St. Anna Children`s Cancer Research Institute Science Report 2009

Transcription

St. Anna
Children’s Cancer Research Institute
Science Report 2009–2010
St. Anna
Kinderkrebsforschung
Forschungsbericht 2009–2010
St. Anna
St. Anna
Florian (7)
St. Anna
St. Anna
6
10
Foreword
Introduction
116
Molecular Microbiology and
Labdia Labordiagnostik GmbH
Prof. Thomas Lion, MD, PhD
16
Facts and Figures
The 4 Pillars of the CCRI
National and International Research Networks
Clinical Research
Overview of Staff and Financing
132
Clinical Research
S 2 IRP, Studies & Statistics of Integrated
Research and Projects
Assoc. Prof. Ruth Ladenstein, MD, MBA, cPM
154
Administration
Department of Finance, Administration
and Research Support
IT Department
PR and Donations Department
Appendix
157
158
159
163
164
165
173
178
Scientific Advisory Board
Completed MSc Diplomas and PhD Theses
External Grants and Research Funding Bodies
Awards
Acknowledgements
Publications
Glossary (only available in German)
Imprint
Research Report
32
40
52
Leukaemias
Immunological Diagnostics
Assoc. Prof. Michael N. Dworzak, MD
Biology of Leukaemias
Prof. Renate E. Panzer-Grümayer, MD
Genetics of Leukaemia
Sabine Strehl, PhD
64
76
Solid Tumours
Tumour Biology
Assoc. Prof. Peter F. Ambros, PhD
Molecular Biology of Solid Tumours
Prof. Heinrich Kovar, PhD
86
94
106
Immunology
Tumour Immunology
Assoc. Prof. Thomas Felzmann, MD, MBA
Clinical Cell Biology and FACS Core Unit
Assoc.Prof. Gerhard Fritsch, PhD
Transplantation-Immunology
Assoc. Prof. Andreas Heitger, MD
8
12
Vorwort
Einleitung
116
Molekulare Mikrobiologie und
Univ. Prof. DDr. Thomas Lion
16
Daten und Fakten
132
Klinische Forschung
S 2 IRP, Studien und Statistik
Univ. Doz. Dr. Ruth Ladenstein, MBA, cPM
152
Administration
Kaufmännische Abteilung und
Research Support
EDV-Abteilung
PR- und Spendenabteilung
Anhang
157
158
159
163
164
165
173
178
Wissenschaftlicher Beirat
Abgeschlossene Diplomarbeiten und
Dissertationen
Extern geförderte Projekte und Fördergeber
Preise
Danksagung
Publikationen
Glossar
Impressum
Die 4 Säulen der St. Anna Kinderkrebsforschung
Nationale und internationale Forschungs-
netzwerke
Klinische Forschung
Personelle Zusammensetzung und
Finanzierungsübersicht
Forschungsbericht
32
40
52
Leukämien
Immunologische Diagnostik
Univ. Doz. Dr. Michael N. Dworzak
Biologie der Leukämien
Univ. Prof. Dr. Renate E. Panzer-Grümayer
Leukämiegenetik
Dr. Sabine Strehl
64
76
Solide Tumoren
Tumorbiologie
Univ. Doz. Dr. Peter F. Ambros
Molekularbiologie Solider Tumoren
Univ. Prof. Dr. Heinrich Kovar
86
94
106
Immunologie
Tumor-Immunologie
Univ. Doz. Dr. Thomas Felzmann, MBA
Klinische Zellbiologie und FACS Core Unit
Univ. Doz. Dr. Gerhard Fritsch
Transplantations-Immunologie
Univ. Doz. Dr. Andreas Heitger
As the research institute of the St. Anna Children’s
Cancer Research Association (St. Anna Kinderkrebsforschung e.V.) is funded to a large degree by donations,
it was our wish to relocate the PR & Donations office
to the ground floor of the new institutional building,
too, which was made possible in 2010 thanks to the
forthcoming cooperation of the district authority.
The building was approved when the district authority’s
offer for a local supply facility was deemed unnecessary
by the population and the district council passed on the
availability to the CCRI.
The current developments are the main results of the
restructuring of the administration according to the
principles of a medium-sized business, taking into
consideration all regulatory guidelines as well as the
establishment of a grant management position for
acquiring third-party funds. This could only be realised
through the visionary attitude and dedicated efforts
of our Financial & Administrative Director, Claudia
Hochweis, MBA, whom we would like to thank for her
many years of working with us and whom we wish great
success in her future endeavours.
In the summer of 2010, Karla Valdés Rodríguez, PhD,
took on the role of Financial & Administrative Director
with the aim to constantly provide a contemporary
administration with lean and effective processes that
lighten our researchers’ workload while ensuring
the regulatory and quality compliance of diagnostic
services, blood stem cell production and clinical
research.
Research at the CCRI is also financed by third-party
funds from competitive research projects appraised
by experts. In order to strengthen our institute in the
acquisition of these projects, in the summer of 2010
Karla Valdés Rodríguez established the Research
Support Office, which includes grant management and
science communication.
In close cooperation with the Financial & Administrative
Director and the Head of Documentation (Senior
Physician Associate Prof. Ruth Ladenstein, MD, MBA,
cPM), a concept for the optimisation of documentation
and statistics (SI 2 RP) was also established with the
purpose of collecting and pursuing data from clinical
and experimental studies for children and adolescents
with cancer from Austria and other cooperating European countries in compliance with legal regulations.
The conditions are thus assured for a professional
department that is recognised and esteemed across
Austria and Europe, which is also equipped for the
future application of modern cancer treatments for
children and adolescents. This was an important step
towards strengthening clinical research at the St. Anna
Children’s Hospital and undertaking visible steps
towards “translational research”.
In the fall of 2010, Prof. Stephan Ladisch, MD, principal
investigator at the Center for Cancer and Immunology
Research (CCIR) at the Children’s National Medical
Center, and Vice Chair for External Affairs, Department
of Pediatrics, George Washington University School
of Medicine, was voted into the Board of the St. Anna
Kinderkrebsforschung Association as Deputy
Chairman. Stephan Ladisch provided important
support for setting up a special budget in order to
finance clinical studies.
Finally, I would like to thank all employees, all the cooperating institutions, the various funding bodies, the
members of the St. Anna Kinderkrebsforschung
Association, and especially all the Board members,
the mentors of the foundation, as well as the media
for their altruistic and dedicated support.
My special gratitude goes to the numerous donors
who have supported us loyally for many years,
thus contributing to the success and the future of
children’s cancer research.
Prof. Helmut Gadner, MD, MD (HC)
Director of the Institute
St. Anna Kinderkrebsforschung /CCRI Scientific Report 2009–2010
Three years ago, the last report on the achievements
of the Children’s Cancer Research Institute (CCRI) was
published, in which the relocation of the laboratory on
the top floor of the St. Anna Children’s Hospital to the
newly-constructed independent research institute
on Zimmermannplatz was announced. Now, after two
years of construction work and since the relocation in
January 2009, there is sufficient space for a proliferating research institute in the vicinity of the St. Anna
Children's Hospital that was also in need of additional
space. A big opening ceremony was held, which was
attended by loyal donors, as well as prominent politicians of the city of Vienna and representatives from
neighbouring and cooperating scientific institutions.
The relocation into the 3-storey glass building led
to a surge in motivation for the approximately 100
employees, which not only manifested itself as an
increase in research projects acquired through thirdparty funds, but also as a pleasant and thus successful
working climate.
6–7
Foreword
Da das Forschungsinstitut des Vereins St. Anna Kinderkrebsforschung zum Großteil durch Spenden finanziert
wird, war es uns ein Anliegen, auch das Spendenbüro
in das Erdgeschoß des neuen Institutsgebäudes
zu verlegen, das 2010 tatsächlich durch ein großes
Entgegenkommen der Bezirksleitung ermöglicht wurde.
Die Freigabe der Räumlichkeiten erfolgte, nachdem das
Angebot der Bezirksleitung für eine Nahversorgungseinrichtung von der Bevölkerung als nicht notwendig
erachtet wurde und vom Bezirksrat die Verfügbarkeit
an die St. Anna Kinderkrebsforschung weitergegeben
wurde.
Ein wesentlicher Beitrag zur gegenwärtigen Entwicklung
war die notwendige Umstrukturierung der Administration nach Prinzipien eines mittelgroßen Unternehmens
unter Berücksichtigung aller behördlich vorgegebenen
Richtlinien sowie die Etablierung einer Grantmanagement-Position für die Anbahnung von Drittmittelgeldern. Dies konnte nur durch die hohe Kompetenz und
den engagierten Einsatz unserer kaufmännischen
Leiterin, Frau Claudia Hochweis, MBA, realisiert werden,
der wir herzlich für die langjährige Zusammenarbeit
danken möchten und viel Erfolg für ihre zukünftigen
Pläne wünschen.
Im Sommer 2010 übernahm Fr. Dr. Karla Valdés
Rodríguez als kaufmännische Leiterin die finanziellen
und administrativen Agenden unseres Forschungsinstitutes. Ziel ist es, eine moderne Verwaltung zu
entwickeln, die mit schlanken und effektiven Prozessen
unsere ForscherInnen entlasten und weiterhin die
Sicherheit von Diagnostikleistungen, Blutstammzellproduktion und klinischer Forschung gewährleisten soll.
Die St. Anna Kinderkrebsforschung finanziert sich auch
aus Drittmittelgeldern von kompetitiven, von Experten
begutachteten Forschungsprojekten. Um unser Institut
in der Akquisition dieser Projekte zu stärken, etablierte
Frau Dr. Valdés Rodríguez im Sommer 2010 auch das
Research Support Office, das sich aus dem Grantmanagement und der Wissenschaftskommunikation
zusammensetzt.
In enger Zusammenarbeit der kaufmännischen Leitung
mit der Leiterin der Dokumentation (OÄ Univ. Doz. Dr.
Ruth Ladenstein, MBA, cPM) wurde auch ein Konzept
zur Optimierung der Dokumentation und Statistik
(SI 2 RP) aufgebaut, um die Daten von klinischen und
experimentellen Studien für krebskranke Kinder und
Jugendliche aus Österreich und kooperierenden
anderen Ländern Europas nach den gesetzlichen
Bestimmungen zu sammeln und weiterzuverfolgen.
Damit sind die Voraussetzungen für eine professionelle,
österreich- und europaweit anerkannte und geschätzte
Abteilung gesichert, die auch für zukünftige Anwendung moderner Medikationen bei Krebserkrankungen
im Kindes- und Jugendalter gerüstet ist. Dies war
ein wichtiger Schritt, um die klinische Forschung im
St. Anna Kinderspital zu stärken und sichtbare Schritte
in Richtung „Translational Research“ zu setzen.
Im Herbst 2010 wurde Univ. Prof. Dr. Stephan Ladisch,
Leiter des Center for Cancer and Immunology
Research (CCIR) am Children’s National Medical Center
und stellvertretender Vorsitzender der Univ.-Klinik für
Kinder- und Jugendheilkunde in Washington, USA, als
Obmann-Stellvertreter in den Vorstand des Vereins
St. Anna Kinderkrebsforschung gewählt. Stephan
Ladisch hat bereits 2009 wichtige Hilfestellung
für die Aufstellung eines Sonderbudgets für klinisch
initiierte Studien geleistet.
Abschließend möchte ich allen Mitarbeitern und
Mitarbeiterinnen, den kooperierenden Institutionen,
den verschiedenen Förderungsfonds, den Mitgliedern
des Vereins St. Anna Kinderkrebsforschung und
besonders den Vorstandsmitglieder, den Mentoren und
Mentorinnen der Foundation, aber auch den Medien
für ihre uneigennützige und engagierte Unterstützung
danken. Ein besonderer Dank gilt den unzähligen
Spendern und Spenderinnen, die uns seit vielen Jahren
die Treue halten und damit zum Erfolg und der Zukunft
der Kinderkrebsforschung beitragen.
Univ. Prof. Dr.Dr.h.c. Helmut Gadner
Institutsleiter
Vor 3 Jahren wurde der letzte Bericht über die Leis
tungen der St. Anna Kinderkrebsforschung publiziert,
wobei die Überführung der im Dachgeschoß des
St. Anna Kinderspitals eingerichteten Labors ins neu
erbaute selbständige Forschungsinstitut am Zimmermannplatz angekündigt wurde. Der Grund dafür, nämlich Platzmangel für eine proliferierende Einrichtung
in einem ebenfalls um Platzerweiterung kämpfenden
Kinderspital, wurde schon jahrelang im Vorhinein artikuliert und konnte im Frühjahr 2008 nach 2-jährigem
Bau beendet werden. Es gab eine große Eröffnungsfeier,
in der nicht nur die treuen Spender, sondern auch
prominente Politiker der Stadt Wien und Vertreter der
nachbarlichen und kooperierenden wissenschaftlichen
Institutionen vertreten waren. Die Übersiedlung in den
3-geschoßigen Glasbau hat bei den ca. 100 Mitarbeitern zu einem enormen Motivationsschub geführt, der
sich nicht nur in einem erfreulichen Anstieg der durch
Drittmittel akquirierten Forschungsprojekte niederschlug, sondern auch in einer wohltuenden und damit
erfolgreicheren Arbeitsatmosphäre.
8–9
Vorwort
2009 and 2010 were particularly eventful years for the
Children’s Cancer Research Institute (CCRI). In January
2009 we were able to relocate our research labora
tories into the newly-constructed institutional building
right next to the St. Anna Children’s Hospital. Not only
did this put an end to the cramped conditions of the
researchers on the top floor of the St. Anna Children’s
Hospital, but through additional equipment and spaces
it also opened up new paths for the CCRI working
groups as regards translational and applied research.
This restructuring was necessary in order to continue
keeping pace with the latest technical developments in
biomedicine and applying holistic research approaches
in terms of comprehensive analyses of pathogenesis
through the integration of large biological data sets.
A growing research institute needs innovative
support for administrative agendas.
The participation in clinical studies, cooperative
projects, the production of therapeutic drugs
(quality-assured production of therapeutic agents for
blood stem cell transplantations and immunological
therapeutic agents), and the performance of diagnostics require adherence to strict guidelines and the
resulting need for documentation. For this reason,
the organisational structure of the Children’s Cancer
Research Institute has been expanded.
In previous years, we focused on the organisationalstructural side of the research institute, i.e. on building
an effective and clear organisational structure. In the
years 2009 to 2010, the core elements of organisational development were the extension of quality
management, the improvement of administration,
support in the acquisition of third-party funds, and
the introduction of a finance and resource r eporting
system, which is adapted to the special features
of third-party funded projects. The introduction
of a quality management system is essential due to
the strictly-regulated operation of the diagnostics
outpatient clinic and the production of blood stem
cells, which are used for various therapeutic purposes.
In the course of the relocation, two clean rooms were
registered, guaranteeing the smooth continuation of
activities carried out in our GMP (Good Manufacturing
Practise) laboratories.
In addition, there was a personnel change in the
management of the CCRI in June 2010. Claudia
Hochweis, MBA, – whom we would like to thank at this
point for her outstanding work – retired into the
private sector and handed over the role as Financial &
Administrative Director to Karla Valdés Rodríguez.
With her take over, the grant management was
integrated into a new administrative group. The
new Research Support Office provides organisational
and administrative s upport to researchers when it
comes to project submissions and completions, as
well as the communication of research results to the
public or the media.
In a small institution, each member contributes
significantly to its success.
In order to advance into new fields of research, the
according financial and technical resources are a
fundamental prerequisite; but what is truly crucial
to scientific top performances are highly-qualified
research personalities. More than in most other fields
of medicine, in the paediatric-oncological area it is
vital to bridge geographical boundaries and form
collaborations. In the years 2009 to 2010, we completed important projects such as GEN-AU CHILD II
and the EU science-communication project “DIRECT –
Overcoming Cancer with Research”. In a
ddition, the
CCRI proved highly successful in the initiation and
execution of international collaborative studies, so
that submissions from 2009 to 2010 received more
third-party funding than in previous years from national
and international funding bodies. On the one hand, we
are very happy about the performance of the individual
heads of our research groups; on the other hand, we
are proud of the recognition we received from various
national and international funding bodies: ÖNB, the
Research Foundation of the Austrian National Bank;
FWF, the Austrian Science Fund; FFG, the Austrian
Research Promotion Agency; ÖAW, the Austrian
Academy of Sciences; the City of Vienna Fund; ÖGKJ,
the Austrian Society of Paediatrics and Adolescence
Medicine; WWTF, Vienna Science and Technology
Fund; ZIT, Technology Promotion Agency of the City of
Vienna and the European Commission.
Our participation in various EU-funded projects and
networks enabled our researchers to gain access to
very expensive genomic and post-genomic highthroughput technology, which is necessary in order to
access large amounts of new biological data. However,
the processing of such data, be it for diagnostic,
prognostic or therapeutic purposes, requires processing and adaptation by means of modern statistical and
bio-information methods. For this reason, the CCRI
established a central bio-information point in 2009 and
initiated the pan-European systems biology project
ASSET.
This union of international and multi-disciplinary
researchers and clinics in the field of so-called
“rare diseases”, of which childhood cancer is one,
contributes to the consolidation of European research
and is a valuable tool for offering the great expertise
of paediatric-oncological clinicians and researchers to
politicians, regulatory authorities and industry, on both
the national and international level. This bundling of
efforts increases the pace of innovation in our research
field, which is primarily to the benefit of young patients.
We are thus very happy that the EU-funded network
ENCCA (European Network for Cancer Research in
Children and Adolescents) was established and began
work in January 2011. The network is led by Assoc. Prof.
Ruth Ladenstein, MD, MBA, cPM, Head of our Coordinating Centre for C
linical Studies and Statistics.
With all these new developments, we are very well
prepared for the challenges of the coming decade.
In this bi-annual report, we want to outline the
continuous development of a competitive,
internationally-renowned research institute for the
benefit of children and adolescents with cancer.
Scientific Director
Karla Valdés Rodríguez, PhD, cPM
Financial & Administrative Director
Head of Research Support
A new location for our journey into the future.
10–11
Introduction
Für die St. Anna Kinderkrebsforschung waren 2009 und
2010 besonders ereignisreiche Jahre. Im Januar 2009
konnten die Forschungslabors in das neu errichtete
Institutsgebäude unmittelbar neben dem St. Anna
Kinderspital übersiedeln. Dies bereitete nicht nur den
inzwischen beengten Raumverhältnissen der Forscher
Innen im Dachgeschoß des St. Anna Kinderspitals
ein Ende, sondern eröffnet den Arbeitsgruppen der
St. Anna Kinderkrebsforschung nun auch durch zusätzliche Ausstattungen und Räumlichkeiten neue Wege
in der translatorischen und angewandten Forschung.
Diese Umstrukturierungen sind nötig, möchte man
weiterhin mit den neuesten technischen Entwicklungen
in der Biomedizin Schritt halten und ganzheitliche
Forschungsansätze im Sinne umfassender Analysen
der Krankheitsentstehung durch Integration großer
biologischer Datenmengen anwenden.
Ein wachsendes Forschungsinstitut braucht
innovativen Support in administrativen Agenden.
Die Teilnahme an klinischen Studien, kooperativen
Projekten, die Herstellung von therapeutischen
Arzneimitteln (die qualitätsgesicherte Herstellung von
Therapeutika für Blutstammzelltransplantationen und
immunologische Therapeutika) und die Durchführung
von Diagnostikleistungen bedingen die Einhaltung
strenger rechtlicher Auflagen und die daraus folgende
Notwendigkeit zur Dokumentation. Aus diesem Grund
wurde die Organisationsstruktur der St. Anna Kinderkrebsforschung erweitert.
In den Jahren zuvor lag der Schwerpunkt auf der
organisatorisch-strukturellen Seite des Forschungs
institutes im Aufbau einer effektiven und klaren Unter
nehmensstruktur. In weiterer Folge waren in den Jahren
2009 bis 2010 die Kernelemente der Organisationsentwicklung der Ausbau des Qualitätsmanagements, die
Verbesserung der Verwaltung und Hilfestellung in der
Einwerbung von Drittmitteln und die Einführung eines
Finanz- und Ressourcen-Berichtsystems, das an die
Besonderheiten von Drittmittelprojekten angepasst ist.
Die Einführung eines Qualitätsmanagements ist
durch den streng regulierten Betrieb eines Diagnostik
ambulatoriums und durch die Produktion von Blutstammzellen, die für diverse Zelltherapien verwendet
werden, essentiell. Im Zuge der Übersiedlung wurden
zwei Reinräume zugelassen, sodass der Betrieb in den
neuen Räumlichkeiten des Forschungsinstitutes bald
wieder reibungslos f ortgesetzt werden konnte.
Darüber hinaus gab es im Juni 2010 eine personelle
Veränderung in der Leitung der St. Anna Kinderkrebsforschung. Frau Claudia Hochweis, MBA, bei der wir
uns an dieser Stelle für die hervorragende Leistung
bedanken möchten, zog sich in die Privatwirtschaft
zurück und übergab die Funktion der kaufmännischen
Leitung an Frau Karla Valdés Rodríguez. Mit ihrer
Übernahme wurde das Grantmanagement in eine neue
Stabstelle eingegliedert. Das neue Research S
upport
Office bietet den ForscherInnen organisatorische und
administrative Unterstützung in der Projekteinreichung
und - abwicklung sowie in der Kommunikation von
Forschungsergebnissen an die Öffentlichkeit bzw.
gegenüber den Medien.
In einer kleinen Institution trägt jeder einzelne
wesentlich zum Erfolg bei.
Wenn man in neue Forschungsbereiche vordringen
will, ist eine entsprechende finanzielle und technische
Ausstattung eine grundlegende Voraussetzung; entscheidend für wissenschaftliche Höchstleistungen sind
jedoch hochqualifizierte Forscherpersönlichkeiten.
Mehr als in den meisten anderen Gebieten der Medizin
ist es vor allem im pädiatrisch-onkologischen Bereich
wesentlich, geografische Grenzen zu überbrücken
und Kollaborationen zu bilden. In den Jahren 2009
bis 2010 kamen für uns wichtige Projekte wie GEN-AU
CHILD II und das EU-WissenschaftskommunikationsProjekt “DIRECT – Forschen heilt Krebs“ zum Abschluss.
Zudem erwies sich die St. Anna Kinderkrebsforschung
als äußerst erfolgreich in der Anbahnung und Durch
führung von international kollaborierenden Studien,
sodass aus zwischen 2009 und 2010 erfolgten Einreichungen mehr Drittmittelgelder als in den Jahren zuvor
von nationalen und internationalen Förderungsgebern
erfolgreich angebahnt werden konnten. Hier freuen
wir uns einerseits über die Leistung der einzelnen
ForschungsgruppenleiterInnen, andererseits sind
wir stolz auf die Anerkennung durch diverse nationale und internationale Förderungsgeber: ÖNB, der
Jubiläumsfonds der Österreichischen Nationalbank,
FWF, der Fonds zur Förderung der wissenschaftlichen
Forschung, FFG, die Forschungsförderungs
gesellschaft, ÖAW, die Österreichische Akademie der
Wissenschaften, der Fonds der Stadt Wien, ÖGKJ, die
Österreichische Gesellschaft für Kinder- und Jugendheilkunde, WWTF, Wiener Wissenschafts-, Forschungsund Technologiefonds, ZIT, Technologieagentur der
Stadt Wien und die Europäische Kommission.
Unsere Mitarbeit bei diversen EU-geförderten Projekten und Netzwerken ermöglichte es unseren Forschern,
Zugang zu sehr teuren genomischen und postgenom
ischen Hochdurchsatz-Technologien zu erlangen, die
für den Zugriff auf große Mengen an neuen biologischen
Daten notwendig sind. Die Auswertung solcher Daten,
sei es für diagnostische, prognostische oder therapeutische Zwecke, bedarf jedoch der Ver- und Bearbeitung
durch moderne statistische und bioinformatische
Methoden. Aus diesem Grund richtete die St. Anna
Kinderkrebsforschung 2009 eine zentrale Bioinformatikstelle ein und initiierte das pan-europäische
Systembiologie-Projekt ASSET.
Die Vereinigung von internationalen und multidiszi
plinären Forschern und Klinikern im Feld der
sogenannten „rare diseases“, zu denen Kinderkrebs
zählt, trägt zum Zusammenschluss europäischer
Forschung bei und ist ein wertvolles Instrument, um
Politikern, regulatorischen Behörden und der Industrie
sowohl auf nationaler wie auf internationaler Ebene
die hohe Expertise von pädiatrisch-onkologischen
Klinikern und Forschern anzubieten. Die Bündelung
von Anstrengungen beschleunigt Innovationen in
unserem Forschungsbereich, von welchen primär die
jungen PatientInnen profitieren. Wir freuen uns daher
über das Zustandekommen des EU-geförderten
Netzwerkes ENCCA (European Network for Cancer
Research in Children and Adolescents), das im Januar
2011 seine Arbeit aufnahm und von OÄ Univ. Doz.
Dr. Ruth Ladenstein, MBA, cPM, Leiterin unseres
Koordinierungszentrums für Klinische Studien und
Statistik, geleitet wird.
Mit allen diesen Neuerungen sind wir für die Herausforderungen des kommenden Jahrzehnts bestens
vorbereitet. In diesem Zweijahresbericht möchten wir
die kontinuierliche Entwicklung eines kompetitiven,
international renommierten Forschungsinstitutes zum
Wohle krebskranker Kinder und Jugendlicher darstellen.
Wissenschaftlicher Direktor
Dr. Karla Valdés Rodríguez, cPM
Kaufmännische Leitung,
Leitung des Research Support
Ein neuer Standort für unseren Weg in die Zukunft.
12–13
Einleitung
Schätzungen zufolge gibt es derzeit
in Europa ungefähr 300.000 bis
500.000 Erwachsene, die eine
Kinderkrebserkrankung überlebt haben.
It is estimated that there are currently between 300,000 and
500,000 adults in Europe who have survived a childhood cancer.
Die Entwicklung von neuen Therapien
erfordert ein besseres Verständnis
der Tumorbiologie. Insbesondere
müssen die Auslöser für bösartiges
Verhalten und der Einfluss von
Interaktionen zwischen Tumor- und
Wirtsfaktoren entschlüsselt werden.
The development of innovative therapies needs to be based
on a better understanding of tumour biology; particularly the
“drivers” of malignant behaviour and the influence of interactions
between tumour and host factors must be identified.
In Europa werden heuer ungefähr
20.000 junge Menschen bis zum
19. Lebensjahr an Krebs erkranken.
Almost 20,000 young people aged up to 19 years
will be diagnosed with cancer this year in Europe.
Die Überlebensraten sind im Allgemeinen
von 40% in den frühen 1970er Jahren
auf über 75% angestiegen. Dennoch ist
Krebs nach wie vor die häufigste
Todesursache durch Krankheit bei Kindern
in Europa nach dem ersten Lebensjahr.
While overall survival rates have incrased from 40% in the early 1970s to
over 75% today, cancer remains the leading cause of death from disease
for children aged one and above in Europe.
Zu den bösartigsten pädriatischen
Erkrankungen, die dringend neue
Therapiekonzepte benötigen, zählen
Neuroblastome und HochrisikoLeukämien, Sarkome und bösartige
Hirntumoren, die zusammen für
80% aller krebsbedingten Todesfälle
im Kindesalter verantwortlich sind.
The most refractory paediatric malignancies with an urgent therapeutic
need are neuroblastomas, high-risk leukaemias, sarcomas and malignant brain tumours, which account for 80% of paediatric cancer deaths.
Facts &
Figures
Daten &
Zahlen
The Children’s Cancer Research Institute (CCRI) at a Glance
Die St. Anna Kinderkrebsforschung im Überblick
The 4 Pillars
Die 4 Säulen
Laboratory
Research
Laborforschung
Production of
Cell Therapeutics
Produktion
von zellulären
Therapeutika
Diagnostics
Diagnostik
Clinical
Research
Klinische
Forschung
The Children’s Cancer Research Institute (CCRI) of
the St. Anna Kinderkrebsforschung Association
advances diagnosis, prognosis and treatment strategies
for children and adolescents suffering from cancer
by conducting basic laboratory, translational and
clinical research into the specific features of different
paediatric cancers.
Our comprehensive approach bundles all fields of
childhood cancer research within a permanent cycle:
basic, translational and clinical research, the improve
ment of diagnostic and prognostic methods, and
immunological therapies. The Unit for Studies and
Statistics for Integrated Research and Projects (S 2 IRP)
provides an essential link to research by acting as clinical
coordinating centre. Based on questions formulated
by clinicians and researchers, Labdia Labordiagnostik
GmbH, the non-profit subsidiary of the CCRI, develops
and offers innovative diagnostic approaches for the
main areas of haematology/oncology and infectiology.
The working group Clinical Cell Biology and FACS Core
Unit, a further interface between research, diagnostics
and therapy, is responsible for the GMP conform
production of haematopoietic stem cells that are
administered to patients.
Die St. Anna Kinderkrebsforschung betreibt grund
lagenorientierte, translationale und klinische Forschung,
um die Diagnostik, Prognose und Behandlungs
möglichkeiten krebskranker Kinder und Jugendlicher
zu verbessern.
Unser ganzheitlicher Ansatz bündelt alle Bereiche der
Kinderkrebsforschung innerhalb eines sich wiederholenden Kreislaufs: Grundlagen-, translationale und
klinische Forschung, die Verbesserung diagnostischer
und prognostischer Methoden und immunologischer
Therapien. Die Abteilung S2IRP für Studien & Statistik
verbindet in ihrer Funktion als klinisches Koordinierungszentrum Forschung und Klinik. Basierend auf Fragestellungen seitens der Kliniker und Forscher entwickelt
das gemeinnützige Tochterunternehmen der St. Anna
Kinderkrebsforschung, die Labdia Labordiagnostik
GmbH, innovative Diagnostika für die Hauptbereiche
Hämatologie/Onkologie und Infektiologie. Die Arbeitsgruppe Klinische Zellbiologie und FACS Core Unit, ein
weiteres Bindeglied zwischen Forschung, Diagnostik
und Therapie, produziert gemäß 9 GMP Richtlinien Blutstammszellen, die den Patienten verabreicht werden.
9 Siehe Glossar
Austria
Denmark
• Austrian Children’s Cancer
Charity (Österreichische
Kinder-Krebs-Hilfe, Verband der Österreichischen Kinder-
Krebs-Hilfe Organisationen)
• Austrian Institute of Technology
GmbH, AIT
• BKH St. Johann in Tirol, Dept.
of Paediatrics and Adolescence
Medicine
• Boehringer Ingelheim
• CeMM, Research Center for
Molecular Medicine of the
Austrian Academy of Sciences
• Children’s Hospital (MUV/AKH)
• Children’s Hospital of
LKH Klagenfurt
• ESQH, Viennese Office
(Europäische Gesell. für
Qualität im Gesundheitswesen)
• Hospital of the Merciful Sisters
• Innsbruck Medical University
• KH Dornbirn, Dept. of Paediat rics and Adolescence Medicine
• LKH Feldkirch
• LKH Leoben
• LKH Linz
• LKH Salzburg, Dept. of
Paediatrics and Adolescence
Medicine
• Ludwig Boltzmann Institute
for Cancer Research (LBI-CR)
• Max F. Perutz Laboratories,
Vienna
• Medical University of Vienna
• Medical University, Graz
• Red Cross, Upper Austria
• rho-BeSt
• St. Anna Children’s Hospital
• Tyrolean Cancer Research
Institute and Biocenter
• University of Veterinary
Medicine, Vienna
• Various hospitals, Vienna
• Vienna University of
Technology
• Charitè – Universitätsmedizin
Berlin
• Christian-Albrechts-Universität
zu Kiel
• German Cancer Research
Center
• Goethe University,
Frankfurt am Main
• Helios Klinikum Berlin
• IBA Göttingen
• Institute of Electron Devices
and Circuits, University Ulm
• Justus-Liebig-University Gießen
• Landeshauptstadt Stuttgart
• Max Planck Institute for
Molecular Genetics
• Medical University of Hannover
• MetaSystems
• Universitätsklinikium Essen
• University Children’s Hospital
Freiburg
• University Erlangen-Nuernberg
• University Hospital Ulm
• University Kiel
• Westfaelische Wilhelms
University Muenster
Belgium
Greece
• European Cancer Organisation
• Ghent University Medical Center
• SIOP Europe (International
Society of Paediatric Oncology)
• University Ghent
• University Maastricht
Chile
• Hospital San Salvador, Santiago
Czech Republic
• Masaryk University Brno
• University Hospital Motol
• Technical University of Denmark
• University of Copenhagen
Finland
• VTT Technical Research
Centre of Finland
France
• Assistance Publique Hôpitaux de Paris
• Centre Anticancereux
“Léon Bérard”
• Centre international de
Recherche sur le Cancer
• Institut Curie
• Institut Gustave Roussy
• Interdisciplinary Research
Institute
Germany
• Foundation for Research
and Technology Hellas
Hungary
• University of Debrecen
Ireland
• Systems Biology Ireland (SBI)
(research initiative between
Univ. College Dublin, UCD,
and National Univ. of Ireland,
Galway, NUI)
• University College Dublin
Israel
• Weizmann Institute of Science
• Sheba Medical Center,
Tel-Hashomer
Research Networks
Forschungsnetzwerke
Italy
• Consorzio Interuniversitario
CINEC
• Rizzoli Institute, Bologna
• Instituto Giannina Gaslini
• Università Cattolica del
Sacro Cuore
• Università degli Studi di
Milano-Bicocca
• Università degli Studi di Padova
• University of Perugia
Finland
Sweden
Poland
• Gdański Uniwersytet Medyczny
Spain
• Centro Nacional de
Investigaciones Oncológicas
• Fundación para la Investigación
del Hospital Universitario La Fe
de la Comunidad Valenciana
Denmark
Ireland
United Kingdom
The Netherlands
Sweden
• Karolinska Institutet
Switzerland
• University Children’s Hospital
Zürich
• Zeptosens
Germany
Czech
Republic
Poland
Belgium
The Netherlands
• Academisch Medisch Centrum
bij de Universiteit van Amsterdam
• Academisch Ziekenhuis
Leiden – Leids Universitair
Medisch Centrum
• Erasmus MC-Sophia Children’s
Hospital
• University Medical Center
Rotterdam
St. Anna
USA
Austria
France
Children’s Cancer
Research Institute
Hungary
Switzerland
United Kingdom
• Northern Institute for Cancer
Research, University of Newcastle
• The Leeds Teaching Hospitals
National Health Service Trust
• University College London
• University of Birmingham
• University of Glasgow
• University of Southampton
Italy
USA
• Children’s Hospital Los Angeles
• Columbia University
• Children’s National Medical
Center, Washington
• National Cancer Institute (NIH),
Bethesda, Maryland
• University of Michigan Health
System, Ann Arbor, Michigan
Greece
Spain
Israel
Chile
ca. 500 km
National and International Research Networks
Nationale und Internationale Forschungsnetzwerke
Clinical Research
Klinische Forschung
The CCRI acted as international coordinating centre for the clinical studies illustrated here and on the following pages. The management of these
studies was performed by the S 2 IRP, our Coordinating Centre for paediatric-oncological trials.
Die St. Anna Kinderkrebsforschung fungierte als internationales Koordinierungszentrum für die hier und auf den Folgeseiten abgebildeten Studien.
Das Studienmanagement wurde von unserem Koordinierungszentrum, der Abteilung S 2 IRP, durchgeführt.
82 Israel Israel
Österreich Austria 3,925
10,000 Patients
recruited
to international
studies
Deutschland
Germany
2,013
Patienten,
die für internationale Studien
Italien Italy 613
8,000 rekrutiert wurden
9,130
64 Czech Republic Tschechien
Total number of patients
50 Gesamtpatientenanzahl
Belgium Belgien
34 Switzerland Schweiz
Great Britain and Ireland 550
Großbritannien und Irland
6,000
32 Greece Griechenland
Frankreich France 528
31Other
Denmark
solidDänemark
tumours (2%)
Andere solide Tumoren
27 Turkey Türkei
Other leukaemias/
haematological diseases (1%)
Patients
in AustriaNiederlande
21Andere
The
Netherlands
Leukämien/
Patienten in Österreich
hämatologische
Erkrankungen
15 Slovenia Slowenien
(2%) Hodgkin Lymphoma – HD
USA 354
HodgkinUSA
Lymphom
– HD
4,000
3,925
4,000
Patients in Austria
15 Brasil Brasilien
Skandinavien Scandinavia 125
(6%) Ewing Sarcoma – Ewing
Ewing Sarkom
Ungarn
Hungary– Ewing
106
(8%) Acute Myeolid Lymphoma – AML
Akute myeloische Leukämie – AML
2007
ALL-SCT International
6,000
Tumour
– Wilms
2,000 (6%) Wilms
Polen
Poland
128
Wilms Tumor – Wilms
2001
LCH-III
2002
HR-NBL 1
2003
ALL-SZT 2003
Total number of patients
Gesamtpatientenanzahl
1997
LCH-II
9,130
(3%) Langerhans
Cell Histocytosis
– LCH
Argentinien
Argentina 180
Langerhanszell-Histiozytose – LCH
1991
LCH-I
8,000
Patients
recruited to international studies
Patienten,
die für internationale Studien
rekrutiert wurden
1983
DAL-HX83/90
10,000
3,925
(3%) Osteosarcoma – Osteo
Spanien Spain 218
Osteosarkom – Osteo
15ALL
Portugal
Portugal
– Acute
Lymphoblastic
Years
Leukaemia
(41%)
Jahre
4 ALL
Australia
Australien
– Akute
lymphoblastische
Leukämie
Total number of patients recruited by country from 1981-2010 through international studies coordinated by the CCRI
Gesamt-Patientenrekrutierung durch internationale, vom CCRI koordinierte Studien pro Land im Zeitraum 1981-2010
(8%) Non-Hodgkin Lymphoma – NHL
Non-Hodgkin Lymphom – NHL
2,000
DAL-HX83/90,
LCH-I,University
LCH-II
Medical
Langerhans CellofHistocytosis
Studies
Graz (14%) 542
HR-NBL
1
Medizinische
Universität Graz
Neuroblastoma Studies
ALL-SZT 2003
Stem Cell Transplantation Studies
in Austria, Germany, Switzerland
Innsbruck
International
Stem Cell (13%)
Transplantation
Studies
Medical University
513
Medizinische Universität
Innsbruck
2007
2001
LCH-III
2002
HR-NBL 1
2003
ALL-SZT 2003
1997
LCH-II
1991
LCH-I
1983
DAL-HX83/90
Medical
University
(9%) Soft Tissue
Sarcoma
– STS
of Graz (14%) 542
Weichteil-Sarkom
– STS
Medizinische Universität Graz
DAL-HX83/90, LCH-I, LCH-II
Langerhanszell-Histiozytose-Studien
HR-NBL 1
Hochrisiko-Neuroblastom-Studien
ALL-SZT 2003
Stammzelltransplantations-Studien in
Österreich, Deutschland und der Schweiz
Internationale Stammzelltransplantations-Studien
3,925
Patients in Austria
Years
Jahre
Innsbruck
Medical University (13%) 513
Medizinische Universität
Innsbruck
1,684 (43%)
3,925
Patients in Austria
St. Anna
Children’s Hospital, Vienna
St. Anna Kinderspital, Wien
LKH Linz (9%) 362
LKH Linz
1,684 (43%)
St. Anna
Children’s Hospital, Vienna
St. Anna Kinderspital, Wien
LKHatLinz
362 Cancer Research Institute
Clinical Research
the(9%)
Children’s
Linz Kinderkrebsforschungs-Institut
Klinische Forschung amLKH
St. Anna
LKH Salzburg (6%) 235
LKH Salzburg
LKH Klagenfurt (3%) 118
LKH Klagenfurt
Linz (3%) 102
Hospital of the Merciful Sisters
KH Barmherzige Schwestern Linz
195 (5%) Other Austrian areas
Übriger österreichischer Raum
94 (2%) Vienna General Hospital
AKH Wien
80 (2%) LKH Leoben
LKH Leoben
Austrian patients recruited by clinical centres for the period 1981–2010
Patientenrekrutierung in Österreich nach Zentrum für den Zeitraum 1981–2010
Österreich Austria 3,925
LKH Salzburg (6%) 235
LKH Salzburg
NBL – Neuroblastoma (10%)
NBL – Neuroblastom
195 (5%) Other Austrian areas
Übriger österreichischer Raum
Deutschland Germany 2,013
82 Israel Israel
64 Czech Republic Tschechien
Diagnoses
Diagnosen
Survival Rates of Children and Adolescents with Cancer
Überlebensraten von Kindern und Jugendlichen mit Krebs
(2%) Hodgkin Lymphoma – HD
Hodgkin Lymphom – HD
Other solid tumours (2%)
(3%) Osteosarcoma – Osteo
Osteosarkom – Osteo
Other leukaemias/
haematological diseases (1%)
Andere Leukämien/
hämatologische Erkrankungen
(3%) Langerhans Cell Histocytosis – LCH
Langerhanszell-Histiozytose – LCH
Hodgkin Lymphoma
Morbus Hodgkin
Malignant Germ Cell Tumour
Maligne Keimzelltumoren
Wilms Tumour
Wilms-Tumor
ALL – Acute Lymphoblastic Leukaemia
Akute lymphoblastische Leukämie
NHL – Non-Hodgkin-Lymphoma
Non-Hodgin Lymphom
Neuroblastoma
Neuroblastom und Ganglioneuroblastom
Osteosarcoma
Osteosarkom
Rhabdomyosarcoma
Rhabdomyosarkom
Central Nervous System (CNS-)Tumours
Hirntumoren
Ewing Sarcoma
Ewingsarkom
ALL – Acute Myeloid Leukaemia
Akute myeloische Leukämie
100 %
80 %
(6%) Wilms Tumour – Wilms
Wilms Tumor – Wilms
60 %
(6%) Ewing Sarcoma – Ewing
Ewing Sarkom – Ewing
ALL – Acute Lymphoblastic
Leukaemia (41%)
ALL – Akute lymphoblastische
Leukämie
40 %
(8%) Acute Myeolid Lymphoma – AML
Akute myeloische Leukämie – AML
20 %
Other solid tumours
MGCT – Malignant Germ Cell Tumours
HB – Liver Tumours
NPC – Nasopharyngeal Carcinoma
MB – Medulloblastoma
RB – Retinoblastoma
MGCT – Maligne Keimzelltumoren
HB – Lebertumoren
NPC – Nasenrachenkrebs
MB – Medulloblastom
RB – Retinoblastom
Other leukaemias/haematological diseases
CML – Chronic Myeloid Leukaemia
JMML – Juvenile Myelomonocytic Leukaemia
RA – Refractory Anaemia
FA – Fanconi Anaemia
MDS – Myelodysplastic Syndrome
Andere Leukämien, hämatologische Erkrankungen
CML – chronische myeloische Leukämie
JMML – juvenile myelomonozytäre Leukämie
RA – Refraktorische Anämie
FA – Fanconi-Anämie
MDS – myelodysplastisches Syndrom
Frequency distribution of diagnoses in Austria for the period 1981–2010
Häufigkeitsverteilung der Diagnosen in Österreich im Zeitraum 1981–2010
Brain tumour patients are followed-up by the paediatric oncology teams at the University Hospital Vienna/AKH
and at the University Hospital in Graz. For this reason, they are not included in this graph.
Hirntumorpatienten werden von den pädiatrisch-onkologischen Teams an der Universitätsklinik Wien/AKH
und am LKH Universitätsklinikum Graz betreut. Diese Patienten sind daher nicht in dieser Grafik erfasst.
Increase in 2-year- (until 1970) and 5-year-survival rates
of children and teenagers with cancer in Germany since 1940
Anstieg der 2-Jahres- (bis 1970) und 5-Jahres-Überlebensraten
von krebskranken Kindern und Jugendlichen in Deutschland seit 1940
2000
1990
1980
1970
NBL – Neuroblastoma (10%)
NBL – Neuroblastom
1960
(9%) Soft Tissue Sarcoma – STS
Weichteil-Sarkom – STS
1950
(8%) Non-Hodgkin Lymphoma – NHL
Non-Hodgkin Lymphom – NHL
Sources: German Childhood Cancer Registry;
Competence Network Paediatric Oncology/
Haematology (KPOH), www.kinderkrebsinfo.de
Quellen: Deutsches Kinderkrebsregister;
Kompetenznetz Pädriatische Onkologie/
Hämatologie (KPOH), www.kinderkrebsinfo.de
Staff
Personal
Management 2%
Management
Management
2%
Management
2%
Secretaries
3%
Management
Management
Sekretärinnen
Secretaries
3%
Secretaries
3%
Finance
& Administration
8%
Sekretärinnen
Sekretärinnen
Finanz
& Administration
FinanceFinance
& Administration
8%
& Administration
8%
IT Department
2%
2%
FinanzManagement
&Finanz
Administration
& Administration
EDV-Abteilung
Management
Department
2%
IT Department
Department
2%
PR &IT
Donation
4%
Secretaries
3%
EDV-Abteilung
EDV-Abteilung
PR- und
Spendenabteilung
Sekretärinnen
PR & Donation
Department
4%
PR & Donation
Department
4%
Civil
Servants
1%
Finance
& Administration
8%
PR- und
Spendenabteilung
PRund Spendenabteilung
Zivildiener
Finanz & Administration
Civil Servants
1%
CivilResearch
Servants
1%
and
S2IRP:
IT Department
2%
Zivildiener
Zivildiener
study
assistants
(RSA)
EDV-Abteilung
and
statisticians
11%
S2IRP: Research
and
Research
and
S2IRP:
2
PR & Donation
4% (RSA)
IRP: Forschungsund
Sstudy
studyDepartment
assistants
(RSA)
assistants
PR- und
Spendenabteilung
StudienassistentInnen
and
statisticians
11% (FSA)
and statisticians
11%
undForschungsStatistikerInnen
Forschungsund
S2IRP:Civil
und
S2IRP:
Servants
1%
(FSA)
(FSA)
Zivildiener
Clinicians
7%
und
StatistikerInnen
und StatistikerInnen
St.
2 Anna Children’s Hospital
S IRP: Research and
Klinische
MitarbeiterInnen,
Clinicians
7%
Clinicians
7%
study
assistants
(RSA)
St.Children’s
Anna
Kinderspital
St. Anna
Children’s
Hospital
St.
Anna
Hospital
and
statisticians
11%
Klinische
MitarbeiterInnen,
MitarbeiterInnen,
Forschungsund
S2IRP:Klinische
Internships
1%
St. AnnaSt.
Kinderspital
Anna
Kinderspital
(FSA)
PraktikantInnen
und StatistikerInnen
Internships
1%
Internships
1%
Technicians
21%
PraktikantInnen
PraktikantInnen
Clinicians
7%
TechnikerInnen
St. Anna Children’s
Hospital
Technicians
21%
Technicians
21%
Klinische MitarbeiterInnen,
TechnikerInnen
TechnikerInnen
St. Anna Kinderspital
Internships 1%
PraktikantInnen
Technicians 21%
TechnikerInnen
Nationalities
Nationalitäten
Österreich Austria
Österreich
Austria
Österreich
Austria
Deutschland
Germany
Deutschland
Germany
Deutschland
Germany
Italien
Italy
Research Grants
Forschungsförderungen
8% Research Group Leaders
ForschungsgruppenleiterInnen
8% Research
Group Leaders
8% Research
Group Leaders
4% Senior PostDocs
Senior PostdoktorandInnen
4% Senior
4%PostDocs
Senior PostDocs
8%
Research
Leaders
Senior
PostdoktorandInnen
SeniorGroup
PostdoktorandInnen
14% PostDocs
PostdoktorandInnen
14% PostDocs
14% PostDocs
4%
Senior
PostDocs
PostdoktorandInnen
PostdoktorandInnen
Senior PostdoktorandInnen
14% PostDocs
PostdoktorandInnen
11% PhD Students
DoktorandInnen
11% PhD11%
Students
PhD Students
DoktorandInnen
DoktorandInnen
5% Diploma Students
DiplomandInnen
5% Diploma
StudentsStudents
5% Diploma
DiplomandInnen
11%
PhDDiplomandInnen
Students
DoktorandInnen
male/female
männlich/weiblich
5% Diploma Students
male/female
male/female
scientific/non-scientific
DiplomandInnen
männlich/weiblich
männlich/weiblich
wissenschaftlich/
nicht-wissenschaftlich
wissenschaftlich/
wissenschaftlich/
male/female
männlich/weiblich
wissenschaftlich/
Finland Finnland
Finland Finland
FinnlandFinnland
Greece
Griechenland
Greece Greece
Griechenland
Griechenland
Guatemala
Guatemala
Italien
Italy
Italien
Italy
Frankreich
France
Österreich Austria
Guatemala
Guatemala
NewGuatemala
ZealandGuatemala
Neuseeland
Finland Finnland
Frankreich
FranceSlovakia
Frankreich
France
Slovakei
Deutschland Germany
New Zealand
Neuseeland
New
Zealand
Neuseeland
Portugal
Portugal
Greece Griechenland
Slovakei
SlovakiaSlovakia
Slovakei
Bosnia-Herzegovina
Italien Italy
Bosnien
Herzegovina
Bosnia-Herzegovina
Bosnia-Herzegovina
Frankreich
France
Bosnien
Herzegovina
Bosnien
Herzegovina
Slovakei Slovakia
PortugalPortugal
Portugal
Portugal
Spain
Spanien
Guatemala Guatemala
Spain Spanien
Spain
Spanien
USA USA
New Zealand Neuseeland
Austrian Research
Promotion Agency 4%
Österreichische
ForschungsAustrianAustrian
Research
Research
förderungsgesellschaft
Promotion
Agency Agency
4% (FFG)
Promotion
4%
Österreichische
ForschungsÖsterreichische
Forschungsförderungsgesellschaft
(FFG) (FFG)
2% Austrian Academy of Science
Österreichische Akademie
der
(ÖAW)
2% Austrian
Academy
of Science
2% Wissenschaften
Austrian
Academy
of Science
Österreichische
Akademie
Österreichische
Akademie
1%
Awards
der Wissenschaften
(ÖAW) (ÖAW)
der Wissenschaften
Preise
Industry 11%
Austrian ResearchIndustrie
Promotion Agency 4%
IndustryIndustry
11%
11%
Österreichische ForschungsIndustrie
(FFG)Industrie
1% Awards
1% Awards
Preise Preise
2% Austrian Academy of Science
Österreichische Akademie
der Wissenschaften (ÖAW)
1% Awards
Preise
Research Foundation
of the Austrian
National
Bank 12%
Industry
11%
Jubiläumsfonds
der
Research
Foundation
Research
Foundation
Industrie
Österreichischen
Nationalbank
(ÖNB)
of the
Austrian
National
Bank 12%
of the Austrian
National
Bank
12%
Jubiläumsfonds
der
Jubiläumsfonds
der
Österreichischen
Nationalbank
(ÖNB) (ÖNB)
Österreichischen
Nationalbank
54% Sixth and Seventh
EU Framework Programmes
of
the
European
Commission
54% Sixth
andSixth
Seventh
54%
and Seventh
6.
