Granule cell precursors (GCPs) drive the major postnatal expansion of the cerebellum and are the cells of origin of sonic hedgehog medulloblastoma (SHH MB). Although GCPs are often treated as a uniform population, increasing evidence suggests they are heterogeneous, and whether specific subpopulations show distinct tumorigenic competence remains unclear. Here, we identified a rare Nestin-expressing GCP subpopulation in the normal early postnatal cerebellum and showed that it is spatially restricted, molecularly distinct and highly competent to form tumors. These cells are enriched in the posterior external granule layer and co-express Atoh1. Using different SHH MB mouse models, we showed that when this rare subpopulation of GCPs is targeted they can give rise to SHH MB with an efficiency comparable to targeting a larger number of Atoh1-expressing GCPs and that tumors derived from Nestin-expressing GCPs arise in the posterior-lateral cerebellum. Single cell RNA sequencing revealed that Nestin-expressing GCP have a transcriptome indicating reduced neuronal differentiation and enrichment for stem cell genes compared to bulk GCPs and more closely align with SHH MB cells. Together, our findings reveal functionally important heterogeneity within the GCP lineage and suggest that SHH MB arises preferentially from a small subpopulation of GCPs that express Nestin.

A third of patients with the pediatric cerebellar tumor Medulloblastoma (MB) have mutations that activate Sonic hedgehog (SHH) signaling (SHH-MB subgroup). The contribution of secondary mutations to tumor severity, however, is not clear. PTEN mutations are enriched in the SHH-1 subtype that has the lowest survival rate. Widespread heterozygous loss of Pten in two SHH-MB mouse models increases penetrance and accelerates onset of differentiated tumors. We delineated cellular and transcriptional changes that accelerate tumor growth and cause differentiation using a sporadic SHH-MB mouse model expressing oncogenic SmoM2 in rare cerebellar granule cell precursors (GCPs) and scRNA-seq analysis. Homozygous but not heterozygous sporadic loss of Pten resulted in rapid acceleration of tumor growth and end-stage disease by 40 days, compared to ~25% survival in control SmoM2 mice at 100 days. Heterozygous PTEN mutations, therefore, should negatively impact disease outcome primarily with germline mutations. Loss of Pten in normal or SmoM2-expressing GCPs increased proliferation and enhanced progenitor state initially, but by 12 days Pten mutant SmoM2 tumors were highly differentiated due to increased survival of non-proliferating GCPs. Furthermore, macrophage infiltration and cytotoxicity appeared reduced in differentiated regions of tumors lacking Pten, indicating cell nonautonomous changes could also contribute to accelerated tumor growth.

Decreased brain levels of coenzyme Q10 (CoQ10), an endogenously synthesized lipophilic antioxidant1,2, underpin encephalopathy in primary CoQ10 deficiencies3,4 and are associated with common neurodegenerative diseases and the ageing process5,6. CoQ10 supplementation does not increase CoQ10 pools in the brain or in other tissues. The recent discovery of the mammalian CoQ10 headgroup synthesis pathway, in which 4-hydroxyphenylpyruvate dioxygenase-like protein (HPDL) makes 4-hydroxymandelate (4-HMA) to synthesize the CoQ10 headgroup precursor 4-hydroxybenzoate (4-HB)7, offers an opportunity to pharmacologically restore CoQ10 synthesis and mechanistically treat CoQ10 deficiencies. To test whether 4-HMA or 4-HB supplementation promotes CoQ10 headgroup synthesis in vivo, here we administered 4-HMA and 4-HB to Hpdl-/- mice, which model an ultra-rare, lethal mitochondrial encephalopathy in humans. Both 4-HMA and 4-HB were incorporated into CoQ9 and CoQ10 in the brains of Hpdl-/- mice. Oral treatment of Hpdl-/- pups with 4-HMA or 4-HB enabled 90-100% of Hpdl-/- mice to live to adulthood. Furthermore, 4-HB treatment stabilized and improved the neurological symptoms of a patient with progressive spasticity due to biallelic HPDL variants. Our work shows that 4-HMA and 4-HB can modify the course of mitochondrial encephalopathy driven by HPDL variants and demonstrates that CoQ10 headgroup intermediates can restore CoQ10 synthesis in vivo.

