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1 Brain Tumor Center, Department of Pathology, Duke University Medical Center, Durham, North Carolina; 2 The Johns Hopkins University Medical Institutions, Baltimore, Maryland; and 3 University of Utah School of Medicine, Salt Lake City, Utah
| ABSTRACT |
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| Introduction |
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| Materials and Methods |
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Choice of Brain Tumors.
Six brain tumor types were selected for mutational analysis. Included were the most common infiltrative astrocytic tumors, glioblastoma multiforme (WHO grade IV), anaplastic astrocytoma (WHO grade III), and low-grade infiltrative astrocytoma (WHO grade II). We also included anaplastic oligodendroglioma (WHO grade III). Medulloblastoma and ependymoma, the most common malignant brain tumors of childhood, were included.
PCR and Sequencing.
Primer sequences and PCR conditions have been described previously (9)
. PCR products were sequenced by Agencourt Bioscience Corp. (Beverly, MA).
| Results and Discussion |
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Analysis of 285 selected brain tumors identified mutations in 3 of 21 (14%) anaplastic oligodendrogliomas, 4 of 78 (5%) medulloblastomas, 5 of 105 (5%) glioblastomas, and 1 of 31 (3%) anaplastic astrocytomas. No mutations were observed in 24 low-grade astrocytomas or 26 ependymomas (Table 1)
. Among these alterations, 11 were located at positions previously observed to be altered in colorectal cancers (9)
, whereas two alterations affected residues not known to be mutated. All but one of the mutations were shown to be heterozygous. We also evaluated whether the mutations were somatically acquired (i.e., tumor specific) by examining the sequence of PIK3CA in genomic DNA from normal tissue of the relevant patient. Corresponding normal tissue was available for 7 of the 13 tumors, and in all 7 cases, the mutations were observed to be somatic.
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40 per Mb of tumor DNA, more than 40 times higher than the background mutation frequency of nonfunctional alterations observed in the genome of cancer cells [
1 per Mb (10)
]. Finally, all of the mutated residues we identified were highly conserved evolutionarily, with retention of identity in mouse, rat, and chicken. Furthermore, we performed a mutational analysis of PTEN in a subset of the samples. We identified PTEN mutations in 15 of 22 glioblastoma multiforme cell lines, 2 of 18 glioblastoma multiforme primary tumors, and 0 of 7 anaplastic astrocytomas. No PTEN mutations were identified in any of the 13 tumors with PIK3CA mutations, indicating that PIK3CA mutations in brain tumors occur only in tumors that do not carry PTEN mutations.
Proto-oncogenes can be activated by point mutation or gene amplification. To determine whether PIK3CA gene dosage might contribute to oncogenic activity in brain tumors, we measured PIK3CA amplification in four categories of brain tumors by quantitative real-time PCR. No evidence of significant gene amplification (>5-fold) was shown in 60 medulloblastomas, 50 glioblastomas, 21 anaplastic oligodendrogliomas, or 14 anaplastic astrocytomas (data not shown). Furthermore, no significant increase of PIK3CA expression was observed in 42 medulloblastomas or 21 glioblastomas by quantitative real-time PCR, suggesting that gene amplification and overexpression were not significant mechanisms of PIK3CA activation among these tumors, as was found in colorectal cancer (9) .
Among the brain cancers we analyzed, only glioblastomas have been shown previously to have alterations in PIK3CA (9) . Samuels et al. (9) examined 15 glioblastomas and found 4 PIK3CA mutations. One mutation was present in exon 20, whereas the other three were scattered in different exons outside the hot spot regions. The overall decreased incidence of PIK3CA mutations in our glioblastoma samples may be consistent with the finding in the study by Samuels et al. (9) of an increased incidence of non-hot spot mutations among glioblastomas. In addition, the mutation frequency might also depend on the selection of samples. One suggestive explanation for a difference may reflect on the age distribution of PIK3CA mutations seen in our samples. It was noted that four of six patients with PIK3CA mutations in high-grade astrocytomas (WHO grade III and IV) were diagnosed with the disease at a relatively young age (19, 36, 49, and 53 years). Only one was diagnosed with glioblastoma multiforme at age 65 years, and for another, the patient age at diagnosis was unknown. Furthermore, after performing additional mutational analyses on 53 glioblastoma multiforme tumors in patients older than 55 years, no further PIK3CA mutations were identified in exon 9 or 20. One possibility for this difference is that PI3KCA mutations occur less frequently in primary glioblastomas than in secondary glioblastomas, the latter of which are known to evolve through different genetic alterations and affect a younger age group (11) . Further support for this possibility is the fact that PTEN mutations occur predominantly in primary glioblastomas (12) and are uncommonly found in secondary glioblastomas (13) . It could be postulated that the PI3K pathway is in fact activated in some secondary glioblastomas, through gain of function of PIK3CA mutations rather than PTEN mutations.
The absence of mutation in low-grade astrocytoma and the presence of a single mutation among 31 anaplastic astrocytomas suggest that PIK3CA abnormalities might occur at relatively later stages of glioma progression. Similar to our findings, PIK3CA mutations were previously found to occur at a relatively late stage of colon cancer progression (9) .
Four PIK3CA mutations were identified in 78 medulloblastomas, suggesting that in addition to the involvement of the hedgehog/patched and Wnt signaling pathways (14 , 15) , PI3K and its upstream and downstream factors might also play important roles in medulloblastoma tumorigenesis.
Three of 21 anaplastic oligodendrogliomas contained PIK3CA mutations in exon 9 or exon 20. To our knowledge, the identified PIK3CA mutations represent the first oncogene-specific mutations in anaplastic oligodendrogliomas. Although oligodendrogliomas affect younger adults, they tend to be more indolent and have an overall better prognosis than astrocytic tumors (16) . Accurate diagnosis is a key to the management of oligodendrogliomas. However, prognosis can be somewhat variable. Evidence from several retrospective studies suggests that allelic losses of 1p and 19q serve as molecular markers of response to chemotherapy and radiation therapy and are an indicator of prolonged survival in patients with oligodendrogliomas (17) . The discovery here of relatively common PIK3CA mutations in anaplastic oligodendroglioma gives new insight into the molecular pathogenesis of these tumors and suggests the need to evaluate outcomes of patients with PIK3CA mutations.
Our observations of PIK3CA mutations in multiple brain tumor types extend the recent observations of PIK3CA mutations in glioblastomas. In particular, we found mutations of the PIK3CA gene in a substantial proportion of anaplastic oligodendrogliomas, as well as in high-grade astrocytomas and medulloblastomas. The consistency of hot spot mutations in PIK3CA across diverse tumor types suggests a possible approach to targeted therapy. One could envision the development of agents acting as highly selective antagonists of the mutant alleles products, sparing normal cells exhibiting wild-type PIK3CA activity. Our findings suggest that PIK3CA is an important oncogene in common malignant brain tumors and has the potential to make a significant impact on the future of cancer therapeutics.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Requests for reprints: Hai Yan, Duke University Medical Center, Department of Pathology, DUMC-3156, 199A-MSRB Building, Research Drive, Durham, NC 27710. Phone: (919) 668-7850; Fax: (919) 684-5483; E-mail: hai.yan{at}duke.edu
Received 4/ 5/04. Revised 5/14/04. Accepted 6/ 7/04.
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