US20110195975A1 - Materials and methods for suppressing and/or treating neurofibroma and related tumors - Google Patents

Materials and methods for suppressing and/or treating neurofibroma and related tumors Download PDF

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US20110195975A1
US20110195975A1 US12/996,891 US99689109A US2011195975A1 US 20110195975 A1 US20110195975 A1 US 20110195975A1 US 99689109 A US99689109 A US 99689109A US 2011195975 A1 US2011195975 A1 US 2011195975A1
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Wade D. Clapp
David Ingram
Feng-Chun Yang
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/14—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing three or more hetero rings

Definitions

  • Various aspects and embodiments disclosed herein relate generally to the modeling, treatment, prevention and diagnosis of diseases characterized by the formation of tumors, for example, neurofibroma.
  • NF1 tumor suppressor gene Mutations in the NF1 tumor suppressor gene cause neurofibromatosis type 1 (NF1), a common, widely distributed human genetic disorder that affects approximately 250,000 patients in the US, Europe, and Japan alone.
  • the NF1 gene encodes neurofibromin, a 320 kilodalton protein that functions, at least in part, as a GTPase activating protein (GAP) for p21ras.
  • GAP GTPase activating protein
  • Neurofibromin is highly conserved among vertebrate species and has high homology with its counterparts, yeast and Drosophila.
  • Some embodiments include methods of treating a patient having a form of neurofibromatosis, for example, plexiform neurofibroma, comprising the steps of: providing at least one therapeutically effective dose of a compound according to Formula 1:
  • R 1 is 4-pyrazinyl; 1-methyl-1H-pyrrolyl; amino- or amino-lower alkyl-substituted phenyl, wherein the amino group in each case is free, alkylated or acylated; 1H-indolyl or 1H-imidazolyl bonded at a five-membered ring carbon atom; or unsubstituted or lower alkyl-substituted pyridyl bonded at a ring carbon atom and unsubstituted or substituted at the nitrogen atom by oxygen; R 2 and R 3 are each independently of the other hydrogen or lower alkyl; one or two of the radicals R 4 , R 5 , R 6 , R 7 and R 8 are each nitro, fluoro-substituted lower alkoxy or a radical of formula II
  • R 9 is hydrogen or lower alkyl
  • X is oxo, thio, imino, N-lower alkyl-imino, hydroximino or O-lower alkyl-hydroximino
  • Y is oxygen or the group NH
  • n is 0 or 1
  • R 10 is an aliphatic radical having at least 5 carbon atoms, or an aromatic, aromatic-aliphatic, cycloaliphatic, cycloaliphatic-aliphatic, heterocyclic or heterocyclic-aliphatic radical, and the remaining radicals R 4 , R 5 , R 6 , R 7 and R 8 are each independently of the others hydrogen, lower alkyl that is unsubstituted or substituted by free or alkylated amino, piperazinyl, piperidinyl, pyrrolidinyl or by morpholinyl, or lower alkanoyl, trifluoromethyl, free, etherified or esterified hydroxy, free, alkylated or acy
  • the compound is a pharmaceutically acceptable salt of Formula 1, in some embodiment the pharmaceutically acceptable salt of Formula 1 is a mesylate salt.
  • Some other embodiments further include the step of; diagnosing a patent with plexiform neurofibroma or a similar condition. While still other embodiments include the step of identifying a patent at risk for developing plexiform neurofibroma or a similar condition.
  • the therapeutically effective dose of the compound according to Formula 1 is on the order of between about 200 mg to about 500 mg and the dose of the compound is administered to at patient at least once per day. In still other embodiments the therapeutically effective dose of the compound according to Formula 1, is on the order of between about 350 mg to about 450 mg and the dose of the compound is administered to at patient at least once per day. In some embodiment a patient is treated twice dialing with a therapeutically effective dose of the compound according to Formula 1, of about 400 mg.