The neonatal mouse cerebellum shows remarkable regenerative potential upon injury at birth, wherein a subset of Nestin-expressing progenitors (NEPs) undergoes adaptive reprogramming to replenish granule cell progenitors that die. Here, we investigate how the microenvironment of the injured cerebellum changes upon injury and contributes to the regenerative potential of normally gliogenic-NEPs and their adaptive reprogramming. Single-cell transcriptomic and bulk chromatin accessibility analyses of the NEPs from injured neonatal cerebella compared to controls show a temporary increase in cellular processes involved in responding to reactive oxygen species (ROS), a known damage-associated molecular pattern. Analysis of ROS levels in cerebellar tissue confirms a transient increase 1 day after injury at postnatal day 1, overlapping with the peak cell death in the cerebellum. In a transgenic mouse line that ubiquitously overexpresses human mitochondrial catalase (mCAT), ROS is reduced 1 day after injury to the granule cell progenitors, and we demonstrate that several steps in the regenerative process of NEPs are curtailed, leading to reduced cerebellar growth. We also provide preliminary evidence that microglia are involved in one step of adaptive reprogramming by regulating NEP replenishment of the granule cell precursors. Collectively, our results highlight that changes in the tissue microenvironment regulate multiple steps in adaptive reprogramming of NEPs upon death of cerebellar granule cell progenitors at birth, highlighting the instructive roles of microenvironmental signals during regeneration of the neonatal brain.

The major cause of treatment failure and mortality among medulloblastoma patients is metastasis intracranially or along the spinal cord. The molecular mechanisms driving tumor metastasis in Sonic hedgehog-driven medulloblastoma (SHH-MB) patients, however, remain largely unknown. In this study we define a tumor suppressive role of KMT2D (MLL2), a gene frequently mutated in the most metastatic beta-subtype. Strikingly, genetic mouse models of SHH-MB demonstrate that heterozygous loss of Kmt2d in conjunction with activation of the SHH pathway causes highly penetrant disease with decreased survival, increased hindbrain invasion and spinal cord metastasis. Loss of Kmt2d attenuates neural differentiation and shifts the transcriptional/chromatin landscape of primary and metastatic tumors toward a decrease in differentiation genes and tumor suppressors and an increase in genes/pathways implicated in advanced stage cancer and metastasis (TGF beta, Notch, Atoh1, Sox2, and Myc). Thus, secondary heterozygous KMT2D mutations likely have prognostic value for identifying SHH-MB patients prone to develop metastasis.

The developmental gene OTX2 is expressed by cerebellar granule cell precursors (GCPs), a cell population which undergoes massive expansion during the early postnatal period in response to sonic hedgehog (Shh). GCPs are thought to be at the origin of most medulloblastomas, a devastating paediatric cancer that arises in the developing cerebellum. OTX2 is overexpressed in all types of medulloblastomas, except in Shh-dependent type 2 medulloblastomas, although it has GCPs as cell-of-origin. This has led to the current view that OTX2 is not involved in tumorigenesis of this subgroup. How OTX2 might contribute to normal or tumoral GCP development in vivo remains unresolved. Here, we have investigated, for the first time, the physiological function of this factor in regulating proliferation and tumorigenesis in the developing mouse cerebellum. We first characterized Otx2-expressing cells in the early postnatal cerebellum and showed that they represent a unique subpopulation of highly proliferative GCPs. We next performed in vivo loss-of-function analysis to dissect out the role of Otx2 in these cells and identified a novel, Shh-independent, function for this factor in controlling postnatal GCP proliferation and cerebellum morphogenesis. Finally, we addressed the function of Otx2 in the context of type 2 medulloblastomas by directing Shh-dependent tumour formation in Otx2+ cells of the developing cerebellum and assessing the effects of Otx2 ablation in this context. We unravel an unexpected, mandatory function for Otx2 in sustaining cell proliferation and long-term maintenance of these tumours in vivo, therefore bringing unpredicted insight into the mechanisms of type 2 medulloblastoma subsistence. Together, these data pinpoint, for the first time, a crucial Shh-independent role for Otx2 in the control of proliferation of normal and tumoral granule cell precursors in vivo and make it an attractive candidate for targeted therapy in Shh-dependent medulloblastomas.