7.Programmes
EU-Rahmenprogramme
EU Framework
EUund
Framework
Programmes
der
Europäischen
Kommission
of the European
Commission
of the
European
Commission
6. und 7.(FP6,
EU-Rahmenprogramme
6.
undFP7)
7. EU-Rahmenprogramme
der Europäischen
Kommission
der Europäischen
Kommission
(FP6, FP7)
(FP6, FP7)
54% Sixth and Seventh
EU Framework Programmes
of the European Commission
6. und 7. EU-Rahmenprogramme
der Europäischen Kommission
(FP6, FP7)
Research Foundation
of the Austrian National Bank 12%
Jubiläumsfonds der
Austrian Science Foundation 16%
Österreichischen Nationalbank (ÖNB)
Fonds zur Förderung der
wissenschaftlichen
Forschung
Austrian
ScienceScience
Foundation
16% (FWF)
Austrian
Foundation
16%
Fonds zur
Förderung
der
Fonds
zur Förderung
der
wissenschaftlichen
Forschung
(FWF) (FWF)
wissenschaftlichen
Forschung
Austrian Science Foundation 16%
Successful project
submissions
Fonds zur
Förderung during
der 2009–2010
wissenschaftlichen
Forschung
(FWF)
Volumina der erfolgreichen
Projekteinreichungen
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USA USA
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Herzegovina
Staff ofBosnien
the CCRI
& Labdia Labordiagnostik GmbH and Affiliated Clinicans, as of May 2011
Personelle Zusammensetzung der St. Anna Kinderkrebsforschung & Labdia Labordiagnostik GmbH, inklusive
angegliederte Kliniker, Stand Mai 2011
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during 2009–2010
during 2009–2010
Research
Report
Forschungs
bericht
How many
leukaemia cells
are still in
Claudia’s blood?
We aim at developing and evaluating new diagnostic,
prognostic and therapeutic approaches for
paediatric leukaemias using high-end multi-colour
flow cytometry.
Michael N. Dworzak, Immunological Diagnostics
Leukaemias
Group leader
Assoc. Prof. Michael N. Dworzak, MD
[email protected]
Gruppenleiter
Univ. Doz. Dr. Michael N. Dworzak
[email protected]
32–33
Michael N. Dworzak, Immunologische Diagnostik
Staff scientist
Zvenyslava Husak, PhD
Wissenschaftliche Mitarbeiterin
Dr. Zvenyslava Husak
Technician
Angela Schumich
Technische Mitarbeiterin
Angela Schumich
IT Support
Gerald Peter, MSc 1
EDV
Gerald Peter, MSc 1
� since Feb. 2011
� seit Febr. 2011
Unsere Forschung dient der
Entwicklung neuer diagnostischer,
prognostischer sowie
therapeutischer Methoden bei
Leukämien im Kindes- und
Jugendalter auf Basis von
„high-end“ Durchflusszytometrie.
Leukaemias Leukämien
Neue diagnostische Methoden
für Kinder und Jugendliche
mit Leukämien sowie
Lymphomen mit Hilfe der
Durchflusszytometrie
Our working group’s research focus deals with the
development and validation of new diagnostic methods
based on flow cytometry. We focus mainly on
leukaemia and lymphomas, which make up about 50%
of all cases of cancer in children and adolescents. In
summary, the topics of our work are investigations into
disease-associated peculiarities of protein expression,
which could in future be exploited clinically for
elaborate diagnostics, risk stratification and treatment
tailoring to individual needs (see abstracts 1 and 3 for
further scientific details). Our scientific focus also lies
on the goal of developing new therapies for children
and adolescents with leukaemia and lymphomas
(for further scientific details, see abstract 2).
Unsere Arbeitsgruppe beschäftigt sich schwerpunktmäßig mit der Entwicklung und Validierung neuer
diagnostischer Methoden auf Basis der Durchfluss
zytometrie. Wir konzentrieren uns vor allem auf
9 Leukämien sowie 9 Lymphome, die gemeinsam
etwa 50% aller Krebserkrankungen im Kindes- und
Jugendalter ausmachen. Zusammenfassend sind
die Themen unserer Arbeit die krankheitsassoziierten
Besonderheiten in der 9 Proteinexpression und die
daraus resultierenden Möglichkeiten für die Fein
diagnostik, Risikoanpassung, Prognosebeurteilung und
individualisierte Behandlungsplanung (für vertiefte
wissenschaftliche Details siehe Abstracts 1 und 3).
Unser wissenschaftlicher Fokus gilt auch dem Ziel, neue
Therapiemöglichkeiten für Kinder und Jugendliche
mit Leukämien sowie Lymphomen zu entwickeln (für
vertiefte wissenschaftliche Details siehe Abstract 2).
9 Siehe Glossar
Leukaemias
New diagnostic methods for
children and adolescents with
leukaemia and lymphomas
using flow cytometry
immunophenotyping
Abstract 1
FLOW-MRD
Acute leukaemias have become curable diseases.
However, 20–30% of children with these diseases still
relapse. To optimise and economise treatment further,
therapy must be tailored upon individual factors
of relapse risk. Of these, one of the most relevant is
response to treatment which can be estimated with
high accuracy by assessing minimal residual disease
(MRD) using flow cytometry (FLOW).
Since 2000 we conducted an internationally
collaborative study (Berlin, Monza, Padova, and
Vienna – M.N. Dworzak, coordinator) of FLOW-MRD
in paediatric acute lymphoblastic leukaemia (ALL). In
this period we proved that FLOW-quantification of
MRD is a robust, standardizable assay in our hands and
has independent prognostic impact when applied to
children with ALL even when treated in multi-centric
and multi-national trials 1234567. Based on our
findings, FLOW-MRD is now incorporated as a tool
to plan treatment intensity in current ALL front-line
trials AIEOP-BFM ALL 2009 and ALL IC-BFM 2009.
These trials are conducted in 20 countries in- and
outside Europe with an approximate combined annual
accrual of 2000 patients. M.N.D. has been assigned as
coordinator for “FLOW Immunophenotyping and MRD”
of the Trial Diagnostic Committee of AIEOP-BFM-ALL
2009, as well as into the Trial Scientific Committee
of ALL IC-BFM 2009 as coordinator of the iBFM
FLOW-MRD twinning program. This twinning program
serves to establish quality assured FLOW-MRD testing
for all children tested in the many centres based on
provision of staff training and continuous web-based
performance supervision. Our laboratory, for example,
is involved in the quality development and assurance
of 6 labs located in Chile, Hungary, Slovakia, Bulgaria,
Ukraine, and Turkey.
In addition, it was recently decided by the IntReALL
2010 committee that FLOW-MRD should also play a
role in this upcoming international trial for European
patients with relapsed ALL. To meet all these needs as
well as research prospects under quality-assured and
harmonised conditions including diagnostic immuno
phenotyping, the International-BFM (iBFM) FLOWnetwork of more than 25 centres throughout Europe
and abroad was founded in May 2009 and M.N.D. was
appointed as general coordinator. The iBFM group also
decided to roll out MRD-research to acute myeloid
leukaemias in children and adolescents under the
coordination of M.N.D. – to support this, we recently
acquired financial support from the EU by participation
in ENCCA 261474 (2011 – 2014).
In collaboration with
A. Biondi and G. Gaipa, Tettamanti Research Centre, Monza,
University Milano-Bicocca, Italy.
G. Basso, Laboratory of Paediatric Onco-Haematology,
University of Padova, Italy.
W. D. Ludwig and R. Ratei, Zellmarkerlabor, RRK,
HELIOS Klinikum Berlin, Charite MS, Berlin, Germany.
O. Hrusak, Department of Paediatric Haematology and Oncology,
University Hospital Motol, Prague, Czech Republic.
D. Reinhardt, Abteilung für Kinderheilkunde – Onko-Haematologie,
Hannover Medical School, Germany.
J. Kappelmayer, University of Debrecen, Hungary – ALL IC-BFM
2009 FLOW-group coordinator.
M. Campbell, Hospital San Salvador, Santiago, Chile – ALL IC-BFM
2009 study chair person.
For further reading
1 Ratei R., Basso G. et al. (2009). Monitoring treatment response
of childhood precursor B-cell acute lymphoblastic leukaemia
in the AIEOP-BFM-ALL 2000 protocol with multiparameter flow
cytometry: predictive impact of early blast reduction on the
remission status after induction. Leukemia 23(3): 528–534.
2 Basso G., Veltroni M. et al. (2009). Risk Of Relapse Of Childhood
Acute Lymphoblastic Leukaemia Is Predicted By Flow Cytometric
Measurement Of Residual Disease On Day 15 Bone Marrow. Journal
of Clinical Oncology 27(31): 5168–5174.
3 Brüggemann M., Schrauder A. et al. (2010). Standardized MRD
quantification in European ALL trials: Proceedings of the Second
International Symposium on MRD assessment in Kiel, Germany,
18–20 September 2008. Leukemia 24(3): 521–535.
4 Rhein P., Mitlohner R. et al. (2010). CD11b is a therapy-resistance
and minimal residual disease-specific marker in precursor B-cell
acute lymphoblastic leukaemia. Blood 115(18): 3763–3771.
34–35
Forschungsschwerpunkt
Research Focus
Leukaemias
CD99 TARGET
SIGNAL-FLOW
CD99, an antigen implicated in cell survival and adhesion, is strongly expressed on Ewing tumours and on
acute leukaemias. We recently found that modulation
of this antigen induces cell death in TEL/AML1-positive
ALL (FWF P18196-B05 project conducted till early
2008) 1. We also observed that CD99-modulation
up-regulates hsp70 in leukemic cells. Based on this, we
successfully applied for support to continue with this
research line (ÖNB grant 13081; 2008 – 2009), speculating that CD99-mediated hsp70-up-regulation would
induce NK-cell cytotoxicity. In this project we found
that CD99-mediated hsp70-up-regulation induces
increased NK-cell cytotoxicity against primary ALL cells
and lymphoblastic leukaemia cell lines, but only weakly,
if at all, against Ewing tumour cell lines (manuscript submitted). This observation puts CD99-targeting forward
as a potential tool to augment defense mechanisms of
the immune system against ALL.
Treatment of acute myeloid leukaemia (AML) is about to
change as a result of the development of new targeted
agents like small molecules which block intracellular
signalling pathways. The interaction of such drugs with
their targets either inhibits pathways essential for cell
proliferation or activates pathways that culminate in
apoptosis. The full potential of signal inhibition therapy
will ultimately depend on the definition and reliable
assessment of markers, which can indicate responsiveness to these compounds.
For further reading
1 Husak Z., Printz D. et al. (2010) Death induction by CD99 ligation
in TEL/AML1-positive acute lymphoblastic leukaemia and normal
B cell precursors. Journal of Leukocyte Biology 88(2): 405–412.
Launched in 2007, our project, which is conducted
in co-operation with Prof. V. Sexl from the Institute of
Pharmacology, University of Vienna, gained external
Supported by external grants
• “Funktion von CD99 in der B-Zell Entwicklung”; Austrian Science
Foundation: FWF Project Nr. P18196-B05; period covered
2005–2008.
• “Towards targeted treatment of CD99+ childhood malignancies:
a study on the interrelation of CD99-induced apoptosis, heat-shock
protein biology and NK-cell dependent tumor control“; Research
Foundation of the Austrian National Bank: OeNB Project No. 13081;
period covered 2008–2009.
For further details, see chapter “External Grants”,
Michael N. Dworzak
Our project aims at determining the intracellular signalling status of paediatric AML cases in order to identify
new therapeutic options. Certain patterns of activation
in the signalling network may correlate with specific
leukaemia subtypes, genetic lesions, and/or therapy
response to a new class of anti-cancer drugs (signal
transduction inhibitors).
funding in 2008 by WWTF grant LS07-037. In 2009, we
applied to the international AML-BFM group for support
with leukaemic samples for the project and were rated
2nd of 26 research applications in the priority list, thus
gaining full support immediately and as add-on study
to the upcoming clinical trials AML-BFM 2010 and iBFM
relapsed AML 2010/01 which will both include such a
novel signal transduction inhibiting drug.
Based on the WWTF funding and the cooperations,
we established, augmented, and validated the
underlying FLOW technology (Stanford-approach).
The assessment of the planned screening cohort
of patients (n=100) has recently been concluded and
an interim analysis before entering the validation
phase is c
urrently underway.
V. Sexl, Institute of Pharmacology,
Medical University of Vienna, Austria.
Fig. 1 – Application of flow
cytometry to analyse the
activity of signal-inhibitors
in leukaemic cells
Inhibition of pSTAT5 signalling
in an AML case by signal inhibitor drugs
Key
constitutive expression
negative control
positive control
Dasatinib inhibition
PKC412 inhibition
Sorafenib inhibition
36–37
5 Dworzak M.N., Gaipa G. et al. (2010). Modulation of antigen
expression in B-cell precursor acute lymphoblastic leukaemia
during induction therapy is partly transient: Evidence for a druginduced regulatory phenomenon. Results of the AIEOP-BFM-ALLFLOW-MRD-Study Group. Cytometry B Clin Cytom. 78(3):
147–153.
6 Gaipa G., Cazzaniga G. et al. (2010). Time Point-Dependent
Concordance of Flow Cytometry and RQ-PCR in Minimal Residual
Disease Detection in Childhood ALL: The Experience of the
AIEOP-BFM ALL MRD Study Group. Submitted to Journal of
Clinical Oncology (MND and GB share the senior authorship of
this paper).
7 Fiser K., Sieger T. et al. (2010). Detection and monitoring of
normal and leukemic cell populations with Hierarchical Clustering
of flow cytometry data. Submitted Cytometry Part A.
Abstract 3
Abstract 2
How does
leukaemia develop?
Will we identify
targets for future
therapies?
Understanding leukaemia pathogenesis
not only allows us to gain exciting new
insights into the biology of this disease
but, even more importantly, to identify
novel biomarkers and potential targets
for future specific therapies.
Leukaemias
Group leader
Prof. E. Renate Panzer-Grümayer, MD
[email protected]
Gruppenleiterin
Univ. Prof. Dr. E. Renate Panzer-Grümayer
[email protected]
40–41
Renate E. Panzer-Grümayer, Biologie der Leukämien
Biology of Leukaemias
Biologie der Leukämien
Postdoct. research fellows
DI Reinhard Grausenburger, PhD1
Gerd Krapf, PhD 2
DI Maria Morak, PhD 3
PostdoktorandInnen
DI Dr. Reinhard Grausenburger1
Dr. Gerd Krapf 2
DI Dr. Maria Morak3
PhD students
Gerhard Fuka, MSc 4
Ulrike Kaindl, MSc 5
Ing. Gerd Krapf, MSc 2
DI Lilian Kuster 6
Christine Nassimbeni, MSc7
DoktorandInnen
Mag. Gerhard Fuka4
Mag. Ulrike Kaindl 5
Ing. Mag. Gerd Krapf 2
DI Lilian Kuster 6
Christine Nassimbeni, MSc7
Technicians
Susanna Fischer
Ruth Joas, MSc
Andrea Inthal, PhD
Technische MitarbeiterInnen
Susanna Fischer
Mag. Ruth Joas
Dr. Andrea Inthal
Internships
Rima Mystri 8
Katharina Winter 9
PraktikantInnen
Rima Mystri 8
Katharina Winter 9
Indem wir die Entstehung von Leukämie
erforschen, gewinnen wir nicht nur
wichtige Informationen über die Biologie
der Erkrankung, sondern können
darüber hinaus neue prognostische
Marker und mögliche Ansatzpunkte für
zukünftige Therapien finden und so
die Heilungschancen von krebskranken
Kindern weiter erhöhen.
� since Mar. 2010
2 until Apr. 2009,
May 2009 – Dec. 2010
3 since Feb. 2010
4 since May 2007
5 since May 2008
6 Sept. 2008 – Sept. 2009
7 since Feb. 2011
8 June – July 2010
9 Sept. – Oct. 2009
� seit März 2010
2 bis Apr. 2009,
Mai 2009 – Dez. 2010
3 seit Febr. 2010
4 seit Mai 2007
5 seit Mai 2008
6 Sept. 2008 – Sept. 2009
7 seit Febr. 2011
8 Juni – Juli 2010
9 Sept. – Okt. 2009
Renate E. Panzer-Grümayer, Biology of Leukaemias
Molekulare Entstehungsmechanismen der
Leukämie entschlüsseln: Vertiefte Einblicke
sollen helfen, die Nebenwirkungen aktueller
Therapien zu mindern
Acute lymphoblastic leukaemia (ALL) is the most
frequent cancer in children and adolescents. With
contemporary treatment protocols, about 80% of
affected children can be cured. However, about 20%
of cases suffer a relapse, which comes with a very
unfavourable prognosis. For some leukaemia groups,
the cure rate could be improved by means of more
intensive treatments. The consequence: an increased
risk of side-effects and late effects. Thus, it is clear:
only through a deeper understanding of the molecular
mechanisms of leukaemia pathogenesis, the development of relapses and resistances, can new therapeutic
aspects be opened up. We want to achieve our
research goal – to increase the cure rate for children
with ALL and to reduce the side-effects of current
treatments – in two ways: on the one hand, we want
to understand why and how leukaemia develops and,
on the other hand, we assess the individual treatment
responses in children with ALL in Austria (for further
scientific details see abstract 1). We expect that this
approach will yield new prognostic markers and identify
targets for future therapies.
Die akute lymphoblastische Leukämie (ALL) ist die
häufigste Krebsform im Kindes- und Jugendalter. Mit
derzeitigen Behandlungsprotokollen können ungefähr
80% der betroffenen Kinder geheilt werden. Trotzdem
erleiden bis zu 20% einen Rückfall ihrer Leukämie, der
dann mit einer ungünstigen Prognose einhergeht. Bei
einigen Leukämieuntergruppen verbesserten sich
zwar die Heilungsraten mittels intensiverer Therapien.
Die Folge: ein gleichzeitig erhöhtes Risiko an Neben
wirkungen und Spätfolgen. Somit steht fest: Nur durch
ein besseres Verständnis der molekularen Mechanismen der Leukämie-Enstehung, der Entwicklung von
Rezidiven und Resistenzen eröffnen sich uns neue
therapeutische Aspekte. Unser Forschungsziel – die
Heilungsraten von Kindern mit ALL zu erhöhen und die
Nebenwirkungen der derzeitigen Therapien zu reduzieren – möchten wir auf zweifache Weise erreichen:
einerseits untersuchen wir, wie die Leukämie entsteht,
und andererseits bestimmen wir das individuelle
Ansprechen der Leukämie auf die Therapie bei Kindern
mit ALL in Österreich (für vertiefte wissenschaftliche
Details siehe Abstract 1). Wir erwarten, dass wir mit
diesen Ansätzen neue 9 prognostische Marker sowie
Angriffspunkte für zukünftige Therapien identifizieren.
Leukaemogenesis is initiated in utero by genomic
aberrations of the fetus. But which additional factors
ultimately cause disease manifestation in childhood?
For some time now, our research focus has been on
the subgroup of ALL that is carrying the ETV6/RUNX1
fusion gene generated by a t(12;21) chromosomal
translocation, which is present in about 20% of children
with ALL. This translocation is probably the initiating
event in leukaemogenesis and – like many other early
genomic aberrations – already occurs in the womb.
Further collaborating hits are required, however, to
produce overt leukaemia. Unfortunately, only little is
known about the precise role of the fusion gene and the
additional critical collaborating events. Furthermore,
it is still unclear whether or not the fusion protein is
required for the survival of the leukaemia cells. We
are therefore continuing our research efforts with an
integrated molecular and bioinformatic approach in
order to understand the impact of the fusion gene
on the regulation of genes and pathways by gain- and
loss-of-function experiments. In addition, we are
investigating genome-wide copy number alterations in
leukaemias and we characterise the resulting cellular
effects. These studies are supplemented by investigations into the timely sequence of specific aberrations
(for further scientific details, see Abstract 2).
Origins of disease, relapses and drug resistance:
what are the causes?
Our latest research findings demonstrate that the
fusion gene ETV6/RUNX1 interferes widely with gene
regulation and that the expression of the fusion gene
is responsible for the malignant phenotype of the
cells (for further scientific details, see Abstract 3.1). In
addition, we also showed that ETV6/RUNX1 interferes
with mitotic checkpoint function (see Abstract 3.2) and
we investigated the activation of the PI3K/Akt pathway
(see Abstract 3.1). We were also able to confirm our
hypothesis that the relapse of a ETV6/RUNX1 positive
leukaemia generally emerges from an ancestral clone –
and not from the dominant leukaemia clone present
at initial diagnosis. Our studies also provided first
evidence that the relapse clone frequently acquires
genetic alterations likely to be associated with drug
resistance (see Abstract 4).
Genetische Veränderungen des Fötus im Mutterleib
bilden die Basis der Leukämie. Doch welche
Zusatz-Faktoren lösen schließlich die Erkrankung
im Kindesalter aus?
Seit langem schon ist unser Forschungsschwerpunkt
auf die Untergruppe der ALL mit einer t(12;21)
9 chromosomalen Translokation gerichtet, die in der
Bildung des ETV6/RUNX1 Fusionsgens resultiert und
bei ungefähr 20% der Patienten mit ALL im Kindesalter
vorhanden ist. Diese Translokation ist wahrscheinlich
das erste Ereignis in der Leukämieentstehung und
tritt – wie auch viele andere frühe genetische Veränderungen – bereits im Mutterleib auf. Sie benötigt
jedoch zusätzliche Veränderungen, um eine Leukämie
erkrankung auszulösen. Leider gibt es nur wenig
Information über die genaue Wirkungsweise des
Fusionsgens sowie der kritischen zusätzlichen Veränderungen. Darüber hinaus ist nicht klar, ob das Fusionsprotein für das Weiterbestehen der Leukämiezellen
notwendig ist. Daher setzen wir unsere Forschung in
diesem Bereich mit einem integrativen molekularen
und bioinformatischen Ansatz fort, um die Regulation
von Genen und Signalwegen nach Ausschaltung oder
Überexpression des Fusionsgens zu verstehen. Weiters
untersuchen wir Veränderungen der Genkopien
in den Leukämien und charakterisieren die daraus
resultierenden zellulären Effekte. Diese Studien werden
durch Untersuchungen über die zeitliche Abfolge von
ausgewählten Veränderungen ergänzt (für vertiefte
wissenschaftliche Details siehe Abstract 2).
Krankheitsentstehung, Rezidive und Therapie
resistenzen: Was liegt ihnen zugrunde?
Unsere neuesten Daten zeigen, dass das Fusionsgen
ETV6/RUNX1 massiv die Genregulation beeinflusst
und die Expression des Fusionsgens für den malignen
Phänotyp der Zellen verantwortlich ist (für vertiefte wissenschaftliche Details siehe Abstract 3.1).
Darüber hinaus haben wir die Interaktion von ETV6/
RUNX1 mit Kontrollmechanismen der Zellteilung
(siehe Abstract 3.2) sowie der Aktivierung des PI3K/
Akt Signalweges untersucht (siehe Abstract 3.1). Wir
konnten auch unsere Hypothese bestätigen, dass
die Rückfallserkrankung einer ETV6/RUNX1 positiven
Leukämie aus einer Vorläuferzelle – und nicht von der
Erstleukämie – abstammt. Ebenso zeigten unsere
Untersuchungen, dass diese Rezidive häufig zusätzliche
genetische Veränderungen aufweisen, die mit einer
Resistenz auf bestimmte Medikamente einherzugehen
scheinen (siehe Abstract 4).
9 Siehe Glossar
Leukaemias
Decoding the pathogenesis mechanisms
of leukaemia: deeper insights to help
reduce side-effects of current therapies
42–43
Research Focus
Timing of genetic events
in childhood ALL
For many years now we have been performing the
molecular detection of minimal residual disease (MDR)
(i.e. the presence of leukaemic cells below the detection limit of light microscopy, the conventional means to
evaluate remission) in current treatment protocols for
all children with ALL in Austria. In these protocols, the
level of MRD was used to stratify treatment according
to the individual in vivo response of the leukaemic cells.
The relevance of MRD during the first three months
of treatment according to AIEOP/BFM protocols has
recently been confirmed as the overriding prognostic
parameter for B cell precursor 12 and T-ALL (manuscript submitted). Consequently, the detection of MRD
has also been implemented for treatment stratification
in the new protocol ALL BFM 2009.
Accumulating evidence suggests that the ETV6/
RUNX1 gene fusion is an early or even initiating event in
leukaemia development and occurs already in utero
in the majority of cases with t(12;21) positive ALL. The
fusion gene alone, however, is insufficient to cause
overt leukaemia. At least one or, most likely, several
other cooperating oncogenic lesions, as recently
identified by 1, are needed for the manifestation of the
clinically apparent disease. It remains unclear, however,
when or in which order they occur. The aim of this study
is to assess the timing of genetic lesions by tracking
them back individually to archived neonatal blood
spots, the earliest and frequently only blood sample
available before the initial diagnosis of leukaemia. For
this purpose we are screening leukaemia samples from
children with t(12;21) positive ALL for genetic alterations by genome-wide SNP arrays. Selected recurrent
deletions that belong to one of the major affected
pathways, e.g. B cell differentiation and proliferation/
cell cycle, will be cloned by a multiplex long-range
PCR approach. Genomic DNA sequence information
will be used to design highly specific and sensitive
allele-specific PCRs for the ensuing screening of DNA
from neonatal blood spots, as previously reported 23.
If none of these genetic lesions can be detected in this
material, the presence of the leukaemia clone can be
confirmed at birth by a clone-specific immunoglobulin
or T cell receptor rearrangement or the patient-specific
genomic ETV6/RUNX1 breakpoint 4.
Currently, MRD is mandatory for risk assessment
for children with ALL enrolled in several interna
tional protocols: BFM-ALL 2009 and ESPHALL (for
Philadelphia-positive ALL) for front line therapy,
REZ-BFM ALL 02 for relapsed leukaemias, interfant
06 protocol for children with ALL younger than one
year, and in stem cell transplant protocols for children
at high risk for relapse in first, second and subsequent
remission. Within the Euro-MRD Group1, comprising
more than 30 European reference laboratories, regular
standardisation and quality controls are performed
that guarantee an EU-wide high standard and comparability of MRD determination as well as ensuring
further development of methods to meet clinical needs
and pursue related biological research. The close collaboration with the German and Italian treatment and
research groups provides the opportunity to validate
results and join projects. Several associated research
projects try to answer other biologically and clinically
relevant questions, as for instance, the meaning of
MRD levels at certain time points during treatment in
the context of BFM protocols within defined genetic
subgroups of childhood ALL and the implication of IGH
rearrangement patterns in the subgroup of ALL cases
with a high hyperdiploid karyotype 3456. Moreover,
molecular MRD data were compared to flow-MRD
results to assess their similarities as well as differences
for prognostic relevance 7.
� European Study Group for the detection of MRD
(minimal residual disease)
Austrian ALL and SCT Study Groups (Georg Mann,
Andishe Attarbaschi, Christina Peters, Helmut Gadner, St. Anna
Children’s Hospital, Vienna), German, Italian (AIEOP) and International BFM-ALL and SCT Study Groups and the European Study
Group for the detection of MRD (EURO-MRD).
For further reading
1 Conter, V., Bartram, C. R. et al. (2010). “Molecular response to
treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results
in 3184 patients of the AIEOP-BFM ALL 2000 study” Blood 115(16):
3206–14.
2 Manuscript submitted
3 Meyer, C., Kowarz, E. et al. (2009). “New insights to the MLL
recombinome of acute leukemias.” Leukemia. 23(8): 1490–9.
4 Pichler, H., Moricke, A. et al. (2010). “Prognostic relevance of
dic(9;20)(p11;q13) in childhood B-cell precursor acute lympho
blastic leukemia treated with Berlin-Frankfurt-Munster (BFM)
protocols containing an intensive induction and post-induction
consolidation therapy.” Br J Haematol 149(1): 93–100.
5 Attarbaschi, A., Pisecker, M. et al. (2010). “Prognostic relevance of
TLX3 (HOX11L2) expression in childhood T-cell acute lymphoblastic
leukemia treated with Berlin-Frankfurt-Munster (BFM) protocols
containing early and late re-intensification elements.” Br J Haematol
148(2): 293–300.
6 Csinady, E., van der Velden, V. H. et al. (2009). “Chromosome
14 copy number-dependent IGH gene rearrangement patterns in
high hyperdiploid childhood B-cell precursor ALL: implications for
leukemia biology and minimal residual disease analysis.”
Leukemia. 23(5): 870–6.
7 Manuscript submitted in collaboration with M. Dworzak.
For further reading
1 Mullighan, C. G. et al. (2008). „Genomic analysis of the clonal
origins of relapsed acute lymphoblastic leukemia.“ Science 322;
5906: 1377–80.
2 Fasching, K. et al. (2000). ”Presence of clone-specific antigen
receptor rearrangements at birth indicates an in utero origin of
diverse types of early childhood acute lymphoblastic leukemia.”
Blood 95: 2722–4.
3 Fischer, S.et al. (2007). ”Screening for leukemia- and clonespecific markers at birth in children with T-cell precursor ALL
suggests a predominantly postnatal origin." Blood 110: 3036–8.
4 Konrad, M. Et al. (2003). ”Late relapses evolve from slow-
responding subclones in t(12;21)-positive acute lymphoblastic
leukemia: evidence for the persistence of a preleukemic clone.”
Blood 101: 3635–40.
Supported by external grant
• “Timing of genetic ‘second hit’ alterations in childhood acute
lymphoblastik leukemia”; Austrian Science Foundation: FWF
Project Nr. P 22073-B19; period covered 01.01.2010 – 31.06.2012.
Renate E. Panzer–Grümayer
44–45
Detection of minimal residual disease
in childhood ALL
Leukaemias
Abstract 2
Abstract 1
Leukaemias
Abstract 3
While ETV6/RUNX1 seems critical in the initiation
of leukaemia, its functional contribution to overt
leukaemia is largely unclear. Our first analysis of
siRNA-mediated ETV6/RUNX1 knockdown, however,
suggested that the fusion protein interferes with the
regulation of survival/apoptosis and hence may also
be important for the maintenance of the malignant cell
(Diakos et al.). We therefore extended these studies
and repressed the ETV6/RUNX1 fusion protein by
lentiviral transduction of shRNA vectors in ETV6/RUNX1
positive leukaemia cell lines.
Depletion of ETV6/RUNX1 protein resulted in reduced
proliferation and survival and, at the molecular level, in
downregulation of PI3K/AKT signalling. In line, pharmacological inhibition of PI3K produced similar cellular
effects. Of particular interest, PI3K inhibition sensitised
glucocorticoid (GC) resistant cells to prednisone, which
might be clinically relevant in the context of our recent
finding showing that deletions of the GC-receptor gene
are frequently found in relapses from ETV6/RUNX1
positive leukaemia 1. We further assessed the in vivo
Control
G1
P 0.0004
0
0
4
8
12
16
20
24
Maximilian Kauer, Michael Dworzak and Oskar A. Haas, Children’s
Cancer Research Institute and St. Anna Children’s Hospital,
Vienna, Austria.
Hans Peter Kantner, Ludwig Boltzmann Institute for Cancer Research
(LBI-CR), Vienna, Austria.
Rainhard Kofler and Johannes Rainer, Tyrolean Cancer Research
Institute and Biocentre – Division Molecular Pathophysiology,
Innsbruck Medical University, Innsbruck, Austria.
Dagmar Stoiber, Ludwig Boltzmann Institute for Cancer Research,
Vienna, Austria.
For further reading
1 Kuster, L. et al. (2011). “ETV6/RUNX1-positive relapses evolve from
an ancestral clone and frequently acquire deletions of genes
implicated in glucocorticoid signaling.” Blood 3;117(9):2658–67.
2 Manuscript in preparation.
3 Diakos, C. et al. (2007). “RNAi-mediated silencing of TEL/AML1
reveals a heat-shock protein- and survivin-dependent mechanism
for survival.” Blood 2007;109: 2607–10.
• “Deletion of the second TEL gene in TEL–AML1 positive acute
lymphoblastic leukemia (ALL): Implications for clinic and biology”;
Research Foundation of the Austrian National Bank: GEN–AU Child,
OeNB Nr. 12213; period covered 01.2007 – 12.2008.
• “Genome-wide analysis of genetic alterations in ETV6/RUNX1+
childhood acute lymphoblastic leukemia”; Research Foundation
of the Austrian National Bank: OeNB Nr. 13466; period covered
01.07.2009 – 31.12.2010.
Renate E. Panzer-Grümayer
100
50
clonogenicity – a surrogate parameter for stemness
properties of leukaemia cells – and provided first evidence that the repopulation capacity of the leukaemia
cell line REH is significantly impaired in a xenotransplant
NOD/SCID mouse model upon ETV6/RUNX1 depletion
(Figure 1). Collectively, our data show that ETV6/RUNX1
expression is pivotal for the leukaemia phenotype and
imply that the PI3K/AKT pathway plays an important
role in leukaemia pathogenesis, thereby providing the
rationale for targeting the fusion oncogene or the PI3K
pathway in the future 23.
Weeks
Fig. 1 – Leukaemia-free survival of NOD/SCID mice transplanted
with the leukaemia REH cells upon ETV6/RUNX1 depletion.
G1 denotes mice receiving REH cells upon ETV6/RUNX1 depletion;
Control, control mice carrying a lentivirus containing a non-targeting
shRNA vector. Leukaemia free survival (%, y-axis) in weeks (x-axis).
3.2 ETV6/RUNX1 attenuates the mitotic checkpoint
Given the fact that ETV6/RUNX1-positive leukaemia is
associated with near-triploidy, near-tetraploidy, and trisomy 21 as rather specific types of secondary changes,
we tested the hypothesis that ETV6/RUNX1 may interfere with the mitotic checkpoint (MC). Here we show
that, unlike various controls, ETV6/RUNX1-expressing
Ba/F3 clones acquire a tetraploid karyotype on prolonged
culture, corroborating the assumption that ETV6/RUNX1
may attenuate the MC. C
onsistent with this notion,
ETV6/RUNX1-expressing diploid murine and human cell
lines have decreased proportions of cells with 4N DNA
content and a lower mitotic index when treated with
spindle toxins. Moreover, both RUNX1 and ETV6/
RUNX1 regulate mitotic arrest deficient 2 L1 (MAD2L1),
an essential MC component, by binding to promoter-in
herent RUNX1 sites, which results in down-regulation of
MAD2L1 mRNA and protein in ETV6/RUNX1-expressing
cells. Forced expression of ETV6/RUNX1 also abolishes
RUNX1-induced reporter activation, whereas ETV6/
RUNX1 with a mutant DNA-binding site leads to only
minor effects. Our data link – for the first time – ETV6/
RUNX1, MC, and MAD2L1 and provide new insights into
the function of the ETV6/RUNX1 fusion gene product.
Although tetraploidy is an almost exclusive feature
of ETV6/RUNX1-positive leukaemias, its rarity within
this particular subgroup indicates that additional, yet
unknown, factors are required for its manifestation 1.
Georg Mann and Oskar A. Haas, Children’s Cancer Research Institute
and St. Anna Children’s Hospital, Vienna, Austria.
Anna Kilbey and James Charles Neil, University of Glasgow, UK.
For further reading
1 Krapf, G., Kaindl, U. et al. (2010). “ETV6/RUNX1 abrogates
mitotic checkpoint function and targets its key player MAD2L1.”
Oncogene 29(22):3307–12.
• “GEN-AU CHILD 2” Austrian Federal Ministry of Science and Research:
GZ200.136/1-VI/1/2005; period covered 01.01.2006 – 31.06.2009.
• “GEN-AU Frauenförderung” Austrian Federal Ministry of Science and
Research: GZ200.136/1-VI/1/2005; period covered 01.01.2006 –
31.06.2009. For further details, see chapter “External Grants”,
3.3 The role of hypoxia in ETV6/RUNX1
expressing cells
46–47
3.1 Consequences of ETV6/RUNX1 repression
by lentiviral-mediated shRNA transfer
The ETV6/RUNX1-positive subgroup of ALL differs from
others with regard to clinical and biological features
as, for instance, predominantly late occurring relapses,
low haemoglobin at initial diagnosis and expression
of the erythropoietin receptor on the surface of the
leukaemic cells (Inthal et al.). The latter two findings and
the fact that “response to hypoxia” was one of the major
affected GO terms upon ETV6/RUNX1 knockdown in
leukaemia cells suggest – together with our own preliminary data – that hypoxia plays a role in the pathogenesis
of this leukaemia subtype and that its signalling is
modulated by the ETV6/RUNX1 fusion gene 1.
Exploring the function of
ETV6/RUNX1 in leukaemia
Stefan Niedan, Max Kauer, Children’s Cancer Research Institute,
Vienna, Austria.
For further reading
1 Inthal, A. et al. (2008). “Role of the Erythropoietin Receptor
in ETV6/RUNX1-positive Acute Lymphoblastic Leukemia.”
Clin Cancer Res 2008, 14;22: 7196–204.
Supported by external grant
• “The role of hypoxia in ETV6/RUNX1 positive childhood leukemia:
Implications for biology and clinic”, Research Foundation of the
Austrian National Bank: OeNB Nr. 13665, period covered
01.01.2010 – 31.07.2011
receptor NR3C1 (n=4) and components of the
mismatch repair (MMR) pathways (n=3). FISH screening
of additional 24 relapsed and 72 non-relapsed ETV6/
RUNX1-positive cases demonstrated that BMF deletions were significantly more common in relapse cases
(16.6% versus 2.8%; P=0.02). Unlike BMF deletions,
which were always already present at diagnosis, NR3C1
Fig. 2 – Heatmaps of copy number alterations in 18 relapsed E/Rpositive leukaemias reveal wide-spread clonal heterogeneity.
Overview of somatic CNA in diagnosis and relapse samples. Copy
number changes are mapped according to their chromosomal position
and indicated by colour (blue, losses; red, gains) for each chromosome
from 1 to X (row) and each sample 1-18 (column; white, diagnosis; grey,
relapse leukaemia).
Leukaemias
To test our hypothesis that relapses of ETV6/RUNX1
positive leukaemia emerge from an ancestral –
probably preleukaemia – subclone and to gain insight
into the relapse mechanisms, we analyzed SNP arrays
for DNA copy number aberrations (CNA) in 18 matched
diagnosis and relapse leukaemias (Figure 2). CNA were
more abundant at relapse than at diagnosis (mean 12.5
versus 7.5 per case; P=0.01) with 5.3 shared on average.
Their patterns revealed a direct clonal relationship with
exclusively new aberrations at relapse in only 21.4%,
whereas 78.6% shared a common ancestor and subsequently acquired distinct CNA. Moreover, we identified
recurrent, mainly non-overlapping deletions associated
with glucocorticoid-mediated apoptosis targeting the
Bcl2 modifying factor (BMF) (n=3), glucocorticoid
Analysis of clonality and molecular MRD within
childhood ALL treatment protocols using Ig/TCR and
genomic breakpoint sequences of various trans
locations including the MLL gene as clonotypic markers.
• BFM-ALL 2009 and ESPHALL (for Philadelphia positive ALL) for front line therapy
• REZ-BFM ALL 02 for relapsed leukaemias
• interfant 06 protocol for children with ALL younger
than one year
• and in stem cell transplant protocols for children
at high risk for relapse in first, second and subsequent
remission
48–49
Origin of relapses from childhood
acute lymphoblastic leukaemia
Services
Diagnostics
and MMR aberrations prevailed in relapse leukaemias.
Strikingly, these aberrations appeared to be associated
with drug resistance as children responded poorly
to treatment and underwent stem cell transplantation. These findings imply glucocorticoid-associated
drug resistance in ETV6/RUNX1-positive relapse
pathogenesis and therefore may help to guide future
therapies 1. By a similar approach the origin of late
occurring relapses from T-ALL has been investigated
and is c
urrently also analyzed in high hyperdiploid ALL
cases 2.
Georg Mann, Max Kauer and Oskar A. Haas, Children’s
Cancer Research Institute and St. Anna Children’s Hospital,
Vienna, Austria.
Rainhard Kofler and Johannes Rainer, Tyrolean Cancer Research
Institute and Biocentre – Division Molecular Pathophysiology,
Innsbruck Medical University, Innsbruck, Austria .
Andrew Hall, Christine Harrison and Anthony Moorman,
Northern Institute for Cancer Research, Newcastle University,
Newcastle upon Tyne, UK.
Markus Metzler, Department of Paediatrics, University of
Erlangen-Nuremberg, Erlangen, Germany.
Lüder Hinrich Meyer, Universitätsklinik für Kinder- und Jugend
medizin, Ulm, Germany.
Claus Meyer and Rolf Marschalek, Inst. Pharm. Biology / DCAL,
Goethe-University, Frankfurt, Germany.
Jochen Harbott, Onkogenetic Laboratory, Dept. Ped. Haematol/
Oncol., Justus-Liebig-University Gießen, Germany.
For further reading
1 Kuster, L. et al. (2011). “ETV6/RUNX1-positive relapses evolve
from an ancestral clone and frequently acquire deletions of
genes implicated in glucocorticoid signaling.” Blood 3;117(9):
2658–67.
2 Szczepański, T. et al. (2011). “Late recurrence of childhood
T-cell acute lymphoblastic leukemia presents a second leukemia
rather than a relapse: first evidence for genetic predisposition.”
Journal of Clinical Oncology Feb. 28.
• “Genome-wide analysis of genetic alterations in ETV6/RUNX1+
childhood acute lymphoblastic leukaemia”; Research Foundation
of the Austrian National Bank: OeNB Nr. 13466; period covered
01.07.2009 – 31.12.2010.
• “Origin of relapses from childhood hyperdiploid B-lineage leukaemias”; Research Foundation of the Austrian National Bank: OeNB
Nr. 13881; period covered 01.08.2010 – 31.07.2012.
For further details, see chapter “External Grants”, Renate E. PanzerGrümayer
Collaborations
There are long-standing collaborations with members
of the Biology Group of the International-BFM Group
and the Study Centres for front-line and relapse
therapy of ALL in Germany and Italy and within the
EURO-MRD1 Group.
MRD detection in ALL
The CCRI’s group of “Molecular Microbiology” serves
as reference laboratory for MRD detection in ALL
using genomic markers (e.g. Ig/TCR rearrangements,
MLL fusions).
Renate Panzer-Grümayer is the Austrian representative
in the Trial Research Committee of the AIEOP-BFM ALL
Study Group for childhood ALL.
� Euro-MRD Group: European Study Group for the detection
of MRD (minimal residual disease, minimale Resterkrankung),
Europäische Studiengruppe für MRD Nachweis
Abstract 4
What genetic changes
give information
on the progress of
Alexander’s leukaemia?
Tracking down the faulty genes that cause leukaemia
with the ultimate goal to establish predictive biomarkers
for the optimisation of risk-adapted therapy.
Sabine Strehl, Genetics of Leukaemia
Leukaemias
Group leader
Sabine Strehl, PhD
[email protected]
Gruppenleiterin
Dr. Sabine Strehl
[email protected]
52–53
Sabine Strehl, Leukämiegenetik
Genetics of Leukaemia
Leukämiegenetik
DI Klaus Fortschegger, PhD 1
Karin Nebral, PhD 2
PostdoktorandInnen
DI Dr. Klaus Fortschegger1
Dr. Karin Nebral 2
PhD students
DI Dagmar Denk
Karin Nebral, MSc 2
DI Markus Pisecker 3
DoktorandInnen
DI Dagmar Denk
Mag. Karin Nebral 2
DI Markus Pisecker 3
Technician
Margit König
Technische Mitarbeiterin
Margit König
Internships
Lisa Arzt 4
Wiebke Mensing 5
Erwin Tomasich6
PraktikantInnen
Lisa Arzt 4
Wiebke Mensing 5
Erwin Tomasich6
Clinicians,
St. Anna Children’s Hospital
Assoc. Prof.
Andishe Attarbaschi, MD
Assoc. Prof. Michael Dworzak, MD
Assoc. Prof. Georg Mann, MD
Klinische Mitarbeiter vom
St. Anna Kinderspital
Univ. Doz. Dr.
Andishe Attarbaschi
Univ. Doz. Dr. Michael Dworzak
Univ. Doz. Dr. Georg Mann
Auf der Suche nach defekten Genen
erforschen wir die Auslöser von
Leukämien und deren prognostische
Bedeutung für die Optimierung
risiko-adaptierter Therapien.
� since Nov. 2009
2 until Mar. 2009,
since Apr. 2009
3 until Nov. 2009
4 July – Aug. 2009
5 Feb. 2010 – Jan. 2011
6 Feb. 2010
� seit Nov. 2009
2 bis März 2009,
seit April 2009
3 bis Nov. 2009
4 Juli – Aug. 2009
5 Nov. 2010 – Jan. 2011
6 Febr. 2010
Today, we have access to improved knowledge
on how acute leukaemia develops in children and
adolescents. The delineation of a significant number
of genetic alterations and gene expression profiling have contributed significantly to our knowledge.
Nevertheless, the genetic alterations that lead to the
development of leukaemia are by no means comprehensively researched, which means that we are unable
to predict the biological effects and the clinical process
of leukaemia. Therefore, the main research focus of
the Genetics of Leukaemia group is the identification
of novel genetic alterations that are involved in the
pathogenesis and progression of childhood acute
leukaemia. The evaluation of the prognostic relevance
of certain genetic alterations is being carried out in
cooperation with doctors from the St. Anna Children’s
Hospital. The purpose of these studies is to find genetic
biomarkers that are relevant to prognosis, to include
these in diagnostics – which refines the subdivision into
risk groups – and to enable the optimum adaptation of
therapies.
National and international clinical studies
on risk assessment
In order to accomplish this goal, we carry out extensive
genetic analyses of leukaemia cells in all patients
registered with Austrian leukaemia studies. We use
both the fluorescence in situ hybridisation (FISH)
and molecular genetic approaches here. Genetic and
clinical datasets are then linked (correlated) in order to
determine whether any recurring genetic alteration may
serve as biomarker for treatment failure. Such studies
are conducted not only on a national basis but also in
international collaborations.
Focus of our laboratory research activities:
elucidating the functions of the PAX5 gene
To gain further insights into the pathogenetic role of
genetic alterations, we have, in recent years, been
focusing on the functional consequences of PAX5
lesions in B-cell precursor acute lymphoblastic
leukaemia (BCP‑ALL). These mutations include
deletions (loss of genome-wide copy number), point
mutations, and – of particular interest to us – gene
rearrangements that lead to gene fusions. It is now
the aim of our research to elucidate the role of these
chimeric fusion proteins in leukaemogenesis.
Wir verfügen heute über ein verbessertes Wissen, wie
eine akute Leukämie bei Kindern und Jugendlichen
entsteht. Die Entdeckung einer sehr großen Anzahl
von genetischen Veränderungen und die Erstellung
von 9 Genexpressionsprofilen haben wesentlich
dazu beigetragen. Dennoch sind die genetischen
9 Veränderungen, die zur Leukämieentwicklung
führen, keineswegs umfassend erforscht, wodurch wir
deren biologische Auswirkungen und den klinischen
Verlauf der Leukämieerkrankung nicht vorhersagen
können. Deshalb liegt der Forschungsschwerpunkt
der Arbeitsgruppe für Leukämiegenetik bei der
Identifizierung neuer genetischer Veränderungen, die
an der Krankheitsentstehung und dem Fortschreiten
einer akuten Leukämie beteiligt sind. Eine Bewertung
der prognostischen Relevanz bestimmter genetischer
Veränderungen führen wir in enger Zusammenarbeit
mit den ÄrztInnen des St. Anna Kinderspitals durch.
