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      Molecular subgroups of medulloblastoma: an international meta-analysis of transcriptome, genetic aberrations, and clinical data of WNT, SHH, Group 3, and Group 4 medulloblastomas

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          Abstract

          Medulloblastoma is the most common malignant brain tumor in childhood. Molecular studies from several groups around the world demonstrated that medulloblastoma is not one disease but comprises a collection of distinct molecular subgroups. However, all these studies reported on different numbers of subgroups. The current consensus is that there are only four core subgroups, which should be termed WNT, SHH, Group 3 and Group 4. Based on this, we performed a meta-analysis of all molecular and clinical data of 550 medulloblastomas brought together from seven independent studies. All cases were analyzed by gene expression profiling and for most cases SNP or array-CGH data were available. Data are presented for all medulloblastomas together and for each subgroup separately. For validation purposes, we compared the results of this meta-analysis with another large medulloblastoma cohort ( n = 402) for which subgroup information was obtained by immunohistochemistry. Results from both cohorts are highly similar and show how distinct the molecular subtypes are with respect to their transcriptome, DNA copy-number aberrations, demographics, and survival. Results from these analyses will form the basis for prospective multi-center studies and will have an impact on how the different subgroups of medulloblastoma will be treated in the future.

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          The online version of this article (doi:10.1007/s00401-012-0958-8) contains supplementary material, which is available to authorized users.

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          Most cited references18

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          Genome sequencing of pediatric medulloblastoma links catastrophic DNA rearrangements with TP53 mutations.

          Genomic rearrangements are thought to occur progressively during tumor development. Recent findings, however, suggest an alternative mechanism, involving massive chromosome rearrangements in a one-step catastrophic event termed chromothripsis. We report the whole-genome sequencing-based analysis of a Sonic-Hedgehog medulloblastoma (SHH-MB) brain tumor from a patient with a germline TP53 mutation (Li-Fraumeni syndrome), uncovering massive, complex chromosome rearrangements. Integrating TP53 status with microarray and deep sequencing-based DNA rearrangement data in additional patients reveals a striking association between TP53 mutation and chromothripsis in SHH-MBs. Analysis of additional tumor entities substantiates a link between TP53 mutation and chromothripsis, and indicates a context-specific role for p53 in catastrophic DNA rearrangements. Among these, we observed a strong association between somatic TP53 mutations and chromothripsis in acute myeloid leukemia. These findings connect p53 status and chromothripsis in specific tumor types, providing a genetic basis for understanding particularly aggressive subtypes of cancer. Copyright © 2012 Elsevier Inc. All rights reserved.
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            Subtypes of medulloblastoma have distinct developmental origins

            Medulloblastoma encompasses a collection of clinically and molecularly diverse tumor subtypes that together comprise the most common malignant childhood brain tumor1–4. These tumors are thought to arise within the cerebellum, with approximately 25% originating from granule neuron precursor cells (GNPCs) following aberrant activation of the Sonic Hedgehog pathway (hereafter, SHH-subtype)3–8. The pathological processes that drive heterogeneity among the other medulloblastoma subtypes are not known, hindering the development of much needed new therapies. Here, we provide evidence that a discrete subtype of medulloblastoma that contains activating mutations in the WNT pathway effector CTNNB1 (hereafter, WNT-subtype)1,3,4, arises outside the cerebellum from cells of the dorsal brainstem. We found that genes marking human WNT-subtype medulloblastomas are more frequently expressed in the lower rhombic lip (LRL) and embryonic dorsal brainstem than in the upper rhombic lip (URL) and developing cerebellum. Magnetic resonance imaging (MRI) and intra-operative reports showed that human WNT-subtype tumors infiltrate the dorsal brainstem, while SHH-subtype tumors are located within the cerebellar hemispheres. Activating mutations in Ctnnb1 had little impact on progenitor cell populations in the cerebellum, but caused the abnormal accumulation of cells on the embryonic dorsal brainstem that included aberrantly proliferating Zic1+ precursor cells. These lesions persisted in all mutant adult mice and in 15% of cases in which Tp53 was concurrently deleted, progressed to form medulloblastomas that recapitulated the anatomy and gene expression profiles of human WNT-subtype medulloblastoma. We provide the first evidence that subtypes of medulloblastoma have distinct cellular origins. Our data provide an explanation for the marked molecular and clinical differences between SHH and WNT-subtype medulloblastomas and have profound implications for future research and treatment of this important childhood cancer.
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              Integrative genomic analysis of medulloblastoma identifies a molecular subgroup that drives poor clinical outcome.

