxicity, apoptosis induction and caspase-3/7 activation were determined. Results Cellular IAP-1 (cIAP-1) and X-linked IAP (XIAP) expression was increased in cell line CHLA-20. Moreover, biological effects of vincristine were significantly lower in these cells. Treatment of cells with Smac mimetic LCL161 increased the effects of vincristine in CHLA-15 cells and more importantly was able to overcome vincristine resistance in CHLA-20 cells. Conclusions These findings demonstrate the potential of Smac mimetics for the development of novel therapeutic approaches for the treatment of relapsed/resistant neuroblastoma.

SummaryAim: According to German guidelines, I-123-MIBG scintigraphy in neuroblastoma (NB) is preferably performed as early (about 4 h p.i.) and late (24 h p.i.) planar imaging and single- photon emission computed tomography (SPECT) or SPECT/CT 24 h p.i. This study evaluated if the work-up could be reduced to a single timepoint.Methods: Retrospective analysis of 37 examinations in 26 patients (f:8; m:18; age, 0.5–23.5a) with NB (initial, 15; restaging, 22). All 74 (early + late) pairs of ventral/dorsal planar whole-body images were reviewed by 3 independent readers in random order blinded to clinical data (1, certainly physiological; 2, likely physiological; 3, likely malignant; 4, certainly malignant). CT/MRI or SPECT served as standard of reference if planar images were equivocal.Results: Two-hundred malignant lesions were rated (1–23 lesions per examination). The lesions’ mean score was higher at late vs. early imaging for all readers (3.6 vs. 3.4, 3.7 vs. 3.2, 3.5 vs. 3.2; each p < 0.01). Fifty-one lesions (25.5 %) were considerably underrated at early vs. late imaging (score difference ≥2) by any reader (29/153 skeletal lesions, 12/28 primary tumors [PT], 10/18 abdominal lymph nodes [LN]). Early image did not detect any lesion in 6 patients with PT only. In contrast, 9 lesions (4.5 %) were underrated by late vs. early imaging: 5 skeletal lesions (pelvis, 2; femoral shaft, 3), 1 PT, 3 LN, and 0/1 liver lesions. Tumor spread was underestimated thereby at late vs. early imaging in 1 patient (LN) but SPECT was correct.Conclusion: The early planar image provided no relevant information over the late image in any patient and may only be performed after weighting of risks (stress) and benefits – especially if SPECT or SPECT/CT is routinely performed. Vice versa, early planar image alone does not suffice.

// Doerte Langemann 1 , Magdalena Trochimiuk 1 , Birgit Appl 1 , Patrick Hundsdoerfer 2 , Konrad Reinshagen 1 and Georg Eschenburg 1 1 Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 2 Department of Pediatric Oncology/Hematology, Charite - Universitatsmedizin Berlin, Berlin, Germany Correspondence to: Georg Eschenburg, email: g.eschenburg@uke.de Keywords: neuroblastoma, LCL161, vincristine, NFκB, G2 cell cycle arrest Received: June 27, 2017 Accepted: August 14, 2017 Published: September 23, 2017 ABSTRACT We demonstrated sensitization for chemotherapy by Smac mimetic (SM) LCL161, a potent antagonist of inhibitor of apoptosis proteins (IAP), in neuroblastoma (NB). Vinca alkaloids, particularly vincristine (VCR), displayed the strongest impact on inhibition of proliferation and apoptosis induction in combination with LCL161. The underlying signaling pathways remain elusive, though. LCL161 induces a quick degradation of cellular IAP 1 (cIAP-1). Combination of LCL161 with VCR had only marginal effects on X-linked IAP (XIAP) protein expression. Cell death is accompanied by activation of intrinsic (caspase-9 and MMP) and extrinsic (caspase-8) pathways of apoptosis, repression of migratory potential and cell cycle arrest in G2 phase. LCL161-induced cIAP degradation leads to activation of non-canonical and blockade of canonical NF-κB pathways but not induction of apoptosis. Surprisingly NF-κB and TNF-α signaling is negligible for VCR- and VCR/LCL161-induced apoptosis since chemical inhibition of NF-κB using BAY-7085 and PBS-1086, as well as application of TNF-α blocking antibody Humira (adalimumab) has no relevant effect on cell death. Recently formation of a TNF-α-independent complex (ripoptosome) consisting of RIP1, FADD and caspase-8 following IAP inhibition by SM has been described. However, targeting of RIP1 by Necrostatin was not sufficient to influence apoptosis induced by VCR/LCL161.

The clinical course of neuroblastoma is more heterogeneous than any other malignant disease. Most low-risk patients experience regression after limited or even no chemotherapy. However, more than half of high-risk patients die from disease despite intensive multimodal treatment. Precise patient characterization at diagnosis is key for risk-adapted treatment. The guidelines presented here incorporate results from national and international clinical trials to produce recommendations for diagnosing and treating neuroblastoma patients in German hospitals outside of clinical trials.