Diese Studien dienen dazu, prognostisch aufschluss
reiche genetische 9 Biomarker zu finden, diese in die
Diagnostik einzubeziehen – wodurch die Einteilung
in Risikogruppen verfeinert wird – und eine optimale
Abstimmung der Therapie zu ermöglichen.
Leukaemias
Die umfassende Entdeckung genetischer
Veränderungen als Potential für verbesserte
Diagnostik und Therapie bei akuter Leukämie
im Kindes- und Jugendalter
Nationale und internationale klinische Studien
zur Risikoeinschätzung
54–55
Comprehensive characterisation of genetic
alterations has potential to improve diagnosis
and therapies for acute leukaemia in children
and adolescents
Um dieses Ziel zu erreichen, führen wir umfassende
genetische Analysen der leukämischen Zellen aller
PatientInnen, die in den österreichischen Leukämie
studien registriert sind, durch. Hierfür verwenden
wir sowohl die Methode der Fluoreszenz-in-situHybridisierung (9 FISH), als auch molekulare Techniken.
Um festzustellen, ob das Auftreten einer bestimmten
genetischen Veränderung mit einem hohen Risiko eines
Therapieversagens einhergeht, werden genetische und
klinische Daten miteinander verknüpft. Solche Studien
werden nicht nur auf nationaler, sondern auch auf
internationaler Ebene durchgeführt.
Research Focus
Ziel unserer Grundlagenforschung:
Mehr Erkenntnisse über die Funktion des PAX5-Gens
In den letzten Jahren konzentrierten wir unsere
Grundlagenforschung auf ein spezielles Gen, nämlich
PAX5, das eine zentrale Rolle in der 9 B-Zellentwicklung
spielt und in ungefähr 30% aller B-Zell-VorläuferLeukämien genetisch verändert ist. Diese Veränder
ungen umfassen Deletionen (Verlust einer Genkopie),
Mutationen und – für uns von besonderem Interesse –
Genrearrangements, die zu Genfusionen führen. Ziel
unserer Forschung ist es nun, die Rolle dieser chimären
Fusionsproteine bei der Leukämieentstehung
aufzuklären.
9 Siehe Glossar
Leukaemias
Abstract 1
Functional consequences
of PAX5 fusion genes
So far, we have determined that PAX5 fusion proteins
mainly localise to the nucleus supporting the notion
that they potentially act as aberrant trans-dominant
transcription factors and antagonise wild‑type PAX5
function. Nevertheless, PAX5‑HIPK1 displayed a diffuse
nuclear and cytoplasmic distribution pattern, and
assessment of the self-interaction properties of the
PAX5 chimeric proteins by co‑immunoprecipitation
(Co‑IP) determined that PAX5‑DACH1 was able to olig
omerise. Despite differences in their self-interaction
properties, chromatin-immunoprecipitation (ChIP)
revealed that all examined fusion proteins were able
to occupy PAX5 target loci suggesting that the paired
domain was sufficient to recruit the proteins to the
specific DNA-sequences. Further, we have determined
that expression of PAX5-JAK2 results in constitutive
cytokine stimulation-independent tyrosine kinase
On the one hand, our data substantiate the current
concept that all PAX5 fusion proteins share the common feature to act as dominant negative forms of PAX5.
On the other hand, the diverse fusion proteins also
appear to possess distinct properties, which may be
responsible for differences in the pathogenesis of the
respective leukaemia.
For further reading
1 Nebral, K. et al. (2007). “Identification of PML as novel PAX5
fusion partner in childhood acute lymphoblastic leukemia.”
Br J Haematol, 139:269–274.
2 Mullighan, C.G. et al. (2007). “Genome-wide analysis of genetic
alterations in acute lymphoblastic leukaemia.” Nature, 446:758–764.
3 Bousquet, M. et al. (2007). “A novel PAX5-ELN fusion protein
identified in B-cell acute lymphoblastic leukemia acts as a dominant
negative on wild-type PAX5.” Blood, 109:3417–3423.
4 Kawamata, N. et al. (2008) “Cloning of genes involved in
chromosomal translocations by high-resolution single nucleotide
polymorphism genomic microarray.” PNAS, 105:11921–11926.
5 Coyaud, E. et al. (2010). “Wide diversity of PAX5 alterations in
B-ALL: a Groupe Francophone de Cytogenetique Hematologique
study.” Blood, 115:3089–3097.
• “Genome Plasticity and Childhood Cancer – Chromosomal aberrations in life threatening disease”; Austrian Federal Ministry of
Science and Research: GEN-AU CHILD II, Project No. GZ 200.136/1VI/1/2005; period covered 01.01.2010 – 30.06.2011.
• “Elucidating the Role of PAX5 Chimeric Proteins in the Pathogenesis of Childhood B-Cell Precursor Acute Lymphoblastic Leukemia”;
Austrian Science Foundation: Project No. P 21554-B19;
period covered 11.2009 – 10.2012.
For further details, see chapter “External Grants”, Sabine Strehl
56–57
activity of the fusion protein and at the same time may
interfere with normal B‑cell development. In contrast
to ETV6-JAK2 – the only other JAK2 chimeric protein
analysed in detail to date – which resides in the cytoplasm and is tyrosine phosphorylated upon dimerisation, PAX5-JAK2 localises to the nucleus and lacks any
putative self-association motif. Hence, PAX5-JAK2
represents the first nuclear JAK2-fusion protein, which
constitutively activates the JAK-STAT signaling pathway.
Fig. 1 – The localisation of PAX5 fusion proteins was determined by
indirect immunofluorescence. The chimeric proteins are visualised in
green and counterstaining of the nuclei in blue. While PAX5-JAK2
(left image) and PAX5-DACH1 (right image) localise to the nucleus,
JAK2-PAX5 (middle image) mainly resides in the cytoplasm.
The function of the transcription factor PAX5, which
is required for B-cell commitment and maintenance,
is impaired by genetic alterations including deletions,
point mutations, and genetic rearrangements in about
30% of B-cell precursor acute lymphoblastic leukaemia
(BCP-ALL). Specifically, PAX5 rearrangements resulting
in the expression of chimeric PAX5 fusion proteins
account for about 2.5% of all childhood BCP-ALL cases.
We 1 and others 234 have recently determined that
PAX5 is recurrently fused to several different partner
proteins including other transcription factors, struc
tural proteins, and the tyrosine kinase JAK2. The various
chimeric proteins consistently retain the N‑terminus
of PAX5 comprising the DNA-binding paired domain,
but intriguingly the C-terminal fusion partners are
substantially heterogeneous. A thorough characterisation of PAX5 fusion proteins is, therefore, required to
determine their oncogenic properties and to unravel
whether they affect common or distinct pathways.
We have also contributed to a study evaluating the
prognostic relevance of a dic(9;20) chromosome,
which accounts for ~2% of paediatric BCP-ALL cases.
The main finding of this study was that – compared
to other clinical trials, in which this genetic alteration
conferred a rather poor outcome – in the context of
ALL-BFM protocols dic(9;20) leukaemia appears to
have a rather favourable prognosis. The better outcome of these patients may be due to the dose- and
time-intensified induction and induction consolidation
therapy employed 1. We are now evaluating whether
alterations of potential high-risk markers such as alterations of IKZF1 and CRLF2 may – in those cases that
nevertheless relapse – predict therapy failure 2345.
Although the occurrence of a cytogenetically identified
dic(9;20) is considered to define a specific disease
entity, thus far, it lacks a molecular genetic lesion that
may be regarded as a common denominator. Our comprehensive molecular genetic analyses of dic(9;20)
leukaemia revealed that all childhood cases categorically display homozygous CDKN2A deletions, and that
the frequency of PAX5 alterations by far exceeds
the one found in any other genetically defined entity.
Intriguingly, in several cases we observed heterozygous
deletions of PAX5 and concomitant alterations (mutations or deletions) of the second allele, i.e. the absence
of an intact copy of the PAX5 gene. Nevertheless, such
cases – as determined by immunophenotyping – are
CD19 positive B‑cell precursor ALLs suggesting the
impairment rather than the complete loss of PAX5
function. Currently, we aim to determine how these
alterations may contribute to the pathogenesis of this
specific leukaemia subtype.
dic(9;20)
Andishe Attarbashi, St. Anna Children’s Hospital, Vienna, Austria
German and Swiss Acute Lymphoblastic Leukaemia Berlin-
Frankfurt-Münster (ALL-BFM) Study Groups.
For further reading
1 Pichler, H. et al. (2010). “Prognostic relevance of dic(9;20)
(p11;q13) in childhood B-cell precursor acute lymphoblastic
leukaemia treated with Berlin-Frankfurt-Munster (BFM) protocols
containing an intensive induction and post-induction consolidation
therapy.” Br J Haematol 149(1): 93–100.
2 Mullighan, C.G. et al. (2009). “Deletion of IKZF1 and prognosis in
acute lymphoblastic leukemia.” N Engl J Med, 29:470–480.
3 Cario, G. et al. (2010). “Presence of the P2RY8-CRLF2 rearrangement is associated with a poor prognosis in non-high-risk precursor
B-cell acute lymphoblastic leukemia in children treated according to
the ALL-BFM 2000 protocol.” Blood, 115:5393–5397.
4 Kuiper, R.P. et al. (2010). “IKZF1 deletions predict relapse in uniformly treated pediatric precursor B-ALL.” Leukemia, 24:1258–1264.
5 Harvey, R.C. et al. (2010). “Identification of novel cluster groups
in pediatric high-risk B-precursor acute lymphoblastic leukemia
with gene expression profiling: correlation with genome-wide DNA
copy number alterations, clinical characteristics, and outcome.”
Blood, 116:4874–4884.
Fig. 2 – Detection of a dic(9;20) chromosome by fluorescence in
situ hybridisation (FISH). The normal chromosomes 9 and 20 show
a single red and a single green signal, respectively. The rearranged
dic(9;20), which consists of genetic material derived from both
chromosomes, shows one signal for each of the probes.
Genetic alterations in dic(9;20)
leukaemia
58–59
Leukaemias
Abstract 2
Andishe Attarbashi, St. Anna Children’s Hospital, Vienna, Austria
Reinhard Ullmann, Max Planck Institute for Molecular Genetics,
Berlin, Germany.
For further reading
1 De Keersmaecker, K. et al. (2005). ”Genetic insights in the pathogenesis of T-cell acute lymphoblastic leukemia.” Haematologica.
90(8):1116–27.
2 Bernard, O. A. et al. (2001). “A new recurrent and specific cryptic
translocation, t(5;14)(q35;q32), is associated with expression of
the Hox11L2 gene in T acute lymphoblastic leukemia.” Leukemia 15:1495–504.
3 Ballerini, P. et al. (2008). “Impact of genotype on survival of
children with T-cell acute lymphoblastic leukemia treated according
to the French protocol FRALLE-93: the effect of TLX3/HOX11L2
gene expression on outcome.” Haematologica. 93:1658–65.
4 Cavé, H. et al. (2004). “Clinical significance of HOX11L2 expression linked to t(5;14)(q35;q32), of HOX11 expression, and of SIL-TAL
fusion in childhood T-cell malignancies: results of EORTC studies
58881 and 58951.” Blood. 103:442–50.
5 Gottardo, N. G. et al. (2005). “Significance of HOX11L2/TLX3
expression in children with T-cell acute lymphoblastic leukemia
treated on Children's Cancer Group protocols.” Leukemia 19: 1705–8.
6 Attarbaschi, A. et al. (2010). “Prognostic relevance of TLX3
(HOX11L2) expression in childhood T-cell acute lymphoblastic
leukaemia treated with Berlin-Frankfurt-Munster (BFM) protocols
containing early and late re-intensification elements.” Br J Haematol
148(2): 293–300.
• “Genome Plasticity and Childhood Cancer – Chromosomal
aberrations in life threatening disease”.
Austrian Federal Ministry of Science and Research:
GEN-AU CHILD II, Project No. GZ 200.136/1-VI/1/2005.
For further details, see chapter “External Grants”, Sabine Strehl
In a number of international collaborations we have
contributed to investigations aiming to identify novel
genetic alterations and to determine their prognostic
relevance. These studies have unraveled that ALL in
Down Syndrome patients is a highly heterogeneous
disease in which aberrant expression of CRLF2 is
associated with mutated JAK2 1. The I-BFM-SG has
also conducted a large-scale meta-analysis assessing
the clinical impact of specific MLL rearrangements
in paediatric AML. The main conclusions from this
study are that there are significant differences in the
outcome within the group of 11q23/MLL rearranged
cases and that translocation partners and additional
secondary aberrations independently predict clinical
outcome 23. Moreover, these joint projects led to
the identification of PHF6 as novel frequent target
of mutation in T-ALL. Intriguingly, PHF6 is located on
the X‑chromosome providing a potential explanation
for the male predominance of patients with T‑ALL 4.
Based on a project proposal by L. Russell & C. Harrison
to identify novel IGH@ translocations, to obtain an
unbiased incidence of known and novel IGH@ partner
genes, and to further genetically characterise this
subtype of BCP-ALL, we have almost completed an
IGH@ rearrangement-specific FISH screening of all
patients enrolled in the Austrian ALL‑BFM 2000 trial,
and the identification of the respective translocation
partners is ongoing.
Andishe Attarbashi, Georg Mann, Michael Dworzak, St. Anna
Children’s Hospital and Children’s Cancer Research Institute,
Vienna, Austria.
Shai Izraeli, Sheba Medical Centre, Israel
Brian Balgobind and Marry van den Heuvel-Eibrink, Erasmus MCSophia Children's Hospital, The Netherlands
Lisa Russell and Christine Harrison, Northern Institute for Cancer
Research, UK.
Pieter van Vlierberghe and Adolfo Ferrando, Institute for Cancer
Genetics, Columbia University, USA.
The International Berlin-Frankfurt-Münster Study Group (I-BFM-SG).
For further reading
1 Hertzberg, L. et al. (2010). “Down syndrome acute lymphoblastic
leukemia, a highly heterogeneous disease in which aberrant expression of CRLF2 is associated with mutated JAK2: a report from the
International BFM Study Group.” Blood 115:1006–17.
2 Balgobind, B. et al. (2009). “Novel prognostic subgroups in childhood 11q23/MLL-rearranged acute myeloid leukemia: results of an
international retrospective study.” Blood 114(12): 2489–96.
3 Coenen, E. A. et al. submitted
4 Van Vlierberghe, P. et al. (2010). “PHF6 mutations in T-cell acute
lymphoblastic leukemia.” Nat Genet 42(4): 338–42.
60–61
T-cell acute lymphoblastic leukaemia (T-ALL) is a
genetically heterogeneous disease and alterations
affecting at least four specific pathways including
self-renewal capacity, cell cycle regulation, differentiation, proliferation and survival are required before
thymocytes become fully malignant 1. Therefore, in
contrast to B-cell precursor acute lymphoblastic
leukaemia, in which meaningful prognostic subgroups
are determined by distinct genetic alterations, such
entities are not readily apparent in T-ALL. Following
the detection of TLX3 rearrangements in about 20% of
T‑ALL 2, their prognostic relevance has been controversially discussed 345. Our own study showed that
using BFM‑type ALL therapy the treatment outcome
of TLX3 positive paediatric T-ALL patients is excellent.
However, the concurrent presence of a NUP214‑ABL1
fusion/amplification may define a relapse risk‑prone
subgroup. Therefore, in the context of ALL‑BFM trials
analysis of TLX3 status is dispensable, but further
studies regarding the predictive value of NUP214-ABL1
are required 6.
Novel genetic alterations
in childhood leukaemia
Prognostic relevance of TLX3
and NUP214-ABL1 in T-cell
acute lymphoblastic leukaemia
Leukaemias
Abstract 4
Abstract 3
When will the tumour cells
finally disappear
from David’s body?
Peter F. Ambros, Tumour Biology
Solid Tumours
We aim to establish, validate and apply new
diagnostic and therapeutic tools to
facilitate personalised treatment of children
with malignant tumours.
Gruppenleiter
Univ. Doz. Dr. Peter F. Ambros
[email protected]
64–65
Peter F. Ambros, Tumorbiologie
Group leader
Assoc. Prof. Peter F. Ambros, PhD
[email protected]
Staff scientists
Ingeborg M. Ambros, MD
Eva Bozsaky, PhD1
Sabine Taschner-Mandl, PhD 2
Wissenschaftliche MitarbeiterInnen
Dr. Ingeborg M. Ambros
Dr. Eva Bozsaky1
Dr. Sabine Taschner-Mandl 2
PhD students
Heide-Maria Binder, MSc 3
Dominik Bogen, MSc 4
DoktorandInnen
Mag. Heide-Maria Binder 3
Mag. Dominik Bogen4
Diploma students
Heide-Maria Binder 3
Dominik Bogen4
Nelli Frank5
DiplomandenInnen
Heide-Maria Binder 3
Dominik Bogen4
Nelli Frank5
Technicians
Bettina Brunner
Andrea Ziegler
Bettina Brunner
Andrea Ziegler
Clinicians,
Assoc. Prof. Leo Kager, MD
Assoc. Prof. Ruth Ladenstein,
MD, MBA, cPM
Klinische MitarbeiterInnen
vom St. Anna Kinderspital
Univ. Doz. Dr. Leo Kager
Univ. Doz. Dr. Ruth Ladenstein,
MBA, cPM
Ein wesentliches Ziel meiner
Arbeitsgruppe ist es, neue
diagnostische und therapeutische
Verfahren für eine individuelle
Therapie bei Kindern mit
Tumorerkrankungen zu etablieren,
validieren und anzuwenden.
Solid Tumours Solide Tumoren
� Nov. 2007 – May 2009,
since Sept. 2010
2 Mar. 2008 – Sept. 2008,
since Sept. 2009
3 Mar. 2007 – Oct. 2008,
Feb. – Dec. 2009
4 Mar. 2009 – May 2010,
since Sept. 2010
5 since Oct. 2010
� Nov. 2007 – Mai 2009,
seit Sept. 2010
2 Mai 2008 – Sept. 2008,
seit Sept. 2009
3 März 2007 – Okt. 2008,
von Febr. – Dez. 2009
4 März 2009 – Mai 2010,
seit Sept. 2010
5 seit Okt. 2010
Tumour Biology
Tumorbiologie
Tumour cell senescence as a new strategy for
therapy for highly aggressive neuroblastomas
Another research focus of our working group concerns
the treatment of highly aggressive neuroblastomas.
The neuroblastoma is one of the most common
tumours in infants and, despite significant diagnostic
and therapeutic advances, remains fatal in many
cases (death rate ~40% for aggressive tumours). The
innovative therapeutic approach consists of exploiting
the positive effect of tumour cell senescence. Tumour
cell senescence arrests further uncontrolled tumour
growth and, like apoptosis and necrosis, ultimately
leads to cell death of the tumour cell. In previous
research we were able to show that in those neuro
blastomas that are among the most aggressive due to
an amplification of the MYCN oncogene, tumour cell
aging (senescence) can be induced. Tumours thus
lose their malignant properties. Currently, we are
experimenting with in vitro and in vivo systems in
order to comprehensively analyse the effects of
tumour cell aging. Furthermore, we are working on the
most efficient options for letting tumour cells “age”
(senescence induction). This strategy is intended to
enable doctors in the future to treat patients with highly
aggressive neuroblastomas, whose tumours display
genetic a
lterations, in an individualised way with greater
chances for healing.
Highest diagnosis quality through
international cooperation
In order to safeguard highest quality standards for
examinations and put research findings into practise,
international cooperation is indispensable for us, such
as our work with the INRG, the International Neuro
blastoma Risk Group, for example. In addition, we have
been in charge of the European working group, the socalled SIOPEN biologists’ group (International Society
of Paediatric Oncology European Neuroblastoma
Research Network). The task area of this working
group comprises the establishment of new factors for
prognosis, the adaptation and development of new
methods as well as quality assurance. The visualisation
and quantification of disseminated tumour cells in
the bone marrow, performed with a fully automated
microscope, enable the monitoring of the tumour
burden during therapy and are thus further important
processes in therapy adaptation.
Die Arbeitsgruppe für Tumorbiologie konzentriert sich
primär auf die Entwicklung einer gut fundierten wissenschaftlichen Basis für die Therapieindividualisierung
krebskranker Kinder und Jugendlicher mit 9 soliden
Tumoren. Die individuelle Anpassung der Therapie an
den jeweiligen Tumor des Patienten stützt sich heute
größtenteils auf den Nachweis von 9 genomischen
Tumorzellveränderungen. Diese liefern nicht nur
Informationen über die Diagnose, sondern auch über
die Tumoraggressivität und somit über die Prognose
des Patienten. Mithilfe von 9 Tumorgenomanalysen, die
von unserer Gruppe durchgeführt werden, erhält der
behandelnde Arzt eine Entscheidungsgrundlage für die
optimale Therapieplanung.
Tumorzellalterung als neue Therapiestrategie
bei hochaggressiven Neuroblastomen
Ein anderer Forschungsbereich unserer Arbeitsgruppe
gilt der Behandlung von hochaggressiven 9 Neuroblastomen. Das Neuroblastom ist einer der häufigsten
Tumoren bei Kleinkindern und verläuft trotz erheblicher
diagnostischer und therapeutischer Fortschritte nach
wie vor in vielen Fällen tödlich (Sterberate ~40% bei
aggressiven Tumoren). Der innovative Therapieansatz
besteht darin, den positiven Effekt der Tumorzellalter
ung zu nützen. Tumorzellalterung verhindert weiteres
unkontrolliertes Tumorwachstum und führt schließlich,
so wie auch 9 Apoptose und 9 Nekrose, zum Absterben
der Tumorzelle. In vorangegangenen Arbeiten konnten
wir zeigen, dass in jenen Neuroblastomen, die aufgrund
einer 9 Onkogenvervielfachung (MYCN Amplifikation)
zu den aggressivsten Neuroblastomen gehören,
Tumorzellalterung (9 Seneszenz) ausgelöst werden
kann. Dadurch verlieren diese Tumoren ihre bösartigen
Eigenschaften. Gegenwärtig experimentieren wir mit
9 in vitro und in vivo Systemen, um die Mechanismen
und Folgen der Alterung umfassend zu analysieren. Des
Weiteren arbeiten wir an den effizientesten Optionen,
um Tumorzellen „altern“ zu lassen (Seneszenz
induktion). Diese Strategie soll es Ärzten in Zukunft
ermöglichen, Patienten mit hochaggressiven Neuroblastomen, deren Tumoren eine bestimmte genetische
Veränderung aufweisen, maßgeschneidert und mit
höheren Heilungschancen behandeln zu können.
Höchste Qualität der Diagnose durch
internationale Kooperationen
Um höchste Qualitätsstandards bei den Unter
suchungen gewährleisten und Forschungsergebnisse
in die Praxis umsetzen zu können, sind internationale
Kooperationen für uns unerlässlich, wie beispielsweise die Zusammenarbeit mit der 9 INRG1. Darüber
hinaus leiten wir seit vielen Jahren eine Europäische
Arbeitsgruppe, die sogenannte SIOPEN 2 Biologengruppe. Der Aufgabenbereich dieser Arbeitsgruppe
umfasst das Etablieren neuer Prognosefaktoren, das
Adaptieren und Entwickeln neuer Prognosefaktoren,
das Adaptieren und Entwickeln neuer Methoden sowie
die Qualitätssicherung. Die visuelle Darstellung und
Quantifizierung von 9 disseminierten Tumorzellen im
Knochenmark, die mit Hilfe eines voll automatischen
Mikroskops erfolgen, ermöglichen eine Überwachung
der Tumorlast während der Therapie und sind daher
weitere wichtige Verfahren der Therapieanpassung.
� INRG: Internationale Arbeitsgruppe für die Neuroblastom-
Risikoeinschätzung, International Neuroblastoma Risk Group
2 SIOPEN-R-NET: Internationale Gesellschaft des Europäischen
pädiatrisch-onkologischen Neuroblastom-Forschungsnetzwerks,
International Society of Paediatric Oncology European
Neuroblastoma Research Network; www.siopen-r-net.org
9 Siehe Glossar
66–67
The main research focus of the tumour biology working
group lies on providing a well-founded scientific basis
for therapy individualisation for children with cancer
and adolescents with solid tumours. Today, the
individualised adaptation of therapies to the respective
tumours is largely based on the detection of genomic
alterations of the tumour cells. Not only do these
provide information on the diagnosis, but also on the
tumour aggression and thus on the patient’s prognosis.
Tumour genomic analyses carried out by our group
provide the attending doctor with the basis for choosing the best course of therapy.
Tumorgenomanalysen für
individuelle Therapien bei
Kindern mit soliden Tumoren
Tumour genomic analyses
for individualised therapies
for children with solid tumours
Solid Tumours
Research Focus
Solid Tumours
Abstract 1
For further reading
1 Brodeur, G. M. (2003). Neuroblastoma: biological insights into a
clinical enigma. Nat Rev Cancer. 3(3): 203–16.
2 Cohn, S. L., Pearson, A. D. et al. (2009). The International Neuro
blastoma Risk Group (INRG) classification system: an INRG Task
Force report. J Clin Oncol 27(2): 289–97.
3 Ambros, P. F., Ambros, I. M. et al. (2009). International consensus
for neuroblastoma molecular diagnostics: report from the
International Neuroblastoma Risk Group (INRG) Biology Committee.
Br J Cancer 100(9): 1471–82.
4 Ambros, I. M., Brunner, B., et al. (2011). A multilocus technique
for risk evaluation of patients with neuroblastoma. Clin Cancer Res.
Feb 15;17(4): 792–804.
2.0
1.5
Fig. 1 – Multiplex Ligation-dependent Probe Amplification (MLPA)
of a neuroblastoma tumour. This PCR based technique allows the
quantification of 100 genes in a single experiment. In the upper row
the different chromosomes are listed (p stands for the short arm and
q stands for the long arm of the individual chromosome). The green
and yellow bars represent the copy number of the individual gene
listed at the bottom. The MYCN gene, for example, is present in three
copies because the fluorescence ratio – given on the left side – is
close to 1.5. The genes with the yellow bars are present in two copies
in this tumour. This type of genomic pattern characterised by gains of
total chromosomes but without structural aberrations is typical of a
non-aggressive, rather benign behaving tumour.
� SCA: Segmental chromosomal aberrations
Ratio
1.0
The presence of the amplified MYCN oncogene is still
the strongest prognostic marker in Neuroblastoma and
thus it is applied worldwide to direct therapy. However,
in case of intratumoural heterogeneity concerning the
MYCN oncogene, i.e. the co-existence of MYCN amplified (often in a minority of tumour cells) and non MYCN
amplified tumour cells, it is still unclear whether these
MYCN amplified tumour cells display the same features
of malignancy as found in homogeneous MYCN
amplified tumours. Consequently, it is unclear how to
proceed in case of only partly amplified tumours. To
address the clinically most relevant question regarding
the impact of heterogeneous MYCN amplification in
localised neuroblastoma tumours, we applied pan- and
multi-genomic techniques (SNParray and MLPA) and
quantitative fluorescence imaging procedures. Summarising these results, we have evidence that MYCN
amplified cells in neuroblastomas with intratumoural
heterogeneity have (in most cases) simply not reached
full-blown malignancy yet. 0.5
Advancing therapy individualisation is a great chance
to maximise therapeutic success. In the case of
Neuroblastoma, the most frequent solid tumour in
early childhood, individualisation of therapy is essentially based on tumour genomics which represents
the first option to discriminate distinct biological risk
groups (INRG) 1 2. A recent worldwide study – in which
our group was responsible for the monitoring of genetic
data – confirmed the prognostic impact of single
genomic aberrations 3. Based on these data we aimed
to develop and validate a method which can be used
by all European partners (SIOPEN Biology Reference
Centres) to run current and future SIOPEN studies
which implement segmental chromosomal aberrations
(SCA1) into the decision making p
rocess 4. However,
since not all questions concerning the clinical impact
of SCA are solved yet, we analised 636 tumour samples
from 400 NB patients by a multilocus approach to
address the impact of SCA in patients of different age
groups and clinical stages, focusing on the following
question: does age influence the prognostic meaning
of SCA in localised non MYCN amplified Neuroblastoma tumours? Genomic data based on the Localised
Neuroblastoma European Study (LNESGI) and results
of the Austrian NB-94 Study, which have yet to be validated on larger patient cohorts, indicate that SCA have
no impact on prognosis in patients below 18 months
with localised resectable neuroblastomas without
MYCN amplification. This surprising result is opposed
by findings in patients older than 18 months with the
same clinical characteristics where SCA are clearly
associated with an unfavourable prognosis. If these
results can be confirmed, we must consider increasing
treatment intensity for patients older than 18 months
with resectable, localised, MYCN not-amplified
tumours with segmental chromosomal aberrations.
68–69
Genomic features of the tumour
cell help to direct therapy
in Neuroblastoma patients
Whether or not treatment is successful in Neuroblastoma patients with disseminated disease is one of the
key questions in clinical routine. However, there is still
a lack of reliable response criteria for Neuroblastomas.
It is well known that tumour cell dissemination into the
bone marrow occurs in most stage 4 neuroblastoma
patients (>95% of the patients) and a dissemination
rate of up to 80% tumour cells in the bone marrow is
not uncommon. In addition, different reports indicate
that the number of tumour cells in the bone marrow
decreases during treatment 1. However, data on
the reliability of BM investigations, and thus also on
BM involvement in neuroblastoma patients, and the
prognostic meaning of BM clearing are still controversially discussed by researchers. To overcome these
technical problems we established a highly sensitive
and specific detection device 2 3 4. For nearly a
decade now we have been applying the AIPF (automatic
immunofluorescence plus FISH) technology to all bone
marrow samples from all neuroblastoma patients from
Austria, enabling highest possible reliability by FISH
validation of immunologically positive cells by proving
the presence of tumour-typical aberrations in the cells
under investigation.
We hypothesised that the d
ynamics of BM clearing
mirrors the response to cytotoxic treatment and is
thus able to identify prognostically different subgroups
of stage 4 patients. For this purpose, we tested BM
samples from 81 stage 4 patients registered in two
neuroblastoma Trials using this fully automatic fluorescence based device. 44 patients (age 0 to 239 months,
219 BM specimens, median observation time 8.2 years)
met the inclusion criteria (BM specimens at diagnosis
and given time points during treatment and genomic
information on the primary tumour) with a complete
data set. BM clearing after 2 to 4 chemotherapy
cycles was achieved by 28 patients (63.6%) and was
significantly associated with overall survival (OS) in
patients above 18 months at diagnosis (p<0.0002,
Logrank test) but not in the younger age group.
Stage 4 patients below 18 months had a good prognosis
Induction of tumour cell senescence
in MYCN amplified Neuroblastoma –
a possible therapeutic approach
irrespective of BM clearing and tumour genetics. In
younger patients, none of the genetic markers showed
a correlation with OS. MNA was associated and intact
11q showed a trend towards association with BM clearing (p<0.3 and p=0.0735, both Fisher’s Exact Test).
Summarising our data, we conclude that bone marrow
clearing is the most powerful prognostic indicator in
neuroblastoma patients with disseminated disease
but only in patients older than 18 months of age and in
such cases it does indeed represent a reliable way to
measure therapy response.
For further reading
1 Seeger, R. C., Reynolds, C. P. et al. (2000). Quantitative tumour
cell content of bone marrow and blood as a predictor of outcome
in stage IV neuroblastoma: a Children’s Cancer Group Study.
J Clin Oncol 18(24): 4067–76.
2 Méhes, G., Luegmayr, A. et al. (2001). Combined aAutomatic
immunological and molecular cytogenetic analysis allows exact
ientification and quantification of tumour cells in the bone marrow.
Clin Cancer Res 7: 1969–1975.
3 Méhes, G., Luegmayr, A. et al. (2003). Potential application
of ELAVL4 real-time quantitative reverse transcription-PCR
for detection of disseminated neuroblastoma cells.
Am J Pathol 163: 393–9.
4 Ambros, P.F., Méhes, G. et al. (2001). Unequivocal identification
of disseminated tumour cells in the bone marrow by combining
immunological and genetic approaches--functional and prognostic
information. Leukemia 15(2): 275–7.
Activation as well as inactivation of oncogenes can
cause cellular senescence, a permanent state of
proliferative arrest, and have been shown to be associated with tumour “regression”. A few years ago we
discovered that MYCN amplified neuroblastoma cell
lines have a low percentage of tumour cells which show
signs of cellular senescence 1. Interestingly, low dose
long-term hydroxyurea treatment in vitro leads to two
different pathways of tumour cell kill, senescence and
apoptosis. These cultures contain a varying number of
morphologically different looking neuroblastoma cells
showing a reduction of episomal MYCN amplification
and all typical signs of cell senescence, as, for example,
senescence associated- β-galactosidase positivity,
reduced telomerase and shortened telomeres 2.
To further characterize these cells, we studied the
gene expression profile by array and CESH (Comparative expressed sequence hybridisation) technique.
According to gene expression profiling, 409 genes were
differentially regulated in 2 senescent versus control
early passage NB-cell lines. Also the CESH pattern
differed drastically between non-senescent and senescent neuroblastoma cells. In aggressive non-senescent
neuroblastoma cells a preferential expression of
GGCC rich chromatin domains was noted, whereas
senescenT-cells showed preferential expression in AT
rich domains. Both, the array expression profile and the
CESH profile of senescent cells correlated with that of
low risk neuroblastoma. Preliminary functional in vitro
analyses revealed that senescent tumour cells reduce
cell growth and GD2 level and – in line with increased
expression of MHCI and other immune-responserelated molecules – that senescent NB cells allowed
CD8+ T-cell activation. These data indicate that HU
may induce a senescent, non-malignant, immunogenic
state in MYCN amplified neuroblastoma cells. All
together, in vivo and in vitro studies on senescence
induction in tumour cells shall be utilised to establish
an additional maintenance therapy for patients with
the most aggressive neuroblastoma with MYCN
amplification.
For further reading
1 Ambros, I. M., Rumpler, S. et al. (1997). Neuroblastoma cells
can actively eliminate supernumerary MYCN gene copies
by micronucleus formation—sign of tumour cell revertance?
Eur J Cancer 33: 2043–2049.
2 Narath, R., Ambros, I. M. et al. (2007). Induction of senescence
in MYCN amplified neuroblastoma cell lines by hydroxyurea.
Genes Chromosomes Cancer. 46(2): 130–42.
Fig. 2 – Comparative hybridisation of all
RNA species – except rRNA – of nonsenescent and senescent neuroblastoma
cells to normal human chromosomes
(bluish fluorescence). The RNA species
from aggressive, non-senescent tumour
cells result in a red fluorescence whereas
the senescent tumour cell derived
RNAs show green fluorescence. Certain
chromosomal regions show a distinct
red fluorescence whereas other regions
are clearly green fluorescent indicating
a well separated expression of these
two genetically identical cell types –
besides lack of MYCN amplification in
the senescent cells. Only regions with
yellow fluorescence show co-expression
of RNAs from both, senescent and nonsenescent neuroblastoma cells.
Solid Tumours
Accurate measurement
of therapy response in
Neuroblastoma patients
70–71
Abstract 3
Abstract 2
Diagnostics
FISH experiments on chromosomes indicated that
human herpesvirus-6 (HHV-6) integrates into host
cell chromosomes and is vertically transmitted in the
germ line. Peripheral blood mononuclear cells (PBMCs)
were isolated from families in which several members,
including at least one parent and child, had unusually
high copy numbers of HHV-6 DNA per milliliter of
blood. FISH confirmed that HHV-6 DNA co-localised
with t elomeric regions of one allele on chromosomes
17p13.3, 18q23, and 22q13.3, and that the integration site was identical among members of the same
family. Integration of the HHV-6 genome into TTAGGG
telomere repeats was confirmed. Taken together,
the data suggest that HHV-6 is unique among human
herpesviruses: it specifically and efficiently integrates
into telomeres of chromosomes during latency rather
than forming episomes, and the integrated viral
genome is capable of producing virions 1.
Genomic features of paediatric tumours
For further reading
1 Arbuckle, J. H., Medveczky, M. M. et al. (2010). The latent human
herpesvirus-6A genome specifically integrates in telomeres of
human chromosomes in vivo and in vitro. Proc Natl Acad Sci USA
107(12): 5563–8.
As recommended by the INRG (International Neuro
blastoma Risk Group) we perform FISH analyses on all
neuroblastoma tumour samples to identify the status
of the MYCN amplification. Detection of all typical
segmental genomic aberrations (e.g. amplification of
MYCN, DDX1, NAG, MDM2; deletion 1p36, 4p, 11q and
gain of 2p, 17q) found in neuroblastoma and Wilms’
tumours and other paediatric tumours is done by
MLPA (multiplex ligation-dependent probe amplifica
tion). The presence of the Ewing tumour typical
genetic rearrangement of the EWS gene; including the
cryptic EWS/ERG translocation is done by interphase
FISH (I-FISH). Presence of the ETV6-NTRK3 gene to
verify the diagnosis of congenital fibrosarcoma and
rearrangements of the FKHR gene typical for alveolar
rhabdomyosarcomas is done by I-FISH. Furthermore,
presence of integrated/episomal EBV, AdV and HHV6
copies can be analised by the FISH technique and
quantified with an automatic microscope (Metafer,
MetaSystems).
Unambiguous identification and quantification of
disseminated tumour cells in bone marrow, peripheral
blood and aphaeretic samples is crucial to learn about
the disease status of tumour patients. This analysis,
routinely done on all neuroblastoma and rhabdomyo
sarcoma patients from Austria is facilitated by using
the Automatic Immunofluorescence Plus FISH
(AIPF) method (RCDetect, MetaCyte, MetaSystems,
Germany).
72–73
The latent human herpesvirus-6A
genome specifically integrates in
telomeres of human chromosomes
in vivo and in vitro
Solid Tumours
Services
Abstract 4
How can we remove
the cause of Lena’s
bone cancer once it
has been determined?
To increase therapeutic efficacy while decreasing side effects,
we have to specifically target the Archille’s heel of the disease.
Heinrich Kovar, Molecular Biology of Solid Tumours
Solid Tumours
Group leader
[email protected]
Gruppenleiter
[email protected]
76–77
Heinrich Kovar, Molekularbiologie Solider Tumoren
Molecular Biology of Solid Tumours
Molekularbiologie Solider Tumoren
Staff scientist
Assoc. Prof. Dave Aryee, PhD
Wissenschaftlicher Mitarbeiter
Univ. Doz. Dr. Dave Aryee
Jozef Ban, PhD
Idriss Bennani-Baiti, PhD
Argyro Fourtouna, PhD1
David Herrero Martín, PhD 2
Max Kauer, PhD
Oskar Smrzka, MD 3
PostdoktorandInnen
Dr. Jozef Ban
Dr. Idriss Bennani-Baiti
Dr. Argyro Fourtouna1
Dr. David Herrero Martín 2
Dr. Max Kauer
Dr. Oskar Smrzka3
PhD students
Lucia Riedmann, MSc
Raphaela Schwentner, MSc
Stefan Niedan, MSc 4
DoktorandInnen
Mag. Lucia Riedmann
Mag. Raphaela Schwentner
Mag. Stefan Niedan4
Diploma student
Stefan Niedan4
Diplomand
Stefan Niedan4
Technicians
Ing. Gunhild Jug
Ing. Karin Mühlbacher
Ing. Gunhild Jug
Ing. Karin Mühlbacher
Clinician,
Caroline Hutter, MD, PhD
Klinische Mitarbeiterin
DDr. Caroline Hutter
Eine Steigerung der Therapieeffizienz
bei gleichzeitiger Verminderung
der Nebenwirkungen kann nur gelingen,
wenn wir die Achillesferse der
Erkrankung gezielt zu treffen verstehen.
Solid Tumours Solide Tumoren
1 since Mar. 2011
2 since Mar. 2011
3 July 2006 – Feb. 2010
4 until Apr. 2009,
since Nov. 2009
1 seit März 2011
2 seit März 2011
3 Juli 2006 – Febr. 2010
4 März 2008 – Febr. 2009,
seit Nov. 2009
Die Erforschung des Ewing Sarkoms,
eines sehr bösartigen Knochentumors
bei Kindern und Jugendlichen
The Molecular Biology Group focuses predominantly
on basic research with the aim of translating clinical
observations into molecular patterns, and molecular
patterns into diagnostic/prognostic tools and novel
treatment options. For many years, our research has
focused on Ewing’s sarcoma. There is an urgent need
for new treatment options for this very malignant form
of bone cancer in children and adolescents. Due to
its relatively simple genetic makeup, this disease is
particularly open to further research.
targeted mutagenesis of genes of interest) and
chemical (small molecule inhibitors) tools. We also
investigated the influence of the microenvironment
(e.g. hypoxia) on the EWS-FLI1 gene regulatory network
in vitro and studied characteristics associated with
malignancy and metastasis formation. Finally, the EWSFLI1 gene rearrangement was also prospectively tested
for its potential prognostic utility in terms of the course
of a disease and according treatments in a Europe-wide
clinical trial 1.
The search for the right medication
For further reading
1 Le Deley M.C., et al. (2010). Impact of EWS-ETS fusion type on
disease progression in Ewing's sarcoma/peripheral primitive
neuroectodermal tumor: prospective results from the cooperative
Euro-E.W.I.N.G. 99 trial. J Clin Oncol. 28(12): 1982–8.
The central genetic aberration of the Ewing sarcoma
is a fusion between the Ewing sarcoma gene EWS and
the ETS oncogene FLI1 that results in the production
of an aberrant gene regulatory protein, EWS-FLI1. Thus,
the study of Ewing’s sarcoma also serves as a seminal
example for ETS oncogene-driven oncogenesis in
human cancer. The overall aim of our research is to
identify druggable vulnerabilities in the molecular pathways that drive Ewing’s sarcoma pathogenesis. Since
transcription factors – such as EWS-FLI1 – have thus
far represented rather inaccessible therapeutic targets,
we want to decode the molecules and biochemical
pathways, which are active up- and downstream of
EWS-FLI1 and are modulating EWS-FLI1 expression
and its effects. We are approaching this goal through
experimental perturbation in Ewing’s Sarcoma cell lines
and validation in primary tumour samples.
Studies of gene regulatory networks
of the protein EWS-FLI1
During the reporting period, we focused on the gene
regulatory networks of EWS-FLI1. We used pangenomic
screening approaches (mRNA and microRNA profiling,
and high-throughput sequencing) to generate hypo
theses about mechanisms of altered gene regulation
in Ewing’s sarcoma. These were subsequently tested
by targeted pathway perturbations using genetic
(RNA interference, ectopic overexpression and
Die Arbeitsgruppe Molekularbiologie widmet sich vor
allem der Grundlagenforschung, die klinische Beobach
tungen in molekulare Muster und molekulare Muster
in diagnostische oder prognostische Instrumente und
neue Behandlungsmöglichkeiten übersetzen helfen
soll. Seit vielen Jahren steht das 9 Ewing Sarkom im
Mittelpunkt unserer Untersuchungen. Es besteht
ein dringender Bedarf nach neuen therapeutischen
Ansätzen für diese sehr bösartige Form des Knochenkrebses im Kindes- und Jugendalter. Aufgrund ihrer
verhältnismäßig einfachen genetischen Beschaffenheit
ist diese Erkrankung der Forschung besonders gut
zugänglich.
Auf der Suche nach richtigen Medikamenten
Die zentrale genetische Veränderung des Ewing
Sarkoms ist eine Fusion zwischen dem Ewing SarkomGen EWS und dem ETS Onkogen FLI1, die die Bildung
eines krankhaft veränderten genregulatorischen
Proteins – EWS-FLI1 – bewirkt. Die Erforschung von
Ewing Sarkomen dient auch als wegweisendes Beispiel
für andere Krebserkrankungen, in denen veränderte
ETS Proteine eine wichtige Rolle spielen. Ziel unserer
Forschung ist es, verwundbare Stellen der Erkrankung
zu identifizieren, die einer Medikamentenbehandlung
zugänglich sind. Da 9 Transkriptionsfaktoren – wie
EWS-FLI1 – bisher eher unzugängliche therapeutische
Angriffspunkte darstellten, wollen wir EWS-FLI1 vorund nachgeschaltete Moleküle und biochemische
Pfade entschlüsseln, die die Bildung und Wirkung von
EWS-FLI1 beeinflussen. Diesem Ziel nähern wir uns
durch experimentelle Störung in Zelllinien und Über
prüfung in primärem Tumormaterial.
Untersuchungen über genregulatorische
Netzwerke des Proteins EWS-FLI1
Im Berichtszeitraum konzentrierten wir uns auf
genregulatorische Netzwerke von EWS-FLI1. Wir
verwendeten pan-genomische Screening-Verfahren
(Erstellung von mRNA und microRNA Profilen, und
Hochdurchsatzsequenzierung), um Hypothesen
zum Mechanismus der veränderten Genregulation in
Ewing Sarkomen zu generieren. Diese wurden durch
gezielte Störung des genregulatorischen Netzwerkes
mittels genetischer (RNA Interferenz, ektopische
Überexpression, gezielte Mutagenese) und chemischer (kleinmolekulare Inhibitoren) Instrumente
getestet. Wir untersuchten auch den Einfluss der
unmittelbaren Tumorgewebeumwelt (z.B. 9 Hypoxie)
auf das genregulatorische Netzwerk von EWS-FLI1 in
vitro und studierten Eigenschaften der Bösartigkeit
und 9 Metastasierung. Schließlich überprüften wir
prospektiv in einer europaweiten klinischen Studie,
ob der molekulargenetische Nachweis des EWS-FLI1
Genrearrangements prognostische Informationen
über den Krankheitsverlauf und damit für die entsprechende Therapie liefern kann 1.
9 Siehe Glossar
Literaturangaben
1 Le Deley M.C., et al. (2010). Impact of EWS-ETS fusion type on
disease progression in Ewing's sarcoma/peripheral primitive
neuroectodermal tumor: prospective results from the cooperative
Euro-E.W.I.N.G. 99 trial. J Clin Oncol. 28(12): 1982–8.
Solid Tumours
The study of Ewing Sarcoma,
a highly malignant bone-tumour
in children and adolescents
78–79
Research Focus
Mechanisms of EWS-FLI1
mediated gene activation
activated genes, whose expression decreases rapidly
after downregulation of EWS-FLI1. This result suggested that EWS-FLI1 activated genes are more likely
direct targets of the chimeric oncoprotein than
EWS-FLI1 repressed genes (Figure 2). Strikingly, the in
silico analysis of EWS-FLI1 activated genes revealed a
co-enrichment of binding motifs for the transcription
factor E2F. In collaboration with Sven Bilke and Paul
Meltzer from the National Cancer Institute (Bethesda,
USA), simultaneous binding of EWS-FLI1 and members
of the E2F family to EWS-FLI1 activated promoters was
physically confirmed by next generation sequencing
Interestingly, when analysing the gene regulatory proof immunoprecipitated Ewing’s sarcoma chromatin
moter regions of the various gene clusters, an enrich(manuscript in preparation). In her PhD thesis,
EWS-FLI1
dependent
geneassumed
expression
patterns in
relation
to the
number
ofresults by
ment
of ETS binding motifs
to be recognition
Raphaela
Schwentner
is validating
these
sites(red)
for EWS-FLI1
was noticed exclusivelydetected
for EWS-FLI1 (blue)
mutation
analysis forEWS-FLI1
ten selected target
genes.sites
Her
predicted
and experimentally
genomic
binding
results demonstrate for the first time functional cooperativity of EWS-FLI1 with other transcription factors
in Ewing’s sarcoma specific gene regulation.
0.75
For further reading
1 Kovar, H. (2010). “Downstream EWS/FLI1 – upstream Ewing's
sarcoma.” Genome Med 2(1): 8.
2 Kauer, M., Ban, J. et al. (2009). “A molecular function map of
Ewing's sarcoma.” PLoS One 4(4): e5415.
3 Aryee, D. N., Niedan, S. et al. (2010).“Hypoxia modulates EWS-FLI1
transcriptional signature and enhances the malignant properties of
Ewing's sarcoma cells in vitro.” Cancer Res 70(10): 4015–23.
4 Bennani-Baiti, I. M., Cooper, A. et al. (2010). “Intercohort gene
expression co-analysis reveals chemokine receptors as prognostic
indicators in Ewing's sarcoma.” Clin Cancer Res 16(14): 3769–78.
Our gene expression studies so far described the
downstream consequences of EWS-FLI1 modulation
in Ewing’s sarcoma, but did not allow to discriminate
between direct and indirect effects of the chimeric
oncoprotein. This, however, is necessary to understand
the mechanisms of aberrant gene regulation. As a first
approach to identify direct EWS-FLI1 target genes, we
performed time-resolved expression analyses upon
inducible EWS-FLI1 knockdown. Several kinetic expression patterns of EWS-FLI1 responsive genes were
observed (Figure 2).
