人脑胶质瘤中的IDH1/2突变

胶质母细胞瘤的基因组突变分析中发现的异柠檬酸脱氢酶(isocitrate dehydrogenase,IDH1)突变对胶质瘤的认识具有突破性意义。随后,在胶质瘤中发现了IDH1的R132碱基和IDH2的R172碱基突变。IDH1突变较多的发生在WHOII-III级胶质瘤和继发胶质母细胞瘤中。这种突变改变了异柠檬酸脱氢酶的结构,从而使将异柠檬酸转化为a-酮戊二酸的能力丧失,而获得将a-酮戊二酸转化为2-羟基戊二酸这一新的酶活性。在临床中,IDH1和IDH2突变已经显示对胶质瘤患者有诊断和预后意义。同时,现今也发展了一些检测方法。     

胶质瘤中的异柠檬酸脱氢酶突变

胶质母细胞瘤的基因组突变分析中发现的异柠檬酸脱氢酶（isocitrate dehydrogenase,IDH）突变对胶质瘤的认识具有突破性意义.随后,在胶质瘤中发现了IDH1的R132碱基和IDH2的R172碱基突变.IDH1突变较多的发生在WHOⅡ～Ⅲ级胶质瘤和继发胶质母细胞瘤中.这种突变改变了异柠檬酸脱氢酶的结构,从而使将异柠檬酸转化为α-酮戊二酸的能力丧失,而获得将α-酮戊二酸转化为D-2-羟基戊二酸这一新的酶活性.在临床中,IDH1和IDH2突变已经显示对胶质瘤患者有诊断和预后意义.同时,现今也发展了一些检测方法.     

《自然-遗传学》:脑干胶质瘤特异基因突变首次发现

近日《自然-遗传学》报道,首都医科大学附属北京天坛医院副院长张力伟与美国杜克大学教授阎海共同合作,将临床医学研究优势转化为基础研究成果,在国际上首次发现脑干胶质瘤中特异的基因突变。这一重大发现成为"全基因组外显子测序在脑干胶质瘤发生机制及治疗分子靶点研究"项目的新突破。脑干是身体各部位神经与大脑之间的必经之路,是负责心跳、呼吸、循环、消化和意识等功能的关键部位之一。由于周边组织的重要性和脆弱性,历史上脑干胶质瘤是手术禁区。研究发现,脑干胶质瘤与大脑半球、丘脑等常见部位胶质瘤的生物特性差异明显,术后放疗和化疗均难以控制肿瘤生长,预后差,平均生存时间不到两年。此次科学家发现了脑干胶质瘤中特异的PPM1D基因突变。该突变与同时观察到的IDH1基因突变存     

线粒体DNA突变与相关人类疾病

在过去的20年里, 人们发现线粒体DNA(mitochondrial DNA, mtDNA)突变与多种人类疾病相关, 其致病范围从单器官组织损害到多系统受累。文章目的在于探讨mtDNA突变与人类疾病的关系。文章重点论述: (1)线粒体遗传学特征; (2) mtDNA突变与人类遗传性疾病; (3)体细胞mtDNA突变在衰老和肿瘤中的作用; (4)mtDNA疾病的诊断和治疗。     

IDH1基因突变在胶质瘤中的研究进展

胶质瘤是颅内最常见的恶性肿瘤,发病率逐年增高。越来越多的证据表明IDH1基因突变与胶质瘤密切相关。本文就近年来有关胶质瘤与IDH1基因突变的研究作一综述。IDH1基因编码胞浆内NADP依赖的异柠檬酸脱氢酶,后者能够对异柠檬酸进行催化生成α-酮戊二酸。在40%的胶质瘤中存在IDH1突变,在继发性胶质母细胞瘤中变异率最高。作为一种代谢的关键酶,IDH1突变后可以将α-KG转变成2-HG,后者具有促进细胞增殖和促进肿瘤发生的作用。而且,IDH1突变可以导致胶质瘤代谢和表观遗传学方面的改变。同时,IDH1突变可以通过增加HIF-1α水平及活性增加血管生成。目前在不同级别的胶质瘤当中,IDH1突变已经成为一个与预后密切相关的独立预测因素。对IDH1突变的研究有助于深入了解胶质瘤病因及干预措施的具体机制,有助于胶质瘤的分子水平分类和治疗。     

