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Evolution of DNA repair defects during malignant progression of low-grade gliomas after temozolomide treatment

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Abstract

Temozolomide (TMZ) increases the overall survival of patients with glioblastoma (GBM), but its role in the clinical management of diffuse low-grade gliomas (LGG) is still being defined. DNA hypermethylation of the O 6-methylguanine-DNA methyltransferase (MGMT) promoter is associated with an improved response to TMZ treatment, while inactivation of the DNA mismatch repair (MMR) pathway is associated with therapeutic resistance and TMZ-induced mutagenesis. We previously demonstrated that TMZ treatment of LGG induces driver mutations in the RB and AKT–mTOR pathways, which may drive malignant progression to secondary GBM. To better understand the mechanisms underlying TMZ-induced mutagenesis and malignant progression, we explored the evolution of MGMT methylation and genetic alterations affecting MMR genes in a cohort of 34 treatment-naïve LGGs and their recurrences. Recurrences with TMZ-associated hypermutation had increased MGMT methylation compared to their untreated initial tumors and higher overall MGMT methylation compared to TMZ-treated non-hypermutated recurrences. A TMZ-associated mutation in one or more MMR genes was observed in five out of six TMZ-treated hypermutated recurrences. In two cases, pre-existing heterozygous deletions encompassing MGMT, or an MMR gene, were followed by TMZ-associated mutations in one of the genes of interest. These results suggest that tumor cells with methylated MGMT may undergo positive selection during TMZ treatment in the context of MMR deficiency.

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Acknowledgments

This project was generously supported by Accelerate Brain Cancer Cure; The Grove Foundation; The TDC Foundation; The Anne and Jason Farber Foundation; and a generous gift from the Dabbiere family, UCSF Brain Tumor SPORE grant (NIH P50CA097257) (A.M., J.F.C., B.T., S.M.C., M.S.B.), the Dutch Cancer Society (KWF) grant number 2009-4470 and personal travel grant (H.F.v.T), foundation ‘STOPHersentumoren’, Edli foundation, LiU Cancer Research Network, The Medical Research Council of Southeast Sweden. Additional support by the National Institute Of General Medical Sciences T32GM008568 (T.M.), the National Institutes of Health 1T32CA15102201, the National Cancer Institute R01CA169316 (J.F.C.), Sontag Foundation (B.T.), NCI RO1 (R01 CA163687) (A.M.). This project was supported in part by a research program of the Project for Development of Innovative Research on Cancer Therapeutics (P-Direct) (A.M., N.S., and H.A.), Grant-in-Aid for Scientific Research on Innovative Areas (No. 23134501) (A.M.), and Grant-in-Aid for Scientific Research (No. 24221011) (H.A.) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. We are grateful to our Dutch collaborators Guus Beute and Ruth Fleischeuer from St. Elisabeth hospital, Wimar van den Brink and Miek Havenith from Isala hospital, Hans Baayen, David Noske and Philip de Witt Hamer from VU University Medical Center and Anja M. Gijtenbeek from the Radboud University Medical Center Nijmegen for providing samples and clinical data. We thank collaborators from the South-East Sweden Brain Tumor Group for providing samples and clinical data; neurosurgeon Peter Milos, clinical oncologists Anna-Lotta Hallbeck, Linköping Charlotte Bratthäll, Kalmar and Michael Strandéus, Jönköping.

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401_2015_1403_MOESM1_ESM.pdf

Supplementary material 1 (PDF 911 kb) Fig. S1. Methylation status of CpG sites in 10 individual clones of the PCR product from bisulfite-treated DNA from the initial tumor and the recurrent tumor of patient 296. Each row represents a single clone with each CpG site marked as either methylated (red) or unmethylated (blue). The total methylation percentage of all CpGs in all clones is presented to the left of each panel

401_2015_1403_MOESM2_ESM.pdf

Supplementary material 2 (PDF 4753 kb) Fig. S2. Hypermutated recurrent tumors show single copy loss and accompanying loss-of-heterozygosity (LOH) at loci encompassing MGMT and members of the DNA mismatch repair pathway. For each patient with a hypermutated recurrent tumor, the genomic location of genes of interest is indicated in purple on chromosomal plots. Somatic copy number alterations identified in each tumor are shown and the minor allele frequency of heterozygous germline SNPs is graphed. The presence of germline SNPs with low variant allele frequencies indicates genomic regions of allelic imbalance and LOH

Supplementary material 3 (DOCX 26 kb)

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van Thuijl, H.F., Mazor, T., Johnson, B.E. et al. Evolution of DNA repair defects during malignant progression of low-grade gliomas after temozolomide treatment. Acta Neuropathol 129, 597–607 (2015). https://doi.org/10.1007/s00401-015-1403-6

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