•
0.70
The metastatic process is complex and, for Ewing’s
sarcoma, almost nothing is known about molecular
factors involved in tumour dissemination and, consequently, prognosis. In part, this is due to a lack of
adequate sample sizes of Ewing’s sarcoma cohorts
for comparative studies of metastatic versus nonmetastatic tumours. Using a novel algorithm, Ican,
we searched different tumour and cell line data sets
for genes with an expression variability similar to the
frequency of metastasis in Ewing’s sarcoma, and
identified differential expression of chemokine
receptors CXCR4 and CXCR7. Chemokines and their
receptors are well known to play a role in metastasis of
other cancers. Testing primary tumour tissues on tissue
arrays by immunohistochemistry we found that CXCR4
associated with the presence of metastasis and CXCR4
and CXCR7 together correlated to patient survival 4.
• •
0.65
EWS-FLI1 is an aberrant regulator of gene expression
and the driving force of Ewing’s sarcoma pathogenesis 1. However, neither the cell type in which this
chimeric oncoprotein disrupts regular gene regulation
nor the mechanisms that lead to tumourigenesis are
known. We therefore studied the functional consequences of RNA interference-mediated experimental
EWS-FLI1 ablation in several human Ewing’s sarcoma
cell lines. We reasoned that genes downregulated upon
silencing of EWS-FLI1 in the cell lines should be higher
expressed in Ewing’s sarcoma tumours than in the
enigmatic tissue of origin, and that, vice versa, genes
that increase in expression when EWS-FLI1 is reduced
should be repressed by the chimeric oncogene and
therefore be less abundant in tumours than in the
relevant reference tissue. By whole genome expression
profiling of Ewing’s sarcoma cell lines with and without
EWS-FLI1 modulation and of primary tumours, we
established a Ewing’s sarcoma specific expression
signature of EWS-FLI1 consisting of similar numbers of
activated and repressed genes. Functional annotation
of aberrantly EWS-FLI1 regulated genes revealed that
activated genes are predominantly associated with proliferation functions, while repressed genes annotated
primarily to signal transduction, development and
differentiation functions 2.
SK-N-MC
P = 0.0001
250
P = 0.0063
200
1000
0.55
150
100
500
50
0
0.45
Colony formation
0.50
0
Normoxia
Hypoxia
Normoxia
Hypoxia
Fig. 1 – Hypoxia increases invasiveness and colony formation of
Ewing’s sarcoma cells
0.40
invasive cells
1500
TC252
0.60
Hypoxia increases invasiveness and colony formation of Ewing´s sarcoma cells
These experiments were performed under optimal
in-vitro tumour cell growth conditions. However, primary
tumours frequently suffer from a lack of oxygen supply
leading to the activation of a transcriptional emergency
program orchestrated by hypoxia inducible factor
HIF1α. Mimicking hypoxic growth conditions in-vitro,
we demonstrated that EWS-FLI1 expression is
transiently increased and the EWS-FLI1 expression
signature is modulated in a HIF1α dependent way in
Ewing’s sarcoma cell lines. Importantly, hypoxia leads
to increased invasivity and anchorage independent
growth of Ewing’s sarcoma cells, properties that are
well known to support tumour metastasis 3 (Figure 1).
•
• •
•
•
• •
•
• •
•
•
•
Fig. 2 – EWS- FLI1 dependent
gene expression patterns
in relation to the number of
predicted (red) and experimentally detected (blue) genomic
EWS-FLI1 binding sites
80–81
A molecular function map
of Ewing’s sarcoma
Solid Tumours
Abstract 2
Abstract 1
Our time-resolved expression analysis of Ewing’s
sarcoma gene expression upon inducible EWS-FLI1
silencing showed that binding sites for EWS-FLI1 are
under-represented in the vicinity of repressed genes.
This result suggests that EWS-FLI1 modulates gene
expression by indirect mechanisms. In silico promoter
analysis of EWS-FLI1 repressed genes identified
enrichment of putative binding motifs for members
of the forkheadbox (FOX) transcription factor family.
In his PhD thesis, Stefan Niedan investigates the role
of several FOX family members in EWS-FLI1 driven
gene repression. Preliminary results confirm a role for
these proteins in a repressive subsignature of EWS-FLI1
and suggest several levels of indirect transcriptional
regulation by EWS-FLI1.
The EWS-FLI1 fusion gene is the product of the
rearrangement of one EWS allele with one FLI1 allele.
Usually, the second, unaffected EWS allele is normally
expressed in Ewing’s sarcoma. EWS is an RNA binding
protein involved in RNA transcription, processing,
maturation and transport and in DNA recombination
repair, and plays a role in senescence 1 (for review,
Kovar 2011). We have previously shown that EWS-FLI1
can interact with EWS. We therefore hypothesised
that indirect gene regulation by EWS-FLI1 may involve
functional interference with the normal function of
EWS. In her PhD thesis, Lucia Riedmann investigates
the role of EWS for the EWS-FLI1 transcriptional and
splicing signature. Preliminary results suggest that
aberrant regulation of a subset of EWS-FLI1 responsive
genes is EWS dependent.
An increasingly recognised mechanism of gene
regulation involves post-transcriptional repression by
microRNAs. We have therefore established the EWSFLI1 microRNA signature of Ewing’s sarcoma following
the same strategy as previously used for the definition of gene expression patterns. Among EWS-FLI1
repressed microRNAs we identified hsa-mir-145, an
established regulator of cellular stemness. We found
EWS-FLI1 and the p53
tumour suppressor pathway
that hsa-mir-145 is not only a repressed target of EWSFLI1 but also a negative regulator of its expression suppressing Ewing’s sarcoma cell growth 2. Thus, in addition to HIF1α 3 and O-linked N-Acetylglucosaminylation
(GlcNAc) and phosphorylation previously identified by
us 4, we defined hsa-mir-145 as a third modulator of
EWS-FLI1 expression in Ewing’s sarcoma.
For further reading
1 Kovar, H. for review
2 Ban, J., Jug, G. et al. (2011). “Hsa-mir-145 is the top EWS-FLI1
repressed microRNA involved in a positive feed-back loop in
Ewing’s sarcoma.” Oncogene 5;30(18):2173-80.
3 Aryee, D. N, Niedan, S., Kauer, M., et al. Hypoxia modulates EWSFLI1 transcriptional signature and enhances malignant properties
of Ewing’s sarcoma cells in-vitro. Cancer research 2010; 70(10):
4015–232.
4 Bachmaier, R., Aryee, D. N. et al. (2009). “O-GlcNAcylation
is involved in the transcriptional activity of EWS-FLI1 in Ewing's
sarcoma.” Oncogene 28(9): 1280–4.
Although the tumour suppressor p53 is widely mutated
in human cancer and is therefore considered a central
target generally impaired in cancerogenesis, about 50%
of human malignancies express wildtype p53. In Ewing’s
sarcoma, p53 mutations occur at a frequency of less
than 10% and are associated with bad prognosis. We
have previously demonstrated that in Ewing’s sarcoma
retaining wildtype p53 expression, basal p53 levels
are reduced by EWS-FLI1. We identified suppression
of the NOTCH signalling pathway as the mechanism
of EWS-FLI1 mediated p53 modulation 1. NOTCH is a
developmental pathway that is frequently aberrantly
activated in acute lymphoblastic leukaemia. The major
downstream effectors of NOTCH signalling are the
repressive transcription factors HES1 and HEY1. We
found that in response to experimental NOTCH activation in Ewing’s sarcoma HEY1 is activated resulting in a
shift in the balance between p53 regulatory proteins
MDM2 and MDM4, p53 modification and stabilization. In
contrast HES1 was found to be uncoupled from NOTCH
signalling and constitutively expressed in an inactive
form in Ewing’s sarcoma 2. These results suggested
that Ewing’s sarcoma should be exquisitely sensitive
to p53 stabilising inhibitors of p53/MDM2 protein
interaction. Preliminary results using the small molecule
drug nutlin 3 confirm this hypothesis. Already at low
concentrations, nutlin 3 treatment very efficiently killed
wildtype p53 Ewing’s sarcoma cells in vitro.
Pathogenetic Mechanisms in Langerhans
Cell Histiocytosis (LCH)
Our group hosts and mentors a clinical fellow, Caroline
Hutter, who aims to elucidate pathogenetic mechanisms in Langerhans cell histiocytosis (LCH), a disease
of still unknown aetiology. She performed comparative
transcriptome analysis of purified LCH cells derived
from different locations and disease courses and of
three major, functionally divergent human dendritic
cell lineages, namely Langerhans cells, myeloid and
plasmacytoid dendritic cells, which were isolated from
healthy donors. Our data show that LCH cells form a
distinct entity when compared to other dendritic cell
lineages, challenging the notion that Langerhans cells
are the progenitors of this disease. We found that JAG2
is highly and selectively expressed in LCH lesions and
that one of its receptors, NOTCH1 seems to be activated. Furthermore, NOTCH signalling confers in vitro
an LCH like phenotype to monocytes by cooperating
with TGF β1, which is expressed in LCH lesions. Together,
these data suggest that the Notch pathway may
contribute to the development of LCH.
For further reading
1 Ban, J., Bennani-Baiti, I., Kauer, M. et al. EWS-FLI1 suppresses
NOTCH-activated p53 in Ewing’s sarcoma. Cancer research 2008;
68: 7100–9.
2 Bennani-Baiti, I. et al., in revision.
82–83
Mechanisms of EWS-FLI1
mediated gene repression
Solid Tumours
Abstract 4
Abstract 3
How can we activate
Tara’s immune system
against the cancer cells?
Thomas Felzmann, Tumor-Immunologie
The last decades brought enormous progress in our
understanding of the cellular and molecular biology of
cancerous disease. One of the areas of hope is cancer
immune therapy. We work on concepts for manipulating
the immune system in order to trigger anti-tumour
immunity, which has the capacity to control the growth
of cancer cells.
Thomas Felzmann, Tumour Immunology
Group leader
Assoc. Prof.
Thomas Felzmann, MD, MBA
[email protected]
Gruppenleiter
Univ. Doz. Dr.
Thomas Felzmann, MBA
[email protected]
Staff scientist
Alexander M. Dohnal, PhD
Wissenschaftliche Mitarbeiter
Dr. Alexander M. Dohnal
Postdoct. research fellow
Caterina Vizzardelli, PhD 1
Postdoktorandin
Dr. Caterina Vizzardelli1
PhD students
Marie Le Bras, MSc 2
Mareike Lindbauer, MSc 3
Romana Luger, MSc 4
DoktorandInnen
Mag. Marie Le Bras2
Mag. Mareike Lindbauer 3
Mag. Romana Luger 4
Diploma students
Friedrich Erhart5
Angela Halfmann6
Cornelia Schuh7
Sarah Vittori 8
DiplomandenInnen
Friedrich Erhart5
Angela Halfmann6
Cornelia Schuh7
Sarah Vittori 8
Technicians
Olenka Burdeljski, BMA9 *
Christina Eichstill, BMA
Angela Halfmann, MSc 6
DI Barbara Leithner*
DI Sidrah Ul-Haq*
Sneha Valookaran, BSc*
Dagmar Wagner, BMA*
Olenka Burdeljski, BMA9 *
Christina Eichstill, BMA
Mag. Angela Halfmann 6
DI Barbara Leithner*
DI Sidrah Ul-Haq*
Sneha Valookaran, BSc*
Dagmar Wagner, BMA*
� since Jan. 2011
2 since Apr. 2011
3 Apr. 2005 – Jan. 2009
4 since May 2008
5 Aug. 2009 – Oct. 2010
6 Oct. 2008 – Dec. 2010,
since Nov. 2010
7 July 2008 – Dec. 2009
8 Jan. 2010 – Feb. 2011
9 since Nov. 2010
� seit Jän. 2011
2 seit Apr. 2011
3 Apr. 2005 – Jän. 2009
4 seit Mai 2008
5 Aug. 2009 – Okt. 2010
6 Okt. 2008 – Dez. 2010,
seit Nov. 2010
7 Juli 2008 – Dez. 2009
8 Jän. 2010 – Febr. 2011
9 seit Nov. 2010
* Staff of Trimed Biotech GmbH
* Mitarbeiter der
9 Trimed Biotech GmbH
Immunology
Tumour Immunology
Tumor-Immunologie
86–87
Die letzten Jahrzehnte brachten gewaltige Fortschritte in
unserem Verständnis der zellulären und molekularen Biologie
von Krebserkrankungen. Ein neues Hoffnungsgebiet ist die
Krebsimmuntherapie. Durch die Manipulation des
Immunsystems wollen wir eine Antitumorimmunität erzeugen,
die das Wachstum der Krebszellen kontrollieren kann.
Immunology Immunologie
Clinical pilot study with brain tumour patients
Under the roof of the biotech company Trimed, we are
currently conducting a randomised phase II clinical
trial for the treatment of patients suffering from brain
cancer. One half of the patients receive the current
standard treatment, the other half receive the DC
cancer vaccine in addition to the standard treatment.
We are planning to include about 60 patients in this
study; so far, 25 patients have been recruited. Final
results are expected in 1–2 years.
Immune regulation by dendritic cells
is in need of dedicated research.
Our basic research programme addresses questions
of DC-mediated immune regulation. In the absence
of any danger from microorganisms, DCs suppress
immune system activity. When the DCs encounter
a microbial infection, they assume highly immune
stimulatory properties. This ability only lasts for about
one day, however, and is followed by a switch into an
immune suppressive mode. Whereas the immune
stimulatory capacity of DCs is well understood,
only little is known about how they mediate immune
suppression.
Promising observations on the MK2 gene
in the mouse tumour model
For our research work we used genomics technologies
in order to identify molecules that inhibit immune
reactions and where this blockade results in improved
proliferation of T-lymphocytes. One particularly
promising candidate, the MK2 molecule, is involved in
signal transduction and might be a master switch of
immune regulation by DCs. We continued to investigate
MK2 in vitro in cells derived from mice in which the
MK2 gene had been deleted. T-cells co-cultivated with
antigen-charged DCs from MK2 deleted mice have a
more than hundred-fold stronger proliferative capacity
compared to co-cultivation with DCs with an intact MK2
gene. If this superior immune stimulatory potential is
confirmed in a mouse tumour model, a blockade of the
MK2 gene might be an attractive candidate for a next
generation of DC-based cancer vaccines in humans.
Seit 15 Jahren erforscht das Labor für Tumorimmuno
logie Mechanismen der 9 Antitumorimmunität –
Mechanismen der Abwehrreaktion gegen Krebszellen –
und Möglichkeiten, diese mit dem Ziel einer Therapie
bei Krebspatienten zu manipulieren. Dazu entwickelten
wir eine Technologie zur Herstellung 9 Dendritischer
Zellen (DCs) für die individualisierte Krebsbehandlung.
Zunächst entnehmen wir dem Patienten operativ
Tumorgewebe und gewinnen aus seinen weißen
Blutzellen die DCs1. Anschließend werden die DCs
mit Tumorzellextrakt beladen und einem Cocktail von
Aktivierungsstimuli ausgesetzt, der eine mikrobielle
Infektion vortäuscht. Danach werden die DCs eingefroren und wir kontrollieren ihre Qualität. Wenn alle
Spezifikationen den Vorgaben entsprechen, werden die
DCs dem Patienten als therapeutischer Krebsimpfstoff
verabreicht.
Klinische Pilotstudie mit Hirntumorpatienten
Unter dem Dach der Biotechnologiefirma 9 Trimed
Biotech GmbH führen wir derzeit eine randomisierte
klinische Phase-II-Studie durch, in der Patienten
behandelt werden, die an einem Gehirntumor leiden.
Die Hälfte der Patienten erhält die derzeitige Standard
therapie, die andere Hälfte erhält zusätzlich zur
Standardtherapie den von uns entwickelten Krebs
impfstoff mit DCs. Wir planen, ungefähr 60 Patienten
in diese Studie einzuschließen; bisher konnten
25 Patienten rekrutiert werden. Die Endergebnisse
erwarten wir in 1–2 Jahren.
Die Immunregulation der Dendritischen Zellen
muss intensiviert beforscht werden.
Im Bereich der Grundlagenforschung beschäftigen
wir uns mit Fragen der Immunregulation durch DCs.
In Abwesenheit einer Gefahr durch Mikroorganismen
unterdrücken die DCs die Aktivität des Immunsystems.
Stellen die DCs eine mikrobielle Infektion fest,
wirken sie stark immunstimulatorisch. Diese Fähigkeit
hält aber nur für etwa einen Tag an und geht dann in
einen 9 immunsuppressiven Modus über. Obwohl wir
die immunstimulatorischen Fähigkeiten von DCs gut
verstehen, gibt es nur spärliche Informationen darüber,
wie DCs Immunsuppression bewirken.
Vielversprechende Beobachtungen
zum MK2-Gen im Maustumormodell
Für unsere Forschungsarbeiten verwendeten wir
moderne 9 Genomik-Technologien, um Moleküle zu
identifizieren, die Immunreaktionen hemmen und
deren Blockade zu einer verbesserten Vermehrung
von 9 T-Lymphozyten führt. Ein besonders viel
versprechender Kandidat, das MK2-Molekül, ist an der
Signalübertragung beteiligt und könnte ein Schlüssel
schalter in der Immunregulation durch DCs sein. Wir
setzten unsere Versuche in vitro mit aus Mäusen
gewonnenen Zellen fort, in denen das MK2-Gen
ausgeschaltet ist. T-Zellen, die mit 9 antigenbeladenen
DCs von MK2 defekten Mäusen ko-kultiviert wurden,
zeigten eine bis zu hundertfach stärkere Vermehrungskapazität im Vergleich zu einer Ko-Kultivierung mit DCs
mit intaktem MK2-Gen. Wenn sich diese überlegene
immunstimulatorische Fähigkeit in einem Maustumor
modell bestätigen lässt, könnte eine Blockade des
MK2-Gens eine attraktive Strategie für eine verbesserte
Generation von auf DCs basierenden Krebsimpfstoffen
beim Menschen sein.
� DCs: Dendritische Zellen
9 Siehe Glossar
88–89
For 15 years, the laboratory for Tumour Immunology
has been researching mechanism of antitumour
immunity – mechanisms of innate resistance against
cancer cells – and possibilities of manipulating these for
the purpose of therapy in cancer patients. To this end,
we developed a technology for the creation of dendritic
cells (DCs) for individualised cancer treatment. First,
we surgically extirpate tumour tissue from the patient
and obtain the DCs from the patient’s white blood cells.
Then, the DCs are charged with tumour material and
exposed to a cocktail of activation stimuli that mimic a
microbial infection. Following this, the DCs are frozen
and we control their quality. When all specifications
correspond to the parameters, the DCs are administered to the patient as a therapeutic cancer vaccine.
Tumorimpfstoff als innovative
Methode zur Krebsbehandlung
Tumour vaccine as an innovative
method of cancer treatment
Immunology
Research Focus
Abstract 3
Time dependent changes
of immune regulation
by monocyte derived
dendritic cells
Current status of the clinical development
of a cancer immune therapy technology
based on LPS matured IL-12 secreting
dendritic cells
In vitro from monocytes differentiated myeloid
dendritic cells (DC) orchestrate the function of the
immune system. They act on the detection of microbial
signals by assuming a strong immune stimulatory
phenotype for approximately one day. This is followed
by the activation of negative immune regulatory
feedback loops signalling the termination of an immune
response. We used expression profiling and RNA interference to spot molecules in human DCs participating
in immune regulation. We identified the MAPKAP kinase
2 (MK2) as a potent mediator in switching DCs from the
stimulatory into the immune regulatory mode. Upon
activation with lipopolysaccharide (LPS), bone marrow
derived DCs from wild type mice down-regulate MK2
expression during the early immune stimulatory phase
characterised by high IL-12 secretion and up-regulate
MK2 expression during the late immune regulatory
phase characterised by expression of IL-10 and the
soluble IL-2 receptor alpha chain, sIL2R α (sCD25).
MK2-/- DCs show decreased IL-10 or sIL2R α expression.
Both, IL-10 and soluble sIL2R α represent immune regulatory molecules, which inhibit CD8+ cytotoxic T-cells
(CTL). In a syngeneic mouse in vitro model MK2-/- DCs
induce an up to 100-fold increased proliferation of
ovalbumin specific CD8+ OT-I cells compared to wild
type DCs. First evidence for reduced STAT3 phos
phorylation in MK2-/- DCs highlights involvement of the
JAK-STAT3 pathway in MK2 driven immune regulation.
Ongoing in vivo studies have been designed in order to
demonstrate enhanced stimulatory capacity of MK2-/DCs for CTL induction. The regulatory potential of
MK2 in mice correlates with observations in the human
system. Thus, blocking MK2 may be a critical feature of
a next generation of DC therapeutics for the treatment
of cancer.
Lipopolysaccharide (LPS) and IFN-γ matured monocyte derived dendritic cells (DCs) may act immune
stimulatory and immune suppressive depending on the
time at which DC/T-cell contact starts after initiation of
maturation. In order to more specifically define these
respective time windows, we used allogeneic mixed
leukocyte reactions (alloMLR). Th1 polarisation requires
using DCs after only a few hours of maturation, as IL-12
secretion is terminated within 24 hours. DCs were
first matured for 6 hours and then co-cultivated with
T-cells for another 6 hours. Subsequently, T-cells were
flow-sorted and re-cultivated without DCs, resulting in
up to 26-fold increased proliferation as compared to a
DC/T-cell co-culture. This was evident at a 1:1 DC/T-cell
ration, whereas at a 1:10 ratio strong proliferative
responses were observed in T-cells separated from
DCs and DC/T-cell co-cultures. These observations
were confirmed using T-cell receptor transgenic OT-I
and OT-II cells. Similar to the human model, separating
ovalbumin presenting murine DCs from OT-I and OT-II
cells resulted in significantly up-regulated proliferation
as compared to continuous co-cultivation. Furthermore, we observed cytokine expression patterns
corresponding to the phase of immune stimulation
(IL-1 β, TNF- α, IL-12p70) and immune suppression (IL-10,
soluble IL-2 receptor alpha chain, sIL2R α). Also, we
confirmed earlier observations that indoleamine 2,3
dioxygenase IDO activity becomes detectable in the
suppressive time window. Our data suggest that current
interpretations of DC function as exerted by distinct
DC subsets might need to be amended. LPS/IFN-γ
matured monocyte derived DCs go through a time
dependent differentiation programme with a dominant
immune stimulatory mode early after maturation that
switches into an immune suppressive mode at later
time points.
The first dendritic cell (DC) based cancer immune
therapy (CIT) was approved in 2010 by the US FDA
for the treatment of advanced prostate cancer. The
technology used, however, originates from the early
1990ies. Much has been learned since then about
the biology of DCs. Implementation of this improved
understanding in the design of DC-CIT strategies will
help fulfilling the potential of DC cancer vaccines. In our
efforts towards the development of an independent
DC-CIT we relied on classical immunological paradigms, one of which states that the immune system
acts on the notion of danger; another one suggests that
for priming cytolytic immunity, DCs need to release
IL-12 for T-helper (Th) 1 polarisation that supports
cytotoxic T-cell (CTL) activation. Exposing DCs to a
Toll-like receptor (TLR) agonist fulfils both requirements. We used lipopolysaccharide (LPS) to mature
monocyte derived DCs charged with autologous
Tumour cell lysate. IL-12 secretion reaches high levels
but is limited to approximately one day. We, therefore,
terminate the maturation culture after 6 hours, freeze
the DCs in suitable aliquots, and perform an extensive
quality control programme. After thawing, the DCs
continue their maturation in vitro without any more
LPS being added, making it reasonable to assume that
DC maturation continues also in vivo. This assures
IL-12 secretion during DC/T-cell contact triggering Th1
polarisation. This critical feature of our DC-CIT concept
is currently explored in a randomised clinical phase II
trial for the treatment of brain cancer. First efficacy
data are expected in two years.
Dagmar Stoiber, Medical University, Ludwig Boltzmann Institute
for Cancer Research, Vienna, Austria
Matthias Gaestel, Hannover Medical School, Institute of
Biochemistry, Hannover, Germany
GBM – Vax Consortium (GBM: Glioblastoma Multiforme)
90–91
MK2 in immune regulation
by dendritic cells
Immunology
Abstract 2
1
2
3
4
Fig.
1 Monocytes are collected by leukocyte apheresis and enriched using
elutriation.
2 Differentiation of monocytes in the presence of IL-4 and GM-CSF
into immature DCs.
3 Immature DCs are charged with tumour antigens and stimulated
with LPS/IFN-γ.
4 DCs present tumour antigens to T-cells after intranodal inoculation
into the cancer patient.
Abstract 1
Is it possible to prevent
dangerous virus infections
by administering purified
defence cells after a stem
cell transplantation?
With our engagement in flow cytometry
and GMP-compliant work, we are a supportive
interface between research and therapy.
Gerhard Fritsch, Clinical Cell Biology and FACS Core Unit
Immunology
Group leader
Assoc. Prof. Gerhard Fritsch, PhD
[email protected]
Gruppenleiter
[email protected]
94–95
Gerhard Fritsch, Klinische Zellbiologie und FACS Core Unit
Clinical Cell Biology and FACS Core Unit
Klinische Zellbiologie und FACS Core Unit
Staff scientist
René Geyeregger, PhD
Dr. René Geyeregger
Diploma student
Christine Freimüller1
Diplomandin
Christine Freimüller1
Technicians
Christine Freimüller, MSc1
Ing. Dieter Printz
Daniela Scharner
Julia Stemberger
Dijana Trbojevic
Elke Zipperer
Mag. Christine Freimüller1
Ing. Dieter Printz
Daniela Scharner
Julia Stemberger
Dijana Trbojevic
Elke Zipperer
Clinicians,
Assoc. Prof.
Susanne Matthes-Martin, MD
Volker Witt, MD
Klinische MitarbeiterInnen
Univ. Doz. Dr.
Susanne Matthes-Martin
Dr. Volker Witt
� Oct. 2009 – July 2010,
since Feb. 2011
� Okt. 2009 – Juli 2010,
seit Febr. 2011
Mit unserem Engagement
in Durchflusszytometrie und
GMP-gerechten Arbeiten
sehen wir uns als unterstützende
Schnittstelle zwischen
Forschung und Therapie.
Die 3 Kernbereiche der Gruppe
„Klinische Zellbiologie und FACS Core Unit“
Diagnostics
Research activites, including FACS Core Unit
Diagnostik
Forschungsaktivitäten und FACS Core Unit
The largest part of our department is engaged in
activities of diagnostics and provides cytometric cell
analyses and cell sorting services, primarily to the
St. Anna Children’s Hospital, but also for the Children’s
Cancer Research Institute (CCRI) as well as external
research institutes. The number of applications has
increased and now also includes analyses that address
spherocytosis and evaluate human sperm fertility.
Every year, over 40,000 cytometric cell analyses and
more than 2,000 cell sorts are carried out. The main
purpose of these is to control the donor/recipient type
of the different blood cells using FISH or PCR methods
in post allo-transplantation patients. Internal quality
control mechanisms are in place, which conform to
internal standard operating procedures (SOPs) and to
JACIE (Joint Accreditation Committee-ISCT & EBMT)
guidelines. In addition, we participate in the regular
Austrian and German quality control trials, organised by
ÖQUASTA (Austrian Society for Quality Assurance and
Standardisation of Medical-Diagnostics) and INSTAND
(Society for Promotion of Quality Assurance in Medical
Laboratories). Our task here is to measure subtypes of
blood leukocytes, stem cells, and residual leukocytes in
blood products.
As a FACS (Flow-activated cell sorting = flow cytometry) core unit, our laboratory presently has at its
disposal 3 own flow cytometers for 6 to 16 parameter
cell measurements, one of which is a multi-colour
device (FACSAria) for sorting cells, the others being a
4 and 13 colour device (FACSClibur and LSRII) for
cell analyses. A fourth device (17-colour Fortessa) is
scheduled to replace the 14 year old FACSCalibur in
2011. A 6-colour FACSCanto was provided to us by BD
Biosciences for the validation of a new 5-colour test for
the quantification of CD34+ stem cell quantification.
All devices are serviced by an experienced technician.
In close cooperation with clinicians, researchers of the
CCRI and other scientists, our laboratory offers practical and theoretical support for all questions regarding
flow cytometry. Our research interests are focused
primarily on the detection, quantification, and selection
of T-cells observed in clinically relevant viruses that can
lead to live-threatening complications in blood stem
cell transplantations.
Der größte Bereich unserer Abteilung stellt im Rahmen
von Diagnostikaktivitäten 9 durchflusszytometrische
Analysen sowie ein Zell-Sort Service zur Verfügung,
primär für Patienten des St. Anna Kinderspitals, aber
auch für die St. Anna Kinderkrebsforschung sowie für
externe Forschungsinstitute. Die Zahl der Anwendungen hat sich ausgeweitet und umfasst neuerdings
auch Analysen zur Diagnose der 9 Kugelzellanämie oder
zur Fruchtbarkeit humaner Spermien. Jährlich werden
über 40.000 durchflusszytometrische Analysen und
mehr als 2.000 Zell-Sortierungen durchgeführt. Diese
dienen in erster Linie dazu, bei fremd-transplantierten
Patienten den Spender/Empfängertyp der verschiedenen Blutzellen mittels FISH oder 9 PCR-Methoden
zu überprüfen. Laufende interne Qualitätskontrollen
entsprechen eigenen Standardvorgehensweisen
(SOPs) sowie jenen von 9 JACIE1. Zudem nehmen wir
regelmäßig an Rundversuchen teil, die von 9 ÖQUASTA2
und 9 INSTAND3 organisiert werden. Dabei ist es unsere
Aufgabe, Leukozytenuntergruppen, Stammzellen und
Restleukozyten in Blutprodukten zu messen.
Als FACS6 Core Unit verfügt unser Labor derzeit über
drei eigene Durchflusszytometriegeräte für 6
bis 16 Parameter Zellmessungen, von denen ein Vielfarbengerät (FACSAria) dem Sortieren von Zellen dient
und ein 4- bzw. 13-Farbengerät (FACSCalibur und LSRII)
der Zellanalyse. Ein neues 17-Farbengerät (Fortessa)
soll 2011 den 14 Jahre alten FACSCalibur ersetzen. Ein
6-Farben FACSCanto wurde uns von BD Biosciences
für die Validierung eines neuen 5-Farben-Tests zur
Quantifizierung von CD34+ Stammzellen zur Verfügung
gestellt. Alle Geräte werden von einem erfahrenen
Techniker betreut. In enger Zusammenarbeit mit
Klinikern, St. Anna Forschern und anderen Wissenschaftern bietet unser Labor bei sämtlichen Fragen
der Durchflusszytometrie praktische und theoretische
Unterstützung an. Eigene Forschungsinteressen
zielen vor allem auf die Messung, Quantifizierung
und Selektion humaner Abwehrzellen gegen klinisch
relevante Viren ab, die im Rahmen der Blutstammzell
transplantation zu lebensbedrohlichen Komplikationen
führen können.
Klinische Routine
9 Siehe Glossar
Clinical routine
The second largest area encompasses clinical routine
and concerns the manipulation of all cells or blood
products that are administered to patients as part of
treatment. This takes place under sterile conditions in
our GMP laboratory (Figure 1). After successful validation, we were able to introduce a new freezing medium
for the storage of patient cells. The preparation of MNC
for clinical use in extracorporeal photopheresis („mini
ECP“) proved successful for treatment of Graft-versushost disease (GVHD) in very young patients. All these
activities require a valid accreditation under JACIE,
which was renewed in November 2008, as well as the
certification of the laboratory by the AGES PharmMed,
which we were able to renew in May 2010.
Der zweite große Bereich umfasst die klinische
Routine und betrifft die Manipulation aller Zellen oder
Blutprodukte, die einem Patienten zur Behandlung
zugeführt werden. Dies geschieht unter sterilen
Bedingungen in unserem dafür speziell zertifizierten
9 GMP 4-Labor (Abbildung 1). Nach erfolgreicher
Validierung konnten wir ein neues Einfriermedium zur
Lagerung von Patientenzellen einführen. Die Reinigung
von weißen Blutzellen und deren Verwendung in der
Extracorporalen Photopherese („Mini ECP“) erwies
sich als erfolgreich zur Bekämpfung der 9 Graft-versusHost-Erkrankung bei sehr kleinen Patienten. Alle
diese Tätigkeiten erfordern eine gültige Akkreditierung
nach JACIE, die im November 2008 erneuert wurde,
sowie die Zertifizierung des Labors durch die 9 AGES
Pharmed5, welche wir im Mai 2010 erneuern konnten.
� JACIE: Joint Accreditation Committee-ISCT & EBMT. Das JACIE
Akkreditierungsprogramm wurde 1999 mit dem Ziel etabliert,
ein einheitliches Akkreditierungssystem für Transplantationszentren
zu kreieren.
2 ÖQUASTA: Österreichische Gesellschaft für Qualitätssicherung
und Standardisierung medizinisch-diagnostischer Untersuchungen
3 INSTAND: Gesellschaft zur Förderung der Qualitätssicherung in
medizinischen Laboratorien
4 GMP: Gute Arbeitspraxen (GxP), Good Manufacturing Practise
5 AGES Pharmed: Nationale Zulassungsstelle für Arzneimittel
6 FACS, FACS Core Unit: Zentrum für Durchflusszytometrie
Flow-activated cell sorting = 9 Durchflusszytometrie
Immunology
The 3 core areas of the group
“Clinical cell biology & FACS Core Unit”
96–97
Research Focus
Leukoapheresis
Leukozytenapherese
Apheresis product including
stem cells and white blood cells,
such as CD3+ T-cells
Apheresat beinhaltet
Stammzellen und weiße Blutzellen,
inklusive CD3+ T-Zellen
Addition of beads-bound
anti-CD3 antibodies
to the apheresis product
Zugabe von an Eisenbeadgebundenen anti-CD3 Antikörpern
zum Apheresat
Stem cells
Stammzellen
CD3+ T-cells
CD3+ T-Zellen
Beads-bound anti-CD3 antibodies
bind specifically to CD3+ T-cells
Eisenbeads-gebundene anti-CD3 Antikörper
binden nur spezifisch an CD3+ T-Zellen
White blood cells (WBC)
Weiße Blutzellen (WBC)
Bead (iron)
Anti-CD3 Antibody
Eisenbead
Anti-CD3 Antikörper
Magnet
Magnet
Infusion into the patient
Infusion für den Patienten
Patient
Patient
Beads-labeled CD3+ T-cells
are magnetically removed
Eisenbeads-markierte CD3+ T-Zellen
werden am Magneten festgehalten
Other cells (stem cells) pass through
and are collected in a new bag.
Restliche Zellen (z.B. Stammzellen) gehen
durch und werden in einem Endbeutel
aufgefangen. Der Patient bekommt nun keine
gefährlichen T-Zellen mehr infundiert.
Entfernung gefährlicher
Immunabwehrzellen (T-Zellen)
eines nicht HLA-passenden
Spenders vor der
Stammzelltransplantation
Stem cell transplantation (SCT) is the transplantation of hematopoietic stem cells from the donor to
a patient. SCT is most often performed for patients
with life threatening diseases of the blood and cancer
if conventional treatment options failed. For optimal
SCT, the tissue (HLA) type of both the donor and the
patient should match. Unfortunately, for some patients,
an appropriately matched donor is not available. Therefore, mismatched donors are chosen. However, this
mismatched situation increases the risk for graft versus
host disease (GvHD) in patients. GvHD in patients is
induced by potent immune cells (T-cells) from the
donor that will react against patient’s tissue cells. To
overcome that problem, immune cells from the donor
have to be depleted from the stem cell product prior to
transplantation into the patient. This magnetic depletion strategy is shown in the drawing.
Stammzelltransplantation bedeutet, dass Blutstammzellen eines gesunden Spenders zum Patienten
übertragen werden. Oftmals ist dies die einzige
Möglichkeit für eine vollständige Heilung des Patienten,
wenn andere Behandlungsmethoden nicht zum Erfolg
geführt haben. Für einen optimalen Therapieverlauf
sollten die Gewebemerkmale (HLA-Typ) des Spenders
mit dem des Patienten übereinstimmen. Leider sind
passende Spender nur sehr selten vorhanden, weswegen auch nicht-passende Spender herangezogen werden, um eine zu lange Wartezeit zu verhindern. Jedoch
führt gerade dieser unterschiedliche Gewebetyp dazu,
dass Immunzellen (T-Lymphozyten) des Spenders
den Patienten als fremd erkennen, angreifen und eine
Transplantat (Stammzellen) gegen den Wirt (Patienten)
Erkrankung (9 Graft-versus-Host-Erkrankung, GvHD)
auslösen. Um nun diese GvHD Reaktion zu verhindern,
werden bereits im Vorfeld diese T-Zellen aus dem
Stammzellbeutel mittels an Eisenbeads-gekoppelten
Antikörpern markiert und über eine Magnetsäule
entfernt. Der Patient bekommt nun keine gefährlichen
T-Zellen mehr infundiert (siehe Darstellung).
Immunology
Depletion of T-cells from
an HLA mismatched
donor prior to stem cell
transplantation
98–99
Stem cell donor
Stammzellspender
Abbildung
Illustration
Collection and cryopreservation of autologous stem
cells is a routine procedure in a variety of malignant
diseases. Further, improved stability of cell products
is critical to the development of cell and tissue based
therapies as part of the growth in regenerative medicine. A growing body of evidence indicates that one
key method for improved cryopreservation efficacy is
the utilisation of a hyperosmotic/intracellular-like cryo
preservation media, as opposed to the traditional use
of an isotonic/extracellular-like media such as saline as
the vehicle for the cryoprotectant. In this evaluation of
cryopreservation methods for clinical application, cell
samples from apheresis products were cryopreserved
in a conventional isotonic-based freeze medium (CFM;
20% DMSO, 10% human plasma derivate in Ringer
solution) or in intracellular-like CryoStor CS10 (CS10;
10% DMSO, serum-free and protein-free). Immediately
after thawing, the recovery of WBC was 50.7 �14.4%
for CFM versus 70 �11.6% for CS10 (p<0.001), and that
of CD34+ cells 81.8 �36.1% for CFM and 101 �16.4% for
Results 2
Novel single-platform
multi-parameter FCM analysis
of apoptosis: significant
differences between
wash-and no-wash procedure
CS10 (p<0.05). In CFM, 20 to 60 min after thawing there
was a dramatic loss in cell viability (-40% to -90%), up
to complete clotting in 3/10 samples. By contrast, cells
remained viable up to 60 min after thawing in CS10, and
no clotting occurred at all. Because of these positive
validation results, cryopreservation in the intracellularlike CryoStor CS10 was translated to clinical application
for treatment of haematological malignancies. To date,
seven patients have received autologous stem cells
cryopreserved in CS10. Infusions were well tolerated,
and both WBC >1000 and ANC >500 were reached
on day +10.5 (7-11). CryoStor CS10 has demonstrated
benefits in comparison to the previous standard CFM in
terms of cell recovery post-thaw, particularly providing
improved stability after 20 to 60 min storage at room
temperature (RT) in these validation experiments, as
well as demonstrating clinical tolerance in initial patient
applications. Further data will be collected to validate
the outcome of haematopoietic regeneration after
reinfusion.
To improve the single platform flow cytometric CD34
quantification technique and provide unambiguous
results on both myeloid and B-lymphoid progenitor cell
subtypes, we extended the stem cell enumeration kit
(SCE; BD Biosciences), by adding CD38 and CD10 to
the CD34, CD45 and 7AAD kit. We expected distinct
differences between the results obtained from this
5-colour approach compared to 2 conventional kits.
FCM is a generally accepted tool to analyse apoptosis.
Unfortunately, the cell preparation of all commercial
kits available includes cell washing known to cause cell
loss which is most likely to affect apoptotic cells in particular. To address this, we developed a 7-colour singleplatform no-wash analysis technique and compared
the results with those from an analogous procedure
including cell washing. A 5-colour mAb cocktail was
employed to address target cells by surface labelling,
Yo-PRO-1® and DAPI were used to discriminate
apoptotic and necrotic from viable cells. Cells were
quantified on the basis of internal-standard fluorescent
beads. Jurkat cells ACC 282 treated with camptothecin
were employed to establish the staining procedure,
which was then applied to blood cells collected by extra
corporal apheresis and treated with UV irradiation.
Fig. 1 – Results 2: Cell recovery
after 30 (n=6) and 60 min (n=3)
Comparison of conventional
and new synthetic (CS10) freezing media for storage of human
stem cells: time-dependent
recovery of viable cells after
thawing. Since Dec. 2009, CS10
has replaced conventional
medium in clinical application.
Excellent correlations were observed between the
3 kits (R2>0.99), for the quantification of WBC and
total CD34. In contrast to the conventional analyses,
the extended kit showed considerable amounts of
B lymphoid progenitors in all CD34 sources (0-20% of
all CD34 in PB and AP; 2-15% in CB; 3-90% in BM). Very
similar results were obtained when the same sample
was prepared by different technicians. After thawing of
frozen AP, the recovery of viable cells varied depending on the freezing medium employed, but virtually
identical results were obtained with the different tests.
Most nonviable cells were clearly identified with 7AAD,
but an additional gate in the FSC/SSC was necessary
to address dead cells negative for 7AAD. The extended
SCE kit allows rapid and exact quantification of viable
B-lymphoid and myeloid CD34+ cells in all cell sources
and in thawed stem cell harvests.
Cell recovery after 30 (n=6) and 60 min (n=3)
Fresh samples (n >20 each) of G-CSF-mobilised blood,
umbilical cord blood, bone marrow, and aphaeresis
products were stained in BD Trucount™ tubes using the
2-colour conventional CD45/CD34 reagent combination (BD Biosciences) and the 3 colour SCE kit. Using
CD38 and CD10, the SCE kit was extended to 5 colours,
and duplicate analyses were performed for each
material. To address repeatability, 10 samples from one
aphaeresis product were prepared by 4 technicians.
The results of WBC- and CD34 quantification were
compared between the different kits. Aliquots (n=15)
of four aphaeresis products were cryopreserved and
analysed after thawing using the same kits.
Data evaluation showed that, although each method
by itself was highly reproducible (R2=0.973), the
numbers of apoptotic cells detected with the no-wash
procedure were significantly higher than those
obtained after cell washing (p=6.6 E-5, Wilcoxon Test).
In addition, the observed differences increased with
higher cell numbers (Bland and Altmann). We conclude
that the described test is a feasible and reliable tool
for apoptosis measurement, and that it provides
results that are definitely closer to the truth than those
obtained from kits that require cell washing.
Immunology
Single-platform quantification
of CD34 and of CD34 subtypes
in different cell sources and in
thawed apheresis products,
using an extended 5-colour
SCE kit and a FACSCanto
100–101
Improved post-thaw stability validation
of peripheral blood cell products
utilising the intracellular-like CryoStor
cryopreservation solution, and
preliminary results of clinical application
Abstract 3
Abstract 2
Abstract 1
Immunology
•Residual WBC analysis in plasma or p
latelet
concentrates as QC (collaboration with
Humanplasma, Vienna)
•Quantification of WBC in hypoplastic/aplastic blood
or bone marrow, or in blood products
•Single-platform CD34 analysis in thawed cord blood
as QC (since 2010, collaboration with Eurocord
Slovakia, Bratislava)
•Diagnosis of spherocytosis (offered throughout
Austria since 2009)
•Human sperm fertility analysis (since 2010,
collaboration with Kinderwunschzentrum
Goldenes Kreuz, Vienna)
•Apoptotic cell quantification based on a recently
validated single-platform no-wash 7-colour analysis
•Quantification of WBC, WBC subtypes as well as
CD34 and CD34 subtypes in blood, cord blood,
bone marrow, as well as in fresh and thawed PBSC
•Subtype analysis of T-cells (CD4, CD8, alpha-beta,
gamma-delta, HLA-DR, CD25, naïve/memory)
•We participate in the recently commenced CD14/18
study, by providing quantitative data regarding the
numbers of peripheral CD16- NK cells and CD127 CD4+/CD25+ T-cells during the course of radioactive
MAB treatment of neuroblastoma patients.
•Examination of donor and patient blood samples
for the presence of virus-specific CD3 positive
T-cells, using either the cytokine secretion assay
(CSA, expression of interferon-gamma by CD4 and
CD8 positive T-cells upon in-vitro virus-specific
antigen stimulation), and/or multimer analysis which
is specific for CD3/CD8 positive lymphocytes.
Whereas anti CMV analysis has been routinely used
during the last years, new techniques are emerging
that address T-cell specificity against other clinically
important viruses, particularly ADV, EBV and BKV. The
type of analysis chosen depends on the availability of
respective HLA-specific multimers, but also on the
expected percentage of target cells. If necessary, the
analysis is preceded by a several day in-vitro stimulation which usually results in a relative enrichment and
thus a better detectability of the target cells.
•Cryopreservation and storage of, and storage
logistics for autologous and allogeneic blood products
•Thawing for reinfusion
•CD3/19 depletion prior to HLA-mismatch stem cell
transplantation
•Cell manipulations and analyses for DLI
•Depletion of plasma in case of AB0 incompatibility
or for volume reduction prior to infusion of cells
•Preparation of MNC for ECP treatment of GvHD
•Detection and selection (work in progress) of
virus-specific T-cells for adoptive immune therapies
102–103
4.2 Low influence of irradiation on the functional
activity of in-vitro expanded ADV-specific T-cells
Lethal irradiation of T-cells before infusion is known
to inhibit cell division and to induce cell death. It is not
known whether or not virus-specific T-cells lose their
function after irradiation. Our investigations into the
capacity of in-vitro expanded virus-specific T-cells to
kill virus-infected target cells showed that, despite a
loss of viability, even 72 h after irradiation, about 25%
of the T-cells proved highly active. This finding could
have major implications for patients suffering from viral
infections after HSCT.
Before expansion
SSC-A
Fig. 2 – Flow cytometric
detection of ADVspecific CD8+ T-cells
before and after
in-vitro expansion.
PE-A
After expansion
Multimer-pos. ADV-specific T-cells
SSC-A
A fast method was established to expand and detect
virus-specific T-cells. Peripheral blood mononuclear
cells (PBMC) were repeatedly stimulated with
ADV-specific antigens for 12 days. After expansion,
the number of ADV-specific T-cells was increased
by 1-2 log and was easily detectable using HLA-peptide
multimers or the IFNg cytokine secretion assay (CSA).
Experiments with multimer analyses in 20 healthy
volunteers showed that the detection rate increased
from 55% before in-vitro expansion to 90% thereafter.
Using the CSA, the detection rate increased from 20%
to 80% in 5 experiments. More detailed analyses of
in-vitro expanded cells revealed that, even after 6 days
of culture, ADV-specific T-cells (like EBV-specific cells)
could be clearly detected by both technologies, which
reduces costs, is less time-consuming, and improves
the applicability as a routine procedure. Our results
clearly indicate that ex-vivo expansion of PBMC is
necessary to ensure the presence of ADV-specific
T-cells in healthy donors. Furthermore, the expansion
protocol was optimised by the use of IL-15, which was
superior (3.5 fold) over IL-2 or IL-7 stimulation. Regardless of the interleukins used, 96% of all cells exhibited
an effector immunophenotype after in-vitro expansion.
However, about 3% of all cells maintained a central
memory phenotype, indicating that long-lived in-vivo
protection against viral infections is provided. Other
experiments confirmed that expanded ADV-specific
T-cells are functionally active, as they show increased
secretion of Interferon-gamma (IFN-γ) and expression
of activation markers such as CD137 and CD107a after
stimulation with the virus-specific antigen. Additionally, cytotoxicity was observed against autologous and
partially mismatched antigen-pulsed target cells, but
was highly reduced against completely mismatched
target cells, indicating a very low or no alloreactivity of
expanded cells. In conclusion, we defined rapid and
optimal conditions for detection and ex-vivo expansion
of ADV-specific T-cells with high potential for clinical
application.
Cell therapeutics
for clinical routine
PE-A
Detection and characterisation
of adenovirus-specific T-cells
before and after in-vitro
expansion:
4.1 Potential implication for adoptive immunotherapy
Diagnostics
Services
Services
Abstract 4
What is necessary to enable the
donor’s defence system to
assimilate well in Patrick’s organism
after the stem cell transplantation?
Andreas Heitger, Transplantations-Immunologie
To better understand the immune system’s
foundation, its organisation and dynamic regulation
particularly with respect to transplantation tolerance
poses a valuable challenge.
