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Neuroblastoma Cells Isolated from Bone Marrow Metastases Contain a Naturally Enriched Tumor-Initiating Cell

¹ Cell Biology Program, ² Physiology and Experimental Medicine, ³ Department of Surgery, ⁴ Pediatric Laboratory Medicine, ⁵ Developmental and Stem Cell Biology Program, and ⁶ Division of Haematology/Oncology, Hospital for Sick Children; Departments of ⁷ Laboratory Medicine and Pathobiology and ⁸ Molecular and Medical Genetics, University of Toronto, Toronto, Ontario, Canada; ⁹ Pediatric Oncology Branch, NIH, Bethesda, Maryland; and ¹⁰ Department of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts

Requests for reprints: David R. Kaplan, Cell Biology Program, Hospital for Sick Children, Room 12-314, Floor 12, Toronto Medical Discovery Tower, 101 College Street, Toronto, Ontario, Canada M5G 1L7. Phone: 416-813-7654; Fax: 416-813-2212; E-mail: dkaplan{at}sickkids.ca.

Neuroblastoma is a heterogeneous pediatric tumor thought to arise from the embryonic neural crest. Identification of the cell responsible for propagating neuroblastomas is essential to understanding this often recurrent, rapidly progressing disease. We have isolated and characterized putative tumor-initiating cells from 16 tumors and bone marrow metastases from patients in all neuroblastoma risk groups. Dissociated cells from tumors or bone marrow grew as spheres in conditions used to culture neural crest stem cells, were capable of self-renewal, and exhibited chromosomal aberrations typical of neuroblastoma. Primary spheres from all tumor risk groups differentiated under neurogenic conditions to form neurons. Tumor spheres from low-risk tumors frequently formed large neuronal networks, whereas those from high-risk tumors rarely did. As few as 10 passaged tumor sphere cells from aggressive neuroblastoma injected orthotopically into severe combined immunodeficient/Beige mice formed large neuroblastoma tumors that metastasized to liver, spleen, contralateral adrenal and kidney, and lung. Furthermore, highly tumorigenic tumor spheres were isolated from the bone marrow of patients in clinical remission, suggesting that this population of cells may predict clinical behavior and serve as a biomarker for minimal residual disease in high-risk patients. Our data indicate that high-risk neuroblastoma contains a cell with cancer stem cell properties that is enriched in tumor-initiating capacity. These cells may serve as a model system to identify the molecular determinants of neuroblastoma and to develop new therapeutic strategies for this tumor. [Cancer Res 2007;67(23):11234–43]