Choroid plexus carcinomas (CPCs) are highly malignant brain tumours predominantly found in children and associated to poor prognosis. Improved therapy for these cancers would benefit from the generation of animal models. Here we have created a novel mouse CPC model by expressing a stabilised form of c-Myc (MycT58A) and inactivating Trp53 in the choroid plexus of newborn mice. This induced aberrant proliferation of choroid plexus epithelial cells, leading to aggressive tumour development and death within 150 days. Choroid plexus tumours occurred with a complete penetrance in all brain ventricles, with prevalence in the lateral and fourth ventricles. Histological and cellular analysis indicated that these tumours were CPCs resembling their human counterparts. Comparison of gene expression profiles of CPCs and non-neoplastic tissues revealed profound alterations in cell cycle regulation and DNA damage responses, suggesting that dysregulation of cell division and DNA checkpoint pathways may represent key vulnerabilities. This novel animal model of CPC provides an invaluable tool to elucidate the mechanism of CPC formation and to develop successful therapies against this devastating paediatric cancer.

OPEN ACCESS This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http:// creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com C plexus carcinomas (CPCs) are World Health Organization [WHO] grade III brain tumors predominantly found in children (1,2). Implementation of successful therapy for CPCs has been hampered by the lack of appropriate preclinical models. Here we review the Otx2+; Rosa; Trp novel CPC mouse model we recently generated, and compare it to existing models (Table 1). CPCs derive from the choroid plexus (CP), a secretory epithelium of the lateral, third and fourth brain ventricles that is essential for the formation and maintenance of the brain through production of the cerebrospinal fluid (3,4). These highly malignant tumors are characterized by large chromosomal alterations, confusing the identification of the genes actually involved in tumorigenesis (5-7). CPCs have been associated to TP53 germline and somatic mutations, and more recently to c-MYC overexpression, suggesting that these genetic alterations play a crucial role in CPC tumorigenesis (8-10). Improved therapy for these cancers depends on the generation of animal models closely reproducing the genetics of human tumor susceptibility, which can then be used to study tumor biology and for preclinical testing. CPCs were initially observed in transgenic mice expressing SV40 large T antigen, which alters Trp53 and retinoblastoma (Rb) function (11-13). These mice developed various choroid plexus tumors (carcinomas but also benign papillomas) with different latency and incidence rates. However, these models did not allow spatial or temporal control of genetic alterations. More recently, refined approaches were used to incorporate conditional genetic alterations in specific tissues and/or with temporal control. In 2015, Tong et al. generated two novel mouse models of CP tumors by in utero electroporation of a Cre recombinase-expressing plasmid into the fourth ventricle of Trp53; Rb or Trp53; Rb; Pten embryos (14). This provoked the formation of CPCs similar to human tumors in 10% and 38% of the cases, respectively, and led to the identification of a group of three oncogenes concurrently gained in CPCs: TAF12, NFYC and RAD54L, which might favour tumoral progression by promoting aberrant DNA repair and epigenome remodelling. In 2017, Kawauchi et al. (15) used a similar approach to conditionally overexpress c-Myc and inactivate Trp53 in various embryonic subpopulations via in utero electroporation of BlbpCre/+ and Atoh1 embryos. Although these models were initially designed to get type 3 medulloblastomas (MBs), another paediatric cancer with frequent overexpression of c-Myc, CPC were frequently observed in both genetic backgrounds. This was attributed to partial expression of the Cre-genetic drivers in choroid plexus cells, in addition to cerebellar precursors from which MBs normally occur. Interestingly, although tumoral development occurred with a total penetrance in these systems, CPC and MB were never obtained in the same animal, suggesting that inhibitory mechanisms might come into play between these two types of tumors. Lately, we designed a new genetically-engineered mouse model of CPC (16). In this model, expression of a stabilised form of c-Myc (MycT58A) and ablation of Trp53 can be induced by an Otx2-driven, tamoxifen-inducible Cre recombinase (Otx2; Rosa; Trp53). This system enables to target the two genetic alterations most frequently observed in human CPCs directly into the choroid plexus of all brain ventricles, and at any development stage, since Otx2 is strongly expressed in all choroid plexuses from embryogenesis till adulthood (16). In contrast, electroporation is restricted temporally to specific embryonic stages (E12.5-E13.5) and spatially to choroid plexus of the fourth ventricle. Induction of these alterations in A new mouse model for c-Myc induced choroid plexus carcinoma