科研快讯

<正>《自然-遗传学》:脑干胶质瘤特异基因突变首次发现近日《自然-遗传学》报道,首都医科大学附属北京天坛医院副院长张力伟与美国杜克大学教授阎海共同合作,将临床医学研究优势转化为基础研究成果,在国际上首次发现脑干胶质瘤中特异的基因突变。这一重大发现成为"全基因组外显子测序在脑干胶质瘤发生机制及治疗分子靶点研究"项目的新突破。脑干是身体各部位神经与大脑之间的必经之路,是负责心跳、呼吸、循环、消化和意识等功能的关键部位之一。由于周边组织的重要性和脆弱     

研究报告: 第五版《世界卫生组织中枢神经系统肿瘤分类指南》下成人胶质瘤诊断及预后

目的 脑胶质瘤是最常见的恶性原发性中枢神经系统肿瘤,近年来分子病理的快速发展对胶质瘤诊断及分级带来了重要影响,在2021年发布的《世界卫生组织中枢神经系统肿瘤分类指南》（第五版）引入了更多分子指标对肿瘤的诊断和分级进行指导。本研究旨在临床队列中比较最新版指南和上一版指南对肿瘤诊断及预后评估的影响,以期为临床实践活动中新版指南的应用提供数据参考和依据。方法 回顾性纳入了癌症基因组图谱数据库512例胶质瘤样本,分别依据2016版和2021版《世界卫生组织中枢神经系统肿瘤分类指南》进行诊断、通过Kaplan-Meier进行生存曲线绘制和中位总生存期计算和生存差异分析。结果 对512例样本分别完成了上一版指南和最新版指南的诊断及分级。在新版指南下分别有53和72例异柠檬酸脱氢酶（IDH）突变型和IDH野生型的胶质瘤诊断级别升级为了4级,且这些诊断级别升高的胶质瘤的预后更差。结论 最新版指南较上一版指南可对胶质瘤进行更为精准地分类及分级,在有条件的情况下应尽快依据最新版指南开展诊断及分级。     

常规磁共振成像结合磁共振波谱在临床脑胶质瘤诊断及鉴别诊断中的应用价值

目的:分析磁共振氢质子磁共振波谱(Proton Magnetic Resonance Spectroscopy,1H-MRS)的特征与脑胶质瘤病理分级的相关性,探讨氢质子磁共振波谱及常规磁共振成像(Magnetic Resonance Imaging,MRI)联合应用在提高脑胶质瘤的临床诊断中的应用价值.方法:脑胶质瘤(经临床手术证实及病理诊断确诊)患者34例,参照国际卫生组织诊断标准,分为低级别胶质瘤组及高级别胶质瘤组.其中,低级别组16例,高级别组18例,在行常规MRI检查的同时,配合1H-MRS检查,测NAA(N-乙酰天门冬氨酸)、Cho(胆碱)、Cr(肌酸)值,在不同级别胶质瘤、同级别胶质瘤不同位置的代谢物进行综合分析.结果:在获得常规MRI图像并进行诊断后,进行氢质子磁共振波谱检测分析:在低级别胶质瘤及高级别胶质瘤患者中,Cr(肌酸)的总量变化不大,有轻度的下降;而NAA(N-乙酰天门冬氨酸)下降程度较为明显;Cho(胆碱)则明显升高.低级别胶质瘤及高级别胶质瘤患侧的肿瘤组织同对侧的正常脑组织的各种代谢物及其比值(Cho、NAA、NAA/Cho、NAA/Cr值)具有显著性差异(P＜0.05);低级别胶质瘤及高级别胶质瘤的肿瘤组织的代谢物比值NAA/Cr、NAA/Cho值差异具有显著性(P＜0.05).低级别胶质瘤及高级别胶质瘤的Cho/Cr、NAA/Cho、NAA/Cr值与脑胶质瘤的病理分级具有相关性;在各个比值中,NAA/Cr与NAA/Cho值能够较好地反映脑胶质瘤的病理分级,二者的值呈现负相关;Cho/Cr值呈正相关.结论:常规MRI联合1H-MRS在脑胶质瘤的诊断中,能够有效提高准确性,在临床评估脑胶质瘤的分级、确定范围和鉴别诊断都具有重要的指导作用.     