  • Some embodiments include treating a patent having a form of neurofibromatosis, for example, plexiform neurofibroma, comprising the steps of: providing at least one therapeutically effective dose of a compound according to Formula 2:
  • Still other embodiments include a method of treating a patent having a form of neurofibromatosis, for example, plexiform neurofibroma, comprising the steps of: providing at least one therapeutically effective dose of a compound according to Formula 3:
  • Still other embodiments include the use of at least one compound according to Formulas (1), (2) or (3) or a pharmaceutically acceptable salt thereof for the preparation of a medicament for treating a patient having a form of neurofibromatosis, for example. plexiform neurofibroma.
  • FIG. 1A A schematic diagram of a strategy for examining the role of the hematopoietic microenvironment.
  • FIG. 1B Traces generated using fluorescence cytometry. Nf1 +/ ⁇ bone marrow is necessary for plexiform neurofibroma formation in Krox20; Nf1 flox/flox and Krox20; Nf1 flox/ ⁇ mice.
  • FIG. 2A A Kaplan-Meier plot of percent survival (y-axis) as a function of time (x-axis) is shown.
  • FIG. 2B Photographs of Krox20; Nf1 flox/flox mice transplanted with WT BM (1) or Nf1 +/ ⁇ BM (2-3).
  • FIG. 2C Photographs of dissections of dorsal root ganglia and peripheral nerves of Krox20; Nf1 flox/flox mice that were transplanted with WT or Nf1 +/ ⁇ bone marrow. Arrowheads identify tumors in dorsal root ganglia and in peripheral nerves.
  • FIG. 3A Hematoxylin and eosin (H&E) sections of dorsal root ganglia and proximal peripheral nerves.
  • FIG. 3B Photographs of 200 ⁇ magnification of sections stained with Masson's trichrome. The genotypes of donor bone marrow and recipient mice are indicated.
  • FIG. 3C 200 ⁇ magnification of sections stained with Alcian blue. Small arrowheads in Panels 2 and 3 identify mast cells. The large arrowheads in Panel 3 identify blood vessels.
  • FIG. 3D Bar graph showing the difference in the number of mast cells between different genotypes.
  • the lineages are isolated by FACS from tumors of Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ BM.
  • FIG. 3E Graphic presentation of phenotypic evaluation data of various bone marrow-derived lineages using fluorescence cytometry. Bone marrow (panel 1) and tumor cells (panel 2) were isolated and sorted for EGFP+ CD45.2 positive populations. Tumor associated CD45.2 cells were further separated to identify mast cell (panel 3), macrophage (panel 4), B-lymphocyte (panel 4) and T-lymphocyte populations. The proportion of each hematopoietic cell population within the tumor is indicated.
  • FIG. 3F Gel showing genotyping of lineages isolated by FACS from tumors of Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ BM. Arrowheads identify the amplified DNA products of the indicated alleles from the respective phenotypic lineages.
  • FIG. 4A A Kaplan-Meier plot of percent survival (y-axis) as a function of time (x-axis) is shown.
  • FIG. 4B Photographs of the spinal cord and dorsal roots of Krox20; Nf1 flox/flox mice transplanted with WT BM (panel 1) or Nf1 +/ ⁇ BM (panel 2). Arrowheads identify tumors in proximal nerves.
  • FIG. 4C Graph illustrating Dorsal Root Ganglia (DRG) size measured with donor cells of differing genotype.
  • FIG. 4D Photographs of representative histologic sections of dorsal root ganglia and proximal spinal nerves of Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ or Nf1 +/ ⁇ ; W/W mutant marrow.
  • FIG. 5A PET images illustrating effects of treating of Krox20; Nf1 flox/ ⁇ mice with imatinib mesylate.
  • FIG. 5B Graphic summary of changes in mean FDG-PET intensity after a 12 week treatment with imatinib mesylate or PBS.
  • FIG. 5C Graphic representation of the data collected by dissecting certain peripheral nerves.
  • FIG. 5D Photographs showing histological analysis of the Krox20; Nf1 flox/ ⁇ mice treated with imatinib mesylate or placebo.