              Medulloblastomas are heterogeneous tumors that collectively represent the most common malignant brain tumor in children. To understand the molecular characteristics underlying their heterogeneity and to identify whether such characteristics represent risk factors for patients with this disease, we performed an integrated genomic analysis of a large series of primary tumors. We profiled the mRNA transcriptome of 194 medulloblastomas and performed high-density single nucleotide polymorphism array and miRNA analysis on 115 and 98 of these, respectively. Non-negative matrix factorization-based clustering of mRNA expression data was used to identify molecular subgroups of medulloblastoma; DNA copy number, miRNA profiles, and clinical outcomes were analyzed for each. We additionally validated our findings in three previously published independent medulloblastoma data sets. Identified are six molecular subgroups of medulloblastoma, each with a unique combination of numerical and structural chromosomal aberrations that globally influence mRNA and miRNA expression. We reveal the relative contribution of each subgroup to clinical outcome as a whole and show that a previously unidentified molecular subgroup, characterized genetically by c-MYC copy number gains and transcriptionally by enrichment of photoreceptor pathways and increased miR-183∼96∼182 expression, is associated with significantly lower rates of event-free and overall survivals. Our results detail the complex genomic heterogeneity of medulloblastomas and identify a previously unrecognized molecular subgroup with poor clinical outcome for which more effective therapeutic strategies should be developed.
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                Author and article information

                Contributors
                +49-6221-424636 , +49-6221-424639 , m.kool@dkfz.de
                Journal
                Acta Neuropathol
                Acta Neuropathologica
                Springer-Verlag (Berlin/Heidelberg )
                0001-6322
                1432-0533
                23 February 2012
                23 February 2012
                April 2012
                : 123
                : 4
                : 473-484
                Affiliations
                [1 ]Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
                [2 ]Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
                [3 ]Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
                [4 ]Arthur and Sonia Labatt Brain Tumour Research Centre, Program in Developmental and Stem Cell Biology, Hospital for Sick Children, University of Toronto, Toronto, Canada
                [5 ]Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, USA
                [6 ]Department of Oncogenomis, Academic Medical Center, Amsterdam, The Netherlands
                [7 ]Department of Pediatric Oncology, Academic Medical Center, Amsterdam, The Netherlands
                [8 ]Department of Pediatric Oncology/Hematology, Neuro-Oncology Research Group, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
                [9 ]Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
                [10 ]Department of Neuropathology, Bonn University, Bonn, Germany
                [11 ]Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                [12 ]Manchester Academic Health Science Centre, Manchester, UK
                [13 ]Department of Pathology, University of Cambridge, Cambridge, UK
                [14 ]Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
                [15 ]Department of Neuropathology, Medical University, Vienna, Austria
                [16 ]Laboratoire de génétique et biologie des cancers, Institut Curie, Paris, France
                [17 ]Department of Pediatric Oncology, Institut Curie and University Paris Descartes, Sorbonne Paris, France
                [18 ]Department of Pathology, St. Jude Children’s Research Hospital, Memphis, USA
                [19 ]Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, USA
                [20 ]Department of Neurology, Children’s Hospital Boston, Harvard Medical School, Boston, USA
                [21 ]Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
                [22 ]Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
                Article
                958
                10.1007/s00401-012-0958-8
                3306778
                22358457
                92d18212-b5a5-4a30-b7db-8b6631567a61
                © The Author(s) 2012
                History
                : 21 November 2011
                : 7 February 2012
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag 2012

                Neurology
                medulloblastoma,meta-analysis,subgroups,pediatric brain tumor
                Neurology
                medulloblastoma, meta-analysis, subgroups, pediatric brain tumor

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