Andreas Heitger, Transplantation-Immunology
Group leader
[email protected]
Gruppenleiter
Univ. Doz. Dr. Andreas Heitger
[email protected]
Souyet Chang-Rodriguez, PhD 1
Ursula Hainz, PhD 2
Markus Hölzl, PhD 3
Birgit Jürgens, PhD 4
Julia Raberger, PhD 5
PostdoktorandInnen (PhD)
Dr. Souyet Chang-Rodriguez1
Dr. Ursula Hainz2
Dr. Markus Hölzl 3
Dr. Birgit Jürgens 4
Dr. Julia Raberger 5
Postdoct. medical fellow
Sabine Heitzeneder, MD 6
Postdoktorandin der Medizin
Dr. Sabine Heitzeneder 6
PhD student
Birgit Jürgens, MSc 4
Edda Veith, MSc7
Doktorandin
MMag. Birgit Jürgens 4
Mag. Edda Veith7
Diploma students
Barbara Dillinger 8
Margit Lanzinger 9
DiplomandInnen
Barbara Dillinger 8
Margit Lanzinger 9
� Apr. 2009 – Mar. 2010
2 since July 2010
3 since Oct. 2010
4 Apr. 2005 – Nov. 2008,
since Dec. 2008
5 May 2009 – Mar. 2010
6 since Sept. 2008
7 Aug. 2007 – Apr. 2011
8 since Jan. 2011
9 Oct. 2009 – Nov. 2010,
since Feb. 2011
� Apr. 2009 – März 2010
2 seit Juli 2010
3 seit Okt. 2010
4 Apr. 2005 – Nov. 2008,
seit Dez. 2008
5 Mai 2009 – März 2010
6 seit Sept. 2008
7 Aug. 2007 – Apr. 2011
8 seit Jän. 2011
9 Okt. 2009 – Nov. 2010,
seit Febr. 2011
Immunology
106–107
Transplantation-Immunology
Transplantations-Immunologie
Die Grundlagen des Immunsystems,
seiner Organisation und dynamischen
Regulation, insbesondere in Hinblick auf
Transplantationstoleranz zu verstehen,
ist eine reizvolle Herausforderung.
The ultimate vision of the division „Transplantation
Immunology“ is to efficiently support patients after
a haematopoietic stem cell transplantation (HSCT)
in the immunologically critical phase after the transplantation. After an HSCT, due to impaired immunity
lasting for months, patients are highly susceptible
to normally harmless pathogens. Furthermore, a
recovering immune system can mount undesired
immune reactions towards certain organs of the recipient (= the patient). These severe to life-threatening
complications are referred to as the Graft-versushost-disease (GVHD). This problem can be overcome
by, for example, developing T-cells that ensure
protection against pathogens without the risk of GVDH.
T-lymphocytes play a critical role here. T-lymphocytes
that can grant the patient protective immunity without
GVHD are referred to as “allo-specific tolerant”. The
development of strategies for the generation of allospecific tolerant T-lymphocytes therefore represents
a central goal of our research.
Tolerance induction via the metabolising
of the amino acid tryptophan
To date, the focus of our research activity was on the
known tolerance induction via the metabolising of the
amino acid tryptophan 1. Tryptophan metabolism
in mammals is by and large governed by the enzymatic activity of indoleamine 2,3 dioxygenase (IDO).
We developed the hypothesis that T lymphocyte
stimulation by allo-antigens (molecules that constitute immunological differences between donor and
recipient) under the condition of increased tryptophan
metabolism would induce allo-specific tolerance.
We were able to demonstrate that IDO competent
human dendritic cells (DCs) (i) promoted apoptotic
decline of 2 and (ii) induced regulatory activity in
allo-reactive T-cells 3. While this finding constituted
a promising milestone, further experiments revealed
that the initially very promising IDO-mediated effect
rapidly declines again 4. With respect to IDO’s role
in pathophysiology, we showed that, different from a
murine model, chronic granulomatous disease (CGD),
a rare immune disorder, in humans does not involve
impaired IDO activity and therefore, augmentation
of tryptophan metabolism is not a rational treatment
approach 5. Furthermore, we generated first evidence
that IDO activity in humans might be strictly dependent
on oxygen supply 6. Furthermore, we generated first
evidence that IDO activity in humans is significantly
dependent on oxygen supply 6.
Tolerance induction through costimulation blockade
To generate allo-specific tolerance in a stable and
robust fashion, we extended our research activity to
the field of the costimulation blockade. Costimulation
blockade means that when T-lymphocytes are
stimulated but do not receive costimulation, they
readily recognize antigens but subsequently are unable
to mount an effective immune response towards
the respective antigens. Despite the overt immunosuppression observed after clinical application of
costimulation blockade, with a suitable approach, this
mechanism could nevertheless be beneficial for generating allo-specific tolerance in HSCT. Some promising
first results have been obtained here in an in vivo HSCT
model 7. Finally, the 2007 project to determine
the role of mannose-binding lectin (MBL) deficiency
in increasing the susceptibility to severe infections in
HSCT currently involves 70 patient/donor samples and
the study will be completed in 2011.
For further reading
1 Mellor, A.L. & Munn, D.H. (2004). IDO expression by dendritic cells:
tolerance and tryptophan catabolism. Nat Rev Immunol, 4, 762–774.
2 Hainz, U. in preparation.
3 Jurgens, B., et al. (2009). Interferon-gamma-triggered indoleamine
2,3-dioxygenase competence in human monocyte-derived dendritic
cells induces regulatory activity in allogeneic T-cells. Blood, 114,
3235–3243.
4 Lanzinger, M. in preparation.
5 Jürgens, B., et al. (2010). Intact indoleamine 2,3-dioxygenase
activity in human chronic granulomatous disease.
Clin Immunol, 137, 1–4.
7 Veith, E. in preparation.
Die Gruppe Transplantations-Immunologie verfolgt
die Vision, Patienten nach einer hämatopoietischen
Stammzelltransplantation (9 HSZT) in der immunologisch kritischen Phase nach der Transplantation
effizient zu unterstützen. Nach einer HSZT1 sind die
Patienten durch die monatelang andauernde Immun
störung empfindlich gegen ansonsten harmlose
Krankheitserreger. Darüber hinaus kann ein sich
erholendes Immunsystem unerwünschte Abstoßungsreaktionen gegen gewisse Organe des Empfängers
(= des Patienten) auslösen. Man bezeichnet diese
schweren bis lebensbedrohlichen Komplikationen als
9 Spender-gegen-Empfänger Krankheit, im Englischen
als Graft-versus-host-disease (GvHD). Dieses Problem
lässt sich überwinden, indem man beispielsweise
Abwehrzellen entwickelt, die einen Schutz gegen
Krankheitserreger ohne drohende Gefahr durch eine
GvHD2 gewährleisten. Hierbei spielen 9 T-Lymphozyten
eine wichtige Rolle. T-Lymphozyten, die den Patienten
mit schützender Immunität ohne GvHD wappnen
können, nennt man „allo-spezifisch tolerant“. Daher
steht für unsere Forschungsgruppe die Erarbeitung
von Strategien zur Herstellung von allo-spezifisch
toleranten T-Lymphozyten im Vordergrund.
Toleranzinduktion über die Metabolisierung
der Aminosäure Tryptophan
Bisher war der Fokus unserer Forschungsaktivität
auf die bekannte Toleranzinduktion über die Metabolisierung der Aminosäure Tryptophan gerichtet
1. Bei Säugerorganismen wird Tryptophan großteils
über die enzymatische Aktivität der Indoleamine 2,3
Dioxygenase (IDO) aktiviert. Wir entwickelten die
Hypothese, dass eine durch Allo-Antigene (Moleküle, die auf der immunologischen Verschiedenheit
von Empfängern und Spendern beruhen) initiierte
Stimulierung von T-Lymphozyten unter Bedingungen
einer gesteigerten Tryptophanmetabolisierung
allo-spezifische Toleranz auslöst. Wir konnten zeigen,
dass humane IDO-kompetente dendritische Zellen
(DZ) (i) besonders in Anwesenheit exogen zugeführter
Toleranzinduktion durch Kostimulationsblockade
Um Toleranzinduktion auf stabile und robuste Weise
zu erzielen, haben wir unsere Forschungsaktivitäten
auf das Gebiet der Kostimulationsblockade ausgedehnt. Kostimulationsblockade bedeutet, dass
T-Lymphozyten zwar das Antigen erkennen, aber in
weiterer Folge keine Immunreaktion mehr gegen das
betreffende Antigen produzieren können. Obwohl die
klinische Anwendung zu einer erheblichen Immunsuppression führt, könnte dieser Mechanismus durch einen
geeigneten Ansatz allo-spezifische Toleranz im Bereich
der HSZT effektiv erzielen. Wir können hierzu erste
vielversprechende Ergebnisse in einem in vivo HSZT
Modell vorweisen 7. Die 2007 begonnene Untersuchung zur Bestimmung des Einflusses des Fehlens eines
Mannose-bindenden Lektins (MBL) auf die Anfälligkeit
für schwere Infektionen nach einer Stammzelltransplantation hat bereits 70 Patienten- und Spenderproben
erfasst und wird 2011 zum Abschluss gebracht werden.
9 Siehe Glossar
� HSZT: Hämatopoietischen Stammzelltransplantation
2 GvHD: Spender-gegen-Empfänger Krankheit, Graft-versus-host-disease
Literaturangaben
1 Mellor, A.L. & Munn, D.H. (2004). IDO expression by dendritic cells:
tolerance and tryptophan catabolism. Nat Rev Immunol, 4, 762–774.
2 Hainz, U. in preparation.
cells induces regulatory activity in allogeneic T-cells. Blood, 114,
3235–3243.
4 Lanzinger, in preparation.
5 Jurgens, B., et al. (2010). Intact indoleamine
2,3-dioxygenase activity in human chronic granulomatous
disease. Clin Immunol, 137, 1–4.
7 Veith, E. in preparation.
Immunology
Gezielt hergestellte T-Zellen
als Strategie gegen bedrohliche
Immunreaktionen bei Kindern
und Jugendlichen nach
Stammzelltransplantationen
Tryptophanmetaboliten einen Zelltod von allo-antigen
aktivierten T-Lymphozyten begünstigen 2 und (ii) in
allo-antigen aktivierten T-Zellen immunregulatorische
Funktionen anregen 3. Fortführende Experimente
zeigen jedoch, dass dieser zunächst vielversprechende
Effekt sehr rasch zurückgeht 4. Betreffend der
pathophysiologischen Bedeutung von IDO konnten
wir zeigen, dass, anders als in einem Mausmodell, bei
der 9 septischen Granulomatose, einer seltenen
Immunerkrankung, die Pathophysiologie nicht auf einer
gestörten IDO Aktivität beruht 5 und daher auch die
Beeinflussung des Tryptophanstoffwechsels keine
Rationale für eine Therapie darstellt. Weiters gibt es
erste Befunde, die zeigen, dass die IDO Aktivität
wesentlich von der lokalen Verfügbarkeit von Sauerstoff
abhängt 6.
108–109
Targeted creation of T-cells as a strategy against
threatening immune reactions in children and
adolescents after stem cell transplantations
Research Focus
The problem:
Possible solutions:
HSCT can
cause Immune-dysfunctions
Manipulation of T-cells
causing disease
Immune dysfunction
Infectious
diseases
Diseases
E.g.
leukemias
Hematopoietic
stem cell
transplantation
(HSCT)
Immunosuppression
Targeted
tolerization
of “recipient
recognizing”
T-cells
Relapse of
leukemia
In vitro/ex vivo manipulation
of T-cells before transfer
Graft versus
host disease
(GVHD)
Our approach
“Educating” T-cells
T-cells of donor
1. Costimulatory
blockade
2. Induction
of IDO
Allospecific T-cell
Signal II
Signal I
Tryptophan Depletion
(T-cell cycle arrest)
IDO
Deletion of
“Recipient
recognizing”
T-cell
Kynurenine accumulation
Induction of T-cell apoptosis
Dendritic cell
or recipient
GVHD causing
T-cells
Development
of regulatory
T-cells
Maintenance of protective
Immunity (antiviral,
antifungal, antibacterial)
Induction of
anergy (tolerance)
Transfer of T-cells to
recipient that are:
Protective
Tolerized
Regulatory
Fig. 1 – Human haematopoietic
stem cell transplantation (HSCT)
leaves patients with severe
immune dysfunction. Currently,
we probe whether the transfer
of T-cells having undergone
stimulation by recipient cells
under the cover of costimulation
blockade and/or augmented
tryptophan catabolism is
useful for mediating protective
immunity without graft-versushost disease
Full T-cell stimulation requires a coordinated cascade
of signals provided by antigen-presenting cells (APC),
including (1) T-cell receptor binding to the MHC/antigen
complex, (2) co-stimulation by interaction of CD80/86
on APC with CD28 on T-cells and (3) cytokine signals.
Previous reports suggest that antigen stimulation
of T-cells in the absence of co-stimulation induces
sustained non-responsiveness in T-cells specifically
towards the respective antigen, while preserving T-cell
responsiveness to others. This state is compatible
with antigen-specific tolerance. The achievement
of allo-antigen-specific tolerance is a major goal in
haematopoietic stem cell transplantation (HSCT), as it
will allow T-cells to mount protective responses against
infectious challenges while not aggravating graftversus-host disease (GvHD).
On this topic, we present our continuing effort to
explore whether co-stimulation blockade would induce
allo-specific non-responsiveness in T-cells. First, in
a murine model of using C57BL/6 spleen derived
dendritic cells (DCs, CD11c+) as stimulators and Balb/c
derived T-cells as responders (major mismatch), we
investigated the effect of co-stimulation blockade
through CTLA4-Ig, using the native CTLA4-Ig fusion
protein and abatacept, a pharmacologically prepared
CTLA4-Ig fusion protein with a mutation in the Fc
portion of IgG1. We found that both types of CTLA4-Ig
fusion proteins dampened allogeneic T-cell responses
when present during T-cell/DC co-culture. This
dampening effect, however, was not due to CTLA4-Ig
mediated induction of a regulatory DC phenotype, nor
did CTLA4-Ig per se affect the proliferative capacity
of isolated T-cells, but CTLA4-Ig appeared to directly
interfere with the DC/T-cell crosstalk. The inhibitory
effect was more pronounced in the CD4+ than in
the CD8+ population. Moreover, CD4+ T-cells when
recovered from DC/T-cell co-cultures performed in
the presence of CTLA4-Ig exhibited a pronounced
CD25high phenotype and displayed high levels of
expression of CD62L and FoxP3, consistent with a
regulatory phenotype. This regulatory phenotype
appeared to be stable, as it was maintained even after
restimulation. In summary, costimulation blockade
by CTLA4-Ig affected allo-antigen stimulated T-cell
responses quantitatively and qualitatively, by dampening the proliferative response and by inducing a T-cell
regulatory phenotype, respectively. Thus, CTLA4-Ig
may be useful in the generation of allo-specific tolerance in HSCT.
Likewise, we began to probe costimulation blockade
as a means to achieve allo-specific tolerance in
vitro in a human mixed leukocyte reaction (MLR). In
preliminary experiments we found that belatacept, a
variant of CTLA4-Ig with enhanced binding to CD86,
down-regulated allogeneic T-cell responses and that
this effect was sustained upon restimulation. These
promising results will be further explored in future
research.
• “Employing indolamine 2,3-dioxygenase (IDO) activity for the
ex vivo generation of allo-antigen specific tolerized T-cells to be
used for adoptive transfer in murine haematopoietic stem cell
transplantation”; Austrian Science Foundation: FWF Project Nr.
P19865B-13; period covered 2007–2010.
• “Allo-antigen-specific T-cell tolerance induced by human dendritic
cells expressing the tryptophan metabolizing enzyme indoleamine
2,3-dioxygenase”; Austrian Science Foundation: FWF Project
Nr. P20865-B13; period covered 01.08.2008–31.12.2011.
For further details, see chapter “External Grants”, Andreas Heitger
Co-stimulation blockade
to modulate allogeneic
T-cell responses
110–111
Immunology
Abstract 1
Allo-antigen specific tolerance induced
by human dendritic cells featuring
augmented tryptophan metabolism
In mammalian organisms, heme-containing IDO protein
is expressed in an inactive state and has to be activated
to become enzymatically active. To activate IDO, an
electron donor is required to reduce the ferric Fe3+ of
the heme to ferrous Fe2+. It has been proposed that in
mammals reactive oxygen intermediates (ROI), such as
superoxide (produced by NADPH oxidase), molecular
oxygen and cytochrome b5, reductively activate
IDO. Superoxide has been proposed to serve as both
reductant and oxygen source to induce IDO.
In order to enable the safe transfer of patient-tailored
tolerised T-cells to HSCT (haematopoietic stem cell
transplantation) recipients, we have been exploring
the potential of augmented tryptophan catabolism to
induce robust and stable allo-antigen specific toler
ance in primary human T-cells. We found that IDO
(Indoleamine 2,3 dioxygenase) competent human
myeloid derived dendritic cells (DCs), i.e. DCs causing
a rapid tryptophan consumption in the cell culture
medium, potently suppressed allogeneic T-cell
responses and supported the development of regulatory activity in an IDO dependent fashion 1. However,
this effect of IDO was rapidly reversible once the
T-cells were re-stimulated with IDO incompetent
antigen-presenting cells (APC). In detail, we observed
that human DCs, in which abundant IDO activity was
induced by 48-hour exposure to a cocktail containing
prostaglandin E2, Il-10, Il-6 and TNF- α in vitro, potently
suppressed allogeneic CD4+ and CD8+ T-cell responses
(mean 54% and 39% inhibition, respectively, n=4).
Addition of IDO inhibitor methyl-thiohydantoin trypto
phan (MTHT) to co-cultures significantly reduced the
suppressive activity of IDO competent DCs, supporting an IDO-dependent effect. Nevertheless, T-cells
retrieved from cell cultures with IDO-competent DCs
showed an enhanced proliferative potential upon
re-stimulation with monocytes from the same donor
in IDO-absent conditions indicating that the effect
of IDO is rapidly reversible. Additionally, the release
of high amounts of pro-inflammatory cytokines by
re-stimulated T-cells suggested T-cell polarisation
towards an effector phenotype. This finding may limit
the usefulness of IDO-mediated dampening of T-cell
responses for adoptive T-cell transfer strategies in
HSCT, since the effect might be transient.
Chronic granulomatous disease (CGD) is an inherited
immune disorder characterised by a disability to
produce ROI caused by a defect of phagocyte NADPH
oxidase rendering patients highly susceptible to
uncontrolled fungal or mycobacterial infections emerging on the background of hyperinflammation. A recent
study utilising a murine model of CGD proposed that
the hyperinflammatory response was associated with
an inability to induce IDO activity, thus suggesting a
novel pathophysiological mechanism and potentially
new therapeutic avenues for CGD. In our efforts to
advance the knowledge of IDO regulatory activity in
humans, we started a study examining whether NADPH
oxidase deficiency in human CGD would result in IDO
inactivity similarly to the murine system. As a result, we
observed that, strikingly, in human CGD IDO activity
is fully intact. Monocyte-derived DCs generated from
CGD patients, harbouring X-linked and autosomal
recessive forms of CGD, and from healthy controls
produced similar levels of the tryptophan metabolite
kynurenine upon activation. Thus, in humans, ROI
apparently are dispensable for IDO activity, and hyperinflammation in human CGD cannot be attributed to
disabled IDO activation 1.
To further explore the specific relevance of oxygen
or ROI on inducing IDO activity in the human system,
we compared IDO activity in human DCs cultured
under hypoxic (O2 tension 1%) and normoxic (O2 tension 21%) cell culture conditions. In these experiments,
we found that DCs activated under hypoxic conditions
failed to metabolize tryptophan, in contrast to
normoxic DCs. Interestingly, the amount of IDO protein,
as evaluated by immunoblotting, was similar in DCs
independent of whether they had been activated under
normoxic or hypoxic conditions. In further experiments
we re-cultured normoxic or hypoxic activated DCs
under cross-over conditions. We found that DCs, activated under hypoxic conditions (expressing IDO protein
but significantly diminished tryptophan metabolising
activity), regained their ability to metabolize tryptophan
when re-cultured under normoxic conditions. In
contrast, DCs that had been activated under normoxic
conditions, by and large lost tryptophan metabolising
capacity when re-cultured under hypoxic conditions.
These findings suggest that human IDO activity is highly
sensitive to oxygen tension and that molecular oxygen
is crucial for initiation of IDO tryptophan degrading
activity.
Since the oxygen tension in inflamed tissue is supposed
to be low, and IDO is believed to play a crucial role in the
regulation of immune responses to inflammation, these
findings may have significant implications for the full
understanding of the role of IDO in vivo.
In part in collaboration with
J. Reichenbach, Kinderspital Zürich, Switzerland
For further reading
1 Jürgens B., Fuchs D., Reichenbach J., Heitger A. (2010).
Intact indoleamine 2,3-dioxygenase activity in human chronic
granulomatous disease. Clin Immunol. 137(1): 1–4.
In a subsequent study, we specifically examined the
role of tryptophan catabolites, collectively termed
kynurenines, in the depletion of allo-reactive T-cells.
In murine cells, tryptophan catabolites have been
reported to induce apoptosis preferentially of activated
T-cells, thus potentially eliminating allo-reactive
T-cells from the T-cell pool and, thereby, potentially
contributing to sustained induction of allo-specific
tolerance. To test this hypothesis, T-cells were stimulated with allogeneic IDO negative or IDO positive DCs
with or without externally added tryptophan catabolites, comprising kynurenine, 3-=H kynurenine, 3-OH
anthranilic acid and quinolinic acid. T-cell apoptosis
(Annexin+ DAPI+) in activated T-cells (CD25+, HLA-DR+
and CD71+) was determined by flow cytometry. So far,
the experiments show the following: (1) Overall, we find
combined inhibitory effects of IDO positive DCs and
tryptophan catabolites (total amount 200 µM) on T-cell
proliferation but not on T-cell activation. (2) On day 1 of
cell culture, T-cell apoptosis appeared to be increased
preferentially in CD25+ T-cells and less in CD25- (nonactivated) cells, suggesting an effect predominantly
on early activated cells. (3) However, as cell cultures
were continued (day 5 and 7) we found enhanced T-cell
apoptosis to similar extents in activated and non-activated T-cells indicating a general toxic and non-specific
effect of tryptophan metabolites on all T-cells. These
results, differently from the preceding murine studies,
argue against a specific depletion of human alloactivated T-cells by kynurenines when added to the
cell culture. The unresolved question is whether in the
immunological synapse, where IDO positive DCs and
responding T-cells interact, accumulated kynurenines
might specifically affect T-cells going to be activated.
This specificity of an effect will be examined in future
experimentation.
For further reading
cells induces regulatory activity in allogeneic T-cells. Blood, 114, 3235–3243.
• “Allo-antigen-specific T-cell tolerance induced by humen dendritic
cells expressing the tryptophan metabolizing enzyme indoleamine
2,3-dioxygenase”; Austrian Science Foundation: FWF Project
Nr. P20865-B13; period covered 2008–2011.
• “Interference of Immunoregulatory Tryptophan Metabolism
with Translation Initiation”; Research Foundation of the Austrian
National Bank: OeNB Nr. 14225; period covered 2011–2011.
For further details, see chapter “External Grants”, Andreas Heitger
Immunology
Indoleamine 2,3 dioxygenase (IDO)
mediated tryptophan breakdown
and its connection to oxygen tension
112–113
Abstract 3
Abstract 2
How can we recognise
threatening infections
at an early stage and
treat them effectively?
Thomas Lion, Molecular Microbiology and Labdia Labordiagnostik GmbH
Molecular Microbiology
Our group primarily focuses on the improvement
of treatment outcomes, particularly in transplant
recipients and patients with life-threatening
infections, by developing and implementing new
diagnostic technologies.
Group leader
[email protected]
Gruppenleiter
[email protected]
116–117
Thomas Lion, Molekulare Mikrobiologie und Labdia Labordiagnostik GmbH
Molekulare Mikrobiologie
Staff scientist
Reinhard Klein, PhD
Dr. Reinhard Klein
DI Margit Bernroitner, PhD 1
Renate Kastner, PhD 2
DI Karin Kosulin (Ebner), PhD 3
Christine Landlinger, PhD 4
PostdoktorandInnen
DI Dr. Margit Bernroitner1
Dr. Renate Kastner 2
DI Dr. Karin Kosulin (Ebner) 3
Dr. Christine Landlinger 4
PhD students
Mirza Ibrisimovic, MSc 5
Doris Kneidinger, MSc 6
DoktorandInnen
Mag. Mirza Ibrisimovic 5
Mag. Doris Kneidinger 6
Diploma student
Ulrike Nagl7
Diplomandin
Ulrike Nagl7
Visiting scientist
Matthias Müllner, MSc 8
Gastwissenschafter
Mag. Matthias Müllner 8
Technicians
Ing. Helga Daxberger
DI Dragana Jugovic
Michaela Nesslböck
Sandra Preuner, MSc
DI (FH) Margit Rauch
Maria Verdianz9
DI Dragana Jugovic
Michaela Nesslböck
Mag. Sandra Preuner
Maria Verdianz9
Wir beschäftigen uns primär mit der
Verbesserung der Behandlungs
ergebnisse – und zwar insbesondere
bei Transplantat-Empfängern und
Patienten mit lebensbedrohlichen
Infektionen – durch die Entwicklung
und Anwendung neuer
diagnostischer Technologien.
Molecular Microbiology and Labdia Labordiagnostik GmbH
Clinicians, St. Anna Children’s Hospital
Sabine Breuer, MD
Philipp Eickhoff, MD
Tamás Fazekas, MD
Andreas Vécsei, MD
Klinische MitarbeiterInnen vom St. Anna Kinderspital
Dr. Sabine Breuer
Dr. Philipp Eickhoff
Dr. Tamás Fazekas
Dr. Andreas Vécsei
� May 2009 – Aug. 2010
2 since Feb. 2011
3 until June 2009
4 until Mar. 2009
5 since Sept. 2009
6 since Oct. 2009
7 Apr. 2008 – Sept. 2009
8 since Oct. 2010
9 Dec. 2008 – Aug. 2009
� Mai 2009 – Aug. 2010
2 seit Febr. 2011
3 bis Juni 2009
4 bis März 2009
5 seit Sept. 2009
6 seit Okt. 2009
7 Apr. 2008 – Sept. 2009
8 seit Okt. 2010
9 Dez. 2008 – Aug. 2009
Management
Prof. Helmut Gadner, MD
Roland Lavaulx de Vrécourt, PhD
Medical Director
Finance & Administration Director
Secretary
Brigitte Glatz
Molecular Genetic Analysis and
DI Dragana Jugovic
Michaela Nesslböck
Sandra Preuner, MSc
Cytogenetics and
Molecular Cytogenetics
Elisabeth Krömer-Holzinger, PhD
Gudrun Divoky
Ulrike Engel
Brigitte Grimm
Susanna Koskela
Margit König
Bettina Nocker
Gertrud Pass
Eva Winkler
Dept. of Pharmacological Analysis
Ulrike Kastner, MD, PhD
Ulrike Engel
Eva Winkler
The following working groups
of the CCRI contribute to the
activities of diagnostics
provided by Labdia Labor
diagnostik GmbH:
Clinical Cell Biology &
FACS Core Unit
Assoc. Prof.
Gerhard Fritsch, PhD
Christine Freimüller, MSc
René Geyeregger, PhD
Ing. Dieter Printz
Julia Stemberger
Dijana Trbojevic
Elke Zipperer
Assoc. Prof.
Michael Dworzak, MD
Angela Schumich
Leukaemia MRD-Diagnostics
Prof. Renate E. PanzerGrümayer, MD
Susanne Fischer
Andrea Inthal, PhD
Ruth Joas, MSc
Solid Tumour Diagnostics
Assoc. Prof. Peter Ambros, PhD
Ingeborg M. Ambros, MD
Bettina Brunner
Andrea Ziegler
Geschäftsführung
Univ. Prof. Dr. Helmut Gadner
Dr. Roland Lavaulx de Vrécourt
Ärztlicher Direktor
Kaufmännische Leitung
Sekretärin
Brigitte Glatz
Molekulargenetische Analytik
und molekulare Mikrobiologie
DI Dragana Jugovic
Michaela Nesslböck
Sandra Preuner
Zytogenetik und
molekulare Zytogenetik
Dr. Elisabeth Krömer-Holzinger
Gudrun Divoky
Ulrike Engel
Brigitte Grimm
Susanna Koskela
Margit König
Bettina Nocker
Gertrud Pass
Eva Winkler
Pharmakologische Analytik
DDr. Ulrike Kastner
Ulrike Engel
Eva Winkler
Folgende Arbeitsgruppen der
St. Anna Kinderkrebsforschung
tragen zu den Diagnostik
leistungen der Labdia Labor
diagnostik GmbH bei:
Diagnostik solider Tumoren
Univ. Doz. Dr. Peter Ambros
Dr. Ingeborg M. Ambros
Bettina Brunner
Andrea Ziegler
Univ. Doz. Dr. Michael Dworzak
Angela Schumich
Klinische Zellbiologie &
FACS Core Unit
Mag Christine Freimüller
Dr. René Geyeregger
Ing. Dieter Printz
Julia Stemberger
Dijana Trbojevic
Elke Zipperer
Leukämie MRD-Diagnostik
Univ. Prof. Dr. Renate E.
Panzer-Grümayer
Susanne Fischer
Dr. Andrea Inthal
Mag. Ruth Joas
In addition to our activities as a diagnostic reference
centre for national and international therapeutic trials,
Labdia also offers its services to individual patients
that are being treated at various centres in Austria
and other countries. The most important diagnostic
methodologies currently offered by Labdia include
cytogenetic analyses, fluorescence in situ hybridisation
(FISH) assays, qualitative and quantitative PCR tests,
pharmacokinetic analyses, flow cytometry and cell
sorting by FACS, as well as investigation of DNA mutations by various techniques. Labdia is an internationally
certified competence centre for comprehensive
diagnostics of chronic myeloid leukaemia (CML), which
is an important focus within our spectrum of diagnostic
activities. The current range of diagnostic tests offered
by individual divisions of the non-profit CCRI’s subsidiary Labdia Labordiagnostik is displayed on our website
www.Labdia.at.
Neben unserer Tätigkeit als diagnostisches Referenzzentrum im Rahmen nationaler und internationaler
Therapiestudien bietet die Labdia sein Diagnostik
spektrum natürlich auch für individuelle Patienten
an, die an in- und ausländischen Zentren behandelt
werden. Die wichtigsten diagnostischen Methoden,
die von Labdia derzeit angeboten werden, umfassen zytogenetische Analysen, Fluoreszenz in situ
Hybridisierungs (9 FISH)-Assays, qualitative und
quantitative 9 PCR Testmethoden, pharmakokinetische
Bestimmungen, Flow-Zytometrie and Zellsortierung
mittels FACS1 sowie Analysen von DNA-Mutationen mit
verschiedenen Verfahren. Labdia ist unter anderem
ein international zertifiziertes Kompetenzzentrum für
umfassende Diagnostik bei chronisch myeloischer
Leukämie (CML), die einen wichtigen Schwerpunkt
innerhalb des Diagnostikspektrums darstellt. Das
aktuelle Angebot diagnostischer Leistungen der
einzelnen Abteilungen des gemeinnützigen CCRITochterunternehmens Labdia kann der Website
www.Labdia.at entnommen werden.
9 Siehe Glossar
1 FACS: Flow-activated cell sorting = 9 Durchflusszytometrie
Das Ambulatorium Labdia Labordiagnostik GmbH
wurde im Jahr 2006 mit Prof. DDr. Thomas Lion als ärztlichem Direktor als gemeinnütziges Tochterunternehmen
der St. Anna Kinderkrebsforschung mit dem Ziel
gegründet, neue diagnostische Verfahren zu entwickeln
und anzubieten. Die Schwerpunkte unserer Tätigkeit
liegen in den Bereichen Hämatologie/Onkologie und
der Infektiologie. In enger Zusammenarbeit mit der
St. Anna Kindkrebsforschung und anderen nationalen
und internationalen Forschungseinrichtungen werden
laufend neue Methoden etabliert, validiert und in die
klinische Diagnostik eingeführt. Alle angebotenen diag
nostischen Verfahren beruhen auf eigenen, zum Teil
patentierten Entwicklungen. Wir arbeiten in nationalen
und internationalen Gremien an der Standardisierung
verschiedener diagnostischer Verfahren mit und haben
auch selbst europäische Aktivitäten im Bereich der
Diagnostikentwicklung im Rahmen von EU-Projekten
koordiniert. Durch unsere Vernetzung mit anderen
führenden diagnostischen Einrichtungen in Europa,
unsere regelmäßige Teilnahme an nationalen und
internationalen Ringversuchen und die enge Verbindung
zur Forschung und Entwicklung verfügt die Labdia über
neuestes technisches Know-how und weist eine hohe
fachliche Kompetenz in den Bereichen der angebotenen diagnostischen Leistungen auf.
118–119
The SME Labdia Labordiagnostik GmbH was established in the year 2006 (with Prof. Thomas Lion, MD,
PhD, as Medical Director) as a non-profit subsidiary
of the Children’s Cancer Research Institute, with the
aim of promoting development and offering innovative
diagnostic approaches. The main areas of our activity
include haematology/oncology and infectiology. In
close cooperation with the Children’s Cancer Research
Institute (CCRI) and other national and international
research centres, we are continuously establishing
and validating new assays and introducing them into
clinical diagnostics. All diagnostic tests provided are
based on our own developments, some of which have
been patented. We actively participate in national and
international boards focusing on the standardisation of
different diagnostic methodologies, and have coordi
nated European activities in the field of diagnostic
development in projects supported by the EU. Owing to
the established network with other leading diagnostic
centres in Europe, our regular participation in national
and international control rounds, and our tight links
with research and development, the Labdia laboratory has access to the latest technical know-how and
demonstrates high specialist competence in the areas
of diagnostics provided.
Molecular Microbiology and Labdia Labordiagnostik GmbH
The focus of activities in our department lies on the
field of microbiological research and development as
well as chronic myeloid leukaemia (CML). The application of diagnostic processes resulting from our work
and the performance of specific developmental tasks
were transferred to Labdia Labordiagnostik, a nonprofit institution established in 2006 as a subsidiary
of the Children’s Cancer Research Institute.
Besides research projects focusing on the association
of viral pathogens with malignant neoplasias, a major
part of our work is centred on infectious problems in
oncological children and adolescents after intensive
chemotherapy or after allogeneic stem cell transplantation (allo-SCT). In addition to bacteria, viral and
fungal pathogens are particularly frequent causes
of life-threatening infections in severely immuno
compromised children. Early and reliable diagnosis is
an essential prerequisite for successful therapy. We
have therefore developed quantitative molecular
detection assays for many pathogenic viruses and
clinically relevant fungal species, some of which have
been patented. The production and marketing of
pertinent diagnostic kits are currently being negotiated
with our industrial partners. Our publications show that
clinical applications of some of the assays developed
by our department have already been used to predict
pending infectious complications early on 1 2. The new
diagnostic approaches therefore make an important
contribution to the improvement of treatment strategies for life-threatening infections in severely immunocompromised patients.
Standardised methods of diagnosis for greater
success after allogeneic stem cell transplantation
A further important focus of our activities is the
diagnostic monitoring of patients after allo-SCT.
A European project coordinated by our centre has led
to the establishment of a standardised methodology
for quantitative analysis of patient- and donor-derived
cells (chimerism) 3. The patented approach will be
made commercially available as a diagnostic kit in the
near future. Moreover, we have recently established
a methodology that facilitates very early prediction
of graft rejection, which will permit timely therapeutic
interventions 4.
Intensified research for early detection
of therapy-resistant types of leukaemia
The recent development and clinical implementation
of a molecular technique for the surveillance of mutant,
therapy-resistant subclones in patients with CML
provided important information on clonal development
of the disease, timely detection of resistance, and
clone-specific responses to treatment 5 6. On the
basis of these findings, we are planning further research
projects with the aim of improving our understanding of
the dynamics of this type of leukaemia.
National and international reference centre for
molecular diagnostics of infectious diseases and
leukaemia and coordination of clinical studies
In addition to our Research & Development programme,
we provide services as a reference laboratory for
molecular diagnostics within national and international
therapy trials in the fields of infectious diseases and
leukaemia (ALL-BFM, AML-BFM, CML-Ped, CML-11CELSG, BFM-ALL-SCT, EWING, ENEST-1st, CANASCOL,
CARRAFLU), and we perform clinical studies addressing infectious disease-related issues (PULMOVIR,
CARRAGEENAN).
For further reading
1 Landlinger, C., Preuner, S. et al. (2010). „Diagnosis of invasive
fungal infections by a real-time panfungal PCR assay in immuno
compromised pediatric patients.“ Leukemia 24(12): 2032–8.
2 Lion, T., Kosulin, K. et al. (2010). „Monitoring of adenovirus load in
stool by real-time PCR permits early detection of impending invasive
infection in patients after allogeneic stem cell transplantation.“
Leukemia 24(4): 706–14.
3 Lion, T. et al., publication submitted.
4 Breuer, S. et al., publication submitted.
5 Preuner, S., Denk, D. et al. (2008). „Quantitative monitoring of
cell clones carrying point mutations in the BCR-ABL tyrosine kinase
domain by ligation-dependent polymerase chain reaction (LD-PCR).“
Leukemia 22(10): 1956–61.
6 Preuner, S. Bernroitner, M. et al. 2010. „Proliferation kinetics of
subclones carrying point mutations in the BCR-ABL TKD during the
TKI treatment in CML patients: quantitative monitoring by LD-PCR.”
Blood [abstr.]: 933–934.
Modern diagnostic assays for early diagnosis
and successful therapy of viral and fungal
infections in immunocompromised patients
120–121
Research focus
Die Tätigkeitsschwerpunkte unserer Abteilung liegen
im Bereich der mikrobiologischen Forschung und Entwicklung sowie der chronisch myeloischen Leukämie
(9 CML). Die Anwendung diagnostischer Verfahren, die
aus unserer Tätigkeit resultieren, wurde gemeinsam mit
einigen Entwicklungsaspekten in das gemeinnützige
Ambulatorium Labdia Labordiagnostik GmbH trans
feriert, das im Jahr 2006 als Tochterunternehmen der
St. Anna Kinderkrebsforschung gegründet wurde.
Neben Forschungsprojekten, die sich mit der Assozia
tion verschiedener viraler 9 Pathogene mit malignen
9 Neoplasien befassen, beschäftigen wir uns mit
infektiologischen Problemen bei krebskranken Kindern
und Jugendlichen unter intensiver Chemotherapie
und nach allogener Knochenmarktransplantation. Bei
schwer immungeschwächten Kindern rufen – neben
bakteriellen Infektionen – vor allem Virus- und
Pilzinfektionen sehr ernste bis lebensbedrohliche
Komplikationen hervor. Eine frühzeitige und verlässliche Diagnostik ist eine wichtige Voraussetzung, um
PatientInnen rasch und effizient behandeln zu können.
Wir haben daher quantitative molekulare Detektions
methoden für viele pathogene Viren und klinisch
relevante Pilzformen entwickelt, von denen einige
patentiert wurden. Derzeit verhandeln wir mit unseren
Industriepartnern die Herstellung und den Vertrieb
entsprechender Diagnostika. Unsere Publikationen
belegen, dass wir beim klinischen Einsatz einiger in
unserer Abteilung entwickelter Methoden bereits
drohende infektiologische Komplikationen frühzeitig
vorhersagen können 1 2. Die neuen diagnostischen
Möglichkeiten leisten daher einen wichtigen Beitrag
zur Verbesserung der Behandlungsstrategien von
lebensbedrohlichen Infektionen bei schwer immun
geschwächten Patienten.
Standardisierte Diagnostikmethoden für verbesserte
Erfolge nach allogener Stammzelltransplantation
Ein weiterer wichtiger Themenbereich unserer Tätigkeit
ist die diagnostische Überwachung von Patienten nach
allogener Stammzelltransplantation. Im Rahmen eines
von uns koordinierten europäischen Projektes haben
wir eine standardisierte Methodik für die quantitative
Überwachung von Spender- und Empfängerzellen
(9 Chimärismus) etabliert 3. Das patentierte Verfahren
wird demnächst als kommerziell erhältlicher, diagnos
tischer Kit zur Verfügung stehen. Darüber hinaus haben
wir eine Methodik etabliert, die eine sehr frühzeitige
Vorhersage von Transplantatabstoßungen ermöglicht,
die künftig als Grundlage für zeitgerechte Therapiemaßnahmen dienen wird 4.
Intensivierte Forschung zur frühzeitigen Erkennung
therapieresistenter Leukämieformen
Die rezente Entwicklung und klinische Anwendung eines
molekularen Verfahrens zur Überwachung mutierter
Subklone bei Patienten mit CML, die mit 9 Resistenz
gegenüber der Therapie einhergehen, hat es uns
ermöglicht, wichtige Erkenntnisse über die klonale
Entwicklung der Erkrankung, die frühzeitige Resistenz
erkennung und das Klon-spezifische Therapie
ansprechen zu gewinnen 5 6. Auf der Grundlage dieser
Erkenntnisse planen wir weiterführende Forschungsprojekte, die zu einem besseren Verständnis der
Dynamik dieser Leukämieform beitragen sollen.
Nationales und internationales Referenzzentrum
für molekulare Infektions- und Leukämiediagnostik
und Leitung klinischer Studien
Neben unserem Forschungs- und Entwicklungs
programm stellen wir als Referenzlabor für molekulare
Infektions- und Leukämiediagnostik Serviceleistungen
für nationale und internationale Therapiestudien
(ALL1-BFM, AML2-BFM, CML3-Päd, BFM-ALL-SCT4,
EWING, ENEST-1st, CANASCOL, CARRAFLU) zur
Verfügung und führen eigene klinische Studien mit
infektiologischen Fragestellungen durch (PULMOVIR,
CARRAGEENAN).
� ALL: akute lymphatische Leukämie
BFM: Berlin-Frankfurt-Münster Studiengruppe
2 AML: Akute myeloische Leukämie
3 CML: chronisch myeloische Leukämie
4 ALL SCT: allogene Stammzelltransplantation
9 Siehe Glossar
Literaturangaben
fungal infections by a real-time panfungal PCR assay in immuno
compromised pediatric patients.“ Leukemia 24(12): 2032–8.
Leukemia 24(4): 706–14.
3 Lion, T. et al., Publikation eingereicht.
4 Breuer, S. et al., Publikation eingereicht.
5 Preuner, S., D. Denk, et al. (2008). „Quantitative monitoring of
cell clones carrying point mutations in the BCR-ABL tyrosine kinase
domain by ligation-dependent polymerase chain reaction (LD-PCR).“
Leukemia 22(10): 1956–61.
6 Preuner, S. Bernroitner, M. et al. 2010. „Proliferation kinetics of
subclones carrying point mutations in the BCR-ABL TKD during the
TKI treatment in CML patients: quantitative monitoring by LD-PCR.”
Blood [abstr.]: 933–934.
Moderne diagnostische Methoden zur frühzeitigen
Erkennung und effizienten Behandlung von Virus- und
Pilzinfektionen bei immungeschwächten Patienten
122–123
Due to the lack of effective anti-adenoviral
therapeutics, alternative treatment strategies are
urgently needed. We investigated the capacity of RNA
interference (RNAi) to inhibit adenoviruses in vitro.
SiRNAs targeting of viral genes responsible for
transactivation of other viral genes, packaging of viral
DNA, generation of virus capsids, or virus maturation
significantly decreased virus titers. However, targeting
of adenoviral DNA replication was identified as the viral
process which is best amenable to RNAi-mediated
inhibition of virus multiplication. Small interfering
(si)RNAs directed against the viral DNA polymerase
and pre-terminal protein (pTP) genes, which are both
essential for viral DNA replication, were shown to
decrease virus titers by several orders of magnitude,
thus leading to dramatic inhibition of virus spreading.
The data obtained in the course of this project are
currently used for the generation of an adenovirus
vector-based delivery system of adenovirus-targeting
siRNAs in the form of artificial microRNAs.
AdVs have also been implicated in the pathogenesis
of malignant disease, and we have demonstrated
the presence of certain AdV serotypes in specific
malignant disorders including brain tumours 3, breast
cancer and mantle cell lymphoma 4. Our current
research focuses on the elucidation of the source and
the mechanisms of virus reactivation from latent state,
and on novel approaches to effective treatment.
For further reading
1 Lion, T., Baumgartinger, R. et al. (2003). “Molecular monitoring
of adenovirus in peripheral blood after allogeneic bone marrow
transplantation permits early diagnosis of disseminated disease.”
Blood. 2003 Aug 1;102(3): 1114 20. Epub 2003 Apr 17.
Leukemia 24(4): 706–14.
3 Kosulin, K., Haberler, C. et al. (2007). „Investigation of adenovirus
occurrence in pediatric tumor entities.” J Virol. 2007 Jul;81(14):
7629–35. Epub 2007 May 9.
4 Kosulin, K., et al., manuscripts in preparation
In a second approach, we demonstrated that introduction of the herpes simplex virus thymidine kinase
(HSV-TK) gene into adenovirus-infected cells and its
selective expression in these cells offer the opportunity
to inhibit adenovirus DNA replication with approved
anti-herpetic prodrugs such as ganciclovir (GCV)
in vitro. Upon delivery of the HSV-TK gene into cells via
non-replicative recombinant adenoviruses, selective
conversion of the otherwise non-toxic prodrug into its
active form could be achieved by HSV-TK expression
from promoters specifically activated in the presence of wild-type adenoviruses. Selective HSV-TK
expression in conjunction with GCV treatment greatly
decreased virus titers, in some instances actually
bringing the otherwise steady and exponential increase
in virus output to a halt. Thus, both the RNAi and the
HSV-TK/GCV-based proof-of-principle investigations
may pave the way to novel therapeutic scenarios for
treatment of life-threatening adenovirus infections.
• “Alternative approaches to the inhibition of adenoviruses”
Austrian Science Foundation: FWF Project Nr. L665-B13, Period
covered 09.2009–08.2012.
• “Inhibition of adenoviruses by enzyme-dependent activation
of prodrugs”; Research Foundation of the Austrian National Bank:
OeNB Nr. 12184, 03.2008–08.2009.
For further details, see chapter “External Grants”, Thomas Lion
Fig. 1
A The concept of RNA interference-mediated silencing of adenoviral
genes.
B Detection of the HSV-TK protein in adenovirus-infected cells by
Western blotting.
C Real-time qPCR demonstrating the reduction of viral mRNA levels
after siRNA treatment.
B
A
Adenovirus genes
siRNAs
miRNAs
HSV-TK
Tubulin
Degradation of
viral mRNA
C
Halt/slow down of viral
infection cycle
Decrease in virus output
and virus spreading
- siRNA
+ siRNA
cycles
124–125
Adenoviruses (AdVs) are a frequent cause of lifethreatening infections in immunocompromised
patients, particularly in allogeneic stem cell transplant
recipients 1. We have demonstrated that disseminated
AdV disease post-transplant almost invariably originates in the gastrointestinal (GI) tract, thus providing a
basis for timely therapeutic intervention 2.
Inhibition of adenovirus
infections by RNA interference
and gene-directed enzyme
prodrug therapy
pA
dE
pA CM
dE V –
pA CM mo
dE V + ck
pA E2 Ad
dE – m 5
pA E2 oc
dE + A k
pA E3 d5
d –
pA EE3 mo
dE + ck
pA E4 Ad5
d –
A5 EE4 mo
49 + ck
Ad
A5
5
49
+
Ad
5
Role of human adenoviruses
in infectious disease and
cancer
Abstract 2
fluorescence
Abstract 1
% Mut clone
F317L-A
BCR-ABL1/ABL1
BCR-ABL1/ABL1 (%)
100
90
80
70
60
50
40
30
20
10
100
90
80
70
60
50
40
30
20
10
0
0
Diagnosis
IM (400mg > 600 mg)
date
Nilo (800 mg)
Dasa (100 mg)
% Mut clone
T315I(Gruppe
F317L-A
Abb.2
Lion)
BCR-ABL1/ABL1
Fig. 2 – Quantitative analysis of mutant cell clones in a patient with
chronic myeloid leukaemia (CML) over a two-year period under
sequential treatment with different tyrosine kinase inhibitors (TKI)
TKI: IM = Imatinib, Dasa = Dasatinib, Nilo = Nilotinib.
The grey dotted line shows the amount of BCR-ABL1 fusion gene
transcripts (according to the international scale) which reflect the
leukaemia burden. A resistant leukaemic cell clone displaying the
F317L-A mutation in the BCR-ABL1 tyrosine kinase domain appears
and proliferates under Dasatinib. This cell clone is sensitive to
Nilotinib, and disappears below the limit of detection. However, the
multi-resistant mutant T315I appears, and becomes the dominant
leukaemic clone.
IM (400mg > 600 mg)
BCR-ABL1/ABL1 (%)
To address this issue, we have established a ligasedependent (LD) PCR technique permitting quantitative
monitoring of point-mutated subclones 1. We have
investigated a series of prospectively collected PB
specimens derived from CML patients displaying
a variety of mutations with the aim to monitor the
proliferation kinetics of mutant leukaemic cells during
the course of treatment. Serial analyses in patients
carrying mutant clones revealed that a) the appearance
of new mutant subclones can occur within a few weeks
after initiation of treatment with a TKI, b) the time span
until mutant leukaemic cells become the dominant
BCR-ABL positive clone can be highly variable r anging
between 1-18 months following first detection,
c) different mutant subclones appear sequentially
in individual patients upon changes of treatment,
d) the response of mutant subclones to treatment
and the rise of new mutant subclones can be readily
documented by the quantitative LD-PCR approach,
e) expansion of mutant clones can be observed while
total BCR-ABL transcripts are decreasing, f) documentation of expanding mutant subclones can precede
the rise in BCR-ABL transcripts by several weeks. Our
observations indicate that quantitative monitoring of
mutant subclones during treatment with TKIs provides
information on their responsiveness to therapy and
the imminent onset of resistant disease. Judicious
implementation of quantitative diagnostic approaches
For further reading
1 Preuner, S., Denk, D. et al. (2008). „Quantitative monitoring
of cell clones carrying point mutations in the BCR-ABL tyrosine
kinase domain by ligation-dependent polymerase chain reaction
(LD-PCR).“ Leukemia 22(10): 1956–61.