  • FIG. 5E Bar graph showing mast cell Number/HPF plotted as a function of treatment with and without Imatnib mesylate.
  • FIG. 5F Bar graph showing the number of Tunnel Positive Cells/HPF plotted as a function of treatment with and without Imatnib mesylate.
  • FIG. 6 MRI scans of a patient with plexiform neurofibromas before and after treatment with imatinib mesylate.
  • FIG. 7 Ultrastructural analysis of dorsal root ganglia by transmission electron microscopy.
  • U unmyelinated axons
  • S indicates expansion of the endoneurial space. Arrowheads identify collagen bundles;
  • M indicates mast cells infiltrating the tumor.
  • FIG. 8 Photomicrographs of tissue sample taken from mice. These images illustrate the identification of plexiform neurofibromas using FDG-PET. FDG-PET images and dissection of spinal nerves of a Krox20; Nf1 flox/flox mouse and Krox20; Nf1 flox/ ⁇ mouse imaged at 9 months of age.
  • FIG. 9 Photomicrographs of a tissue samples stained with Toludine Blue and shown at 100 ⁇ and 600 ⁇ magnification, the arrows point to mast cells.
  • FIG. 10 Gel showing genotypic identification of DNA of individual myeloid progenitors isolated from bone marrow of irradiated Krox20; Nf1 flox/flox recipients transplanted with Nf1 +/ ⁇ ; Wv/Wv bone marrow.
  • FIG. 11A Identification of plexiform neurofibromas using FDG-PET.
  • FDG-PET images and dissection of spinal nerves of a Krox20; Nf1 flox/flox mouse and Krox20; Nf1 flox/ ⁇ mouse imaged at 9 months of age.
  • FIG. 11B Graph showing the mean intensity of FDG-PET from the sciatic nerve region of interests in Krox20; Nf1 flox/ ⁇ and Krox20; Nf1 flox/flox mice.
  • FIG. 11C Photographs of the representative dissections from the dorsal root ganglia from a Krox20; Nf 1flox/flox mouse (Panel 1) and Krox20; Nf 1flox/ ⁇ mice with PET positive tumors (Panels 2-4).
  • FIG. 12 Evaluation of apoptosis in plexiform neurofibromas using TUNEL following treatment with imatinib mesylate or placebo. Representative sections from plexiform neurofibromas treated with a placebo control (left Panel) or imatinib mesylate (right Panel). Arrowheads indicate TUNEL positive cells.
  • FIG. 13A MRI images, head and neck.
  • FIG. 13B Panels C, D: Axial MRI T2 weighted sequence images; before and after 6 months of treatment with imatinib mesylate respectively.
  • mouse models have been successfully used to study tumor development in humans.
  • genetic modeling is especially fruitful when human tumors are the consequence of a genetically inheritable trait that can be reduced to a single gene mutation such as in the case of Von Recklinghausens's Neurofibromatosis. Accordingly, some aspects of the instant invention teach a mouse model suitable for minimizing some forms of neurofibroma formation in humans.
  • Von Recklinghausen's Neurofibromatosis is a single gene disorder. In the vast majority of cases it is manifested by a germline mutation and complete somatic heterozygosity followed by a rare loss of heterozygosity in cell types that engender the stereotypic manifestations of this disease. Almost invariably in this disorder, tumors develop in the peripheral nervous system of the affected patient. Human tissue studies suggest a critical role for Schwann cells but these studies suffer from relying on a posteriori information to infer a preceding event. A conditional Nf1 knockout mouse model that permits tissue specific deletion of Nf1 has shed light on this process.
  • mice The power of mouse genetics reveals a critical role for a microenvironment that could, in distinct genetic configurations, be either tumor permissive or tumor resistant.
  • the data indicate that Nf1 heterozygosity outside the Schwann cell lineage is required for tumor formation.
  • mast cell infiltration into peripheral nerves appears in these mice months prior to the appearance of tumors, but not in the non tumorigenic Nf1 wild type ( flox/flox ) genotype.