B-cell lymphomas are common malignancies during infancy and childhood with excellent long-term cure rates. However, relapse or refractory disease associated with very poor prognosis (especially for...

// Safiullah Najem 1 , Doerte Langemann 1 , Birgit Appl 1 , Magdalena Trochimiuk 1 , Patrick Hundsdoerfer 2 , Konrad Reinshagen 1 and Georg Eschenburg 1 1 Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 2 Department of Pediatric Oncology/Hematology, Charite - Universitatsmedizin Berlin, Berlin, Germany Correspondence to: Georg Eschenburg, email: // Keywords : neuroblastoma, LCL161, Smac mimetics, chemotherapy, anaplastic lymphoma kinase Received : January 06, 2016 Accepted : August 27, 2016 Published : September 15, 2016 Abstract Neuroblastoma is the most common extracranial solid tumor during infancy and childhood. Outcome of high-risk and late-stage disease remains poor despite intensive treatment regimens. Suppressing inhibitor of apoptosis proteins (IAPs) using Smac mimetics (SM) significantly sensitizes neuroblastoma (NB) cells for chemotherapy, however strongly dependent on the cytotoxic drug combined with SM. Therefore, a systematic analysis of the impact of SM in combination with different classes of chemotherapeutics was of crucial importance. Treatment of NB cell lines with SM LCL161 and vinca alkaloids revealed a strong synergistic inhibition of proliferation and significant induction of apoptosis in virtually all established and de novo NB cell lines ( n =8). In contrast, combination of anthracyclines or topoisomerase inhibitors with LCL161 showed a synergism for single drugs and/or cell lines only. Furthermore, we could show that insensibility to LCL161-mediated sensitization for chemotherapeutics is associated with aberrant activation of anaplastic lymphoma kinase (ALK) by common mutation F1174L. Inhibition of ALK using TAE684 is able to overcome this resistance in a synergistic fashion, a finding that could be highly relevant for improvement of neuroblastoma therapy.

According to German guidelines, I-123-MIBG scintigraphy in neuroblastoma (NB) is preferably performed as early (about 4 h p.i.) and late (24 h p.i.) planar imaging and single- photon emission computed tomography (SPECT) or SPECT/CT 24 h p.i. This study evaluated if the work-up could be reduced to a single timepoint.Retrospective analysis of 37 examinations in 26 patients (f:8; m:18; age, 0.5-23.5a) with NB (initial, 15; restaging, 22). All 74 (early + late) pairs of ventral/dorsal planar whole-body images were reviewed by 3 independent readers in random order blinded to clinical data (1, certainly physiological; 2, likely physiological; 3, likely malignant; 4, certainly malignant). CT/MRI or SPECT served as standard of reference if planar images were equivocal.Two-hundred malignant lesions were rated (1-23 lesions per examination). The lesions' mean score was higher at late vs. early imaging for all readers (3.6 vs. 3.4, 3.7 vs. 3.2, 3.5 vs. 3.2; each p0.01). Fifty-one lesions (25.5 %) were considerably underrated at early vs. late imaging (score difference ≥2) by any reader (29/153 skeletal lesions, 12/28 primary tumors [PT], 10/18 abdominal lymph nodes [LN]). Early image did not detect any lesion in 6 patients with PT only. In contrast, 9 lesions (4.5 %) were underrated by late vs. early imaging: 5 skeletal lesions (pelvis, 2; femoral shaft, 3), 1 PT, 3 LN, and 0/1 liver lesions. Tumor spread was underestimated thereby at late vs. early imaging in 1 patient (LN) but SPECT was correct.The early planar image provided no relevant information over the late image in any patient and may only be performed after weighting of risks (stress) and benefits - especially if SPECT or SPECT/CT is routinely performed. Vice versa, early planar image alone does not suffice.Ziel: Gemäß den deutschen Leitlinien wird die I-123-MIBG-Szintigraphie bei Neuroblastomen vorzugsweise als frühe (ca. 4 h p.i.) und späte (24 h p.i.) planare Aufnahmen und SPECT (Single Photon-Emissionscomputertomographie) oder SPECT/CT-Aufnahmen (24 h p.i.) angefertigt. In dieser Studie wurde untersucht, ob eine methodische Reduktion auf einen einzigen Untersuchungszeitpunkt möglich wäre.Methoden: Retrospektive Analyse von 37 Untersuchungen bei 26 Patienten (w: 8, m: 18; Alter: 0,5–23,5 J.) mit NB (Erstuntersuchung: 15; Re-Staging: 22). Alle 74 (frühen + späten) Paare von ventralen/dorsalen planaren Ganzkörperaufnahmen wurden in zufälliger Reihenfolge von 3 unabhängigen, gegenüber klinischen Daten verblindeten Gutachtern geprüft (1, sicher physiologisch; 2, wahrscheinlich physiologisch; 3, wahrscheinlich maligne; 4, sicher maligne). Bei nicht eindeutigen planaren Aufnahmen dienten CT/MRToder SPECT-Aufnahmen als Referenz.Ergebnisse: Es wurden 200 maligne Läsionen (1–23 Läsionen pro Untersuchung) klassifiziert. Bei allen Gutachtern lag der mittlere Score für späte Aufnahmen höher als für frühe Aufnahmen (3,6 vs. 3,4; 3,7 vs. 3,2; 3,5 vs. 3,2; jeweils p0,01). Einundfünfzig Läsionen (25,5 %) wurden in den frühen vs. späten Aufnahmen von allen Gutachtern erheblich unterschätzt (Score-Differenz ≥2) (29/153 Skelettläsionen, 12/28 Primärtumore [PT], 10/18 abdominale Lymphknoten [LN]). In frühen Aufnahmen konnte bei 6 Patienten, die nur PT aufwiesen, überhaupt keine Läsion nachgewiesen werden. Hingegen wurden 9 Läsionen (4,5 %) beim Vergleich spät vs. früh unterschätzt: 5 Skelettläsionen (Becken, 2; Femur, 3), 1 PT, 3 LN und 0/1 hepatische Läsion). Dadurch wurde bei 1 Patienten die Tumorausbreitung bei der späten vs. frühen Aufnahme unterschätzt (LN), die SPECT war jedoch korrekt.Schlussfolgerung: Bei keinem Patienten erbrachten die frühen planaren Aufnahmen über die Spätaufnahmen hinausgehende relevante Informationen. Daher sollten sie nur nach Nutzen-/Risiko-Abwägung (Stress) angefertigt werden – vor allem, wenn auch SPECT oder SPECT/CT routinemäßig durchgeführt werden. Umgekehrt sind Frühaufnahmen alleine nicht ausreichend.

