Introduction
Treatment after induction and prognosis of High-Risk (HR) neuroblastoma (NB) patients depends on their response to a two-month induction-chemotherapy. Unfortunately, there is no early predictive molecular indicator of sensitivity/resistance to treatment. Circulating exosomes are small vesicles which may represent the molecular bioprint of the tumor cells in liquid biopsies. We investigated whether exosomal miRNAs (Exo-miRs) could be an early biomarker of the response to induction-chemotherapy.
Methods
Exosomes were collected before and after the induction-therapy from plasma samples of 50 HR-NB-patients. Exo-miRs expression was measured by RTqPCR on a 381 miRNA panel. Data analyses included feature selection and pathway analysis.
Results
The expression of 24 exo-miRs was significantly modulated (p<0.05, fold-change>1.5) in response to chemotherapy, providing the first indication that exo-miRs may serve as biomarker of the chemotherapic response. Cluster analysis demonstrated that the response to induction was heterogeneous and distinguished at least two groups of patients that may reflect distinct biological and clinical features. Pathway analysis determined whether chemotherapy affected the expression of miRNAs known to be involved in sensitivity/resistance to drugs commonly employed in the induction-chemotherapy. The analysis revealed that 42% of the 24 differentially expressed exo-miRs were associated with sensitivity/resistance to drug response. Mapping the results to individual patients, we clearly identified distinct groups of subjects totally or partially unresponsive/resistant to the induction drugs. The exo-miR profile in the middle phase of the induction therapy is under investigation to find miRNAs possible predictors of the response and that may allow a timely change in the induction protocol for those patients that do not respond to treatment.
Conclusions
We obtained the proof of principle that exo-miRs can represent biomarkers and indicators of sensitivity/resistance to specific drugs for patients with HR-NB. These results pave the way to a broad application of exo-miRs in liquid biopsies applied to neuroblastoma targeted treatment.