Les médulloblastomes (MB) sont les tumeurs cérébrales les plus fréquentes en pédiatrie. Ils apparaissent le plus souvent au niveau du cervelet. Ils peuvent être stratifiés en quatre groupes : les groupes WNT et SHH, où ces voies de signalisation sont altérées, et les groupes 3 et 4, présentant des anomalies chromosomiques et amplifications multiples, dont c-Myc (groupe 3) et N-Myc (groupe 4). L’une des altérations génétiques les plus retrouvées dans les MB est la surexpression du facteur de transcription OTX2. Ce facteur est exprimé dans les précurseurs des cellules granulaires (GCP) du cervelet, cellules d’origine de la majorité des MB. Pendant la période périnatale, les GCP subissent une phase de prolifération très intense en réponse au mitogène Sonic Hedgehog (SHH), ce qui les rendrait particulièrement sensibles à la tumorigenèse. Au cours de cette thèse, nous nous sommes intéressé à la fonction d’Otx2 dans ces GCP. Nous avons montré que l’ablation conditionnelle d’Otx2 conduit à un défaut de prolifération des ces cellules. L’analyse approfondie de ce phénotype a permis de révéler qu’Otx2 stimule la prolifération des GCP parallèlement à la voie de signalisation Shh. Par ailleurs, l’ablation d’Otx2 dans un modèle murin mimant la formation de MB Shh-dépendants a montré qu’Otx2 s’avère indispensable pour leur maintien à long terme. En parallèle, nous avons tenté de créer un nouveau modèle murin mimant la formation de MB de groupe 3 en induisant l’expression, pendant la période postnatale, d’un dominant actif de c-Myc dans les cellules exprimant Otx2. Cette approche a donné des résultats inattendus : des carcinomes de plexus choroïdes, et non des MB, ont été obtenus.

SummaryThe Otx2 homeodomain transcription factor exerts multiple functions in specific developmental contexts, probably through the regulation of different sets of genes. Protein partners of Otx2 have been shown to modulate its activity. Therefore, the Otx2 interactome may play a key role in selecting a precise target‐gene repertoire, hence determining its function in a specific tissue. To address the nature of Otx2 interactome, we generated a new recombinant Otx2CTAP‐tag mouse line, designed for protein complexes purification. We validated this mouse line by establishing the Otx2 interactome in the adult neural retina. In this tissue, Otx2 is thought to have overlapping function with its paralog Crx. Our analysis revealed that, in contrary to Crx, Otx2 did not develop interactions with proteins that are known to regulate phototransduction genes but showed specific partnership with factors associated with retinal development. The relationship between Otx2 and Crx in the neural retina should therefore be considered as complementarity rather than redundancy. Furthermore, study of the Otx2 interactome revealed strong associations with RNA processing and translation machineries, suggesting unexpected roles for Otx2 in the regulation of selected target genes all along the transcription/translation pathway. The Otx2CTAP‐tag line, therefore, appears suitable for a systematic approach to Otx2 protein–protein interactions. genesis 53:685–694, 2015. © 2015 Wiley Periodicals, Inc.