Background Standardized treatment in pediatric patients with Hodgkin’s lymphoma (HL) follows risk stratification by tumor stage, erythrocyte sedimentation rate and tumor bulk. We aimed to identify quantitative parameters from pretherapeutic FDG-PET to assist prediction of response to induction chemotherapy. Methods Retrospective analysis in 50 children with HL (f:18; m:32; median age, 14.8 [4–18] a) consecutively treated according to EuroNet-PHL-C1 (n = 42) or -C2 treatment protocol (n = 8). Total metabolic tumor volume (MTV) in pretherapeutic FDG-PET was defined using a semi-automated, background-adapted threshold. Metabolic (SUVmax, SUVmean, SUVpeak, total lesion glycolysis [MTV*SUVmean]) and heterogeneity parameters (asphericity [ASP], entropy, contrast, local homogeneity, energy, and cumulative SUV-volume histograms) were derived. Early response assessment (ERA) was performed after 2 cycles of induction chemotherapy according to treatment protocol and verified by reference rating. Prediction of inadequate response (IR) in ERA was based on ROC analysis separated by stage I/II (1 and 26 patients) and stage III/IV disease (7 and 16 patients) or treatment group/level (TG/TL) 1 to 3. Results IR was seen in 28/50 patients (TG/TL 1, 6/12 patients; TG/TL 2, 10/17; TG/TL 3, 12/21). Among all PET parameters, MTV best predicted IR; ASP was the best heterogeneity parameter. AUC of MTV was 0.84 (95%-confidence interval, 0.69–0.99) in stage I/II and 0.86 (0.7–1.0) in stage III/IV. In patients of TG/TL 1, AUC of MTV was 0.92 (0.74–1.0); in TG/TL 2 0.71 (0.44–0.99), and in TG/TL 3 0.85 (0.69–1.0). Patients with high vs. low MTV had IR in 86 vs. 0% in TG/TL 1, 80 vs. 29% in TG/TL 2, and 90 vs. 27% in TG/TL 3 (cut-off, > 80 ml, > 160 ml, > 410 ml). Conclusions In this explorative study, high total MTV best predicted inadequate response to induction therapy in pediatric HL of all pretherapeutic FDG-PET parameters – in both low and high stages as well as the 3 different TG/TL. Trial registration Ethics committee number: EA2/151/16 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12885-018-4432-4) contains supplementary material, which is available to authorized users.

Despite intense efforts, the cure rates of childhood and adult solid tumors are not satisfactory. Resistance to intensive chemotherapy is common, and targets for molecular therapies are largely undefined. We have now found that the majority of childhood solid tumors, including rhabdoid tumors, neuroblastoma, medulloblastoma and Ewing sarcoma, express an active DNA transposasePGBD5that can promote site-specific genomic rearrangements in human cells. Using functional genetic approaches, we found that mouse and human cells deficient in non-homologous end joining (NHEJ) DNA repair cannot tolerate the expression of PGBD5. In a chemical screen of DNA damage signaling inhibitors, we identified AZD6738 as a specific sensitizer of PGBD5-dependent DNA damage and apoptosis. We found that expression of PGBD5, but not its nuclease activity-deficient mutant, was sufficient to induce hypersensitivity to AZD6738. Depletion of endogenous PGBD5 conferred resistance to AZD6738 in human tumor cells. PGBD5-expressing tumor cells accumulated unrepaired DNA damage in response to AZD6738 treatment, and underwent apoptosis in both dividing and G1 phase cells in the absence of immediate DNA replication stress. Accordingly, AZD6738 exhibited nanomolar potency against the majority of neuroblastoma, medulloblastoma, Ewing sarcoma and rhabdoid tumor cells tested, while sparing non-transformed human and mouse embryonic fibroblastsin vitro. Finally, treatment with AZD6738 induced apoptosis and regression of human neuroblastoma and medulloblastoma tumors engrafted in immunodeficient micein vivo. This effect was potentiated by combined treatment with cisplatin, including significant anti-tumor activity against patient-derived primary neuroblastoma xenografts. These findings delineate a therapeutically actionable synthetic dependency induced in PGBD5-expressing solid tumors.

