title: Evolution of VHL tumourigenesis in nerve root tissue.
abstract: Haemangioblastomas are the key central nervous system manifestation of von Hippel-Lindau (VHL) disease, which is caused by germline mutation of the VHL gene. We have recently shown that 'tumour-free' spinal cord from patients with VHL disease contains microscopic, poorly differentiated cellular aggregates in nerve root tissue, which we descriptively designated 'mesenchymal tumourlets'. Here we have investigated spinal cord tissue affected by multiple tumours. We show that a small subset of mesenchymal tumourlets extends beyond the nerve root to form proliferative VHL-deficient mesenchyme and frank haemangioblastoma. We thus demonstrate that tumourlets present potential, but true precursor material for haemangioblastoma. We further show that intraradicular tumourlets consist of scattered VHL-deficient cells with activation of HIF-2alpha and HIF-dependent target proteins including CAIX and VEGF, and are associated with an extensive angiogenic response. In contrast, activation of HIF-1alpha was only observed in the later stages of tumour progression. In addition, ultrastructural examination reveals gradual transition from poorly differentiated VHL-deficient cells into vacuolated cells with a 'stromal' cell phenotype. The evolution of frank haemangioblastoma seems to involve multiple steps from a large pool of precursor lesions.
authors.affiliation: Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20892, USA. vortmeyer@ninds.nih.gov
authors.forename: A O
authors.initials: AO
authors.lastname: Vortmeyer
authors.forename: M G B
authors.initials: MG
authors.lastname: Tran
authors.forename: W
authors.initials: W
authors.lastname: Zeng
authors.forename: S
authors.initials: S
authors.lastname: Gläsker
authors.forename: C
authors.initials: C
authors.lastname: Riley
authors.forename: M
authors.initials: M
authors.lastname: Tsokos
authors.forename: B
authors.initials: B
authors.lastname: Ikejiri
authors.forename: M J
authors.initials: MJ
authors.lastname: Merrill
authors.forename: M
authors.initials: M
authors.lastname: Raffeld
authors.forename: Z
authors.initials: Z
authors.lastname: Zhuang
authors.forename: R R
authors.initials: RR
authors.lastname: Lonser
authors.forename: P H
authors.initials: PH
authors.lastname: Maxwell
authors.forename: E H
authors.initials: EH
authors.lastname: Oldfield
mesh_terms: D051792:Basic Helix-Loop-Helix Proteins / Q000378:metabolism; D002528:Cerebellar Neoplasms / Q000378:metabolism / Q000473:pathology; D018325:Hemangioblastoma / Q000378:metabolism / Q000473:pathology; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000378:metabolism; D007150:Immunohistochemistry / Q000379:methods; D017403:In Situ Hybridization / Q000379:methods; D008854:Microscopy, Electron / Q000379:methods; D009363:Neoplasm Proteins / Q000378:metabolism; D009389:Neovascularization, Pathologic / Q000473:pathology; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000276:immunology; D013120:Spinal Cord Neoplasms / Q000378:metabolism / Q000473:pathology*; D013126:Spinal Nerve Roots / Q000378:metabolism / Q000473:pathology*; D013234:Stem Cells / Q000473:pathology; D015854:Up-Regulation / Q000502:physiology; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D051794:Von Hippel-Lindau Tumor Suppressor Protein / Q000378:metabolism; D006623:von Hippel-Lindau Disease / Q000378:metabolism / Q000473:pathology*; D000099162:Endothelial PAS Domain-Containing Protein 1
chemical_list: D051792:Basic Helix-Loop-Helix Proteins; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D009363:Neoplasm Proteins; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D051794:Von Hippel-Lindau Tumor Suppressor Protein; D000099162:Endothelial PAS Domain-Containing Protein 1; C497446:VHL protein, human