2 Preuner, S., et al., manuscript in preparation
T315I
Mut clone (% )
such as the LD-PCR technique in the surveillance of
CML patients can improve our current options for
timely treatment decisions, and could help optimising
disease management in patients displaying point mutations in the BCR-ABL TKD or other sites of potential
relevance 2.
date
Nilo (800 mg)
BCR-ABL1/ABL1 (%)
In patients with CML, the occurrence of point mutations within the BCR-ABL tyrosine kinase (TK) domain is
currently the most common mechanism of resistance
to therapy with TK inhibitors. However, detection
of mutant subclones may be difficult to interpret
with regard to the risk of imminent onset of resistant
disease. The biological relevance of several mutations is not well understood, and some may indeed be
biologically neutral. Surveillance of the size of mutant
subclones during treatment could therefore provide
better understanding of their biological behaviour in
vivo, and facilitate timely assessment of impending
resistant disease.
Chronic myeloid leukaemia (CML):
Kinetics of mutant subclones
126–127
Abstract 3
Haematopoietic stem cell transplantation (HSCT)
is becoming an increasingly important approach to
treatment of different malignant and non-malignant
disorders. There is therefore growing demand for
diagnostic assays permitting the surveillance of
donor/recipient chimerism post transplant. Current
techniques are heterogeneous, rendering uniform
evaluation and comparison of diagnostic results
between centres difficult. Leading laboratories from
ten European countries have therefore performed
a collaborative study coordinated by our centre,
the EuroChimerism Concerted Action which was
supported by a European grant, and developed a
standardised diagnostic methodology for the detection
and monitoring of chimerism in patients undergoing
allogeneic stem cell transplantation 1. The property
rights for the patented assay were obtained by Miltenyi
Biotec, the industrial partner of our consortium, and
a diagnostic kit based on the EuroChimerism assay
will expectedly be launched in 2011. Wide use of the
European-harmonised protocol for chimerism analysis
will provide a basis for optimal diagnostic support and
timely treatment decisions.
Graft rejection is still one of the major problems of
allogeneic HSCT. Timely diagnosis of impending rejection is crucial for effective therapeutic interventions.
We have therefore investigated the predictive potential
of early leukocyte subset-specific chimerism for graft
loss in children undergoing HSCT. In total, 192 paediatric
patients transplanted for treatment of malignant
and non-malignant diseases after reduced intensity
or myeloablative conditioning were investigated.
Surveillance of lineage-specific chimerism was initiated
upon first appearance of leukocyte counts amenable
to cell sorting. Graft rejection occurred in 23 patients
between 24 and 492 days post-transplant (median
63 days). The first chimerism analysis of T- and NK-cells
performed at a median of 20 days after HSCT identified
three different risk groups which were independent of
the conditioning regimen: recipient chimerism (RC)
levels in T-cells below 50% indicated a very low risk of
Invasive fungal infections in the
immunocompromised host
rejection (1.4%), while high levels of RC (>90%) both
in T- and NK-cells heralded graft loss in the majority
of patients (90%) despite therapeutic interventions.
Recipient chimerism >50% in T-cells and ≤90% in
NK-cells defined an intermediate risk group in which
timely immunotherapy frequently prevented rejection.
Early assessment of T- and NK-cell chimerism can
therefore be instrumental in the risk assessment and
therapeutic management of imminent graft rejection 2.
For further reading
1 Lion, T. et al., manuscript in preparation
2 Breuer, S. et al., manuscript in preparation
Invasive fungal infections (IFI) are life-threatening
events for immunocompromised patients, including
particularly patients with haematological m
alignancies
and bone-marrow transplant recipients. The vast
majority of IFI events are still caused by Candida
and Aspergillus species; however, changes in the
epidemiology have occurred over the past decades.
Recent studies from North American and European
centres indicate an increasing incidence of previously
uncommon fungal genera, such as Cryptococcus,
Trichosporon, and, very importantly, different
members of the class Zygomycetes, such as Rhizopus
and Mucor. Timely detection of the fungal pathogens
is a prerequisite for successful therapy and the clinical
outcome in patients with IFI. In view of the changing
epidemiology and the increasing variety of fungal
genera and species observed in immunosuppressed
patients, there is urgent need for reliable screening
methods facilitating rapid and broad detection of
pathogenic fungi. We have established a panfungal
real-time PCR-assay permitting highly sensitive
detection and quantitative monitoring of more than 80
fungal pathogens, covering a large spectrum of moulds,
yeasts, and Zygomycetes (European patent registration
No. 06817468.9).
To assess the clinical potential of the assay, more
than 600 consecutive specimens from 125 paediatric
patients carrying a high risk of IFI were analysed.
An excellent correlation between PCR-positivity
and the presence of proven, probable or possible
fungal infection according to the EORTC criteria was
demonstrated, as revealed by the sensitivity of the
assay of 96% (95%CI: 82–99%). The negative predictive
value of the panfungal PCR-assay presented was
98% (95%CI: 90–100%), while the specificity and the
positive predictive value were 76% (95%CI: 65–85%)
and 60% (95%CI: 46–74%), respectively. The results
indicate that molecular screening of patients during
febrile neutropenic episodes by the panfungal PCR
assay could help prevent unnecessary toxicity resulting
from empirical antifungal treatment of individuals
who may not be at risk of imminent fungal disease 1.
Our data indicate that rapid species identification and
assessment of the invasive potential of the detected
fungal pathogens would likely increase the positive
predictive value for impending fungus-related disease.
The available data provide a basis for appropriately
designed clinical studies addressing the full diagnostic
potential of fungal screening by highly sensitive, broadspectrum molecular assays in severely immunocompromised patients. Moreover, we are currently
negotiating with an industrial partner interested in
producing and marketing a diagnostic kit based on our
patented assay.
For further reading
fungal infections by a real-time panfungal PCR assay in immunocompromised pediatric patients.“ Leukemia 24(12): 2032–8.
128–129
Lineage-specific chimerism
after allogeneic stem cell
transplantation
Abstract 5
Abstract 4
How can we use our
global research network
in the best possible way
to optimise therapies?
Ruth Ladenstein, S 2 IRP: Studien & Statistik
Multinational networking is fundamental for clinical research
of malignant cancer in children and adolescents. Only
controlled large-scale clinical trials allow improving complex
treatment strategies, whilst smaller studies allow testing
innovative drug medications to further improve survival rates.
The clinical trial unit S 2IRP undertakes all efforts to
serve the complex tasks of clinical trial management.
Ruth Ladenstein, S IRP: Studies & Statistics for Integrated Research and Projects
2
Group leader
MD, MBA, cPM
[email protected]
Stem Cell Transplantation Studies
RSA
Inge Hirsch, MSc
Susanne Karlhuber, PhD
Gruppenleiterin
MBA, cPM
[email protected]
Scientific Assistant, RSA*
Claudia Zeiner, MSc
CC
Assoc. Prof.
Susanne Matthes-Martin, MD
Allogene Stem Cell Transplantation
Prof. Christina Peters, MD
Allogene Stem Cell Transplantation
MD, MBA, cPM
Autologous Stem Cell
Transplantation
Wissenschaftliche Assistentin
Mag. Claudia Zeiner, FSA*
Statisticians
Alisa Alspach, BSc,
junior statistician, RSA
Evgenia Glogova, MSc,
junior statistician
Ulrike Pötschger, MSc,
senior statistician
Leukaemia and Lymphoma Studies
RSA
Corinne Grafl1
Dasa Janousek, MSc 2
Nora Mühlegger, MSc
Marek Nykiel 3
Nina Schmid, MD 4
CC**
Prof. Helmut Gadner, MD 5
ALL and Lymphoma Studies
Assoc. Andishe Attarbaschi, MD
ALL and Lymphoma Studies
AML, MDS, CML Studies
Studies in Solid Tumours
RSA
Ingrid Pribill, PhD
Eva Sorz
Phase I/II/III Studies Sponsored by the Pharmaceutical Industry
RSA
Heike Hügel-Körpert, MBA7
CC
Assoc. Prof. Ruth Ladenstein, MD,
MBA, cPM
Prof. Christina Peters, MD
� since Dec. 2010 2 currently on maternity leave 3 since Sept. 2009 4 Aug. 2009 – Jan. 2011 5 until July 2010 6 until Nov. 2009 7 since Febr. 2011
StatistikerInnen
Alisa Alspach,
Junior-Statistikerin, FSA
Mag. Evgenia Glogova,
Junior-Statistikerin
Mag. Ulrike Pötschger,
Senior-Statistikerin
Leukämie- und Lymphomstudien
Corinne Grafl1
Mag. Dasa Janousek2
Mag. Nora Mühlegger
Marek Nykiel 3
Dr. Nina Schmid 4
CC**
Univ. Prof. Dr. Helmut Gadner 5
Univ. Doz. Dr. Georg Mann
ALL und Lymphom Studien
Univ. Doz. Andishe Attarbaschi
ALL und Lymphom Studien
Univ. Doz. Michael Dworzak
AML, MDS, CML*** Studien
Studien Solider Tumoren
FSA
DI Dr. Ingrid Pribill
Eva Sorz
CC
CC
Univ. Doz. Dr. Ruth Ladenstein
* RSA: Research and Study Assistants Neuroblastome, Weichteil- und
MD, MBA, cPM
Ewing Sarkome
** CC: Clinical Studies Leader and
Neuroblastoma, Soft Tissue Tumors, Collaborator
Univ. Doz. Dr. Leo Kager
Ewing Sarcoma
Osteosarkome, Nephroblastome
Assoc. Prof. Leo Kager, MD
Osteosarcoma, Nephroblastoma
• Langerhanszell-HistiozytoseStudien
LCH-Studies
FSA
RSA
Mag. Elfriede Thiem
Elfriede Thiem, MSc
Marek Nykiel 6
Marek Nykiel 6
CC
CC
Univ. Prof. Dr. Helmut Gadner
Prof. Helmut Gadner, MD
Univ. Doz. Dr. Milen Minkov
Assoc. Prof. Milen Minkov, MD
Stammzelltransplantations-
Studien (SZT)
FSA
Mag. Inge Hirsch
Dr. Susanne Karlhuber
CC
Univ. Doz.
Susanne Matthes-Martin
Allogene SZT
Univ. Prof. Dr. Christina Peters
Allogene SZT
MBA, cPM
Autologe SZT
Phase I/II/III Pharma AMG Studien
FSA
Heike Hügel-Körpert7
CC
Univ. Doz. Michael Dworzak
MBA, cPM
Univ. Prof. Dr. Christina Peters
� seit Dez. 2010 2 derzeit in Karenz 3 seit Sept. 2009 4 Aug. 2009 – Jän. 2011 5 bis Juli 2010 6 bis Nov. 2009 7 seit Febr. 2011
* FSA: Forschungs- und Studien
assistenInnen
** CC: Klinischer Studienleiter und
Mitarbeiter (Clinical Studies Leader
and Collaborator)
*** ALL: akute lymphatische Leukämie
MDS: myelodysplastisches Syndrom
CML: chronisch myeloische Leukämie
9 Siehe Glossar
Clinical Research
S2IRP: Studies & Statistics for
Integrated Research and Projects
S2IRP: Studien & Statistik
132–133
Multinationale Netzwerke stellen die Grundlage der
klinischen Erforschung von Krebserkrankungen bei Kindern
und Jugendlichen dar. Große klinische Studien tragen dazu
bei, komplexe Therapiestrategien zu optimieren: Kleinere
Studien hingegen ermöglichen das Testen innovativer
Medikationen, um die Überlebensraten weiter zu steigern.
Das Koordinierungszentrum für klinische Studien S 2IRP führt
diese Aufgaben des Studienmanagements durch.
Clinical Research Klinische Forschung
The Clinical Trial Unit for Studies & Statistics for Integrated Research & Projects (S 2 IRP) is an important link
between the CCRI laboratory research activities and
the clinical application of trials at the St. Anna Children’s
Hospital. Essentially, S 2 IRP fosters clinical research in
paediatric oncology by coordinating and facilitating
international clinical trials. Within the CCRI, the S 2 IRP is
the centre of excellence for clinical studies and statistics. The S 2 IRP acts as the study centre for prospective
clinical trials aiming to optimise therapies according
to EU directives and the Austrian Pharmaceuticals Act
(AMG). In addition, by running specific projects various
international cooperations are maintained. The skilled
multidisciplinary team and personnel resources enable
the preparation, coordination and quality-control
of TOS. This allows verification of the results and
implementation of innovative stratifying diagnostics to
optimise risk-adapted treatments.
EU-Directive 2001 – a blockade to future TOS
In 2004, the AMG implemented the EU Clinical Trials
Directive 2001/20/EC. The continuation of TOS was
seriously put at risk. However, two major efforts of the
St. Anna Kinderkrebsforschung e.V. permitted continuation. Firstly, the St. Anna Kinderkrebsforschung e.V.
became the Sponsor for TOS in oncology/haematology
for children and adolescents. Secondly, in September
2005, a master insurance policy was taken by the
research institute to cover all TOS in Austria. In addition,
all Austrian haemato-oncologists were trained as investigators and the team of research and study assistants
started trainings relating to the new, extended requirements of the Austrian Pharmaceuticals Act (AMG).
Collecting and evaluating patient data
is of utmost importance for clinical trials
In total, the S 2 IRP has registered data from more
than 9,000 patients. This data has been analysed
according to regulations and communicated in terms
of presentations and publications on a national and
international level. International studies focus on the
fields of Langerhans’ cell histiocytosis (study centre of
LCH trials I, II, III), neuroblastoma (study centre of the
European High Risk Neuroblastoma Study HR-NBL-1/
SIOPEN) and the stem cell transplantation of acute
lymphoblastic leukaemia (study centre of the international ALL-SCT Study).
The patient numbers of these three international
studies are as follows.
•LCH trials (I, II, III): 2,893 patients
•HR-NBL-1/SIOPEN: 1,564 patients
•ALL-SCT International: 815 patients
Die Abteilung S 2 IRP versteht sich als österreichisches
Koordinierungszentrum für klinische Studien und
Statistik der pädiatrischen Onkologie (KKS)1 und
fungiert als Studienzentrale für prospektive, nationale
und internationale 9 Therapieoptimierungsstudien
(TOS), die den AMG2/EU-Richtlinien entsprechen. Die
Forschungsabteilung pflegt vielfältige internationale
Kooperationen und verfügt über die erforderlichen
personellen Ressourcen und fachlichen Kompetenzen eines multidisziplinären Teams, um neue,
qualitätsgesicherte Therapieprotokolle zu erstellen
und durchzuführen. Diese Protokolle tragen dazu
bei, die Überlebenschancen krebskranker Kinder und
Jugendlicher zu verbessern. Außerdem ermöglichen
sie es, die Relevanz von Ergebnissen der assoziierten
Laborforschung zu prüfen und innovative DiagnoseMethoden umzusetzen, die individualisierte Therapien
im Sinne der Risikominimierung für die Patienten
erlauben.
Gefährdung der TOS durch die EU-Direktive 2001
In Österreich war die Möglichkeit zur weiteren
Durchführung von TOS3 durch die Neuauflagen der
EU-Direktive 2001 und deren Umsetzung im österreichischen Arzneimittelgesetz (AMG) im Jahr 2004
ernsthaft gefährdet. Erst als das Forschungsinstitut
St. Anna Kinderkrebsforschung e.V. als Sponsor für
TOS der Hämato-Onkologie für Kinder und Jugendliche
auftrat und im September 2005 für alle laufenden
TOS in Österreich einen Rahmenversicherungsvertrag
abschloss, konnte der Weiterbestand dieser Studien
besiegelt werden. Zusätzlich wurden alle österreichischen Hämato-Onkologen als Prüfärzte ausgebildet
und das Team der Forschungs- und Studienassistent
Innen durch zahlreiche Fortbildungen auf die neuen
erweiterten Auflagen des AMG eingeschult.
Grundlage für klinische Forschung
sind auswertbare Patientendaten
Insgesamt wurden durch das Koordinierungszentrum
S 2 IRP bisher Daten von mehr als 9.000 PatientInnen
erfasst, vorschriftsmäßig ausgewertet und in Form
von Vorträgen und Publikationen sowohl auf nationaler
als auch internationaler Ebene kommuniziert. Ein
nationaler Schwerpunkt liegt auf der Koordination der
Leukämie- und Lymphomstudien. Bezogen auf
Krankheitsbilder liegt der internationale Fokus insbesondere im Bereich der 9 Langerhanszellhistiozytose
(Leitung der LCH Studien I, II, III), dem Neuroblastom
(Leitung der Europäischen Hochrisikoneuroblastom
studie HR-NBL-1/SIOPEN) und der Stammzell
transplantation bei akuter lymphoblastischer Leukämie
(Leitung der Internationalen ALL-SZT 2003 Studie).
Die Patientenzahlen dieser drei internationalen
Studien betragen:
•LCH Studien I,II, III: 2.893 Patienten
•HR-NBL-1/SIOPEN: 1.564 Patienten
•ALL-SZT International: 815 Patienten
�
2
3
KKS: Österreichisches Koordinierungszentrum für klinische
Studien und Statistik der pädiatrischen Onkologie
AMG: Österreichisches Arzneimittelgesetz
TOS: Therapieoptimierungsstudien
9 Siehe Glossar
Clinical Research
Therapieoptimierungsstudien – ein
Garant für verbesserte Heilungsraten
krebskranker Kinder und Jugendlicher
134–135
Therapy Optimisation Studies (TOS)
guarantee better chances of survival of
children and adolescents with cancer
Research Focus
Financial & Administrative Management
K. Valdès Rodriguez, PhD, cPM
Statistics & Data Management
Task Team
Leukaemia & Lymphoma
Task Team
Solid Tumour
Task Team
Langerhans Cell Histiocytosis
Task Team
Stem Cell Transplantation
Task Team
Clinical Research
Organisation Chart
National and International
Paediatric Oncology Groups
Operative & Strategic Management
Assoc. Prof. R. Ladenstein, MD, MBA, cPM
Senior Statistician
U. Pötschger, MSc
Scientific Guidance,
Study Coordinators &
Local Investigators
Assoc. Prof. G. Mann, MD
Assoc. Prof. M. Dworzak, MD
Assoc. Prof. A. Attarbaschi, MD
Local Investigators
Assoc. Prof. L. Kager, MD
Local Investigators
Assoc. Prof. M. Minkov, MD
Assoc. Prof. L. Kager, MD
Scientific Guidance, Study
Coordinators & Local Investigators
Prof. C. Peters, MD
Assoc. Prof. S. Matthes-Martin, MD
A. Lawitschka, MD
V. Witt, MD
Coordinating Operative
And Research Assistant
C. Zeiner, MSc
RSA & Junior
Statistician
A. Alspach, BSc
Junior Statistician
E. Glogova, MSc
Data Manager
M. Nykiel
Data Management,
IT & RDE Tasks
RSA
H. Hügel-Körpert, MBA
Phase I/II/III Pharma
AMG Studies
RSA
N. Mühlegger, MSc
RSA
M. Nykiel
RSA
C. Grafl
RSA
I. Pribill, PhD
RSA
E. Sorz
RSA
E. Thiem, MSc
RSA
I. Hirsch, MSc
RSA
S. Karlhuber, PhD
AGPHO, Austrian Group of
Paediatric HaematoOncology
St. Anna Kinderkrebsforschung e.V,
Vienna
St. Anna Children’s Hospital,
Vienna
Children’s Hospital, Medical
University of Vienna
Medical Univ. of Graz, Dept. of
Paediatrics and Adolescence
Medicine, Styria
Innsbruck Medical Univ., Dept. of
Paediatrics, Tyrol
State Women’s Clinic and
State Children’s Clinic Linz,
Upper Austria
Hospital of the Merciful Sisters,
Linz, Upper Austria
LKH Salzburg, Dept. of Paediatrics
and Adolescence Medicine,
Salzburg
LKH Leoben, Dept. of Paediatrics
Leoben, Styria
Children’s Hospital of LKH
Klagenfurt, Dept. of Paediatrics
Carinthia
BKH St. Johann in Tirol, Dept.
of Paediatrics and Adolescence
Medicine, St. Johann, Tyrol
KH Dornbirn, Dept. of Paediatrics
Dornbirn
LKH Feldkirch, Feldkirch/
Altenstadt, Vorarlberg
ÖGKJ1
Austrian Society for Paediatrics
Okids Partners
Study Centre UKKJ Vienna/
(MUV) Medical University Vienna
Study Centre UKKJ Graz/ (MUG)
Medical University of Graz
Study Centre UKKJ Innsbruck
(MUI) Innsbruck Medical
University, Tyrol
LKH Salzburg/PMU
LKH Linz
LKH Klagenfurt, Carinthia
AIEOP: Associazione Italiana
Ematologia Oncologia Pediatrica
ANZCHOG: Australia and New
Zealand Children’s Haematology/
Oncology Group
BSPHO: Belgian Society of
Paediatric Haemato-Oncology
CCLG: Children’s Cancer and
Leukaemia Group, UK
COG: Children’s Oncology Group,
USA
EBMT: The European Group for
Blood and Marrow Transplantation, Netherlands
GPOH: German Group of
Paediatric Haemato-Oncology
HSPHO: Hellenic Society of
Paediatric HaematologyOncology
I BFM SG: The International BFM
Study Group, Germany
ICCCPO: International Confederation of Childhood Cancer
Parent Organization, Netherlands
ICORG: The All Ireland Cooperative Oncology Research Group
ISPHO: Israeli Society of Paediatric Haematology Oncology
LCH: HS Histiocyte Society, USA
NOPHO: Nordic Society for
Paediatric Haematology and
Oncology, Denmark, Finland,
Iceland, Norway, Sweden
NL MCRN: Netherlands
Medicines for Children Network,
Netherlands
PAED-Net Germany: Paediatric
Network, Germany
PENTA: Pediatric European
Network on the Treatment of
AIDS, UK, France
PRINTO: Paediatric Rheumatology
InterNational Trials Organization,
Italy
SEOP: Spanish Society of
Paediatric Oncology
SFCE: Société Française des
Cancers et Leucémies de
l’Enfant et de l’Adolescent
SFOP: Société Française
d’ Oncologie Pédiatrique
SAKK: Swiss Group for Clinical
Cancer Research
SIOP: International Society
of Paediatric Oncology, SIOP
Office c/o Kenes Associations
Worldwide, Switzerland
SIOP EUROPE: The European
Society for Paediatric Oncology,
Belgium
SIOPEN: International Society of
Paediatric Oncology European
Neuroblastoma, Austria
UK MCRN: United Kingdom
Medicines for Children Research
Network, UK
EURO-HISTIO-NET (EHN)
Consortium
APHP: Assistance Publique Hopitaux de Paris, France
HRTrust: Histiocytosis Research
Trust, UK parents association, UK
CCRI-S 2 IRP: St. Anna Kinderkrebsforschung e.V., Austria
BIOEF: Fundación Vasca de Innovación y Investigación Sanitarias,
Basque Foundation for Health
Innovation and Research, Spain
IGG: Istituto Giannina Gaslini,
Italy
European Network for
Cancer Research in Children
and Adolescents (ENCCA)
All 33 partners are listed on
page 141.
1 ÖGKJ: Österreichische
Gesellschaft für Kinder- und
Jugendheilkunde
136–137
Networks and Groups
Figure
Involvement of the S2IRP/
Coordinating Centre for
paediatric-oncological trials
in International Networks
Therefore, the Clinical Trial Unit has been developed
and trained towards the necessary expertise and
manages the full scope of tasks as required according
to GCP and European Directives as well as national legal
requirements (AMG [Arzneimittelgesetz] – Austrian
Pharmaceuticals Act).
•Legal Sponsorship: both, international and
national (granted through the St. Anna
Kinderkrebsforschung e.V.)
•Submission of clinical trials to Ethics
(Leading Ethicsl Committee at the Medical University
of Vienna) and the Competent Authorities
(Austrian Health Authorities: AGES) as well as
yearly prolongations
•Insurance
•Contracts regulating liabilities, responsibilities
and duties according to the European Clinical Trials
Directive and respective national law and regulations
(international sponsor, national sponsor and
investigational sites)
•Preparation and Updates of Trial Master Files and
Investigator Site Files
•Registering and recording of study patients according
to inclusion/exclusion criteria
•Documentation of therapy and toxicities of in-house
(St. Anna Kinderspital) patients
•Data entry on classical clinical trial data bases as well
as Remote Data Entry (RDE), data capture systems
according to trial.
•Databases dealt within S 2 IRP: a total of 35
•Preparation of regular follow-ups for all study patients
•Pharmacovigilance reporting according to national
rules (includes SAE and SUSAR reporting)
•Annual Safety Reports for the competent authorities
•Trial monitoring according to national requirements
•Work on queries and requests of respective
coordinating study centres
•Communication with respective participating centres
•Communication with all laboratories in the
St. Anna Children’s Hospital and CCRI
•Work on queries and requests of the study centres
outside
•Yearly reports to Statistics Austria
•Certified team education on GCP
•Participation on educational workshops, national
and international meetings
•Preparation of data material for meetings and
lectures
In spite of significant increase of bureaucratic burden
following the EC Clinical Directive in 2001 and its
implementation into the Austrian Pharmaceuticals Act
in 2004 (“AMG 2004”), a total of 17 clinical trials have
been activated according to the new standards.
The S 2 IRP unit supports and runs an immunotherapy
drug development programme, i.e. currently for the
ch14.18/CHO anti-GD2 monoclonal antibody for high
risk neuroblastoma and is currently pursuing the
application to EMA for drug licensing and registration.
This programme links the unit to a strong international
commitment for paediatric oncology as well as close
collaboration with the NIH on specific cross testing
activities. The HR-NBL-1/SIOPEN trial recently demon
strated the break-through result for the high dose
treatment.
EHN (EuroHistioNet) Consortium:
Funded by the Public European Health Agency (PEHA)
under the 6th EU Framework Programme (FP6) –
General objectives of Euro-Histio-Net 2008
Euro-Histio-Net has been brought up to join efforts
in increasing the knowledge of the disease, improving
quantity and quality of knowledge exchange, producing
guidelines and setting up an international data base.
Any newly acquired information will be distributed by a
web portal for LCH professionals, doctors and patients
at www.eurohistio.net.
The associated partners of the project are four Euro
pean research institutes and one patient association:
Public Assistance, Hospitals of Paris (Coordinator),
France: www.aphp.fr; Basque Foundation for Health
Innovation and Research, Bilbao, Spain: www.bioef.org;
Children’s Cancer Research Institute, Vienna, Austria:
www.ccri.at; Giannina Gaslini Institute, Genova, Italy:
www.gaslini.org; The Histiocytosis Research Trust,
Sutton Coldfield, UK: www.hrtrust.org. The project is
supported by 16 collaborating partners from Austria,
Belgium, Canada, France, Germany, Greece, Poland,
Sweden, The Netherlands, UK and USA. Many different
international data bases exist, collecting different data
on histiocytosis patients. The project tends to merge
a lot of this information in an international database
which can serve as a common platform for many
different groups collecting data on Langerhans cell
histiocytosis and associated syndromes, on paediatric
and adult patients. Several persons and teams worldwide have been producing guidelines for diagnosis,
treatment and follow-up of LCH. One of the ambitious
efforts of Euro-Histio-Net will be to review these
works, to generate a synthesis of this information and
to provide guidelines after approval of many involved
specialists.
Included in the Euro-Histio-Net web portal a specific
section will be designed for the expertise of cases
including an opportunity to present case reports
and questions. A panel of the most frequently asked
questions about LCH and associated syndromes will be
listed (“Meet the Expert Web Site”).
In several European countries patient associations
have developed web sites dealing with histiocytic
diseases. Euro-Histio-Net aims to coordinate existing
resources and to extend this network. The European
patient associations will decide jointly about the exact
contents of this part of the Euro-Histio-Net web portal
(Patients’ Web Site).
European Network for Cancer Research
in Children and Adolescents (ENCCA):
Funded under the 7 th EU Framework Programme
(FP7) and coordinated by Ruth Ladenstein, CCRI
S 2 IRP will have an important support role to run the
European Network for Cancer Research in Children
and Adolescents (ENCCA) project over a 4 year
period.ENCCA was successfully submitted under the
European Union’s Seventh Framework Programme
health topic, Structuring clinical research in paediatric
and adolescent oncology in Europe, in November,
2009. This ‘network of excellence’ aims to restructure
knowledge-sharing through the integration of the whole
chain of stakeholders from the European paediatric
oncology community and will support the acceleration
of the development of innovative therapeutic strategies for children and adolescents with cancer. ENCCA
138–139
Activities of the S IRP/
Coordinating Centre for
paediatric-oncological trials
Clinical Research
International Activities
2
Clinical Trial Unit
•Structure and integrate, on a sustainable basis and
at a pan-European scale, clinical and translational
research in children and young people with cancer
by proposing a European Strategy for Clinical and
Translational Research in paediatric and adolescent
oncology.
•Promote innovative methodology and designs for
clinical trials, as well as their implementation and
integration to address the specific needs of these
rare cancers.
•Initiate harmonised therapeutic strategies by
significantly increasing access to knowledge and
technologies on paediatric tumour biology and
interactions between tumour and host.
•Improve substantially the quality-of-life of children
and adolescents with cancer, in particular the longterm side-effects of current and future treatments.
•Propose common ethical definitions of issues and
solutions adapted to national and cultural requirements, while monitoring ethical issues in the
implementation of the European agenda in clinical
research.
This ambitious project is designed to integrate all
clinical trial groups and stakeholders in the future and is
a stepping stone towards an interactive and sustainable European network that can facilitate trials on a
European basis and foster the integration of European
research tasks. ENCCA will also have a political agenda
on behalf of the European Parliament.
There is a political agenda to raise awareness for the
clinical research components for all the respective
Paediatric Oncology tasks and research areas in public
and there are ongoing efforts to enhance visibility
and recognition of these fields in Austria also vis-à-vis
universities and Ministries of Health & Science. Close
collaborations with the Competent Authorities (AGES)
and the Ministry of Health are ongoing.
The primary aim of the O.K.ids project application in
2008 was to fund basic Clinical Trial Unit structures in
5 centres in Austria to cope with requirements of competent authorities and to foster drug development and
approval of medicines for children and adolescents.
S 2 IRP was proposed as major Network Coordination
Unit. These efforts were driven by the vision to support
solutions to overcome off-label and off-licence use in
clinical trials for children and adolescents and hence to
reduce administrative burden in the future.
A project handbook was written on request of the
Austrian Ministry of Health. However, so far the paediatric
network has not achieved government support and
funding. Political negotiations and working groups
ongoing (AGES – Kindergesundheitsdialog). In addition, the commitment in “Politische Kindermedizin”
in A
ustria and problems were summarised in a book
chapter for reference in more details.
Netherlands
AMC
EMC
LUMC
UK
LTHTNHS
SOUTHAMPTON
UCL
UOB
140–141
Clinical Research
ENCCA goals include the following in short:
O.K.ids – A Project on the Political Agenda:
An Austrian Network Application to the Austrian
Ministry of Health
Sweden
KI
Poland
CAU
CHARITÉ
OLGA
UKE
WWU
Belgium
ECCO
SIOPE
U Gent
Austria
AIT
CCRI
ESQH
ÖK
France
AP-HP
CLB
CURIE
IARC
IGR
Spain
LaFe
Italy
CINECA
IGG
UCSC
UNIMIB
UNIPD
Fig.1 – European Network for Cancer in Childhood and
Adolescents (ENCCA Consortium) with 33 partners
AIT: Austrian Institute of Technology GmbH (Vienna, Austria)
AMC: Academisch Medisch Centrum Bij de Universiteit van
Amsterdam (Amsterdam, Netherlands)
AP-HP: Assistance Publique – Hopitaux de Paris (Paris, France)
CAU: Christian-Albrechts-Universitaet zu Kiel (Kiel, Germany)
CCRI: Children’s Cancer Research Institute of the St. Anna Kinderkrebsforschung e.V. (Vienna, Austria)
CHARITE: Charité-Universitätsmedizin Berlin (Germany)
CLB: Centre Anticancereux Léon Bérard (Lyon, France)
CURIE: Institut Curie (Paris, France)
ECCO: European CanCer Organisation (Brussels, Belgium)
EMC: Erasmus Universitair Medisch Centrum Rotterdam
( Netherlands)
ESQH: Europäische Gesellschaft für Qualität im Gesundheitswesen –
Wiener Büro Verein (Vienna, Austria)
FORTH: Foundation for Research and Technology Hellas (Greece)
IARC: Centre international de recherche sur le cancer (Lyon, France)
IGR: Istitut Gustave Roussy (Villejuif, France)
KI: Karolinska Institutet (Stockholm, Sweden)
Greece
Forth
LA FE: Fundación para la investigación del hospital universitario
La Fe de la Comunidad Valenciana (Valencia, Spain)
LTHT NHS: The Leeds Teaching Hospitals NHS Trust R&D Department
(Leeds, UK)
LUMC: Academisch Ziekenhuis Leiden – Leids Universitair Medisch
Centrum (Netherlands)
MUG: Gdanski Uniwersytet Medyczny (Gdansk, Poland)
ÖK: Österreichische Kinder-Krebs-Hilfe Verband der österreichischen
Kinderkrebshilfeorganisation (Vienna, Austria)
OLGA: Landeshauptstadt Stuttgart (Germany)
SIOPE: SIOP Europe (Brussels, Belgium)
Southampton: University of Southampton (Southampton, UK)
UCL: University College London (London, UK)
UCSC: Università Cattolica del Sacro Cuore, Milano, Brescia,
Roma Piacenza e Cremona (Rome, Italy)
U Gent: Universiteit Gent (Ghent, Belgium)
UKA: Universitätsklinikum Essen (Essen, Germany)
UNIMIB: Università degli Studi di Milano-Bicocca (Italy)
UNIPD: Università degli Studi di Padova (Italy)
UOB: The University of Birmingham (Birmingham, UK)
WWU: Westfaelische Wilhelms-Universitaet Muenster
(Germany)
will be managed through the CCRI and S²IRP: the Network of Excellence Manager is R. Ladenstein, current
president of SIOP Europe. 33 European institutions in
16 countries are involved and will deliver 80 milestones
including manifold deliverables.
A number of trials have been successfully managed
in cooperation with the BFM group on the Austrian
platform and under current GCP requirements. The
successful long lasting cooperation with the BFM group
has resulted in a number of top ranking publications in
the field. Austria was able to successfully enter into the
international EuroNet-PHL-C1 and EuroNet-PHL-LP1
studies for the treatment of Hodgkin’s disease in the
children and adolescents under the current terms
of the Austrian Pharmaceuticals Act (AMG) and with
the St. Anna Kinderkrebsforschung e.V. assuming the
sponsor role for the Austrian patients. The same was
achieved for the Interfant 2006 study thus strengthening the international cooperations. The following BFM
open trials are centrally managed for Austria at the
S 2 IRP.
In leukaemia, this includes the following trials: ALL-BFM
2009, Interfant 2006, ALL-REZ BFM 2002, CLARA-DNX
(26.08.10), AML-BFM 2004; in lymphoma: EuroNetPHL-LP1 2010, EuroNet-PHL-C1 2006, LBL-Registry
2008, B-NHL 2004, EICNHL ALCL99, EICNHL ALCLRelapse 2004 and finally in myelodysplastic syndrome:
EWOG-SAA 2010, EWOG MDS 06, EWOG-MDS RC 06.
2. Solid Tumours
D) Acute Myeloid Leukaemia
Head of task team: Assoc. Prof. Michael Dworzak, MD
RSA: Nora Mühlegger, MSc (part time)
A) Acute Lymphoblastic Leukaemia (ALL)
Head of task team: Assoc. Prof. Andishe Attarbaschi, MD
RSA: Dasa Janousek MSc (maternity leave since 2009)
Since Aug. 2009 Nina Schmid, MD
Closed studies
New studies
Ongoing studies
Title
ALL-BFM 2000
EsPHALL 2004
(amended in 2010)
ALL-BFM 2009
Interfant 2006
ALL-REZ BFM 2002
Accrual Austria AMG 20041
612 total
no
6 total
no
Start Dec. 2010 yes
9 total
yes
62 total
Registry
B) Morbus Hodgkin
Head of task team: Assoc. Prof. Andishe Attarbaschi, MD
RSA: Dasa Janousek, MSc; since Aug. 2009 Nina Schmid, MD
Ongoing studies
Title
EuroNet-PHL-LP1
2010
EuroNet-PHL-C1
2006
0
yes
63 total
yes
C) Non-Hodgkin Lymphoma (NHL)
Head of task team: Assoc. Prof. Georg Mann, MD
Assoc. Prof. Andishe Attarbaschi, MD
RSA: Nora Mühlegger, MSc (part-time)
Title
Closed studies
EURO-LB 02
(30.06.08)
B-NHL BFM 2004
Rituximab
(03.09.08)
New studies
LBL-Registry 2008
Ongoing studies B-NHL 2004
EICNHL ALCL99
EICNHL ALCL-
Relapse 2004
� AMG 2004 (yes / no)
15 (total)
no
(+ 5 interim)
15 (total)
no
12 (total)
75 (total,
inkl. Rituximab)
23 (total)
5 (total)
no
no
no
no
Title
Closed studies
Relapsed AML
2001/01 (19.05.09)
New studies
CLARA-DNX
(26.08.10)
Ongoing studies AML-BFM 2004
A) Neuroblastoma
Head of task team: Assoc. Prof. Ruth Ladenstein, MD
RSA: Ingrid Pribill, PhD; Alisa Alspach, MSc (in part)
27 (total, no
since 01.10.01)
0
yes
71 (total, yes
since 01.03.04)
E) Haematology: Myelodysplastic Syndrome (MDS)
Severe Aplastic Anaemia (SAA)
Head of task team: Assoc. Prof. Michael Dworzak, MD
RSA: Susanne Karlhuber, PhD (part time)
New studies
Ongoing studies
Title
EWOG-SAA 2010
EWOG MDS 06
EWOG-MDS RC 06
Accrual Austria
Not yet open
15
6
142–143
1. Leukaemia and Lymphoma
Clinical Research
Working Groups*
AMG 2004
no
no
no
Title
Accrual Int’l
Closed studies
AntiGD2 Ch14.18/CHO 16
Bridging Study (SIOPEN)
TVD (SIOPEN)
682
New studies
TOTEM2/ITCC
21
ch14.18-IL2 1021
11
Long term continuous infusion
ch14.18/CHO plus 0
s.c. aldesleukin (IL-2)
Ongoing studies
LNESG2/SIOPEN 298
HR-NBL-1/SIOPEN 1564
Studies about to be opened
LINES
OMS/DES
8
yes
yes
0
3
yes
yes
0
yes
4
59
yes
yes
TOTEM2/ITCC: Phase 2 Single- arm Studies of Temozolomide in
Combination with Topotecan in Refractory and Relapsed Neuroblastoma and Other Paediatric Solid Tumours
ch14.18-IL2 1021: Phase II feasibility study using ch14.18/CHO antibody
and subcutaneous Interleukin 2 after haploidentical stem cell transplantation in children with relapsed neuroblastoma. A SIOPEN study
ch14.18/CHO plus s.c. aldesleukin (IL-2): A Phase I/II dose schedule
finding study of ch14.18/CHO Continuous Infusion combined with
subcutaneous Aldesleukin (IL-2) in patients with primary refractory or
relapsed neuroblastoma. A SIOPEN Study
LNESG2/SIOPEN: Guidelines for the treatment of patients with localised resectable neuroblastoma and analysis of prognostic factors
HR-NBL-1/SIOPEN : High risk neuroblastoma Study 1 of SIOP-Europe
(SIOPEN)
LINES: European Low and Intermediate Risk Neuroblastoma
OMS/DES: Multinational European Trial for Children with the
Opsoclonus Myoclonus Syndrome/Dancing Eye Syndrome
� AMG 2004 (yes / no)
* Working groups of the S 2 IRP/Coordinating Centre for
Paediatric-Oncological Trials
Working Groups*
Clinical Research
The mission of SIOPEN is to ultimately improve survival
in children suffering from high-risk neuroblastoma
and to support risk adopted treatment and assurance
of quality of life in children with low and intermediate
risk disease. To suffice the multiple aspects of this
disease and to achieve the multiple goals, 22 European
countries and Israel co-ordinate multi-national European infrastructures in about 200 university clinics,
cancer centres and hospitals, research institutes and
laboratories in a disease too rare to be advanced on a
national level. An internet and web-based centralised
remote data entry database and communication
system was developed by AIT Austrian Institute of
Technology GmbH, Austria. The European WEB
portal (http://www.siopen-r-net.org) holds interacting
features. The exchange and circulation of reference
material, built up material resources and repositories
needed for research work. SIOPEN-R-NET helped to
run up-to-date biological risk studies and to establish
new diagnostic tests.
In 2009 the SIOPEN Association to foster Neuro
blastoma Research was established to guarantee
long-term sustainability of the group. The Association
has its registered office in Vienna. The liaison office at
the S 2 IRP acts as the members’ single contact point.
It covers various Association businesses including the
Association’s document management, organisation
of regular telephone conferences and face-to-face
meetings. The Association set up an online registration
Member count by countries:
Australia (1), Austria (7), Belgium (9), Czech Republic
(2), Denmark (3), Finland (1), France (12), Germany (3),
Greece (7), Hungary (1), Ireland (1), Israel (9), Italy (11),
Norway (8), Poland (2), Portugal (3), Serbia (1), Slovakia
(1), Spain (17), Sweden (3), Switzerland (2), Turkey (1),
UK (15).
SIOPEN launched the HR-NBL-1/SIOPEN Study for the
treatment of high risk neuroblastoma which started
accrual on 02/02/2002. This study is one of the international clinical trials run by the Unit. The international
trial coordination is based at S 2 IRP in the research
institute (CCRI). The protocol consists of a rapid, dose
intensive induction chemotherapy (COJEC) adopted
from the UK-ENSG 5 protocol with the use of G-CSF to
rapidly reduce bulky disease. It aims to reduce the incidence of local relapse and hence encourages extensive
surgical removal of the primary tumour at the end of
induction and adds local irradiation to all patients after
megatherapy (MGT) / PSCR.
In 2010 the results of the supportive care question were
published in Journal of Clinical Oncology 1. All patients
now receive G-CSF during induction. A major European
breakthrough was achieved in October 2010 when the
Data Monitoring Committee advised that the high-dose
randomisation should be stopped early. BuMel, the
European regimen, was found to have significantly better (approximately 15%) 3-year event-free-survival and
3-year overall survival rates over CEM, the US Children’s
Oncology Group regimen. As a result, the randomisation was closed in favour of BuMel on the 11th October
2010. An amendment to the protocol is planned.
Ch14.18/CHO anti-GD2 antibody development:
Access to immunotherapy for children with
High-Risk Neuroblastoma (NBL) in Europe
This antibody was originally produced in the mouse
myeloma cell line SP2/0. Due to a production issue in
Europe, the cell line was changed for Chinese Hamster
Ovary (CHO) cell and Polymun Scientific, a contract
manufacturer of SIOPEN, developed the process
and is currently producing ch14.18/CHO anti-GD2.
The whole development and production runs were
achieved through a European wide funding campaign
and is a purely investigator driven SIOPEN effort with
the project management run by Ruth Ladenstein. Since
2006, the antibody is randomised and integrative part
of the European HR-NBL1/SIOPEN Study (Principal
Investigator, PI: R. Ladenstein). When in 2009 through
the close collaboration with the Children’s Oncology
Group (COG), SIOPEN learned early about the major
breakthrough of ch14.18/CHO anti-GD2 containing
immunotherapy (COG) (Alice Yu, N Engl J Med, 2010)
for the treatment of high-risk NBL, a major trial amendment allows access to AntiGD2 14.18/CHO in both
randomised arms.
SIOPEN is now aiming to have this product registered
and commercialised by seeking Scientific Advice at the
European Medical Agency (EMA) as a first step and has
handed in the briefing document to EMA. Company
contacts are made to support this development in the
future. To allow for antibody access also for patients
with primary refractory or relapsing NBL, two further
phase I/II studies with the ch14.18/CHO anti-GD2
were developed with support of the S 2 IRP team in
cooperation: One of them (Continuous Infusion Study,
PI: Holger Lode, Greifswald/Germany) is aiming to find
a less toxic infusion scheme for this drug allowing for
an outpatient setting during therapy. The other one, a
feasibility study, is using the antibody and Interleukin
2 after haploidentical stem cell transplantation in
children with relapsed neuroblastoma (Haplo-Study,
PI Peter Lang, Tübingen/Germany).
In the following solid tumour indications new clinical trials were launched during the reporting period
or are expected to be so soon in 2011: The previous
EURO-E.W.I.N.G.99 was closed with 2881 patients. The
follow-up Ewing 2008 Study was started in June 2010.
In the indication of soft tissue sarcomas, the
CWS2002P trial was closed with a total of 1.239
patients. The standard treatment registration is
captured within the registry SoTisaR in Austria since
November 2010. A new high-risk study CWS2007HR
was started in November 2010.
A major breakthrough in osteosarcoma treatment
and research was achieved with the foundation
of EURAMOS – the European and American Osteo
sarcoma Study Group in 2001. The aims of the
EURAMOS group are to: a) improve survival from
Osteosarcoma, b) conduct large randomised studies,
c) undertake parallel biological studies, and d) develop
a common understanding and language about Osteo
sarcoma. Initially, four trial groups joined together
to undertake the first clinical trial of EURAMOS,
EURAMOS 1 opened in 2005 (in 2008 in AUT). Until the
end of 2010 a total of more than 2000 patients had
been recruited, and the two randomisations (good
responders are randomised to receive MAP or MAP+Ifa;
and poor responders are randomised to receive either
MAP or MAPIE) are expected to be closed around
mid-2011. Currently, the EURAMOS strategy group and
the EURAMOS trial development groups are preparing
the EURAMOS 2 trial. Important activities of this group
are also embedded in the upcoming ENCCA activities. The S 2 IRP is presented through Assoc. Prof. Leo
Kager in the strategic study committee who is also the
Austrian representative.
The SIOP Renal Tumour Study Group (RTSG) trial
SIOP WT 2001 accrued over 3580 patients, including
3187 with Wilms tumour until the end of 2009. The
randomisation for post-operative chemotherapy for
patients with stage II/III intermediate risk histology
144–145
Supported by the European Commission EC Grant
No. QLRI-CT-2002-01768 (project coordination:
Assoc. Prof. Ladenstein, MD, MBA, cPM), the SIOP
(International Society for Paediatric Oncology) Europe
Neuroblastoma Group (SIOPEN) was able to build
the SIOPEN-R-NET research network to optimise the
use of pre-existing European clinical and research infrastructures in the individual countries thus improving
consistency and complementarities.
system to become a SIOPEN member. The website
for the online registration to become a member of the
SIOPEN Association is available at: http://membership.
siopen-r-net.org/ As at 31st August 2010 the SIOPEN
Association had a total of 121 members from 22
countries.
European Neuroblastoma Study Reference Centre
Wilms tumour was closed on Dec. 31st 2009. Patients
are further registered in the trial to identify biomarkers
to guide introduction of new, biologically targeted
therapies, especially for those patients with the highest
risk disease. These efforts will be supported within
the ENCCA project. The S 2 IRP is presented also here
through Assoc. Prof. Leo Kager in the strategic study
committee, who is the Austrian representative.
For further reading
1 Ladenstein, R., Valteau-Couanet, D. et al. (2010). Randomized Trial
of Prophylactic Granulocyte Colony-Stimulating Factor During Rapid
COJEC Induction in Pediatic Patients With High-Risk Neuroblastoma:
The European HR-NBL1/SIOPEN Study. J Clin Oncol. 28(21): 3 516–24.
B) Ewing Tumour
Head of task team: Assoc. Prof. Ruth Ladenstein, MD, MBA, cPM
RSA: Eva Sorz
Title
Accrual Int’l
Closed trial EURO-E.W.I.N.G 992881
Ongoing trial Ewing 2008
Study started
01/06/2010
94
no
6
yes
C) Soft Tissue Sarcoma
Head of task team: Assoc. Prof. Ruth Ladenstein, MD, MBA, cPM
RSA: Eva Sorz
Title
Closed studies
CWS2002P
New studies
CWS2007HR
Registry Registry SoTisaR
Accrual Int’l
1239
95
no
Start: 01.11.2010
yes
Start: 01.11.2010
no
D) Nephroblastoma
Head of task team: Assoc. Prof. Leo Kager, MD (since 2009)
RSA: Eva Sorz
Title
Accrual Int’l
Closed trials
Siop2001/ Closure 3580
of randomisation
1.12.2009
Registry
Siop2001 (since
370
closure of rand.)