Fewer than 50% of patients with high-risk neuroblastoma survive five years after diagnosis with current treatment protocols. Molecular targeted therapies are expected to improve survival. Although MDM2 has been validated as a promising target in preclinical models, no MDM2 inhibitors have yet entered clinical trials for neuroblastoma patients. Toxic side effects, poor bioavailability and low efficacy of the available MDM2 inhibitors that have entered phase I/II trials drive the development of novel MDM2 inhibitors with an improved risk-benefit profile. We investigated the effect of the novel MDM2 small molecular inhibitor, DS-3032b, on viability, proliferation, senescence, migration, cell cycle arrest and apoptosis in a panel of six neuroblastoma cell lines with different TP53 and MYCN genetic backgrounds, and assessed efficacy in a murine subcutaneous model for high-risk neuroblastoma. Re-analysis of existing expression data from 476 primary neuroblastomas showed that high-level MDM2 expression correlated with poor patient survival. DS-3032b treatment enhanced TP53 target gene expression and induced G1 cell cycle arrest, senescence and apoptosis. CRISPR-mediated MDM2 knockout in neuroblastoma cells mimicked DS-3032b treatment. TP53 signaling was selectively activated by DS-3032b in neuroblastoma cells with wildtype TP53, regardless of the presence of MYCN amplification, but was significantly reduced by TP53 mutations or expression of a dominant-negative TP53 mutant. Oral DS-3032b administration inhibited xenograft tumor growth and prolonged mouse survival. Our in vitro and in vivo data demonstrate that DS-3032b reactivates TP53 signaling even in the presence of MYCN amplification in neuroblastoma cells, to reduce proliferative capacity and cause cytotoxicity.

Risk-adapted treatment in children with neuroblastoma (NB) is based on clinical and genetic factors. This study evaluated the metabolic tumour volume (MTV) and its asphericity (ASP) in pretherapeuticThis retrospective study included 23 children (11 girls, 12 boys; median age 1.8 years, range 0.3-6.8 years) with newly diagnosed NB consecutively examined with pretherapeuticMedian follow-up was 36 months (range 7-107 months; eight patients showed disease progression/relapse, four patients died). The only significant predictors of EFS in the univariate Cox regression analysis were ASP (p = 0.029; hazard ratio, HR, 1.032 for a one unit increase), MTV (p = 0.038; HR 1.012) and MYCN amplification status (p = 0.047; HR 4.67). The mean EFS in patients with high ASP (32.0%) and low ASP were 21 and 88 months, respectively (p = 0.013), and in those with high MTV (46.7 ml) and low MTV were 22 and 87 months, respectively (p = 0.023). A combined risk model of either high ASP and high HVA/C or high MTV and high HVA/C best predicted EFS.In this exploratory study, pretherapeutic image-derived and laboratory markers of tumoral metabolic activity in NB (ASP, MTV, urinary HVA/C) allowed the identification of children with a high and low risk of progression/relapse under current therapy.

Purpose Risk-adapted treatment in children with neuroblastoma (NB) is based on clinical and genetic factors. This study evaluated the metabolic tumour volume (MTV) and its asphericity (ASP) in pretherapeutic 123I-MIBG SPECT for individualized image-based prediction of outcome. Methods This retrospective study included 23 children (11 girls, 12 boys; median age 1.8 years, range 0.3–6.8 years) with newly diagnosed NB consecutively examined with pretherapeutic 123I-MIBG SPECT. Primary tumour MTV and ASP were defined using semiautomatic thresholds. Cox regression analysis, receiver operating characteristic analysis (cut-off determination) and Kaplan-Meier analysis with the log-rank test for event-free survival (EFS) were performed for ASP, MTV, laboratory parameters (including urinary homovanillic acid-to-creatinine ratio, HVA/C), and clinical (age, stage) and genetic factors. Predictive accuracy of the optimal multifactorial model was determined in terms of Harrell’s C and likelihood ratio χ2. Results Median follow-up was 36 months (range 7–107 months; eight patients showed disease progression/relapse, four patients died). The only significant predictors of EFS in the univariate Cox regression analysis were ASP (p = 0.029; hazard ratio, HR, 1.032 for a one unit increase), MTV (p = 0.038; HR 1.012) and MYCN amplification status (p = 0.047; HR 4.67). The mean EFS in patients with high ASP (>32.0%) and low ASP were 21 and 88 months, respectively (p = 0.013), and in those with high MTV (>46.7 ml) and low MTV were 22 and 87 months, respectively (p = 0.023). A combined risk model of either high ASP and high HVA/C or high MTV and high HVA/C best predicted EFS. Conclusions In this exploratory study, pretherapeutic image-derived and laboratory markers of tumoral metabolic activity in NB (ASP, MTV, urinary HVA/C) allowed the identification of children with a high and low risk of progression/relapse under current therapy.

