Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation in an Ataxia Telangiectasia Patient

Background Neural stem cells are currently being investigated as potential therapies for neurodegenerative diseases, stroke, and trauma. However, concerns have been raised over the safety of this experimental therapeutic approach, including, for example, whether there is the potential for tumors to develop from transplanted stem cells. Methods and Findings A boy with ataxia telangiectasia (AT) was treated with intracerebellar and intrathecal injection of human fetal neural stem cells. Four years after the first treatment he was diagnosed with a multifocal brain tumor. The biopsied tumor was diagnosed as a glioneuronal neoplasm. We compared the tumor cells and the patient's peripheral blood cells by fluorescent in situ hybridization using X and Y chromosome probes, by PCR for the amelogenin gene X- and Y-specific alleles, by MassArray for the ATM patient specific mutation and for several SNPs, by PCR for polymorphic microsatellites, and by human leukocyte antigen (HLA) typing. Molecular and cytogenetic studies showed that the tumor was of nonhost origin suggesting it was derived from the transplanted neural stem cells. Microsatellite and HLA analysis demonstrated that the tumor is derived from at least two donors. Conclusions This is the first report of a human brain tumor complicating neural stem cell therapy. The findings here suggest that neuronal stem/progenitor cells may be involved in gliomagenesis and provide the first example of a donor-derived brain tumor. Further work is urgently needed to assess the safety of these therapies.

[1]  B. Scheithauer,et al.  Ependymomas with neuronal differentiation: a morphologic and immunohistochemical spectrum , 2007, Acta Neuropathologica.

[2]  Z. Husain,et al.  Disputed maternity leading to identification of tetragametic chimerism. , 2002, The New England journal of medicine.

[3]  T. Deacon,et al.  Transplanted xenogeneic neural cells in neurodegenerative disease models exhibit remarkable axonal target specificity and distinct growth patterns of glial and axonal fibres , 1995, Nature Medicine.

[4]  G. Rechavi,et al.  Identity of rearranged LINE/c-MYC junction sequences specific for the canine transmissible venereal tumor. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[5]  M. Naito,et al.  Astrocytoma linked to familial ataxia-telangiectasia , 2006, Acta Neurochirurgica.

[6]  O. Lindvall,et al.  Stem cells for the treatment of neurological disorders , 2006, Nature.

[7]  Yuri Kotliarov,et al.  Tumor stem cells derived from glioblastomas cultured in bFGF and EGF more closely mirror the phenotype and genotype of primary tumors than do serum-cultured cell lines. , 2006, Cancer cell.

[8]  Benjamin E. Reubinoff,et al.  Neural progenitors from human embryonic stem cells , 2001, Nature Biotechnology.

[9]  D. Givol,et al.  Common origin of transmissible venereal tumors (TVT) in dogs. , 1987, Oncogene.

[10]  I. Penn Transmission of cancer from organ donors. , 1997, Annals of transplantation.

[11]  Angelo L. Vescovi,et al.  Brain tumour stem cells , 2006, Nature Reviews Cancer.

[12]  E. Cesarman,et al.  Molecular pathology of posttransplantation lymphoproliferative disorders. , 1997, Seminars in diagnostic pathology.

[13]  F. Preffer,et al.  Transplacental transmission of natural-killer-cell lymphoma. , 1999, The New England journal of medicine.

[14]  A. Pearse,et al.  Allograft theory: Transmission of devil facial-tumour disease , 2006, Nature.

[15]  M. Greaves Cord blood donor cell leukemia in recipients , 2006, Leukemia.

[16]  M. Hoehn,et al.  Host-Dependent Tumorigenesis of Embryonic Stem Cell Transplantation in Experimental Stroke , 2003, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[17]  H. Halkin,et al.  A coding VKORC1 Asp36Tyr polymorphism predisposes to warfarin resistance. , 2007, Blood.

[18]  A. Trounson,et al.  Embryonic stem cell lines from human blastocysts: somatic differentiation in vitro , 2000, Nature Biotechnology.

[19]  Y. Shiloh,et al.  Ataxia-telangiectasia: founder effect among north African Jews. , 1996, Human molecular genetics.

[20]  R. Sidman,et al.  Engraftable human neural stem cells respond to development cues, replace neurons, and express foreign genes , 1998, Nature Biotechnology.

[21]  D. Lenartz,et al.  Differentiation of green fluorescent protein-labeled embryonic stem cell-derived neural precursor cells into Thy-1-positive neurons and glia after transplantation into adult rat striatum. , 2000, Journal of neurosurgery.

[22]  J. Eshleman,et al.  Mismatch repair defects in human carcinogenesis. , 1996, Human molecular genetics.

[23]  Mitchel S Berger,et al.  Neural stem cells and the origin of gliomas. , 2005, The New England journal of medicine.

[24]  G. Sukhikh,et al.  Evaluation of progenitor cell cultures from human embryos for neurotransplantation. , 2002, Brain research. Developmental brain research.

[25]  M. Beal,et al.  Functional engraftment of human ES cell–derived dopaminergic neurons enriched by coculture with telomerase-immortalized midbrain astrocytes , 2006, Nature Medicine.

[26]  O. Lindvall,et al.  Stem cell therapy for human neurodegenerative disorders–how to make it work , 2004, Nature Medicine.

[27]  R. McKay,et al.  Embryonic stem cell-derived glial precursors: a source of myelinating transplants. , 1999, Science.

[28]  A. Nagler,et al.  Chimerism testing and detection of minimal residual disease after allogeneic hematopoietic transplantation using the bioView (Duet™) combined morphological and cytogenetical analysis , 2002, Leukemia.

[29]  S. Goldman,et al.  Cell replacement therapy in neurological disease , 2006, Philosophical Transactions of the Royal Society B: Biological Sciences.

[30]  Cameron S. Osborne,et al.  LMO2-Associated Clonal T Cell Proliferation in Two Patients after Gene Therapy for SCID-X1 , 2003, Science.

[31]  M. Greaves Infection, immune responses and the aetiology of childhood leukaemia , 2006, Nature Reviews Cancer.

[32]  Lee Wh,et al.  The molecular genetics of retinoblastoma. , 1990 .

[33]  Ross Zafonte,et al.  Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial. , 2005, Journal of neurosurgery.

[34]  Y. Shiloh ATM and related protein kinases: safeguarding genome integrity , 2003, Nature Reviews Cancer.

[35]  Bruce G. Jenkins,et al.  Embryonic stem cells develop into functional dopaminergic neurons after transplantation in a Parkinson rat model , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[36]  J. D. Macklis,et al.  Adult neurogenesis and cellular brain repair with neural progenitors, precursors and stem cells , 2006, Philosophical Transactions of the Royal Society B: Biological Sciences.

[37]  J. Tolar,et al.  Transplacental and other routes of cancer transmission between individuals. , 2003, Journal of pediatric hematology/oncology.

[38]  W. Lee,et al.  The molecular genetics of retinoblastoma. , 1990, Cancer surveys.