A) Acute Lymphoblastic Leukaemia – Stem Cell Transplantation
and the European Group for Blood and Marrow Transplantation
(EBMT) / Paediatric Diseases Working Party (PDWP)
Head of task team: Prof. Christina Peters, MD
RSA: Ingeborg Hirsch, MSc
Title
Accrual Int’l Closed trials
ALL-CR2
60
New trials AML-SCT-BFM
2007
Ongoing trials ALL-SZT-BFM
584
2003
ALL-SCT-BFM
228
international
Accrual Austria AMG-Trial
7
no
Not open yet
yes
66
no
36
yes
B) Stem Cell Transplantation REGISTRATION
Head of task team: Prof. Christina Peters, MD
RSA: Susanne Karlhuber, PhD (part-time)
C) Chronic Myeloid Leukaemia – Stem Cell Transplantation
(CML SCT)
Head of task team: Assoc. Prof. Susanne Matthes-Martin, MD
RSA: Susanne Karlhuber, PhD (part-time)
Accrual Int’l Accrual Austria AMG 20041
1
0
132
no
Title
New studies
CML SCT I-BFM
11
no
� AMG 2004 (yes / no)
E) Osteosarcoma
Head of task team: Assoc. Prof. Dr. Leo Kager (since 2009)
FSA: Eva Sorz
Title
Ongoing studies
Euramos1
Accrual Int’l
1682 (1/2010)
20
� AMG 2004 (yes / no)
Yes
yes
Stem Cell Transplantation Study Centre
Acute lymphoblastic leukaemia (ALL) is the most
frequent haemato-oncological disease in children. In
spite of excellent survival rates of more than 80% after
risk adapted front line studies according to BFM strategies some children will suffer from a relapse. Allogeneic
stem cell transplantation (SCT) is a therapeutic option
opening a second chance for long-term survival.
On this basis the multicentre ALL SCT 2003 trial
(Germany, Austria, Switzerland) was developed aiming
at enrolling about 750 patients with indication for an
allogeneic SCT from a HLA-matched sibling donor,
unrelated und related matched or mismatched donor.
Primary endpoint of the study is the evaluation of
disease free survival of all patients who underwent
allogeneic SCT, the evaluation of acute and chronic
graft-versus-host disease and the incidence and
course of late effects. This is the first transplantation
protocol for ALL-patients defining common strategies
for conditioning regimen, donor recruitment, GVHDprophylaxis and methods of T-cell depletion according
to a given indication for an allogeneic transplantation.
From 2003 till October 2010 624 study patients
entered the trial and in addition 116 registry patients
were notified from 28 German speaking transplant
centres. Of the study patients 116 had an indication
for a matched sibling donor (MSD), 228 patients an
indication for a matched donor (MD) SCT and 282
patients for a mismatched donor (MMD) transplantation. The median age at diagnosis is 9 years. There
were 372 males and 252 females. The preferred stem
cell source is bone marrow for patients with MSD und
MD-indication while in the situation of MMD-indication
peripheral stem cells are preferred. This protocol has
built the basis for a “master protocol”, which is also
used for other disease categories (“Interfant”: treatment protocol for ALL in infants, AML: allogeneic SCT).
The strength of this ongoing study are the risk adapted
therapeutic options on the basis of the long standing
experience of the BFM Group and the quality assurance
measures in the respective study components.
Clinical Research
146–147
3. Stem Cell Transplantation (SCT)
Working Groups*
This successful strategy has raised international
awareness. To allow also these transplant centres to
homogenously treat their patients, an international
component was justified and adopted as the ALL-SCT
BFM international study. So far, 279 patients have been
registered on this GCP study from centres in Belarus,
Denmark, France, Israel, Poland, Netherlands, Slovakia,
Czech Republic, Turkey, Sweden and Italy. Data collection runs on an internet based remote data entry
system developed by the Austrian Research Centre
Seibersdorf (AIT).
In March 2008 Prof. Peters was elected to be chair of
the Paediatric Disease Working Party of the European
Marrow and Bone Transplantation Group (EBMT). This
is an important strategic position to further enhance
international collaboration for patient orientated
clinical research and studies in the field of stem cell
transplantation to ultimately improve survival and quality of life in children subject to stem cell transplantation.
ALL SCT BFM 2003 is the biggest prospective multi
national trial (Germany, Austria, Switzerland) on the
value of allogeneic haematopoietic stem cell transplantation for children and adolescents and demonstrates
that with the given measures (high resolution typing for
unrelated donors, TBI/VP16 as conditioning backbone,
ATG/MTX/CSA for graft-versus-host disease prophylaxis for unrelated matched donor transplantation)
UD-HSCT is equivalent to allogeneic HSCT from HLA
identical siblings. Incidence of severe acute and chronic
GVHD is low and the treatment related mortality after
one year is below 9% in both groups. To confirm these
excellent results the protocol has been running since
2007 in 11 other European countries (ALL-SCT BFM
international).
A) Langerhans Cell Histiocytosis (LCH)
Head of task team: Prof. Dr. Helmut Gadner,
Assoc. Prof Milen Minkov (starting with LCH IV Study)
Study coordinators: Assoc. Prof. Nicole Grois, MD (until November
2008); Assoc. Prof. Milen Minkov, MD
RSA:Elfriede Thiem, MS
Title
Closed studies
–
New studies
LCH-IV Ongoing studies
LCH-III Accrual Int’l
Accrual Austria AMG-study
–
–
–
start 2011
yes
1329
no
10
Langerhans Cell Histiocytosis Study Reference Centre
Main subjects of the Langerhans Cell Histiocytosis
(LCH)-study reference centre are planning, designing
and organising the upcoming LCH-IV study protocol
which is scheduled to be opened during the first
months of the year 2011. The data safety monitoring
committee agreed upon the results of the LCH-III data
analysis provided in August 2007 to stop randomisation
for risk group patients as well as for low-risk patients.
The results of the analysis showed no benefit for
patients treated according to treatment arm B, with
additional Methotrexate compared to the standard
treatment arm A with Prednisone, Vinblastine and
6-Mercapturine referring to time, to non active disease,
overall response or numbers of reactivation. Furthermore, the number of serious adverse events (toxicity
events) was significantly higher in patients treated with
arm B than with arm A. In low-risk patients treated for
12 months with low-risk treatment the reactivation
rate was significantly lower than in patients treated for
6 months.
The LCH-IV study protocol committee agreed upon
diagnostic guidelines for LCH-IV patients. Especially,
criteria for the diagnostic and follow up evaluation of
LCH lung disease, bone or central nervous system
involvement were revised. The LCH-study reference
centre started the development of a web-based
LCH-IV database. AIT, Austrian Institute of Technology
GmbH, Austria, was selected to design a database
including all aspects of a technical and user friendly
solution.
The LCH study reference centre is supported by
the Histiocytosis Association of America (HAA), the
German and Australian LCH parents’ associations, the
Belgian parents’ group, a grant of the Österreichische
Nationalbank (ÖNB, Research Foundation of the
Austrian National Bank) and an EU grant.
Prof. Helmut Gadner, MD, chair of the LCH-studies
since 1991, is currently preparing the publication of the
results of the LCH-III study. Assoc. Prof. Milen Minkov,
MD, finalised his important project on LCH and bone
marrow involvement and on reactivations in multisystem LCH. Assoc. Prof. Nicole Grois, MD, published
results about LCH and CNS involvement. The study
reference centre is going to establish a project called
“Pathogenetic Mechanisms in LCH”. Aim of this project
is to investigate LCH pathology at a molecular level.
4. Langerhans Cell
Histiocytosis (LCH)
148–149
Clinical Research
Working Groups*
How can we provide
the optimal
work environment for
our researchers?
PR- und
Spendenabteilung
Die St. Anna Kinderkrebsforschung setzt auf eine
effiziente, service-orientierte Administration,
eine offene Kommunikation unter allen
MitarbeiterInnen und auf die Bereitschaft zur
steten Entwicklung einer modernen Verwaltung,
die der Dynamik und Vielfalt einer zeitgemäßen
Forschungsinstitution entspricht.
State-of-the-Art Forschung
und grenzen-überschreitender
Wissensaustausch erfordern
moderne Kommunikationsmittel, eine hochwertige
Infrastruktur und maßgeschneiderte Lösungen.
Karla Valdés Rodríguez, Kaufmännische Abteilung und Research Support
Johann Kalhs, EDV-Abteilung
Unsere Finanzierung basiert
vor allem auf der Unterstützung unserer treuen
Spenderinnen und Spender.
Das Kennenlernen dieser
großartigen Menschen macht
die Arbeit im Spendenbüro zu
einem einmaligen Erlebnis,
auf das sich mein Team und
ich jeden Tag freuen.
Andrea Prantl, PR- und Spendenabteilung
Gruppenleiterin
Dr. Karla Valdés Rodríguez,
cPM 1
Claudia Hochweis, MBA2
[email protected]
Assistentin
Mag. Anna Schmidauer 3
Doris Soska4
Personal- & Leistungsverrechnung
Caroline Schmid
Rechnungswesen: Buchhaltung,
Bilanzbuchhaltung & Controlling
Alexandra Lidy 5
Shideh Karvandi
Karin Krainer 6
Qualitätsmanagement
Univ. Doz. Dr. Michaela
Artwohl7
Facility Management und
Materialwirtschaft
Anja Fennes
Klaus Kienzer
Research Support
Gruppenleiterin
Dr. Karla Valdés Rodríguez,
cPM 8
National Grants
Univ. Doz. Dr. Barbara
Brunmair 9
International Grants
Dr. Nuno Andrade10
ENCCA Projektmanagerin
Dr. Ivona Brasnjevic
Wissenschaftskommunikation
Sandra Brezina-Krivda
EDV-Abteilung
Genaue Details finden Sie
auf der nächsten Seite
Die Kaufmännische
Abteilung ist für die St. Anna
Kinderkrebsforschung und
die Labdia Labordiagnostik
GmbH zuständig.
1 ab Juni 2010
2 bis Juni 2010
3 ab Mai 2011
4 bis Apr. 2011
5 in Karenz
6 seit Mai 2011
7 seit Jän. 2009
8 ab Juni 2010
9 seit Juli 2010
10 seit Juli 2010
Gruppenleiter
Johann Kalhs, MSc*
[email protected]
Leiterin
Mag. Andrea Prantl
[email protected]
Mitarbeiter
Navid Kamalejan*
Florian Kromp, BSc
Mark Rossiwall
DI Lukas Schneider*
MitarbeiterInnen
Katarina Krizanac1
Mag. (FH) Bettina Nistler 2
Dagmar Schmidt 3
Mag. Elisabeth Tax
Das EDV-Team betreut die
St. Anna Kinderkrebsforschung,
die Labdia Labordiagnostik
GmbH sowie das St. Anna
Kinderspital.
1 in Karenz
2 seit Sept. 2009
3 seit Aug. 2010
* Mitarbeiter des St. Anna
Kinderspitals
Da nicht nur der Ausbau,
sondern auch der Betrieb der
aus Spendengeldern finanziert
werden, ist die St. Anna Kinderkrebsforschung e.V. auf diese Art
der Geldaufbringung angewiesen.
Die ordnungsgemäße Widmung
der Spenden wird im vorgeschriebenen jährlichen Intervall
durch die Prüfung seitens der
österreichischen Kammer
für Wirtschaftstreuhänder
bescheinigt.
Gemäß dem Bescheid der
Finanzlandesdirektion für Wien
zählt die St. Anna Kinderkrebsforschung e.V. zum begünstigten
Empfängerkreis, so dass
Spenden an uns sowohl von der
Lohnsteuer als Sonderausgabe,
als auch von der Einkommensteuer als Betriebsausgabe
steuerlich absetzbar sind. Unsere
Jahresabschlüsse werden seit
Beginn unseres Bestehens von
einer Wirtschaftsprüfungs- und
Steuerberatungsgesellschaft
jährlich geprüft und testiert.
152–153
EDV-Abteilung
Kaufmännische Abteilung
und Research Support
PR and Donations
Department
The St. Anna Kinderkrebsforschung Association
relies on an efficient, service-oriented
administration, open communication between
all staff members and openness towards the
continuous development of a modern
administration that corresponds to the dynamics
and diversity of a modern research institution.
State-of-the-art research and
cross-border exchange of
knowledge require modern
means of communication, a
high-grade infrastructure and
custom-tailored solutions.
Our financing is based
primarily on the support from
our loyal donors. Getting to
know these amazing persons
makes working in the donations
office a unique experience,
which my team and I look
forward to every day.
Johann Kalhs, IT Department
Karla Valdés Rodríguez, Financial & Administrative Director, Head of Research Support
Andrea Prantl, PR and Donations Department
Group leader
Karla Valdés Rodríguez,
PhD, cPM 1
Claudia Hochweis, MBA2
[email protected]
Assistant
Anna Schmidauer, MSc 3
Doris Soska4
Personnel office & accounting
for services
Caroline Schmid
Accountancy, book-keeping,
balance-sheet accounting &
controlling
Alexandra Lidy 5
Shideh Karvandi
Karin Krainer 6
Quality management
Assoc. Prof. Michaela Artwohl,
PhD7
Facility management
and pursuing
Anja Fennes
Klaus Kienzer
Research Support
Group leader
Karla Valdés Rodríguez,
PhD, cPM 8
National grants
Assoc. Prof.
Barbara Brunmair, PhD 9
International grants
Nuno Andrade, PhD10
ENCCA project manager
Ivona Brasnjevic, PhD
Science communication
IT Department
Details are listed on the
next page.
The Department of Finance and
Administration is responsible for
and Labdia Labordiagnostik
GmbH.
1 since June 2010
2 until June 2010
3 since May 2011
4 until Apr. 2011
5 currently on maternity leave
6 since May 2011
7 since Jan. 2009
8 since June 2010
9 since July 2010
10 since July 2010
Group leader
Johann Kalhs, MSc*
[email protected]
Group leader
Andrea Prantl, MA
[email protected]
Team
Navid Kamalejan*
Florian Kromp, BSc
Mark Rossiwall
Dipl.-Ing. Lukas Schneider*
Team
Katarina Krizanac1
Mag. (FH) Bettina Nistler 2
Dagmar Schmidt 3
Elisabeth Tax, MA
Our IT team supports the
St. Anna Kinderkrebsforschung,
and the St. Anna Children’s
Hospital.
1 currently on maternity leave
2 since Sept. 2009
3 since Aug. 2010
* Staff of the St. Anna
Children’s Hospital
As not only the facility extension
but also the research activities of
the Children’s Cancer Research
Institute (CCRI) are financed
through donations, the St. Anna
Children’s Cancer Research
Association is reliant on this
type of fundraising. The proper
dedication of these private
donations is verified through a
mandatory annual examination
by the Austrian Chamber of
Chartered Accountants.
As per the ruling of the Provincial
Financial Directorate for Vienna,
the St. Anna Children’s Cancer
Research Association is listed as
a preferential recipient so that
donations to us can be deducted
from earnings tax as a special
expense, as well as from income
tax as an operating expenditure.
Our annual financial statements
have been examined and
certified by an auditing and tax
consultancy body since the CCRI
first came into being.
154–155
IT Department
Dept. Finance, Administration
and Research Support
James R. Downing, MD
Scientific Director. Associate Director of
Basic Research. Cancer Center. Co-Leader.
Haematological Malignancies Programme
Director. Molecular Pathology Laboratory
Departments: Administration, Pathology,
St. Jude Children's Research Hospital,
Memphis, USA
Lee J. Helman, MD
Scientific Director for Clinical Research.
Head of the Molecular Oncology Section
Department: Paediatric Oncology Branch
National Cancer Institute (NCI), Bethesda,
USA
Crystal L. Mackall, MD
Branch Chief Paediatric Oncology Branch.
Head of Immunology Section Department:
Paediatric Oncology Branch National Cancer
Institute (NCI), Bethesda, USA
Prof. Andrew Pearson, MD
Chairman, Paediatric Oncology Section.
Head of Paediatric Research Team, Section
of Paediatric Oncology, Institute of Cancer
Research, Royal Marsden Hospital, Sutton, UK
Prof. Gregory H. Reaman, MD
Chair, Children’s Oncology Group. COG,
Bethesda, USA. Principal Investigator: Center
for Cancer and Immunology Research
(CCIR), Children’s National Medical Center,
Washington, USA
Prof. Maria Grazia Valsecchi, MD
Professore Ordinario. Biostatistics Centre;
Department of Clinical Medicine and
Prevention; University of Milano-Bicocca,
Italy
Prof. Shai Izraeli, MD
Professor of Paediatrics, Tel Aviv University.
Head, Functional Genomics and Leukaemia
Research; Paediatric Haemato-Oncology
and Cancer Research Centre; Sheba Medical
Center, Ramat Gan, Israel
Prof. Stephan Ladish, MD (Chair)
Vice Chair for External Affairs. Principal Investigator. Department of Paediatrics; Children’s
Research Institute; Center for Cancer and
Immunology Research (CCIR); Children's
National Medical Center, Washington, USA.
Professor and Vice Chair of Paediatrics. Professor Biochemistry and Molecular Biology
George Washington University, USA
156–157
Prof. Klaus-Michael Debatin, MD
Medical Director. University of Ulm, Clinic
for Paediatrics and Adolescent Medicine,
Germany
Appendix
Anhang
Scientific Advisory Board
Wissenschaftlicher Beirat
Gerd Krapf
The molecular function of ETV6/RUNX1
in t(12;21) positive acute Lymphoblastic
leukaemia. Supervised by Prof. Renate E.
Panzer-Grümayer, MD. PhD Thesis 4
Dominik Bogen
Heterogeneous MYCN amplification
in neuroblastoma – amplicon, genomic
background and genome instability.
Supervised by Assoc. Prof. Peter F. Ambros,
PhD. MSc Diploma Thesis 1
Margit Lanzinger
The immunosuppressive potential of
Indoleamine 2,3-dioxygenase in human
allo-reactivity and its limitations. Supervised
by Assoc. Prof. Andreas Heitger, MD.
Dipl.-Ing. Diploma Thesis5
Madeleine Fichtinger
Klinische Studien an (krebskranken) Minderjährigen unter besonderer Bedachtnahme
der ethischen Aspekte und der Versicherung
des medizinischen Risikos. Supported by
Assoc. Prof. Ruth Ladenstein, MD, MBA, cPM.
Doctoral thesis to obtain the university
degree of Doctor of Law (LLD)2
Ulrike Nagl
Inhibition of Adenoviruses by enzymedependent activation of prodrugs.
Supervised by Reinhard Klein, PhD, working
group of Prof. Thomas Lion, MD, PhD.
MSc Diploma Thesis1
Christina Freimüller
Low influence of irradiation on the functional
activity of in-vitro expanded ADV-specific
T-cells: A safe and potential therapeutic
option for adoptive immunotherapy.
Supervised by Assoc. Prof. Gerhard Fritsch,
PhD. MSc Diploma Thesis 1
Sabine Heitzeneder
Mutation analysis of mannan binding
lectin deficiency examined by denaturing
high performance liquid chromatography.
Supervised by Assoc. Prof. Andreas
Heitger, MD. MD Diploma Thesis 3
Stefan Niedan
Role of hypoxia and hypoxia inducible
factors (HIFs) in cells of Ewing’s sarcoma
family tumours. Supervised by
Prof. Heinrich Kovar, PhD.
MSc Diploma Thesis 1
Sandra Preuner
Development of novel methodological
approaches to detection and quantitative
monitoring of point-mutated clones.
Supervised by Prof. Thomas Lion, MD, PhD.
MSc Diploma Thesis 1
Raphaela Schwentner
Molecular Mechanisms of transcriptional
repression by the EWS-FLI1 oncogene
in Ewing’s sarcoma. Supervised by Prof.
Heinrich Kovar, PhD. MSc Diploma Thesis 1
� Diplomarbeit zur Erlangung des
akademischen Grades Magister
der Naturwissenschaften
2 Dissertation zur Erlangung des
akademischen Grades Doktor
der Rechtswissenschaften
3 Diplomarbeit zur Erlangung des
akademischen Grades Doktorin
der gesamten Heilkunde
4 Dissertation zur Erlangung des
akademischen Grades Doktor
der Naturwissenschaften
5 Diplomarbeit zur Erlangung des
akademischen Grades
Diplom-Ingenieur (FH)
Sixth Framework Programme (FP6)
6. Rahmenprogramm
der Europäischen Union
European Embryonal Tumor (EET) Pipeline.
Coordinated by Angelika Eggert (University
Children’s Hospital Essen, Germany),
Partner Heinrich Kovar. EU 6 th Research
Programme: STREP „E.E.T.Pipeline“ contract
LSHC-CT-2006-037260
Period covered 01.01.2007–31.12.2009
Seventh Framework Programme (FP7)
7. Rahmenprogramm
der Europäischen Union
EURO-HISTIO-NET 2008. In collaboration
with Milen Minkov (St. Anna Children’s
Hospital, Vienna, CCRI group S 2 IRP –
Ruth Ladenstein). Public Health Executive
Agency (PHEA): Project No. 5108081
Period covered 01.01.2008–31.08.2011
DIRECT – Disseminate research funded
by EC improving treatment options for
children suffering from cancer. Coordinated
by Helmut Gadner (CCRI's Director) in
collaboration with Sandra Brezina-Krivda
(science communication) and Michael
N. Dworzak (St. Anna Children's Hospital).
EU 7 th Research Programme (FP7)
Project No. 201868
Period covered 31.03.2008–31.10.2010
Analysing and Stryking the Sensitivities
of Embryonal Tumors. Coordinated by
Walter Kolch (Systems Biology, Univ. College
Dublin, Ireland), Partner Heinrich Kovar.
EU 7th Research Programme (FP7)
STREP „ASSET“ contract 259348-2
Period covered 01.11.2010–31.10.2015
ENCCA – European network for cancer
research in children and adolescents.
Coordinated by Ruth Ladenstein (S 2 IRP:
Studies & Statistics for Integrated
Research and Projects) in collaboration
with Peter F. Ambros and Heinrich Kovar.
EU 7th Research Programme (FP7)
Project No. 261474
Period covered 01.01.2011–01.01.2014
EUROSTARS Programme of the Euro
pean Commission and the Austrian
Research Promotion Agency
EUROSTARS Programm der
Europäischen Kommission und
der Österreichischen Forschungsförderungsgesellschaft (FFG)
ADENOTAG – Validation of a novel powerful
technology for clinical-scale isolation of
T-cells for adenovirus therapy. Coordinated
by Rene Geyeregger, group leader Gerhard
Fritsch. Eurostars/Austrian Research
Promotion Agency Project No. E! 5744
Period covered 01.04.2011–31.03.2014
Austrian Research Promotion Agency
Österreichische Forschungsförderungsgesellschaft (FFG)
Anbahnungsfinanzierung Wissenschaft
ASSET Nr. 825659 (stage 1) and 826700
(stage 2). Coordinated by Heinrich Kovar.
Austrian Research Promotion Agency.
Anbahnungsfinanzierung Wissenschaft
ENCCA No. 825803. Coordinated
by Ruth Ladenstein. Austrian Research
Promotion Agency
Vienna Science and Technology Fund
Wiener Wissenschafts-, Forschungsund Technologiefonds (WWTF)
Flow cytometric signal typing for therapy
response prediction in pediatric myeloid
leukaemia. Coordinated by Michael N.
Dworzak. Vienna Science and Technology
Fund (WWTF) Nr. LS07-037/„Linking
Research and Patients’ Needs” Call 2007
Period covered 01.03.2008–31.08.2013
Austrian Science Foundation
Fonds zur Förderung der wissenschaftlichen Forschung (FWF)
Statins, molecular mining in neuroblastoma.
Coordinated by Martin Hohenegger
(Med. Univ. of Vienna, Institute of Pharma
cology & Toxicology) in collaboration
with Peter F. Ambros. Austrian Science
Foundation (FWF) Project No. P22385-B11
Period covered 02.01.2010–01.01.2013
Funktion von CD99 in der B-Zell Entwicklung.
Coordinated by Michael N. Dworzak.
Austrian Science Foundation (FWF)
Project No. P18196-B05
Period covered 01.08.2005–30.06.2009
MK2/3 in immune regulation by dendritic
cells -DC feedback loops. Coordinated by
Alexander Dohnal, group leader Thomas
Felzmann. Austrian Science Foundation
(FWF) Project No. P 23271-B11
Period covered 01.04.2011–31.03.2014
Allo-antigen-specific T-cell tolerance
induced by human dendritic cells expressing
the tryptophan metabolizing enzyme
indoleamine 2,3-dioxygenase. Coordinated
by Andreas Heitger. Austrian Science
Period covered 01.08.2008–31.12.2011
Employing indolamine 2,3-dioxygenase (IDO)
activity for the ex vivo generation of alloantigen specific tolerized T cells to be used
for adoptive transfer in murine hematopoietic
stem cell transplantation. Coordinated
by Andreas Heitger. Austrian Science
Foundation (FWF) Project No. P19865B-13
Period covered 01.10.2007–31.09.2010
Mechanisms of transcriptional control by
EWS-FLI1 in Ewing’s sarcoma. Coordinated
by Heinrich Kovar. Austrian Science
Period covered 04.01.2010–03.01.2013
Role of EWS-FLI1 in post-transcriptional gene
regulation. Coordinated by Heinrich Kovar.
Project No. P20665-B12
Period covered 01.03.2008–30.09.2011
158–159
Heide-Maria Binder
Time dependent changes during hydroxyurea
induced senescence in MYCN amplified
Neuroblastoma. Supervised by Assoc. Prof.
Peter F. Ambros, PhD. MSc Diploma Thesis 1
External Grants and Research Funding Bodies
Fremdgeförderte Projekte und Fördergeber
Completed MSc Diplomas and PhD Theses
Abgeschlossene Diplomarbeiten und Dissertationen
Timing of genetic „second hit“ alterations in
childhood acute lymphoblastik leukemia.
Coordinated by Renate Panzer-Grümayer.
Project No. P 22073-B19
Period covered 01.01.2010–31.06.2012
Elucidating the Role of PAX5 Chimeric
Proteins in the Pathogenesis of Childhood
B-Cell Precursor Acute Lymphoblastic
Leukemia. Coordinated by Sabine Strehl.
Project No. P 21554-B19
Period covered 01.11.2009–31.10.2012
Research Foundation of the Austrian
National Bank
Jubiläumsfonds der Österreichischen
Nationalbank (OeNB)
Characterization of adenovirus persistence
in normal and malignant T-cells.
Coordinated by Thomas Lion (Molecular
Microbiology) in collaboration with Peter F.
Ambros. Research Foundation of the Austrian
National Bank (OeNB) Project No. 13078
Laufzeit 01.07.2008–30.06.2010
Cost effective multi-genomic technique
allows risk evaluation in large scale
neuroblastoma studies. Coordinated by
Inge Ambros, group leader Peter F. Ambros.
Research Foundation of the Austrian National
Bank (OeNB) Project No. 13422
Period covered 01.07.2009–31.12.2010
Differential expression of chromatin fractions
in aggressive/benign neuroblastomas.
Coordinated by Eva Bozsaki, group leader
Peter F. Ambros. Research Foundation
of the Austrian National Bank (OeNB)
Project No. 13835
Period covered 01.08.2010–31.01.2012
Towards targeted treatment of CD99+
childhood malignancies: a study on the
interrelation of CD99-induced apoptosis,
heat-shock protein biology and NK-cell
dependent tumor control. Coordinated
by Zvenyslava Husak. Group leader
Michael N. Dworzak. Research Foundation
Project No. 13081
Period covered 01.07.2008–31.12.2009
Interference of Immunoregulatory Tryptophan
Metabolism with Translation Initiation.
Coordinated by Birgit Jürgens, group leader
Andreas Heitger. Research Foundation of the
Austrian National Bank (OeNB) No. 14225
Period covered 01.01.2011–31.12.2011
Mannose-binding lectin deficiency – a risk
factor in pediatric stem cell transplantation.
Coordinated by Andreas Heitger. Research
Foundation of the Austrian National Bank
(OeNB) No. 13075
Period covered 01.07.2008–31.08.2011
Detection of metastases in Ewing’s sarcoma
patients. Coordinated by Idriss BennaniBaiti, group leader Heinrich Kovar. Research
(OeNB) Project No. 12765
Period covered 01.04.2008–31.06.2009
Notch dependent and independent
regulation of growth and stemness in Ewing’s
sarcoma. Coordinated by Heinrich Kovar.
Period covered 01.01.2009–30.06.2011
Prognostic impact of hypoxia inducible factor
HIF1- α and underlying biology in the Ewing’s
sarcoma family of tumors. Coordinated by
Dave Aryee, group leader Heinrich Kovar.
Period covered 01.02.2008–31.08.2009
Therapeutic targeting of the tumor
suppressor p53 in Ewing’s sarcoma family
tumors. Coordinated by Dave Aryee, group
leader Heinrich Kovar. Research Foundation
Project No. 14205
Period covered 01.01.2011–31.12. 2011
Uncovering Clinical Markers for Langerhans
Cell Histiocytosis. Coordinated by Caroline
Hutter (St. Anna Children’s Hospital, Vienna),
group leader Heinrich Kovar. Research
Period covered 01.07.2009–30.06.2011
Cost Effective Multi-Genomic Technique
Allows Risk Evaluation In Large Scale
Neuroblastoma Studies. Coordinated
by Inge Ambros (Tumour Biology), partner
Ruth Ladenstein. Research Foundation
Project No. 13422
Period covered 01.07.2009–31.12.2010
Improved management of Langerhans cell
histiocytosis (LCH) through an international
clinical study. Coordinated by Nicole Grois,
group leader Ruth Ladenstein. Research
Period covered 01.07.2008–30.06.2010
Characterization of adenovirus persistence
in normal and malignant cells. Coordinated
by Thomas Lion, partner Peter F. Ambros.
Bank (OeNB) No. 13078
Period covered 01.01.2009–30.06.2010
Inhibition of adenoviruses by enzymedependent activation of prodrugs.
Coordinated by Reinhard Klein, group leader
Thomas Lion. Research Foundation of the
Austrian National Bank (OeNB) No. 12814
Period covered 01.03.2008–31.08.2009
Genome-wide analysis of genetic
alterations in ETV6/RUNX1+ childhood
acute lymphoblastic leukemia. Coordinated
by Renate Panzer-Grümayer. Research
Period covered 01.07.2009–31.12.2010
Origin of relapses from childhood hyper
diploid B-lineage leukemias. Coordinated
by Georg Mann (St. Anna Children’s Hospital,
Vienna), principal investigator Renate
Panzer-Grümayer. Research Foundation
Project No. 13881
Period covered 01.08.2010–31.07.2012
The role of hypoxia in ETV6/RUNX1 positive
childhood leukemia: Implications for biology
and clinic. Coordinated by Gerd Krapf, group
leader Renate Panzer-Grümayer. Research
Period covered 01.01.2010–30.06.2011
Clinical and biological relevance of the
P2RY8-CRLF2 fusion gene in childhood
acute lymphoblastic leukemia. Coordinated
by Maria Morak, group leader Renate
Panzer-Grümayer. Research Foundation
Project No. 14129
Period covered 01.01.2011–31.12.2011
Evaluation of novel predictive biomarkers
in pediatric acute lymphoblastic leukemia.
Coordinated by Karin Nebral, group leader
Sabine Strehl. Research Foundation
Project No. 14133
Period covered 01.01.20110–29.02.2012
Austrian Academy of Sciences
Österreichische Akademie der
Wissenschaft (OeAW)
Mechanisms of target regulation by the
chimeric oncogene EWS-FLI1 in Ewing’s
sarcoma. Applicant Raphaela Schwendtner,
group leader Heinrich Kovar. Austrian
Academy of Sciences, DOC-fFORTE
Award 22882
Period covered 01.01.2010–31.12.2012
Austrian Federal Ministry of Science
and Research: GEN-AU ChILD
Bundesministerium für Wissenschaft
und Forschung (BMWF)
Genome Plasticity and Childhood
Cancer – Chromosomal aberrations in
life threatening disease GEN-AU ChILD II.
Coordinated by Heinrich Kovar. Austrian
Federal Ministry of Science and Research:
Project No. GZ 200.136/1-VI/1/2005
Period covered 01.06.2006–30.06.2009
GEN-AU CHILD II. Coordinated by
Renate Panzer-Grümayer. Austrian
Federal Ministry of Science and
Research: GZ200.136/1-VI/1/2005
Period covered 01.01.2006–31.06.2009
GEN-AU Frauenförderung. Coordinated
by Renate Panzer-Grümayer. Austrian
Federal Ministry of Science and Research:
GZ200.136/1-VI/1/2005
Period covered 1.01.2006–31.06.2009
Genome Plasticity and Childhood Cancer –
Chromosomal aberrations in life threatening
disease GEN-AU ChILD II. Coordinated
by Sabine Strehl. Austrian Federal Ministry
of Science and Research, Project No.
GZ 200.136/1-VI/1/2005
Period covered 01.01.2010–30.06.2011
Technology Promotion Agency
Technologieagentur der Stadt Wien
GmbH (ZIT)
Entwicklung eines molekularen Verfahrens
zur Identifizierung spezifischer Formen
pathogener Pilze. Coordinated by
Thomas Lion. Technology Promotion Agency
(ZIT)-LS2006
Period covered 01.06. 2006–31.05.2009
Molekulares Verfahren zum Nachweis von
Pilzinfektionen: Von klinischer Testung zur
Vermarktung. Coordinated by Thomas Lion.
Technology Promotion Agency (ZIT)
Cooperate Enlarged
Period covered 01.01. 2006–31.12.2009
160–161
Disseminated tumor cells as reliable source
for prognostication in neuroblastoma
patients. Coordinated by Peter F. Ambros.
Period covered 01.01.2007–31.12.2009
Alternative approaches to the inhibition of
adenoviruses. Coordinated by Reinhard Klein,
group leader Thomas Lion. Austrian Science
Foundation (FWF) Project No. L665-B13
Period covered 01.09.2009–31.08.2012
Awards
Preise
AIEOP-BFM ALL 2009, PEG-Asparaginase
(Oncaspar®). Coordinated by Georg Mann.
Medac Gesellschaft für medizinische
Spezialpräparate m.B.H., Germany
Period covered 01.12.2010–01.12.2020
Molekulares Monitoring des BCR/ABL
enrearrangements und von Mutationen
G
in der BCR7ABL Tyrosinkinase-Domäne im
Rahmen des ENEST-1st trials. Group leader
Thomas Lion. Unrestricted/competitive
industrial grant by Novartis
Period covered 10.2010–12.2013
Assoc. Prof. Peter Ambros, PhD
was awarded the HHV-6 Foundation Award
on 05.02.2009 (www.hhv-6foundation.org).
The award was an opportunity to assign
an HHV-6 Foundation research contract
to the CCRI (Children's Cancer Research
Institute). The resulting publication is
depicted below.
Publication: Arbuckle, J. H., Medveczky, M. M.,
Luka, J., Hadley, S. H., Luegmayr, A.,
Ablashi, D., Lund, T. C., Tolar, J., De Meirleir, K.,
Montoya, J. G., Komaroff, A. L., Ambros, P. F.,
Medveczky, P. G. (2010). The latent human
herpesvirus-6A genome specifically integrates in telomeres of human chromosomes
in vivo and in vitro. Proc Natl Acad Sci USA
107(12): 5563–8.
ALL-SZT-Studies. Coordinated by Christina
Peters and Inge Hirsch. Pharmaceutical
companies: Fresenius Biotech GmbH,
Medac, Amomed, Genzyme, Cephalon,
DKMS Deutschland, and private sponsor:
Resch Dachbau
Period covered: 2008–2010
Annual contribution. Coordinated by Milen
Minkov. Histiocytosis Association of America
Period covered: yearly
EBMT-PDWP. Coordinated by
Christina Peters. EBMT
Funding of a research assistant.
Umbrella organisation of the Austrian
Childhood Cancer Aid (Dachverband der
österreichischen Kinder-Krebs-Hilfe)
Research grant (support pharmaceutical
industry) to facilitate the HR-NBL-1/SIOPEN
study by supporting data management
(Study Data Management) – educational
grant. Coordinated by Ruth Ladenstein.
Amgen (Europe) GmbH, Switzerland,
Contract number: 200807395
Period covered 2001–2010
SIOPEN Association to foster Neuroblastoma
Research (SIOP Europe Neuroblastoma
Group), Vienna. Coordinated by Ruth
Ladenstein. Fundraising SIOPEN Association
Voluntary contribution. Coordinated by
Milen Minkov. Philips & House Holdings,
Histiozytose Hilfe e.V. Germany
* Group leader of the S 2 IRP Coordinating
Centre for Paediatric-Oncological Trials at
the CCRI, Ruth Ladenstein
Respiratorische Virusinfektionen bei
immunsupprimierten pädiatrischen
Patienten Principal investigators
Tamás Fazekas, Thomas Lion. Molecular virus
study. Unrestricted/competitive industrial
grant by Marinomed Biotechnologie GmbH
Period covered 01.09.2009–30.09.2010
Respiratory infections in immuno
compromised children. Principal investigators
Tamás Fazekas, Thomas Lion. Unrestricted/
competitive industrial grant by Abbott
Pharmaceuticals
Period covered 06. 2007–12.2008
Topische Therapie bei Influenza (CARRAFLU).
Group leader Thomas Lion. Molecular virus
study. Unrestricted/competitive industrial
grant by Marinomed Biotechnologie GmbH
Period covered 02.11.2010–31.12.2011
Topische Therapie respiratorischer
Virusinfektionen (CANASCOL). Group
leader Thomas Lion. Molecular virus study.
Unrestricted/competitive industrial grant by
Marinomed Biotechnologie GmbH
Period covered 01.09.2010–31.05.2011
Assoc. Prof. Andishe Attarbaschi, MD
was awarded the Science Award 2009 by
the Austrian Society of Paediatrics and
Adolescent Medicine for the best scientific
paper in paediatric haematology/oncology
in Austria, published in 2008. The award
was presented within the framework of
the 47 th annual conference of the Austrian
Society of Paediatrics and Adolescent
Medicine.
Publication: Attarbaschi, A., Mann, G.,
Panzer-Grümayer, R., Röttgers, S., Steiner, M.,
König, M., Csinady. E., Dworzak, M. N.,
Seidel, M., Janousek, D., Möricke, A.,
Reichelt, C., Harbott, J., Schrappe, M.,
Gadner, H., Haas, O. A. (2008). Minimal
residual disease values discriminate between
low and high relapse risk in children with B-cell
precursor acute lymphoblastic leukemia
and an intrachromosomal amplification of
chromosome 21: the Austrian and German
acute lymphoblastic leukemia BerlinFrankfurt-Munster (ALL-BFM) trials; Journal
of Clinical Oncology 26(18): 3046–50
was awarded the Science Award 2008 by the
Austrian Society of Pediatrics and Adolescent
Medicine for the best scientific papers in
pediatric hematology/oncology in Austria,
published in 2008. The award was presented
within the framework of the 47 th annual conference of the Austrian Society of Paediatrics
and Adolescent Medicine.
Publication: Dworzak, M. N., Schumich, A.,
Printz, D., Pötschger, U., Husak, Z.,
Attarbaschi, A., Basso, G., Gaipa, G., Ratei, R.,
Mann, G., Gadner, H. (2008).
CD20 up-regulation in pediatric B-cell
during induction treatment: setting the stage
for anti-CD20 directed immunotherapy.
Blood 112(10): 3982–8.
received the Science Award 2010 by the
Austrian Society of Pediatrics and Adolescent
Medicine for the best scientific papers in
pediatric hematology/oncology in Austria,
published in 2009. For the same publication
Birgit Jürgens, PhD, was awarded the
Research Award 2010 by the Viennese
Foundation of Innovative and Inter
disciplinary Cancer Research.
Publication: Jürgens, B., Hainz, U., Fuchs,
D., Felzmann, T., Heitger, A. (2009).
Interferon-gamma-triggered indoleamine
2,3-dioxygenase competence in human
monocyte-derived dendritic cells induces
regulatory activity in allogeneic T-cells.
Blood 114(15): 3235–43.
Max Kauer, PhD
received a “Highly Rated Paper” recognition
from the American Association of Cancer
Research (AACR). The award was presented
within the framework of the annual meeting
of the American A ssociation of Cancer
Research 2009.
Presentation: Kauer, M., Ban, J., Kofler, R.,
Walker, B., Davies, S., Meltzer, P., Kovar, H.
(2009): A molecular function map of Ewing’s
sarcoma; PLoS One 4(4): e5415.
was awarded the major Central European
Award 2009 by the Viennese Foundation
of Innovative and Interdisciplinary
cancer research. He also received a poster
price from the International Society of
Paediatric Oncology (SIOP) on behalf of all
coauthors at the SIOP annual meeting 2010
in Boston.
Kovar, H., Mestdagh, P., Kauer, M., Ban, J., Bilke,
S., Aryee, D. N. T., Jug, G., Schwentner, R.,
Speleman, F., Meltzer, P., Vandesompele, J.
Presentation: An integrated genomics
approach unravels a role for microRNAs in
EWS-FLI1 driven Ewing’s sarcoma pathogenesis.
Gerd Krapf, PhD
received the first poster price for outstanding
scientific accomplishments. Travel Award;
EMBO annual meeting 2009 in Oxford, topic:
RUNX Transcription Factors in Development
& Disease.
Presentation: Krapf, G., Kaindl, U., Kilbey, A.,
Fuka, G., Inthal, A., Neil, J. C., Haas, O. A.
and Panzer-Grümayer, R. E. ETV6/RUNX1
abrogates the mitotic checkpoint and directly
targets its key player MAD2L1.
Assoc. Prof. Ruth Ladenstein, MD, MBA, cPM
received the Woman Award 2010 for
the 1st prize in the category “Research &
Technology”. On 30th November 2010, the
awards were given to women with outstanding
performances in seven categories at the
Viennese business club K47.
Prof. Renate Panzer-Grümayer, MD
was awarded the Science Award 2009 by
the Austrian Society of Paediatrics and
Adolescent Medicine for the best scientific
papers in paediatric haematology/oncology
in Austria, published in 2007.
Publication: Diakos, C., Krapf, G., Gerner, C.,
Inthal, A., Lemberger, C., Ban, J., Dohnal, A. M.,
Panzer-Grümayer, E. R. (2007). RNAimediated silencing of TEL/AML1 reveals a
heat-shock protein- and surviving-dependent
mechanism for survival. Blood 109(6):
2607–10.
Publication: Fischer, S., Mann, G., Konrad, M.,
Metzler, M., Ebetsberger, G., Jones, N., Nadel, B.,
Bodamer, O., Haas, O. A., Schmitt, K.,
Panzer-Grümayer, E. R. (2007). Screening for
leukemia- and clone-specific markers at birth
in children with T-cell precursor ALL suggests
a predominantly postnatal origin; Blood 2007
110(8): 3036–8.
162–163
Unrestricted
Industrial Grants
Industrie
förderungen
National and International Trusts
for Funding Clinical Trials*
Nationale und internationale
Fördergeber für klinische Studien
Austrian Academy of Sciences.Austrian
Federal Ministry of Science and Research –
“Genomforschung in Austria”.
Austrian Research Promotion Agency (FFG).
Austrian Science Foundation.
EU 6 th Research Programme (FP7).
EU 7th Research Programme (FP7).
Fund of the City of Vienna.
Research Foundation of the
Austrian National Bank (OeNB).
Technology Promotion Agency
of the City of Vienna (ZIT).
Vienna Science and
Technology Fund (WWTF).
We would also like to express our gratitude
to the following organisations for their
support with awards:
American Association for Cancer Research
(AACR).
Austrian Society of Paediatrics and
Adolescent Medicine (ÖGKJ).
European Molecular Biology Organisation
(EMBO).
HHV-6 (Human Herpes Virus Typ 6)
Foundation.
International Society of Paediatric Oncology
(SIOP).
Magazin “Woman” and the Federal Ministry
of traffic, innovation and technology.
Viennese Foundation of Innovative and
Interdisciplinary Cancer Research.
Wir möchten uns gerne an dieser Stelle bei
unseren zahlreichen privaten Spendern
und Spenderinnen bedanken, die uns
seit vielen Jahren treu unterstützen.
Des Weiteren bedanken wir uns bei den
folgenden nationalen und internationalen
Fördergebern:
6. Forschungsrahmenprogramm der
Europäischen Kommission (FP6).
7. Forschungsrahmenprogramm der
Europäischen Kommission (FP7).
Bundesministerium für Wissenschaft und
Forschung (BMWF) – Genomforschung
in Österreich.
Fonds der Stadt Wien.
Fonds zur Förderung der wissenschaftlichen
Forschung (FWF).
Jubiläumsfonds der Österreichischen
Nationalbank (ÖNB).
Österreichische Akademie der
Wissenschaften (ÖAW).
Österreichische Forschungsförderungs
gesellschaft (FFG).
Wiener Wissenschafts-, Forschungs-,
und Technologie Fonds (WWTF).
ZIT – die Technologieagentur
der Stadt Wien GmbH.
Des Weiteren möchten wir uns gerne bei
folgenden Organisationen bedanken, die uns
durch Preise unterstützt haben:
Amerikanische Krebsforschungsgesellschaft
(AACR).
Europäische Organisation für Molekular
biologie (EMBO).
Fonds der Stadt Wien für innovative
interdisziplinäre Krebsforschung.
Frauenzeitschrift „Woman“ und das
Bundesministerium für Verkehr, Innovation
und Technologie.
HHV-6 (Human Herpes Virus Typ 6)
Foundation.
Internationale Gesellschaft für Pädiatrische
Onkologie (SIOP).
Österreichische Gesellschaft für Kinder- und
Jugendheilkunde (ÖGKJ).
Abla, O., Weitzman, S., Minkov, M.,
McClain, K.L., Visser, J., Filipovich, A., and
Grois, N. (2009). Diabetes insipidus in
Langerhans cell histiocytosis: When is
treatment indicated? Pediatric blood &
cancer 52, 555–556.
Ambros, I. M., Brunner, B., Aigner, G.,
Bedwell, C., Beiske, K., Bénard, J., Bown, N.,
Combaret, V., Couturier, J., Defferrari, R.,
Gross, N., Jeison, M., Lunec, J., Marques, B.,
Martinsson, T., Mazzocco, K., Noguera, R.,
Schleiermacher, G., Speleman, F., Stallings, R.,
Tonini, G. P., Tweddle, D. A., Valent, A.,
Vicha, A., Roy, N. V., Villamon, E., Ziegler, A.,
Preuner, S., Drobics, M., Ladenstein, R.,
Amann, G., Schuit, R. J., Pötschger, U.,
Ambros, P. F. (2011).
A multilocus technique for risk evaluation of
patients with neuroblastoma. Clin Cancer
Res. Feb 15;17(4): 792–804.
Ambros, P. F. and Ambros, I. M. (2009).
Free DNA in the blood serum can unmask
MYCN amplified tumors. Pediatr Blood
Cancer 53(3): 306–7.
Ambros, P. F., Ambros, I. M., Brodeur, G. M.,
Haber, M., Khan, J., Nakagawara, A.,
Schleiermacher, G., Speleman, F., Spitz, R.,
London, W. B., Cohn, S. L., Pearson, A. D.,
Maris, J. M. (2009).
International consensus for neuroblastoma
molecular diagnostics: report from
the International Neuroblastoma Risk
Group (INRG) Biology Committee.
Br J Cancer 100(9): 1471–82.
Andreou, D., Bielack, S., Carrle, D., Kevric, M.,
Kotz, R., Winkelmann, W., Jundt, G., M Werner,
Fehlberg, S., Kager, L. et al.
The influence of tumor- and treatmentrelated factors on the development of local
recurrence in osteosarcoma after adequate
surgery. (2010). Ann Oncol 22(5):1228-35.
Arbuckle, J. H., Medveczky, M. M., Luka, J.,
Hadley, S. H., Luegmayr, A., Ablashi, D.,
Lund, T. C., Tolar, J., De Meirleir, K.,
Montoya, J. G., Komaroff, A. L., Ambros, P. F.,
Medveczky, P. G. (2010).
The latent human herpesvirus-6A genome
specifically integrates in telomeres of human
chromosomes in vivo and in vitro. Proc Natl
Acad Sci USA 107(12): 5563–8.
Arico, M., Zimmermann, M., Mann, G.,
De Rossi, G., Stanulla, M., Locatelli, F.,
Basso, G., Niggli, F., Barisone, E., Henze, G.,
Ludwig, W. D., Haas, O. A., Cazzaniga, G.,
Koehler, R., Silvestri, D., Bradtke, J., Parasole,
R., Beier, R., van Dongen, J. J., Biondi, A.,
Schrappe, M. (2010). Molecular response to treatment redefines
all prognostic factors in children and
adolescents with B-cell precursor acute
lymphoblastic leukemia: results in 3184
patients of the AIEOP-BFM ALL 2000 study.
Blood 115(16): 3206–14.