Circular RNAs (circRNAs), a noncoding RNA class originating from alternative splicing, are highly abundant in neural tissues and can regulate gene expression by binding to and inhibiting microRNAs and RNA-binding proteins. We explored whether circRNAs influence pathogenesis in neuroblastoma, the most common solid extracranial tumor of childhood. We performed whole-transcriptome sequencing of primary neuroblastoma samples to identify candidate circRNAs, which were validated in a neuroblastoma cell line panel. Overexpression and knockdown models were created to investigate their impact on cell viability, proliferation, apoptosis and differentiation. We identified 4,482 unique circRNA backsplicing junctions involving 2,080 genes in 69 neuroblastoma samples from all risk groups. Candidate circRNA expression did not correlate with host gene expression, indicating independent regulatory mechanisms. Principal component analysis was conducted using tumor circRNA expression. MYCN-amplified tumors clustered tightly together, demonstrating that variations in circRNA expression identify MYCN-amplified neuroblastomas as do gene expression patterns. Comparing our RNA sequencing data with other cancers and healthy fetal brain tissue revealed a circRNA subset specifically upregulated in neuroblastoma that included a circRNA derived from the ARID1A tumor suppressor gene. Cell fractionization and RNA FISH localized circARID1A to the cytoplasm, where it could interact with miRNAs and RNA-binding proteins for functional consequences. Specific circARID1A knockdown reduced cell numbers and viability, and induced neurite outgrowth and differentiation markers. Neither knockdown, nor overexpression of circARID1A influenced ARID1A mRNA and protein levels. Ongoing efforts applying bioinformatics methods to investigate the mechanism of action have identified several binding sites of microRNAs and RNA-binding proteins enriched in the circARID1A sequence. We demonstrate that circRNAs are expressed in neuroblastomas unrelated to host gene expression, and that their expression can be used to cluster MYCN-amplified tumors. As one in a set of upregulated circRNAs, circARID1A acts in a tumor-promoting manner in neuroblastoma cell lines independent of the host gene. Citation Format: Filippos Klironomos, Clara Danssmann, Julian Naderi, Annika Winkler, Uschi Luz, Patrick Hundsdoerfer, Angelika Eggert, Joern Toedling, Falk Hertwig, Johannes H. Schulte, Steffen Fuchs. Circular RNAs contribute to neuroblastoma pathogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1820.

Background The pathophysiological origin of juvenile idiopathic arthritis (JIA) is largely unknown. However, individuals with presumably pathogenic mutations in FAMIN have been reported, associating this gene with a rare subtype of this disorder. FAMIN, that is formerly also referred to as LACC1 or C13orf31, has recently been shown to play a crucial role in immune-metabolic functions and is involved in regulation of inflammasome activation and promotion of ROS production. Case presentation We describe two siblings with severe familial forms of juvenile arthritis in which whole-exome-sequencing revealed a novel homozygous frameshift mutation (NM_153218.2:c.827delC¸. p.(T276fs*2) in FAMIN. Conclusions The observation of a new deleterious mutation adds further evidence that pathogenic mutations in FAMIN are causal for a monogenic form of JIA. Furthermore the associated phenotype is not restricted to systemic JIA, but can also be found in other forms of familial juvenile arthritis.

Distal 15q25.2 microdeletions have recently been reported as a copy number variation (CNV) locus for neurodevelopmental and neuropsychiatric disorders with variable outcome. In addition, more proximal microdeletions of 15q25.2 have been described as a susceptibility locus for cognitive deficits, congenital diaphragmatic hernia (CDH), and Diamond-Blackfan anaemia (DBA). We describe two patients with 15q25.2 deletion, one with the more distal deletion and the other with a deletion overlapping both the distal and proximal 15q25.2 deletions and compare them to the 18 so far reported patients with 15q25.2 deletions. We provide a characterization of the 15q25.2 microdeletions and contribute to the genotype-phenotype delineation for these two novel microdeletion syndromes.

