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FOXR2-activated CNS neuroblastoma: Characterized by variable structural disruption of the FOXR2 regulatory region,
Jianling Ji1,2, Venkata Yellapantula1,2, Dong Xu
1Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States.
Background:
FOXR2 is a forkhead box transcription factor implicated in central nervous system neuroblastoma (CNS-NB FOXR2). The underlying genetic mechanisms and clinical features of CNS-NB FOXR2 have yet to be elucidated.
Methods:
Six CNS-NB FOXR2 cases were identified through DNA methylation profiling. Optical genome mapping, chromosomal microarray, whole genome sequencing, OncoKids panel, RNA sequencing (RNA-seq), and clinical data were analyzed.
Results:
Case 1 demonstrated a 13-kb insertion approximately 25 kb upstream of FOXR2. Case 2 showed 2 non-contiguous focal gains in Xp11.21 (encompassing FOXR2) and Xp22.2p22.13, approximately 37 Mb apart, resulting from a complex rearrangement disrupting the FOXR2 regulatory region. Case 3 harbored a pericentric inversion between RLIM and a site 17.98 kb upstream of FOXR2. Recurrent copy number alterations included 1q gain (100%), 16q loss (80%), distal 11q loss (60%), and gain of chromosomes 8 and 17q (40% each). All three female patients showed X chromosome loss. FOXR2 expression was elevated in both cases with available RNA-seq data.Overall survival ranged from 1.81-15.62 years. Clinical treatment was highly variable, and molecular testing was unavailable at diagnosis for 4 of 5 patients.
Conclusions:
Structural disruption of the FOXR2 regulatory region, recurrent copy number alterations, and elevated FOXR2 expression are features of CNS-NB FOXR2. These rearrangements do not alter the coding region and may not be detected by routine testing. Initial pathology may suggest other entities, highlighting the importance of molecular testing at diagnosis. Favorable clinical outcomes require accurate initial diagnosis as evidenced by our clinical cohort.
Insights
Genetic alterations disrupting the FOXR2 regulatory region and elevated FOXR2 expression characterize central nervous system neuroblastoma (CNS-NB FOXR2). Molecular testing is crucial for accurate diagnosis and improved patient outcomes.
Area of Science:
- Genetics
- Oncology
- Molecular Biology
Background:
- FOXR2, a forkhead box transcription factor, is implicated in central nervous system neuroblastoma (CNS-NB FOXR2).
- The genetic mechanisms and clinical features of CNS-NB FOXR2 remain largely unelucidated.
- Understanding these factors is critical for diagnosis and treatment.
Purpose of the Study:
- To elucidate the genetic mechanisms underlying CNS-NB FOXR2.
- To identify recurrent genetic alterations and their impact on FOXR2 expression.
- To correlate molecular findings with clinical features and outcomes.
Main Methods:
- Analysis of six CNS-NB FOXR2 cases identified via DNA methylation profiling.
- Utilized optical genome mapping, chromosomal microarray, whole genome sequencing, and RNA sequencing (RNA-seq).
- Integrated clinical data for comprehensive analysis.
Main Results:
- Identified structural disruptions in the FOXR2 regulatory region, including insertions and complex rearrangements.
- Observed recurrent copy number alterations: 1q gain (100%), 16q loss (80%), 11q loss (60%), and gains of chromosomes 8 and 17q (40%).
- All female patients exhibited X chromosome loss, and elevated FOXR2 expression was noted in cases with available RNA-seq data.
Conclusions:
- Structural disruption of the FOXR2 regulatory region and elevated FOXR2 expression are key features of CNS-NB FOXR2.
- These rearrangements may evade detection by routine testing, emphasizing the need for molecular diagnostics.
- Accurate initial diagnosis through molecular testing is essential for favorable clinical outcomes.
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