异柠檬酸脱氢酶-1 突变及MGMT 甲基化在脑胶质瘤的诊断及治疗研究进展

异柠檬酸脱氢酶-1(Isocitrate dehydrogenase-1,IDH1)突变是脑胶质瘤中基因突变所导致的代谢物生成异常,突变型胶质瘤与普通型胶质瘤具有不同的分子生物学特征,并常与患者良好预后相关。MGMT(O6-methylguanine-DNA methyltransferase)启动子甲基化能够降低胶质瘤中DNA修复蛋白MGMT的表达,提高患者对化疗药物烷化剂治疗的敏感性。IDH1突变和MGMT启动子甲基化在胶质瘤的生长过程中存在关联,二者的联合检测对胶质瘤的预后及治疗方式具有一定的提示作用,在胶质瘤的分子病理学诊断方面具有很大的应用前景。目前IDH1突变和MGMT启动子甲基化的检测已逐渐应用于临床,但其诊断方式及治疗指导意义有待进一步研究探讨。本文就IDH1基因突变及MGMT启动子甲基化在胶质瘤诊断及治疗方面的研究进展进行综述。     

肿瘤突变特征与病理分型的关联研究

准确评估肿瘤的病理亚型对诊断、治疗和预后至关重要。以往病理亚型的诊断主要依赖HE染色法和免疫组织化学法,而随着测序技术的不断发展,对患者进行基因型和表型特点的个体分析成为可能,将肿瘤病理分型与基因分型结合用于疾病分型、诊治选择和疗效判断的精准医学研究逐渐兴起。不同病理亚型的肿瘤细胞来源、致癌因素和临床表型均不尽相同,其在基因组上会留下特异“印迹”,即突变特征。本研究通过整合癌症基因组数据库(The Cancer Genome Atlas, TCGA)中肾癌、肺癌和食管癌的外显子测序数据,分别对3种肿瘤通过肿瘤基因突变特征进行肿瘤病理分型聚类和预测。首先通过非监督聚类方法将3种肿瘤分别按照24种突变特征进行聚类分析,其次通过随机森林法从24种突变特征中进一步选择对于区分不同病理亚型有显著性的突变特征并进行聚类分析,构建突变特征对3种肿瘤病理亚型的分型模型。在肾癌中,该模型准确率达到了100% (95% confidence interval (CI): 0.93~1.00),肺癌和食管癌中分别达到了78% (95% CI: 0.66~0.86)和84% (95% CI: 0.60~0.97)。以上研究结果表明,突变特征作为新型分子标记物,对肿瘤的病理分型、诊断,尤其是早诊具有一定的参考意义。     