Synthetic lethal dependencies have recently emerged as tumor-specific vulnerabilities which provide broad therapeutic windows and have successfully been used for rational therapeutic target discovery. Despite intense international efforts over many decades, cure rates for patients with high-risk rhabdomyosarcoma remain dismal. Resistance to intensive chemotherapy is common, and targets for molecular therapies are largely undefined. Telomere maintenance is a hallmark of cancer and requires either activation of telomerase (TERT) or alternative lengthening of telomeres (ALT). ALT is active in a large subset of rhabdomyosarcomas and not active in healthy tissues suggesting it is a unique, tumor-specific process. ALT has recently been shown to depend on DNA damage response activation through the ATR kinase, and studies in osteosarcoma have revealed that ALT renders cancer cells hypersensitive to ATR inhibition. This defines ALT as a tumor-specific synthetic lethal determinant for susceptibility to ATR inhibition. Consistent with previous reports, we observed that ALT-dependent rhabdomyosarcoma cells are hypersensitive to ATR inhibition via AZD6738, a small molecule ATR inhibitor currently being tested in clinical trials. Intriguingly, we found that treatment with ATR inhibitors not only induced DNA damage but also resulted in aneuploidy and subsequent apoptosis in ALT-dependent rhabdomyosarcoma cells, suggesting loss of telomere protection and inadequate chromosomal segregation occur during mitosis upon ATR inhibition. To test this, we measured unrepaired DNA double-strand break formation using TUNEL. ALT-dependent cells, but not TERT-dependent cells, showed increased TUNEL labeling, consistent with an increase in double-stranded DNA breaks and unprotected DNA ends. Consistent with reduced telomere maintenance, ATR inhibition significantly reduced the number of C-circles in rhabdomyosarcoma cells relying on ALT. Furthermore, AZD6738 treatment reduced phosphorylation of known ATR targets, and differentially phosphorylated peptides were enriched for proteins involved in alternative lengthening of telomeres as measured using SILAC labeling and LC-MS/MS phospho-proteomic analysis. Finally, treatment with AZD6738 reduced tumor burden in patient-derived primary rhabdomyosarcoma xenografts, which was potentiated by combined treatment with cisplatin. Our findings delineate a therapeutically actionable DNA repair dependency induced at least in part by ALT and may lead directly to clinical translation of ATR inhibitors for therapy of refractory rhabdomyosarcoma. Citation Format: Heathcliff Dorado García, Jennifer von Stebut, Ian MacArthur, Koshi Imami, Natalie Timme, Kerstin Schoenbeck, Annabell Szymansky, Georg Seifert, Patrick Hundsdoerfer, Andrej Lissat, Matthias Selbach, Angelika Eggert, Johannes Schulte, Anton Henssen. Synthetic lethal targeting of ATR in alternative lengthening of telomeres-dependent rhabdomyosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2628.

Background Resistance to glucocorticoid induced apoptosis is one of the major risk factors for relapse and poor outcome in childhood acute lymphoblastic leukemia (ALL). Overexpression of X-linked inhibitor of apoptosis protein (XIAP) has been shown to be associated with chemotherapy resistance in several malignancies. Procedure XIAP protein and mRNA expression were determined in leukemic blasts of 51 childhood ALL patients and normal bone marrow mononuclear cells. XIAP expression was correlated with glucocorticoid response and outcome. Results XIAP protein but not mRNA expression was found to be highly increased in childhood ALL compared to control bone marrow mononuclear cells (MNC) (median: 3.5 vs. 0.14 ng/105 MNC, P

Purpose In adult Hodgkin's lymphoma (HL) risk stratification after early therapy response assessment with [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) seems to allow tailoring therapy with less toxicity for patients with adequate metabolic response. This study delivers the first prospective data on the potential of FDG-PET for response assessment in pediatric HL. Patients and Methods FDG-PET was performed in 40 pediatric HL patients before polychemotherapy (PET-1), after two cycles of polychemotherapy (PET-2), and after completion of polychemotherapy (PET-3). Mean follow-up was 46 months (range, 26 to 72 months). Results At early and late response assessment, the proportion of PET-negative patients was significantly higher compared with those patients with negative findings in conventional imaging methods (CIMs; PET-2, 26 of 40 v CIM-2, one of 40; P < .001; PET-3, 21 of 29 v CIM-3, four of 29; P < .001). Sensitivity and negative predictive value were 100% for early and late therapy response assessment by PET. Both patients suffering a relapse during follow-up were identified by PET-2/3, whereas one of these patients was not detected by CIM-3. PET was superior to CIMs with regard to specificity in early and late therapy response assessment (68% v 3%, and 78% v 11%, respectively; both P < .001). Specificity of early therapy response assessment by PET was improved to 97% by quantitative analysis of maximal standardized uptake value reduction using a cutoff value of 58%. Conclusion Pediatric HL patients with a negative PET in response assessment have an excellent prognosis while PET-positive patients have an increased risk for relapse.