Aryee, D. N., Niedan, S., Kauer, M.,
Schwentner, R., Bennani-Baiti, I. M., Ban, J.,
Muehlbacher, K., Kreppel, M., Walker, R. L.,
Meltzer, P., Poremba, C., Kofler, R., Kovar, H.
(2010).Hypoxia modulates EWS-FLI1
transcriptional signature and enhances the
malignant properties of Ewing's sarcoma
cells in vitro. Cancer Res 70(10): 4015–23.
Attarbaschi, A., Pisecker, M., Inthal, A.,
Mann, G., Janousek, D., Dworzak, M.,
Pötschger, U., Ullmann, R., Schrappe, M.,
Gadner, H., Haas, O. A., Panzer-Grümayer, R.,
and Strehl, S. (2010).
Prognostic relevance of TLX3 (HOX11L2)
expression in childhood T-cell acute
lymphoblastic leukaemia treated with
Berlin-Frankfurt-Munster (BFM) protocols
containing early and late re-intensification
elements. Br J Haematol. 148(2): 293–300.
Bachmaier, R., Aryee, D. N., Jug, G., Kauer, M.,
Kreppel, M., Lee, K. A., Kovar, H. (2009).
O-GlcNAcylation is involved in the
transcriptional activity of EWS-FLI1 in Ewing's
sarcoma. Oncogene 28(9): 1280–4.
Bader, P., Kreyenberg, H., Henze, G.H.,
Eckert, C., Reising, M., Willasch, A., Barth, A.,
Borkhardt, A., Peters, C., Handgretinger, R.,
Sykora, K.W., Holter, W., Kabisch, H.,
Klingebiel, T., and von Stackelberg, A. (2009).
Prognostic value of minimal residual disease
quantification before allogeneic stem-cell
transplantation in relapsed childhood acute
lymphoblastic leukemia: the ALL-REZ BFM
Study Group. J Clin Oncol 27, 377–384.
Bagatell, R., Beck-Popovic, M., London, W. B.,
Zhang, Y., Pearson, A. D., Matthay, K. K.,
Monclair, T., Ambros, P. F., Cohn, S. L. (2009).
Significance of MYCN amplification in
international neuroblastoma staging system
stage 1 and 2 neuroblastoma: a report from
the International Neuroblastoma Risk Group
database. J Clin Oncol 27(3): 365–70.
Balgobind, B.V., Raimondi, S.C., Harbott, J.,
Zimmermann, M., Alonzo, T.A., Auvrignon, A.,
Beverloo, H.B., Chang, M., Creutzig, U.,
Dworzak, M.N., Forestier, E., Gibson, B.,
Hasle, H., Harrison, C.J., Heerema, N.A.,
Kaspers, G.J., Leszl, A., Litvinko, N.,
Nigro, L.L., Morimoto, A., Perot, C., Pieters, R.,
Reinhardt, D., Rubnitz, J.E., Smith, F.O.,
Stary, J., Stasevich, I., Strehl, S., Taga, T.,
Tomizawa, D., Webb, D., Zemanova, Z.,
Zwaan, C.M., and van den Heuvel-Eibrink,
M.M. (2009). Novel prognostic subgroups
in childhood 11q23/MLL-rearranged acute
myeloid leukemia: results of an international
retrospective study. Blood 114(12): 2489-96.
Ban, J., Jug, G., Mestdagh, P., Schwentner, R.,
Kauer, M., Aryee, D. N. T., Schaefer, K. L.,
Nakatani, F., Scotlandi, K., Reiter, M., Strunk, D.,
Speleman, F., Vandesompele, J., Kovar, H.
(2011).
Hsa-mir-145 is the top EWS-FLI1 repressed
microRNA involved in a positive feed-back
loop in Ewing’s sarcoma. Oncogene Jan 10.
Basso, G., Veltroni, M., Valsecchi, M.G.,
Dworzak M., Ratei, R., Silvestri, D.,
Benetello, A., Buldini, B., Maglia, O., Masera, G.,
Conter, V., Arico, M., Biondi, A., and Gaipa, G.
(2009).
Risk Of Relapse Of Childhood Acute
Lymphoblastic Leukemia Is Predicted By
Flow Cytometric Measurement Of Residual
Disease On Day 15 Bone Marrow. Journal of
Clinical Oncology 27(31): 5168–5174.
Bennani-Baiti, I. M., Cooper, A., Lawlor, E. R.,
Kauer, M., Ban, J., Aryee, D. N., Kovar, H.
(2010).
Intercohort gene expression co-analysis
reveals chemokine receptors as prognostic
indicators in Ewing's sarcoma. Clin Cancer
Res 16(14): 3769–78.
164–165
We would like to express our gratitude to the
numerous private donors who have been
loyal in their support for many years, as well
as the following national and international
funding bodies:
Publications
Publikationen
Acknowledgements
Danksagung
Brugieres, L., Le Deley, M.C., Rosolen, A.,
Williams, D., Horibe, K., Wrobel, G., Mann, G.,
Zsiros, J., Uyttebroeck, A., Marky, I., Lamant, L.,
and Reiter, A. (2009).
Impact of the methotrexate administration
dose on the need for intrathecal treatment
in children and adolescents with anaplastic
large-cell lymphoma: results of a randomized
trial of the EICNHL Group. J Clin Oncol 27,
897–903.
Burkhardt, B., Oschlies, I., Klapper, W.,
Zimmermann, M., Woessmann, W.,
Meinhardt, A., Landmann, E., Attarbaschi, A.,
Niggli, F., Schrappe, M., and Reiter, A. (2010).
Non-Hodgkin's lymphoma in adolescents:
experiences in 378 adolescent NHL patients
treated according to pediatric NHL-BFM
protocols. Leukemia 25(1):153-60. Epub 2010
Oct 29.
Canete, A., Gerrard, M., Rubie, H., Castel, V.,
Di Cataldo, A., Munzer, C., Ladenstein, R.,
Brichard, B., Bermudez, J.D., Couturier, J.,
de Bernardi, B., Pearson, A.J., and Michon, J.
(2009).
Poor survival for infants with MYCN-amplified
metastatic neuroblastoma despite
intensified treatment: the International
Society of Paediatric Oncology European
Neuroblastoma Experience. J Clin Oncol 27,
1014–1019.
Cheok, M.H., Evans, W.E., and Kager, L.
(2009).
High-dose methotrexate: the rationale.
J Pediatr Hematol Oncol 31, 224–225.
Cheok, M.H., Pottier, N., Kager, L., and
Evans, W.E. (2009).
Pharmacogenetics in acute lymphoblastic
leukemia. Seminars in hematology 46, 39–51.
Childhood Acute Lymphoblastic Leukaemia
Collaborative Group (CALLCG). CALLCG
participating groups: amongst others BFM
AUstria: Gadner, H. Mann, G. Attarbaschi, A.
(2009).
Benefical and harmfull effects of anthra
cyclines in the treatment of childhood acute
lymphoblastic leukaemia: a systematic
review and meta-analysis. Br J Haematology
145(3), 376–388.
Cohn, S. L., Pearson, A. D., London, W. B.,
Monclair, T., Ambros, P. F., Brodeur, G. M.,
Faldum, A., Hero, B., Iehara, T., Machin, D.,
Mosseri, V., Simon, T., Garaventa, A., Castel, V.,
Matthay, K. K. (2009).
The International Neuroblastoma Risk Group
(INRG) classification system: an INRG Task
Force report. J Clin Oncol 27(2): 289–97.
Conter, V., Bartram, C.R., Valsecchi, M.G.,
Schrauder, A., Panzer-Grümayer, R.,
Moricke, A., Arico, M., Zimmermann, M.,
Mann, G., De Rossi, G., Stanulla, M.,
Locatelli, F., Basso, G., Niggli, F., Barisone, E.,
Henze, G., Ludwig, W.D., Haas, O.A.,
Cazzaniga, G., Koehler, R., Silvestri, D.,
Bradtke, J., Parasole, R., Beier, R.,
van Dongen, J.J., Biondi, A., and Schrappe, M.
(2010).
Molecular response to treatment redefines
all prognostic factors in children and
adolescents with B-cell precursor acute
lymphoblastic leukemia: results in 3184
patients of the AIEOP-BFM ALL 2000 study.
Blood 115, 3206–3214.
Creutzig, U., Zimmermann, M., Bourquin, J. P.,
Dworzak, M. N., Fleischhack, G.,
von Neuhoff, C., Sander, A., Schrauder, A.,
von Stackelberg, A., Ritter, J., Starý, J.,
Reinhardt, D. (2011).
CNS irradiation in pediatric acute myleoid
leukemia: Equal results by 12 or 18 Gy in
studies AML-BFM98 and 2004. Pediatr
Blood Cancer. Apr 7. doi: 10.1002/pbc.22955.
[Epub ahead of print]
Creutzig, U., Zimmermann, M., Dworzak, M.,
Urban, C., Henze, G., Kremens, B., Lakomek, M.,
Bourquin, J.P., Stary, J., and Reinhardt, D.
(2010).
Favourable outcome of patients with
childhood acute promyelocytic leukaemia
after treatment with reduced cumulative
anthracycline doses. Br J Haematol 149,
399–409.
Csinady, E., van der Velden, V.H.,
Joas, R., Fischer, S., de Vries, J.F.,
Beverloo, H.B., Konig, M., Pötschger, U.,
van Dongen, J.J., Mann, G., Haas, O.A.,
and Panzer-Gruemayer, E.R. (2009).
Chromosome 14 copy number-dependent
IGH gene rearrangement patterns in high
hyperdiploid childhood B-cell precursor
ALL: implications for leukemia biology and
minimal residual disease analysis. Leukemia
23, 870–876.
Daikeler, T., Hugle, T., Farge, D., Andolina, M.,
Gualandi, F., Baldomero, H., Bocelli-Tyndall, C.,
Brune, M., Dalle, J.H., Urban, C., Ehninger, G.,
Gibson, B., Linder, B., Lioure, B., Marmont, A.,
Matthes-Martin, S., Nachbaur, D., Schuetz, P.,
Tyndall, A., van Laar, J.M., Veys, P., Saccardi, R.,
and Gratwohl, A. (2009).
Allogeneic hematopoietic SCT for patients
with autoimmune diseases. Bone Marrow
Transplant 44, 27–33.
De Bernardi, B., Gerrard, M., Boni, L., Rubie, H.,
Canete, A., Di Cataldo, A., Castel, V.,
Forjaz de Lacerda, A., Ladenstein, R., Ruud, E.,
Brichard, B., Couturier, J., Ellershaw, C.,
Munzer, C., Bruzzi, P., Michon, J., and
Pearson, A.D. (2009).
Excellent outcome with reduced treatment
for infants with disseminated neuroblastoma
without MYCN gene amplification.
J Clin Oncol 27, 1034–1040.
Diakos, C. & Kager, L.
Old drug – new insights – better treatment?
(2010) Leuk Research doi:10.1016/j.
leukres.2010.05.033.
Diakos, C., Zhong, S., Xiao, Y., Zhou, M.,
Vasconcelos, G. M., Krapf, G., Yeh, R. F.,
Zheng, S., Kang, M., Wiencke, J. K.,
Pombo-de-Oliveira, M. S.,
Panzer-Grümayer, R., Wiemels, J. L. (2010).
TEL-AML1 regulation of survivin and
apoptosis via miRNA-494 and miRNA-320a.
Blood 116(23): 4885–93.
Dohnal, A. M., Graffi, S., Witt, V., Eichstill, C.,
Wagner, D., Ul-Haq, S., Wimmer, D., and
Felzmann T. (2009).
Comparative evaluation of techniques for the
manufacturing of dendritic cell-based cancer
vaccines. J Cell Mol Med 13(1): 125–35.
Dohnal, A. M., Luger, R., Paul, P., Fuchs, D., and
Felzmann T. (2009).
CD40 ligation restores type 1 polarizing
capacity in TLR4-activated dendritic cells
that have ceased interleukin-12 expression. J
Cell Mol Med 13(8B): 1741–50.
Dworzak, M.N., Gaipa, G., Schumich, A.,
Maglia, O., Ratei, R., Veltroni, M., Husak, Z.,
Basso, G., Karawajew, L., Gadner, H., and
Biondi, A. (2010).
Modulation of antigen expression in B-cell
during induction therapy is partly transient:
evidence for a drug-induced regulatory
phenomenon. Results of the AIEOP-BFMALL-FLOW-MRD-Study Group. Cytometry 78,
147–153.
Ehlers, S., Herbst, C., Zimmermann, M.,
Scharn, N., Germeshausen, M.,
von Neuhoff, N., Zwaan, C.M., Reinhardt, K.,
Hollink, I.H., Klusmann, J.H., Lehrnbecher, T.,
Roettgers, S., Stary, J., Dworzak, M., Welte, K.,
Creutzig, U., and Reinhardt, D. (2010).
Granulocyte colony-stimulating factor
(G-CSF) treatment of childhood acute
myeloid leukemias that overexpress the
differentiation-defective G-CSF receptor
isoform IV is associated with a higher
incidence of relapse. J Clin Oncol 28,
2591–2597.
Fiser, K., Sieger, T., Schumich, A., Wood, B.,
Irving, J., Mejstíková, E., Dworzak, M.N. (2010).
Detection and monitoring of normal and
leukemic cell populations with Hierarchical
Clustering of flow cytometry data. Submitted
Cytometry Part A.
Gaipa, G., Cazzaniga, G., Valsecchi, M.G.,
Panzer-Grümayer, R., Buldini, B., Silvestri, D.,
Karawajew, L., Ratei, R., Benetello, A.,
Sala, S., Schumich, A., Schrauder, A.,
Villa, T., Veltroni, M., Ludwig, W. D., Conter V.,
Schrappe M., Biondi A., Dworzak, M.N.,
Basso G. (2010).
Time Point-Dependent Concordance of Flow
Cytometry and RQ-PCR in Minimal Residual
Disease Detection in Childhood ALL: The
Experience of the AIEOP-BFM ALL MRD
Study Group. Submitted to Journal of Clinical
Oncology (MND and GB share the senior
authorship of this paper).
Gaze, M.N., Boterberg, T., Dieckmann, K.,
Habrand, J.L., Helfre, S., Peylan-Ramu, N.,
Chrzanowska, E.K., Schreier, G., and
Ladenstein, R. (2010).
Development of an electronic database for
quality assurance of radiotherapy in the
International Society of Paediatric Oncology
(Europe) high risk neuroblastoma study.
Radiother Oncol.
Gerr, H., Zimmermann, M., Schrappe, M.,
Dworzak, M., Ludwig, W.D., Bradtke, J.,
Moericke, A., Schabath, R., Creutzig, U., and
Reinhardt, D. (2010).
Acute leukaemias of ambiguous lineage in
children: characterization, prognosis and
therapy recommendations. Br J Haematol
149, 84–92.
Geyeregger, R., Shehata, M., Zeyda, M.,
Kiefer, F. W., Stuhlmeier, K. M., Porpaczy, E.,
Zlabinger, G. J., Jäger, U., Stulnig, T. M. (2009).
Liver X receptors interfere with cytokineinduced proliferation and cell survival in
normal and leukemic lymphocytes.
J Leukoc Biol. 86(5): 1039–48.
Gleixner, K. V., Mayerhofer, M., Vales, A.,
Gruze, A., Hormann, G., Cerny-Reiterer, S.,
Lackner, E., Hadzijusufovic, E., Herrmann, H.,
Iyer, A. K., Krauth, M. T., Pickl, W. F., Marian, B.,
Panzer-Grümayer, R., Sillaber, C., Maeda, H.,
Zielinski C., Valent, P. (2009).
Targeting of Hsp32 in solid tumours and
leukemias: a novel approach to optimize
anticancer therapy. Curr Cancer Drug Targets
9(5): 675–89.
Grois, N., Fahrner, B., Arceci, R.J., Henter, J.I.,
McClain, K., Lassmann, H., Nanduri, V.,
Prosch, H., and Prayer, D. (2010).
Central nervous system disease in Langerhans
cell histiocytosis. J Pediatr 156, 873–881, 881.e1.
Handisurya, A., Schellenbacher, C.,
Reininger, B., Koszik, F., Vyhnanek, P.,
Heitger, A., Kirnbauer, R., Förster-Waldl, E.
(2010).
A quadrivalent HPV vaccine induces humoral
and cellular immune responses in WHIM
immunodeficiency syndrome. Vaccine.
5;28(30): 4837–41.
Herr, A.L., Kabbara, N., Bonfim, C.M., Teira, P.,
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Cytochemically myeloperoxidase positive
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Changes over three decades in outcome and
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Long-term outcome in children with relapsed
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Immune suppression by gammadelta T-cells
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Diagnostic Algorithms, Monitoring,
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Prognostic significance of minimal residual
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PHF6 mutations in T-cell acute lymphoblastic
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Prognostic impact of specific chromosomal
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High STAT5 levels mediate imatinib
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Salvage treatment for children with
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AGES Pharmed
Die AGES PharmMed (www.ages.at) ist
seit 2. Jänner 2006 als nationale Zulassungs
stelle für Arzneimittel tätig. Sie operiert als
ein Geschäftsbereich der Österreichischen
Agentur für Gesundheit und Ernährungs
sicherheit (AGES). Eigentümer und
Auftraggeber der AGES PharmMed ist die
Republik Österreich.
ALL
Akute lymphatische Leukämie
Siehe 9 Leukämie
Allogene Stammzelltransplantation1
Übertragung von Stammzellen von einem
Spender auf einen Empfänger. Voraus
setzung für eine allogene Transplantation –
beispielsweise bei Patienten mit Leukämien
oder Leukämie-Rezidiven – ist, dass die
Gewebemerkmale von Spender und
Empfänger weitestgehend übereinstimmen.
Die Stammzellen werden aus dem Blut oder
Knochenmark gewonnen.
AML
Akute myeloische Leukämie Es gibt verschiedene Unterformen. Etwa 20 % aller Kinder,
die an Leukämie erkranken, leiden an akuter
myeloblastischer Leukämie (AML). Diese
Leukämieform tritt auf, wenn sich Vorstufen
der weißen Blutkörperchen rapide vermehren
und im Knochenmark ausbreiten. Bei Kindern,
die an AML leiden, ist es schwieriger, die
Erkrankung zu beherrschen. Siehe 9 Leukämie
Antigen1
Substanz, die das Immunsystem zur Bildung
von Antikörpern anregt; kann eine allergische
Reaktion auslösen.
Antitumorimmunität2
Mechanismen der Abwehrreaktion gegen
Krebszellen
Apoptose1
Programmierter Zelltod; Form des Zelltodes,
der durch verschiedene Mechanismen in der
Zelle durch diese selbst ausgelöst wird, z.B.
natürlich im Rahmen der Zellalterung oder als
Reaktion auf eine Zellschädigung (z.B. durch
Zytostatika, Strahlentherapie), wobei keine
Entzündungsreaktion ausgelöst wird.
Bedeutung Kinderkrebsheilkunde: Das
natürliche Einsetzen des programmierten
Zelltodes und/oder die dazu notwendigen
Mechanismen sind in vielen Tumor-/Krebs
zellen gestört.
Biomarker3
Biomarker sind charakteristische biologische
Merkmale, die objektiv gemessen werden
können und auf einen normalen biologischen
oder krankhaften Prozess im Körper hin
weisen können. Bei einem Biomarker kann
es sich um Zellen, Gene, oder Genprodukte
wie Enzyme oder Hormone handeln.
Auch komplexe Organfunktionen oder
charakteristische Veränderungen biologischer Strukturen werden als medizinische
Biomarker herangezogen.
Prognostische Biomarker: Die krankheits
bezogenen Biomarker liefern als so genannter
Risikoindikator oder prädiktiver Biomarker
Informationen darüber, ob eine Erkrankung
droht, ob die Krankheit bereits besteht
(diagnostischer Biomarker) oder wie sich
eine Erkrankung im Einzelfall wahrscheinlich
entwickeln wird (prognostischer Marker).
B-Zelle3
B-Lymphozyten oder kurz B-Zellen
gehören zu den Leukozyten (weiße Blut
körperchen). Sie sind als einzige Zellen in
der Lage, Antikörper zu bilden und machen
zusammen mit den T-Lymphozyten den
entscheidenden Bestandteil des adaptiven
Immunsystems aus.
CALLCG
172–173
Szczepanski, T., v. d. Velden, V. H. J.,
Kuiper, R. P., Waanders, E., Vlierberghe, P. V.,
Gruhn, B., Eckert, C., Panzer-Grümayer, E. R.,
Basso, G., Cavé, H., Stadt, U. Z., Campana, D.,
Schrauder, A., Sutton, R., van Wering, E.,
Meijerink, J. P. P., van Dongen, J. J. M. (2011).
Late recurrence of childhood T-cell acute
lymphoblastic leukemia presents a second
leukemia rather than a relapse: first evidence
for genetic predisposition. Journal of Clinical
Oncology Feb. 28.
Chimärismus-Diagnostik2
Glossar
Childhood Acute Lymphoblastic Leukaemia
Collaborative Group; 65 internationale
Partner
Molekulare Analyse von Spender- und
Empfänger-Blutzellen nach Knochenmark-/
Stammzelltransplantation
Chromosomale Translokation3
Unter einer Translokation oder einer
Translozierung versteht man in der Genetik
eine Umlagerung von Chromosomen oder
von Chromosomenabschnitten innerhalb
eines Chromosomenbestandes.
Chromosomenaberration3
Chromosomenaberrationen sind strukturelle
oder zahlenmäßige Veränderungen der
Chromosomen einer Zelle. Es handelt sich
also um größere Erbgutveränderungen, die
zu schwerwiegenden Krankheitsbildern
führen können.
CML
Chronische myeloische Leukämie
Siehe 9 Leukämie
Dendritische Zellen (DCs)1
Sie sind die zentralen Koordinatoren der
Immunität im Allgemeinen und der Anti
tumorimmunität im Speziellen. DCs
sind eine spezialisierte Form der weißen
Blutzellen, die Antigene so präsentieren,
dass das Immunsystem darauf reagieren
kann.
Disseminierte Tumorzellen2
Disseminierte bzw. gestreute Tumorzellen
sind einzelne Zellen aus dem primären Tumor,
die entweder im Knochenmark oder im Blut
nachweisbar sind.
ENCCA
EU-Netzwerk „European Network for Cancer
Research in Children and Adolescents“
Euro-MRD Group
European Study Group for the detection of
MRD (Übertrag ins Deutsche: europäische
Studiengruppe für MRD Nachweis; MRD
minimal residual disease, minimale Rest
erkrankung)
Ewing Sarkom1
Vom Knochen (selten von Weichteilgeweben)
ausgehendes hochmalignes (bösartiges)
Sarkom; zweithäufigster bösartiger Knochen
tumor im Kindes- und Jugendalter nach dem
Osteosarkom, v.a. ab dem zweiten Lebensjahrzehnt auftretend
FISH-Methode2
Die Fluoreszenz-in-situ-Hybridisierung
(FISH) ist eine molekulargenetische
Methode, um Nukleinsäuren, also RNA
oder DNA, in Geweben, einzelnen Zellen
oder auf Metaphase-Chromosomen
nachzuweisen. Die FISH-Methode wird häufig
als diagnostischer Test zur Überprüfung
der zahlenmäßigen und strukturellen
Integrität von Chromosomen angewandt.
Chromosomenumlagerungen, Verlust
oder Zugewinn von ganzen Chromosomen
oder Chromosomenabschnitten sind für
bestimmte Krebserkrankungen oder Krankheitsverläufe charakteristisch. Mithilfe der
FISH-Methode können fast alle chromosomalen Veränderungen mit dem Fluoreszenz
mikroskop sichtbar gemacht werden. Diese
Methode erlaubt es, gesunde Zellen mit
intakten Chromosomen von krankhaft
veränderten Zellen zu unterscheiden und gibt
den Ärzten und Ärztinnen entscheidende
Hinweise für die richtige Therapiestrategie.
Fluoreszenz-in-situ-Hybridisierung
Siehe 9 FISH-Methode
Genexpressionsanalyse3
Die Genexpressionsanalyse bezeichnet die
Untersuchung der Umsetzung genetischer
Information in RNA (Genexpression) mit
molekularbiologischen und biochemischen
Methoden. In der Molekularbiologie kann
mit Hilfe der Genexpressionsanalyse die
Aktivität und Expression tausender Gene
gleichzeitig gemessen werden, was einen
Überblick über zelluläre Funktionen
ermöglicht. Genexpressionsprofile können
beispielsweise verwendet werden, um Zellen
zu identifizieren, die in der aktiven Teilungsphase sind, oder aber um die Reaktion
von Zellen auf eine spezielle Behandlung
aufzuzeigen. Viele derartige Experimente
untersuchen das gesamte Genom, d.h. jedes
Gen einer spezifischen Zelle.
GCP 3
Der Begriff Good Clinical Practise (GCP,
deutsch „Gute klinische Praxis“) bezeichnet
international anerkannte, nach ethischen
und wissenschaftlichen Gesichtspunkten
aufgestellte Regeln für die Durchführung
von klinischen Studien. Dabei steht der
Schutz der Studienteilnehmer und deren
informierte Einwilligung sowie die Qualität
der Studienergebnisse im Mittelpunkt. GCP
ist Teil der GxP genannten Richtlinien für
„gute Arbeitspraxis“ in der Entwicklung und
Herstellung von Arzneimitteln.
Genomik-Technologien2
Methoden zur Analyse des Genoms
basierend auf Hochdurchsatzanalyse der
genetischen Information
Genomische Tumorzellveränderungen2
Tumorzellen zeichnen sich generell durch
Veränderungen in ihrer Erbsubstanz
aus. Dies können Verluste, Zugewinne,
Neukombinationen oder punktuelle
Veränderungen der Erbsubstanz – der DNS
(Abkürzung für Desoxyribonukleinsäure) –
sein. Einzelne dieser Veränderungen können
uns wichtige Hinweise auf die Entstehung
oder das klinische Verhalten dieser Tumoren
geben.
GMP
Gute Arbeitspraxen (GxP),
Good Manufacturing Practise
Graft-versus-Host-Erkrankung1
Die Spender-gegen-Empfänger-Reaktion
oder Erkrankung (englisch: „Graft-versus-
Host“-Reaktion, „GvH“) ist eine spezielle
Komplikation der allogenen HSZT.
Siehe 9 Spender-gegen-Empfänger Krankheit
Hämatopoietische Stammzell
transplantation (HSZT)1
Übertragung Blut bildender (hämatopoietische) Stammzellen nach vorbereitender
Chemotherapie, Bestrahlung oder
Immunsuppression des Empfängers. Die
Stammzellen können entweder aus dem
Knochenmark oder aus der Blutbahn
gewonnen werden. Imersten Fall nennt
man das Verfahren ihrer Übertragung
Knochenmarktransplantation, im zweiten
Fall periphere Stammzelltransplantation.
Nach Art des Spenders (Fremdspender
oder Patient selbst) unterscheidet man
zwei Formen der SZT: die allogene und die
autologe SZT.
Bedeutung Kinderkrebsheilkunde:
Bei manchen Krebserkrankungen (z.B.
akuten Leukämien, Lymphomen) kann als
besonders intensive Form der Behandlung
eine Hochdosis-Chemotherapie (zum
Teil kombiniert mit Ganzkörperbestrahlung)
zur Zerstörung der bösartigen Zellen
sinnvoll sein; dies macht eine anschließende
SZT erforderlich, um das durch die intensive
Behandlung zerstörte Knochenmark zu
ersetzen.
Haploidentische Stammzell
transplantation (HSZT)
Spezielle Form der allogenen Stammzell
transplantation, bei der die Hälfte der
Zelloberflächenmerkmale (HLA-Merkmale)
übereinstimmen. Als haploidente Spender
kommen in der Regel die Eltern des Patienten
in Frage. Da sämtliche Erbmerkmale – also
auch die HLA-Gewebsantigene – zu gleichen
Teilen von Vater und Mutter stammen, kann
der Patient jeweils nur in der Hälfte seiner
Gene mit seinem Vater oder seiner Mutter
übereinstimmen. Man spricht deswegen von
haplo- (=halb) ident.
Hypoxie3
Der Begriff Hypoxie bezeichnet die Mangelversorgung des Gewebes mit Sauerstoff.
I-BFM-SG
Internationale Berlin-Frankfurt-Münster
Studiengruppe, International BerlinFrankfurt-Muenster Study Group
Immunabwehr1
Fähigkeit des Körpers, Krankheitserreger
(Antigene) durch das Immunsystem mit Hilfe
spezifischer Antikörper bzw. bestimmter
Abwehrzellen abzuwehren.
Immunsuppression1
Unterdrückung der körpereigenen Abwehr
Immunsuppression ist eine der Neben
wirkungen der Chemotherapie
INRG
In ternationale Arbeitsgruppe für die
Neuroblastom-Risikoeinschätzung
International Neuroblastoma Risk Group
INSTAND
Gesellschaft zur Förderung der Qualitäts
sicherung in medizinischen Laboratorien
in vitro1
im Reagenzglas, das heißt außerhalb des
lebenden Organismus (in vivo)
JACIE
The Joint Accreditation Committee ISCTEBMT (JACIE) Akkreditierungsprogramm
wurde 1999 mit dem Ziel etabliert, ein
einheitliches Akkreditierungssystem für
Transplantationszentren zu schaffen. Die
Standards basieren auf amerikanischen
Akkreditierungsstandards, die durch die
„Foundation of Cellular Therapy“ (FACT)
definiert sind. Der Akkreditierungsprozess
wurde auf Europäischer Ebene zentralisiert.
Kugelzellanämie3
Die Kugelzellenanämie (Hereditäre
Sphärozytose) ist eine fast ausschließlich
angeborene hämolytische Anämie (Blutarmut
durch krankhaft vermehrte Auflösung der
roten Blutkörperchen). Sie ist die häufigste
hämolytische Anämie in Mitteleuropa, ihr
Auftreten wird auf 1:2500 geschätzt. Die
Diagnose der Sphärozytose erfolgt über die
durchflusszytometrische Messung der roten
Blutkörperchen (Erythrozyten).
Labdia Labordiagnostik GmbH 2
Das Ambulatorium Labdia Labordiagnostik
GmbH wurde im Jahr 2006 als gemein
nütziges Tochterunternehmen der St. Anna
Kinderkrebsforschung mit dem Ziel
gegründet, neue diagnostische Verfahren
zu entwickeln und anzubieten. Die
Schwerpunkte der Tätigkeiten liegen in den
Bereichen Hämatologie/Onkologie und
Infektiologie. In enger Zusammenarbeit mit
der St. Anna Kinderkrebsforschung und
anderen nationalen und internationalen
Forschungseinrichtungen werden laufend
neue Methoden etabliert, validiert und in die
klinische Diagnostik eingeführt.
Langerhanszell-Histiozytose (LCH)2
Langerhanszellen sind fester Bestandteil der
Haut, des Bindegewebes und der Knochen.
Durch einen noch nicht genau bekannten
Prozess können diese Körperzellen zu
wuchern beginnen und damit überall im
Körper, vornehmlich jedoch in den Knochen
und der Haut, zur Knotenbildung führen.
Wenn die Langerhanszell-Histiozytose noch
nicht sehr weit fortgeschritten ist, ist eine
Behandlung sehr von Erfolg begleitet; mit
Rückfällen der Erkrankung muss jedoch
gerechnet werden. Es werden aber mindestens 90% der Kinder geheilt.
Leukämie2
Leukämie ist die häufigste Krebsart im
Kindesalter. Sie stellt eine Krebsform des
Blutes dar, die im Knochenmark, dem
blutbildenden Organ des menschlichen
Körpers, entsteht. Von den rund 250 Kindern
und Jugendlichen, die bis zum 18. Lebensjahr
jährlich in Österreich an Krebs erkranken,
leiden ca. 80–100 an akuter Leukämie.
Unterschieden werden im wesentlichen
zwei Arten von akuten Leukämien: die akute
lymphoblastische Leukämie (ALL), die
überwiegende Leukämieform bei Kindern und
Jugendlichen, und die akute myeloblastische
Leukämie (AML). Chronisch myeloische
Leukämie (CML) Kommt im Kindes- und
Jugendalter äußerst selten vor.
Siehe 9 ALL sowie 9 AML.
174–175
Methode zur Zählung und Charakterisierung
von Zellen (v.a. Blutkörperchen) und Zell
bestandteilen; die suspendierten Zellen
werden in einem automatisierten Verfahren
durch eine Kapillare gesaugt, wobei
physikalische und chemische Eigenschaften
einzeln oder in Kombination gemessen
werden.
Die Durchflusszytometrie wird z.B. im
Rahmen der Diagnose von Leukämien und
malignen Lymphomen (u.a. zur Bestimmung
von Oberflächenmerkmalen der Leukämieund Lymphomzellen) durchgeführt. Eine
weitere Anwendung ist die differentielle
Quantifizierung der verschiedenen Untergruppen der gesunden weißen Blutzellen,
insbesondere nach der Transplantation.
Eine andere wichtige Anwendung der
Durchflusszytometrie ist das Sortieren der
weißen Blutzellen (Leukozyten) in reine Sub
populationen. Diese werden anschließend
der FISH- oder PCR-Analyse unterzogen, mit
deren Hilfe der jeweilige Prozentsatz von
Spender- oder Empfängertyp bestimmt wird.
Diese Analysen dienen unter anderem dazu,
den (langfristigen) Erfolg der Transplantation
zu messen.
FACS Core Unit
Zentrum für Durchflusszytometrie der
Siehe 9 Durchflusszytometrische Analysen
und Zell-Sorts
Durchflusszytometrische Analysen
und Zell-Sorts 1,2
Lymphom1
Sammelbegriff für Lymphknoten
vergrößerungen unterschiedlicher Ursachen
Metastase1
Nekrose1
Veränderungen einer Zelle oder eines
Gewebes, die nach nicht rückgängig zu
machenden (irreversiblen) Ausfällen
verschiedener Zellfunktionen entstehen;
gleichbedeutend mit Zelltod, dessen
Auslöser und Eintreten allerdings andere
biochemische und morphologische Eigenschaften und Vorgänge involviert als die
Apoptose.
Bedeutung Kinderkrebsheilkunde: Nekrosen
können Folge einer lokalen Strahlentherapie
(Strahlennekrose) oder einer Behandlung mit
Steroiden (Knochennekrosen) sein.
Neoplasie1
Tochtergeschwulst, Tumorabsiedlung; Tumor,
der durch Verschleppung von Tumorzellen
aus einem anderen Bereich des Körpers
entstanden ist; insbesondere bei bösartigen
Geschwulsten (Krebs)
Neubildung von Gewebe: (1) im Rahmen
der Geweberegeneration; (2) durch Störung
oder Verlust der Wachstumsregulation
(Neoplasma)
Metastasierung
Neuroblastom2
Sammelbezeichnung für einen Krankheits
prozess, bei dem eine Absiedlung der
kranken Zellen über den Blutweg und/oder
das lymphatische System in ursprünglich
gesunde Körperregionen stattfindet. Zellwanderung, Gewebeinvasion, Oberflächen
unabhängige Koloniebildung
Minimale Resterkrankung (MRD)1
Der Begriff bezeichnet (nach erfolgter
Chemo- und Strahlentherapie) verbliebene
(residuelle) Tumorzellmengen, die sich mit
morphologischen Untersuchungsmethoden
(Mikroskopie) nicht nachweisen lassen; diese
Zellen können sich erneut vermehren und zu
einem Wiederauftreten der Krankheit führen.
Der MRD-Nachweis erfolgt mittels molekular
genetischer Methoden.
der zweithäufigste bösartige solide Tumor im
Kindes- und Jugendalter nach den Tumoren
des Zentralnervensystems. Von dieser
Krebserkrankung sind fast ausschließlich
kleinere Kinder bis etwa zum 8. Lebensjahr
betroffen. In 25 % aller Fälle treten erste
Anzeichen des Leidens bereits innerhalb
der ersten zwölf Lebensmonate auf. Beim
Neuroblastom entarten sehr junge Zellen des
autonomen Nervensystems, von dem u.a.
die Atmung bzw. der Herzschlag gesteuert
wird. Da diese Nerven an der Rückseite des
Bauchraumes und des Brustkorbes entlang
laufen, treten die meisten Neuroblastome
im Bauch-, Becken-, Brust- oder Halsbereich
auf. Mehr als die Hälfte dieser Erkrankungen
gehen von der Nebenniere aus.
ÖGKJ
Österreichische Gesellschaft für
Kinder- und Jugendheilkunde
Onkogen1
So genanntes Geschwulst-erzeugendes
Gen, dessen Produkt (Onkoprotein) an
der Kontrolle normaler Wachstums- und
Differenzierungsprozesse beteiligt ist.
Onkogenvervielfachung,
Onkogenamplifikation
Vervielfachung eines Geschwulsterzeugenden
Tumorgens, d.h. Gene, die unter bestimmten
Voraussetzungen gesunde Zellen in Tumorzellen umwandeln.
ÖQUASTA
Österreichische Gesellschaft für
Qualitätssicherung und Standardisierung
medizinisch-diagnostischer Untersuchungen
Pathogen1
Im engeren Sinne bezeichnet die Pathogenität
in der Mikrobiologie die Fähigkeit einer mikro
biellen Spezies (Bakterium, Virus, Protozoen),
genannt das Pathogen, bei einem bestimmten
Wirt als Krankheitserreger eine Erkrankung
hervorrufen zu können.
Pathogenese1
Entstehung und Entwicklung von Krankheiten
PCR-Methode2
Mithilfe der PCR (Polymerase Kettenreaktion)
lassen sich geringste Mengen kurzer DNA
Abschnitte im Reagenzglas enzymatisch so
stark vervielfachen, dass sie mit einfachen
Mitteln sichtbar gemacht werden können.
Mit jedem Reaktionszyklus verdoppelt sich
die Menge der Moleküle. Aus der Anzahl der
zur Sichtbarmachung notwendigen Zyklen
lässt sich daher auf die Ausgangsmenge der
Moleküle schließen. Ein Anwendungsgebiet
der PCR in der Medizin ist der Nachweis
submikroskopischer Mengen verstreuter
Tumorzellen (minimal disseminierte oder
Resterkrankung). Aber auch mikrobielle
Infektionen können schon lange vor dem
Auftreten klinischer Symptome mittels der
PCR nachgewiesen werden. Da die PCR
auf der Vervielfachung individueller DNASequenzen basiert, werden PCR-basierende
Methoden auch zur Charakterisierung von
Mutationen und für gentechnologische
Zwecke eingesetzt.
Prognostische Biomarker
Siehe 9 Biomarker
Proteinexpression2
Darunter versteht man im engeren Sinne die
Biosynthese von Proteinen – Eiweißkörpern,
den Hauptbausteinen aller Zellen – aus den
genetischen Informationen. Im weiteren
Sinne bezeichnet Proteinexpression auch
die Summe der Merkmale einer Zelle auf
Eiweißbasis.
Resistenz1
Unempfindlichkeit von Krebszellen oder
Pathogenen gegenüber bestimmten
Medikamenten
Rezidiv1
Rückfall, Wiederauftreten einer
Erkrankung nach Heilung
Seneszenz, Tumorseneszenz1
Das zelluläre Altern und die dadurch
bedingten zellulären Veränderungen;
das Altern der Tumorzellen
Septische Granulomatose3
Die Septische Granulomatose ist eine sehr
seltene Erbkrankheit, bei der die Funktion der
neutrophilen Granulozyten gestört ist. Diese
auch als Fresszellen bezeichneten weißen
Blutkörperchen können daher ihren Beitrag
zur Immunabwehr nicht erfüllen. Dies hat zur
Folge, dass sich Krankheitserreger, speziell
pathogene Bakterien und Pilze, ohne ständige
medikamentöse Behandlung weitgehend
ungehindert im Körper der Betroffenen ausbreiten können, was häufig zu Granulomen an
unterschiedlichsten inneren Organen und im
Bereich der Haut und in der Folge zum frühen
Tod führt.
SIOPEN-R-NET
Website: www.siopen-r-net.org
Internationale Gesellschaft des Europäischen
pädiatrisch-onkologischen NeuroblastomForschungsnetzwerks, International
Society of Paediatric Oncology European
Neuroblastoma Research Network
Solider Tumor1
Feste (solide), örtlich umschriebene Zunahme
von körpereigenem Gewebe. Solide Tumoren
können von verschiedenen inneren Organen
bzw. der Haut ausgehen und gut- oder
bösartig sein. Die häufigsten soliden Tumoren
im Kindes- und Jugendalter sind die Hirn
tumoren, gefolgt von Neuroblastomen und
Sarkomen der Weichteile bzw. der Knochen.
SOPs
Standardvorgehensweisen, Standard
Operating Procedures
Spender-gegen-Empfänger Krankheit1
Nach hämatopoietischer Stammzelltransplantation (HSZT) kann das Immunsystem
des Spenders unerwünschte Immun
reaktionen gegen Organe des Empfängers
(= des Patienten) auslösen. Man bezeichnet
diese schweren bis lebensbedrohlichen
Komplikationen als Spender-gegen-Empfänger
Krankheit, im Englischen als Graft-versushost-disease (GvHD).
Therapieoptimierungsstudien (TOS)1
Kontrollierte klinische Studie, die der
optimalen Behandlung der Patienten und
gleichzeitig der Verbesserung und Weiter
entwicklung der Behandlungsmöglichkeiten
dient. Die Therapieoptimierung ist dabei
nicht nur auf eine Verbesserung der Heilungs
aussichten, sondern auch auf eine Begrenzung behandlungsbedingter Nebenwirkungen
und Spätfolgen ausgerichtet. Fast alle Kinder
und Jugendlichen in den europäischen
Industrieländern werden im Rahmen von
Therapieoptimierungsstudien behandelt.
T-Lymphozyten (T-Zellen)1
Unterform der Lymphozyten; entwickeln
sich erst im Knochenmark und dann im
Thymus und sind für die so genannte zelluläre
Immunantwort verantwortlich; spielen eine
wichtige Rolle bei der direkten Abwehr von
Virus- und Pilzinfektionen und steuern die
Aktivitäten anderer Abwehrzellen (z.B. der
Granulozyten).
Transkriptionsfaktoren1
Körpereigenes Eiweiß, das an der Über
tragung der in der DNA gespeicherten
genetischen Information in RNA
( Transkription) mitwirkt.
Trimed Biotech GmbH2
Die Biotechnologiefirma Trimed wurde im
Jahr 2003 als 100-prozentige Tochter des
St. Anna Kinderkrebsforschungsinstitutes
mit dem Ziel gegründet, die Methode der
Krebsimmuntherapie (Krebsimpfung)
mittels Impfstoff weiterzuentwickeln. Dieser
Krebsimpfstoff wurde im Jahr 2000 unter
der Leitung von Doz. Dr. Thomas Felzmann
im Rahmen einer klinischen Pilotstudie im
St. Anna Kinderspital bei Patienten erstmals
eingesetzt. In den Folgejahren wurden
weitere Pilotstudien durchgeführt. Die
St. Anna Kinderkrebsforschung erhielt für
diese Technologie im Jahr 2003 die Patentrechte in allen wichtigen Industrieländern.
2006 zog sich das St. Anna Forschungs
institut aus der Trimed zurück. Die Mehrheit
der Trimed hat die österreichische Pharmafirma AOP Orphan Pharmaceuticals AG inne.
Sie finanziert seither die klinische Entwicklung
des Krebsimpfstoffes.
Tumorgenomanalysen2
Um genomische Tumorzellveränderungen
sichtbar zu machen, wird eine Reihe von
verschiedenen Techniken angewandt. Diese
Verfahren werden unter dem Terminus
„Tumorgenomanalysen“ zusammengefasst.
Tumorzellalterung
Siehe 9 Seneszenz
Quellen
� Kompetenznetz Pädiatrische Onkologie
und Hämatologie (KPOH)
Charité – Universitätsmedizin Berlin,
Augustenburger Platz 1, D-13353 Berlin
www.kinderkrebsinfo.de
[email protected]
2 St. Anna Kinderkrebsforschung
3 Wikipedia, freie Online Enzyklopädie
176–177
Myelodysplastisches Syndrom (MDS)1
bei Kindern sehr seltene Erkrankung des Blut
bildenden Systems im Knochenmark; führt
ähnlich einer Leukämie zu einer Störung der
Blutbildung und infolgedessen zu Anämie,
erhöhter Blutungsneigung und/oder Infekt
anfälligkeit; geht fast immer in eine akute
myeloische Leukämie (AML) über.
Leukozyten2
Weiße Blutkörperchen(Leukozyten) wehren im
Körper Infektionen ab und bekämpfen diese.
Man unterscheidet drei Arten: Granulozyten
(60–70%), Lymphozyten (20–30%) und
Monozyten (2–6% der Leukozyten im Blut).
Sie werden hauptsächlich im Knochenmark
gebildet. Leukämien entstehen dann, wenn
der normale Reifeprozess der weißen
Blutkörperchen aus bisher unbekannten
Gründen unterbrochen wird, und sich die
noch unreifen weißen Blutzellen (Blasten)
explosionsartig vermehren. Vermehren sich
diese Blasten im Knochenmark, ohne ihrer
eigentlichen Aufgabe, normale Blutzellen zu
bilden, gerecht zu werden, ist die Folge ein
Abfall von roten und weißen Blutkörperchen
sowie Blutblättchen.
Publisher
St. Anna Kinderkrebsforschung e.V.
Zimmermannplatz 10, A-1090 Vienna
www.ccri.at
Herausgeber
Zimmermannplatz 10, A-1090 Wien
www.ccri.at, www.kinderkrebsforschung.at
Contact
Marion Zavadil, MA
Secretariat of the institute
[email protected]
Kontakt
Mag. Marion Zavadil
Institutssekretariat
[email protected]
Responsibility for Scientific Content
Scientific Director
[email protected]
Verantwortlich für den wissenschaftlichen Inhalt
Wissenschaftlicher Direktor
[email protected]
Responsibility for Business-Related Content
Financial & Administrative Director
Head of Research Support
[email protected]
Verantwortlich für den kaufmännischen Inhalt
Kaufmännische Leitung,
Leitung des Research Support Office
[email protected]
Text Editor & Project Management
Science Communications
[email protected]
Redaktion & Projektmanagement
Wissenschaftskommunikation
[email protected]
Art Direction & Design
Lichtwitz Leinfellner visuelle Kultur KG
Konzeption und Gestaltung
Lichtwitz Leinfellner visuelle Kultur KG
Photography
Gerhard Wasserbauer
Fotografie
Gerhard Wasserbauer
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Download of the Scientific Report PDF file:
www.ccri.at
Download des Forschungsbericht-PDFs:
www.ccri.at
We would like to express our gratitude to:
Alisa Alspach, Nuno Andrade, Michaela
Artwohl, Barbara Brunmair, Markus Hölzl,
Andrea Inthal, Ruth Joas, Birgit Jürgens,
Waltraud Kail, Julia Krahmer, Florian Kromp,
Michaela Nesslböck, Ulrike Pötschger,
Sandra Preuner, Dieter Printz, Margit Rauch,
Angela Schumich, Karin Stummer,
Susanne Wieczorek, Marion Zavadil.
Großer Dank gilt folgenden Personen:
Alisa Alspach, Nuno Andrade, Michaela
Artwohl, Barbara Brunmair, Markus Hölzl,
Andrea Inthal, Ruth Joas, Birgit Jürgens,
Waltraud Kail, Julia Krahmer, Florian Kromp,
Michaela Nesslböck, Ulrike Pötschger,
Sandra Preuner, Dieter Printz, Margit Rauch,
Angela Schumich, Karin Stummer,
Susanne Wieczorek, Marion Zavadil.
Many thanks to Dilek, Florian, Stefan
and Patricia, patients of the St. Anna
Children’s Hospital.
Des Weiteren möchten wir uns bei folgenden
PatientInnen des St. Anna Kinderspitals
bedanken: Dilek, Florian, Stefan und Patricia.
Bank Account
Bankverbindung
Bank Austria, BLZ 12000
Konto: 00 656 166 600
IBAN: AT 79 12000 00656166600
BIC: BKAUATWW
Bank Austria, BLZ 12000
Konto: 00 656 166 600
IBAN: AT 79 12000 00656166600
BIC: BKAUATWW
Further details:
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Weitere Details:
Seite 153
www.ccri.at
178–179
Support
Unterstützung
Imprint
Impressum
Dilek (16)
Das St. Anna Children’s Cancer Research Institute (CCRI)
betreibt grundlagenorientierte, translationale und klinische
Forschung, um die Diagnostik, Prognose und Behandlungs
möglichkeiten von Kindern und Jugendlichen mit verschie
denen Krebserkrankungen zu verbessern und ihnen innovative
Therapieoptionen zu ermöglichen.
Helmut Gadner, Institutsleiter
The St. Anna Children’s Cancer Research Institute (CCRI)
advances diagnosis, prognosis and treatment strategies for
children and adolescents suffering from cancer by conducting
basic laboratory, translational and clinical research into
the specific features of different paediatric cancers with the
aim to make the most innovative treatment options available
to young cancer patients.
Helmut Gadner, Director
www.ccri.at

St. Anna Children`s Cancer Research Institute Science Report 2009

Transcription

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