Genetic analysis to complement histopathological diagnosis of brain tumors

Gliomas, the most frequent tumors originating in the human nervous system, are divided into various subtypes. Currently, microscopic examination alone is insufficient for classification and grading so that genetic profiles are increasingly being emphasized in recognition of the emerging role of molecular diagnostic approaches to glioma classification. Glioblastomas (WHO grade IV) may develop de novo (primary glioblastomas) or through progression from lower-grade astrocytomas (secondary glioblastomas), while both glioblastomas show similar histological features. In contrast, they do constitute distinct disease entities that evolve through different genetic pathways, and are likely to differ in prognosis and response to therapy. Oligodendrogliomas (WHO grade II) account for 2.7% of brain tumors and 5-18% of all gliomas. Since this tumor is recognized as a particular subtype of glioma that shows remarkable responses to chemotherapy, a correct diagnosis is of prime importance. The difficulty is that histological differentiation of oligodendrogliomas from diffuse astrocytomas is highly subjective in cases without typical morphological features and there is a lack of reliable immunohistochemical markers. While histological distinction of low-grade gliomas from reactive astrocytes is also often difficult, reactive astrocytes usually lack genetic alterations. More biological and molecular approaches to glioma classification thus appear warranted to provide improved means to achieve correct diagnoses.     

Glioma models

Gliomas are primary central nervous system tumors that arise from astrocytes, oligodendrocytes or their precursors. Gliomas can be classified into several groups according to their histologic characteristics, the most malignant of the gliomas is glioblastoma multiforme. In contrast to the long-standing and well-defined histopathology, the underlying molecular and genetic bases for gliomas are only just emerging. Many genetic alterations have been identified in human gliomas, however, establishing unequivocal correlation between these genetic alterations and gliomagenesis requires accurate animal models for this disease. Here we are reviewing the existing animal models for gliomas with different strategies and our current knowledge on the important issues about this disease, such as activation of signal transduction pathways, disruption of cell cycle arrest pathways, cell-of-origin of gliomas, and therapeutic strategies.     

Glioma models.

Gliomas are primary central nervous system tumors that arise from astrocytes, oligodendrocytes or their precursors. Gliomas can be classified into several groups according to their histologic characteristics, the most malignant of the gliomas is glioblastoma multiforme. In contrast to the long-standing and well-defined histopathology, the underlying molecular and genetic bases for gliomas are only just emerging. Many genetic alterations have been identified in human gliomas, however, establishing unequivocal correlation between these genetic alterations and gliomagenesis requires accurate animal models for this disease. Here we are reviewing the existing animal models for gliomas with different strategies and our current knowledge on the important issues about this disease, such as activation of signal transduction pathways, disruption of cell cycle arrest pathways, cell-of-origin of gliomas, and therapeutic strategies.     

Applications of mouse glioma models in preclinical trials

Gliomas are the most common primary tumors that arise from glial cells and their precursors in the central nervous system. Most of the genetic alterations identified in human gliomas result in signal transduction abnormalities or disruption of cell cycle arrest pathways. Over the past years, several mouse glioma models have been generated based on human genetic abnormalities and the induced gliomas exhibit histological similarities to their human counterparts. There is emerging evidence suggesting that an oncogenic signaling initiating tumorigenesis is also required for tumor maintenance, these glioma models can be used to further characterize the mechanisms of oncogenic signaling in tumor formation, as well as identify molecular targets in preclinical trials.     

综述与专论: 脊髓星形细胞瘤研究进展

脊髓星形细胞瘤是一种罕见的中枢神经系统恶性肿瘤,在流行病学、肿瘤临床学表型、分子遗传标记、治疗及研究方面有着独特特征。虽然随着手术技术的进步以及分子病理的发展,脑胶质瘤的研究和治疗取得较大进展,但脊髓星形细胞瘤的研究和治疗却发展缓慢。其原因一方面在于临床样本较少,难以开展研究,另一方面因其分子遗传独特性,对脑胶质瘤一线化疗药替莫唑胺敏感性差。因而亟需理清脊髓星形细胞瘤的研究现状,为改善其临床疗效梳理潜在方向。基于此,本文综述脊髓星形细胞瘤的临床特征、病理分型、分子遗传特征和当前治疗方法等方面的研究进展,在描绘脊髓星形细胞瘤的临床治疗现状和研究进展的基础上,提出了未来研究和治疗潜在方向。     

Malignant glioma: lessons from genomics, mouse models, and stem cells

Eighty percent of malignant tumors that develop in the central nervous system are malignant gliomas, which are essentially incurable. Here, we discuss how recent sequencing studies are identifying unexpected drivers of gliomagenesis, including mutations in isocitrate dehydrogenase 1 and the NF-κB pathway, and how genome-wide analyses are reshaping the classification schemes for tumors and enhancing prognostic value of molecular markers. We discuss the controversies surrounding glioma stem cells and explore how the integration of new molecular data allows for the generation of more informative animal models to advance our knowledge of glioma's origin, progression, and treatment.     