Numerous cellular mRNAs encoding proteins critical during cell stress, apoptosis, and the cell cycle seem to be translated by means of internal ribosome entry sequences (IRES) when cap-dependent translation is compromised. The underlying molecular mechanisms are largely unknown. Using a HeLa-based cell-free translation system that mirrors the function of cellular IRESs in vitro , we recently demonstrated that translation from the c- myc IRES continues after proteolytic cleavage of eukaryotic translation initiation factor (eIF) 4G. To address the role of eIF4G in cellular IRES-driven translation directly, we immunodepleted eIF4GI from the HeLa cell translation extracts. After efficient depletion of eIF4GI (>90%), both cap-dependent and c- myc IRES-dependent translations are diminished to residual levels (myc IRES-dependent translation is fully restored by addition of the conserved middle fragment of eIF4GI, harboring the eIF3- and eIF4A-binding sites. p97, an eIF4G-related protein that has been described both as an inhibitor of translation and as a modulator of apoptosis, not only suffices to also rescue c- myc IRES-driven (but not cap-dependent) translation, but it even superinduces IRES-mediated translation 3-fold compared with nondepleted extracts. Interestingly, both p97 and the middle fragment of eIF4GI also rescue translation driven by proapoptotic (p97) and antiapoptotic [X-linked inhibitor of apoptosis (XIAP) and cellular inhibitor of apoptosis 1 (c-IAP1)] IRESs, reflecting a broader role of these polypeptides in cellular IRES-mediated translation and indicating their importance in apoptosis.

The poly(A) tail at the 3' end of mRNAs enhances 5' cap-dependent translation initiation. We show that it also enhances IRES-directed translation of two cellular mRNAs in vitro and in vivo. The underlying mechanisms, however, differ fundamentally. In contrast to cap-dependent translation, IRES-driven translation continues to be enhanced by the poly(A) tail following proteolytic cleavage of eIF4G. Moreover, the poly(A) tail stimulates IRES-mediated translation even in the presence of PAIP2 or following effective depletion of the poly(A) binding protein (PABP) from HeLa cell extracts. The PABP-eIF4G bridging complex that is critical for cap-dependent translation is thus dispensable for the enhancement of the IRESs by the poly(A) tail. The polyadenylated mRNA translation from cellular IRESs is also profoundly sensitive to eIF4A activity in vitro. These mechanistic and molecular distinctions implicate the potential for a new layer of translational control mechanisms.

The functional analysis of the common prothrombin 20210 G>A(F2 20210*A) mutation has recently revealed gain of function of 3′end processing as a novel genetic mechanism predisposing to human disease. We now show that the physiologic G at the cleavage site at position 20210 is the functionally least efficient nucleotide to support 3′end processing but has evolved to be physiologically optimal. Furthermore, the F2 3′end processing signal is characterized by a weak downstream cleavage stimulating factor (CstF) binding site with a low uridine density, and the functional efficiency of F2 3′end processing can be enhanced by the introduction of additional uridine residues. The recently identified thrombosis-related mutation (F2 20221*T) within the CstF binding site up-regulates F2 3′end processing and prothrombin biosynthesis in vivo. F2 20221*T thus represents the first example of a likely pathologically relevant mutation of the putative CstF binding site in the 3′flanking sequence of a human gene. Finally, we show that the low-efficiency F2 cleavage and CstF binding sites are balanced by a stimulatory upstream uridine-rich element in the 3′UTR. The architecture of the F2 3′end processing signal is thus characterized by a delicate balance of positive and negative signals. This balance appears to be highly susceptible to being disturbed by clinically relevant gain-of-function mutations. (Blood. 2004;104:428-435)

The G-->A mutation at position 20210 of the prothrombin or coagulation factor II gene (F2) represents a common genetic risk factor for the occurrence of thromboembolic events. This mutation affects the 3'-terminal nucleotide of the 3' untranslated region (UTR) of the mRNA and causes elevated prothrombin plasma concentrations by an unknown mechanism. Here, we show that the mutation does not affect the amount of pre-mRNA, the site of 3' end cleavage or the length of the poly(A) tail of the mature mRNA. Rather, we demonstrate that the physiological F2 3' end cleavage signal is inefficient and that F2 20210 G-->A represents a gain-of-function mutation, causing increased cleavage site recognition, increased 3' end processing and increased mRNA accumulation and protein synthesis. Enhanced mRNA 3' end formation efficiency emerges as a novel principle causing a genetic disorder and explains the role of the F2 20210 G-->A mutation in the pathogenesis of thrombophilia. This work also illustrates the pathophysiologic importance of quantitatively minor aberrations of RNA metabolism.

The main reason for the admission of this patient to our clinic was arterial hypertension refractory to extensive multi-drug therapy associated with massive enlargement of the kidneys. The differential diagnosis of bilaterally enlarged kidneys in childhood includes bilateral renal vein thrombosis, renal granulomatous disease, xanthogranulomatous pyelonephritis, glycogen storage disease [1], and autosomal dominant or recessive polycystic kidney disease, all of which could be ruled out by the patients’ history and clinical presentation and the lack of cystic formations on ultrasound respectively. In addition, Perlman syndrome, a rare overgrowth syndrome with distinct phenotypic features, is a rare cause of nephromegaly, but presents in the neonatal period [2]. Therefore, the remaining differential diagnosis includes malignancies, i.e., bilateral Wilms tumor, nephroblastomatosis, primary renal lymphoma, and leukemic infiltration. Bilateral disease occurs in 4–13 % of patients with Wilms tumor [3]. Bilateral nephroblastomatosis can occur either without additional features or in the context of Beckwith– Wiedemann syndrome. Renal abnormalities are a cardinal feature of Beckwith–Wiedemann syndrome and nephromegaly in this overgrowth disorder may be nonmalignant or associated with nephroblastomatosis or Wilms tumor [4, 5]. However, pan-cytopenia, in addition to cerebral seizures and hypertension, were not well explained by nephroblastomatosis or bilateralWilms tumor. Therefore, besides needle biopsy of the kidneys, bone marrow and lumbar punctures were mandatory. Pathological examination of the renal biopsy showed infiltration by lymphoblastic lymphoma (LBL). The normal bone marrow cells were almost completely (>85 %) replaced by lymphoblastic precursor B-cells, confirming the diagnosis of acute lymphoblastic leukemia (ALL; Fig. 1). As expected, lymphoblasts were also detected in the cerebrospinal fluid. Acute lymphoblastic leukemia is the most common malignant disease of infancy and childhood. In this patient, ALL possibly developed secondary to LBL of the kidneys. ALL and LBL both derive from immature lymphoid precursor cells and their differentiation is based on the grade of bone marrow infiltration (more or less than 25 % lymphoblasts). Therefore, treatment strategies of ALL and LBL are similar and longterm cure can be achieved in about 90 % of patients [6]. Multi-drug chemotherapy is the major backbone and treatment intensity is adjusted according to stage of disease and early response to therapy. Central nervous system (CNS)-directed therapy (intrathecal and high-dose intravenous methotrexate, cranial irradiation if required), even for patients with localized LBL, is essential for successful treatment. In This refers to the article that can be found at http://dx.doi.org/10.1007/ s00467-015-3182-7.

SummaryAim: To evaluate the use and reliability of the PET-based response criteria for interim PET (iPET) in terms of interobserver variability in pediatric and adolescent patients suffering from non-Hodgkin´s lymphoma (NHL). Particular attention was given to the identification of visual cutoff to separate patients with a favourable outcome. Patients, methods: Retrospective analysis of PET-datasets of 18 children and adolescents suffering from NHL who underwent iPET after two cycles of chemotherapy for response assessment. Data sets were evaluated and rated in three independent review centers (RC) (blindedread, intra-center consensus) using a visual 5-point response scale. Ratings were compared to clinical outcome. Pairwise interobserver agreement was analysed with Cohen’s kappa-test (k). Overall agreement (between attended RCs) was assessed with Fleiss’ k-test. Results: Four patients suffered relapse (early, n = 2; late, n = 2). Per region analyses on interobserver variability revealed a “substantial” agreement (Fleiss’ k = 0.618). Per patient analyses revealed concordant iPETratings in eight patients: iPET-negative (iPET–), n = 5; iPET-positive (iPET+), n = 2; iPET-inconclusive (iPET±), n = 1. Discordant ratings were found in the remaining patients. Patients with early relapse were concordantly identified using mediastinal blood pool structures (MBPS, score ≥ 3) as visual cutoff between iPET+ or iPET–, respectively. However, patients with late relapse were not concordantly identified taking the MBPS as visual cutoff. Conclusion: The iPET interpretation using a dedicated PET-based response scale assured a low interobserver variability in per-region but not in per-patient analyses in a multicenter read. Using a sensitive read out (iPET+, score ≥ 3) a reliable identification of patients suffering relapse was limited to those with early relapse.

Despite intensive treatment regimens, high-risk and late-stage neuroblastoma tends to have a poor survival outcome. Overexpression of the apoptotic regulator, X-linked inhibitor of apoptosis protein (XIAP), has been associated with chemotherapy resistance in several cancers including neuroblastoma. Here, we report preclinical evidence that XIAP offers an effective therapeutic target in neuroblastoma. Human and murine neuroblastoma cells were treated with the Smac mimetic LBW242 alone or in combination with cytotoxic drugs used clinically to treat neuroblastoma. Expression of XIAP protein, but not mRNA, was highly increased in neuroblastoma cells compared to healthy adrenal gland tissue, consistent with a posttranscriptional regulation of XIAP expression. Treatment with LBW242 sensitized human and murine neuroblastoma cells to chemotherapy-induced apoptosis, which was mediated by activation of both the intrinsic and extrinsic apoptosis pathways. Although Smac mimetics have been reported to stimulate TNF-α–induced apoptosis by degradation of cellular IAP (cIAP)-1/2, we found that LBW242-mediated sensitization in neuroblastoma cells occurred in a TNF-α–independent manner, despite induction of cIAP-1/2 degradation and TNF-α expression. Together, our findings show that XIAP targeting sensitizes neuroblastoma to chemotherapy-induced apoptosis, suggesting a novel therapeutic approach to treat this childhood malignancy. Cancer Res; 72(10); 2645–56. ©2012 AACR.