Inactivation of NF1 in CNS causes increased glial progenitor proliferation and optic glioma formation

The gene responsible for neurofibromatosis type 1 (NF1) encodes a tumor suppressor that functions as a negative regulator of the Ras proto-oncogene. Individuals with germline mutations in NF1 are predisposed to the development of benign and malignant tumors of the peripheral and central nervous system (CNS). Children with this disease suffer a high incidence of optic gliomas, a benign but potentially debilitating tumor of the optic nerve; and an increased incidence of malignant astrocytoma, reactive astrogliosis and intellectual deficits. In the present study, we have sought insight into the molecular and cellular basis of NF1-associated CNS pathologies. We show that mice genetically engineered to lack NF1 in CNS exhibit a variety of defects in glial cells. Primary among these is a developmental defect resulting in global reactive astrogliosis in the adult brain and increased proliferation of glial progenitor cells leading to enlarged optic nerves. As a consequence, all of the mutant optic nerves develop hyperplastic lesions, some of which progress to optic pathway gliomas. These data point to hyperproliferative glial progenitors as the source of the optic tumors and provide a genetic model for NF1-associated astrogliosis and optic glioma.     

体细胞变异对神经系统常见肿瘤和发育异常类疾病的致病性

在生物体发育过程中各种内源性及外源性因素均可造成DNA损伤,引起体细胞变异.研究表明体细胞变异对肿瘤具有致病性作用,而体细胞变异对神经系统发育异常类疾病的致病性鲜有报道.新一代测序技术的发展,尤其是全外显子测序,靶向深度测序的应用大大提高了低频体细胞变异检出的敏感性,使科研人员重新认识了体细胞变异在神经系统肿瘤和发育异常类疾病发生中的致病性.本文综述了体细胞变异在神经系统肿瘤和发育异常类疾病致病性方面的研究进展,旨在为今后研究该类疾病的遗传病因提供新的思路,同时也为新药开发提供理论依据.     

Proteomic analysis of oligodendrogliomas expressing a mutant isocitrate dehydrogenase-1

Gliomas are primary tumors of the human central nervous system with unknown mechanisms of progression. Isocitrate dehydrogenase-1 (IDH1) mutation is frequent in diffuse gliomas such as oligodendrogliomas. To gain insights into the physiopathology of oligodendrogliomas that have a better prognosis than other diffuse gliomas, we combined microdissection, 2-D DIGE and MS/MS focusing on proteome alterations associated with IDH1 mutation. We first compared tumor tissues (TT) and minimally infiltrated parenchymal tissues (MIT) of four IDH1-mutated oligodendrogliomas to verify whether proteins specific to oligodendroglioma tumor cells could be identified from one patient to another. This study resulted in identification of 68 differentially expressed proteins, with functions related to growth of tumor cells in a nervous parenchyma. We then looked for proteins distinctly expressed in TT harboring either mutant (oligodendrogliomas, n=4) or wild-type IDH1 (oligodendroglial component of malignant glio-neuronal tumors, n=4). This second analysis resulted in identification of distinct proteome patterns composed of 42 proteins. Oligodendrogliomas with a mutant IDH1 had noteworthy enhanced expression of enzymes controlling aerobic glycolysis and detoxification, and anti-apoptosis proteins. In addition, the mutant IDH1 migrated differently from the wild-type IDH1 form. Comparative proteomic analysis might thus be suitable to identify proteome alterations associated with a well-defined mutation.