  • Mast cells have been observed in human neurofibromas, although in the absence of a mouse model, examination of a functional role in tumor development or maintenance could not be directly studied.
  • results disclosed herein illustrate that the latter models depart from the physiological situation in humans with NF1 in which LOH is such a rare stochastic event that a nullizygous embryonic Schwann cell precursor arising in isolation is at a relative disadvantage in a microenvironment to develop into a tumor.
  • LOH is such a rare stochastic event that a nullizygous embryonic Schwann cell precursor arising in isolation is at a relative disadvantage in a microenvironment to develop into a tumor.
  • These mouse models indicate that an isolated nullizygous pocket of cells gain a significant selective advantage by apparent synergy with recruited heterozygous mast cells.
  • hyperplasia in robust Cre mediated recombination models reflects a nonphysiologic widespread loss of Nf1, not only in Schwann cells but also an additional Nf1 loss in additional lineages that may overcome the barriers of isolated LOH.
  • Neurofibromas form in association with peripheral nerves and are composed of Schwann cells, endothelial cells, fibroblasts, degranulating inflammatory mast cells, and pericytes/vascular smooth muscle cells (VSMCs) and contain large collagen deposits.
  • An Nf1 conditional knockout mouse model confirms retrospective studies from human tumors, demonstrating that Nf1 loss of heterozygosity (LOH) in the Schwann cell lineage appears to be necessary but not sufficient to elicit neurofibromas.
  • LHO heterozygosity
  • tumor progression requires complex interactions between Schwann cells and Nf1 haploinsufficient cell lineages in the tumor microenvironment.
  • Nf1 nullizygosity in Schwann cells may be necessary but not necessarily sufficient to cause tumor formation.
  • the c-Kit receptor has a central role in mast cell development and function.
  • Schwann cells and fibroblasts two principal components of neurofibromas, secrete kit-ligand in response to many different stimuli.
  • kit-ligand mRNA transcripts have been reported in neurofibroma tissue and it has been reported that NF 1 patients have elevated levels of kit ligand in their serum.
  • Imatinib mesylate an FDA-approved pharmacological agent was thought to act by inhibiting several tyrosine kinases including c-Kit.
  • Imatinib mesylate When tested for efficacy against neurofibroma in a mouse model for the disease, Imatinib mesylate exhibited an unexpected efficacy.
  • Administering therapeutically effective doses of the compound has a dramatic effect on the reversal of neurofibroma pathology.
  • Treatment with imatinib resulted in the disappearance of mast cells from the peripheral nerves in animals treated with this compound.
  • the in vivo studies identify a persisting requirement for imatinib mesylate responsive tumor maintenance.
  • mast cells release mediators of inflammation including histamine, serotonin, proteoglycans, and leukotrienes subsequent to activation of the high affinity IgE receptor (Fc ⁇ RI) and the c-kit receptor.
  • Fc ⁇ RI high affinity IgE receptor
  • mast cells reportedly release VEGF, an angiogenic factor that is also a potent proliferative, survival, and chemotactic factor for Schwann cells.
  • VEGF has also been linked to an angiogenic switch in tumor formation.
  • mast cells also release PDGF- ⁇ , a growth factor that promotes pericyte and fibroblast proliferation; and TGF- ⁇ , a growth factor that promotes fibroblast proliferation and collagen synthesis.
  • Imatinib mesylate and compounds of the same or similar families of compounds may fortuitously inhibit additional and/or other potentially critical tumor promoting activities in other tumor cell types. For instance, in addition to inhibiting c-Kit in mast cells, imatinib mesylate may decrease angiogenesis via PDGFR and reduce fibrosis/collagen production via c-Abl. Additional investigation may be required to resolve these critical and beautiful scenarios, in the interim, one observation is that an effective dose of this compound causes tumor regression in the mouse model for neurofibromas and in human patients affiliated with conditions such as plexiform neurofibromas.
  • R 1 is 4-pyrazinyl; 1-methyl-1H-pyrrolyl; amino- or amino-lower alkyl-substituted phenyl, wherein the amino group in each case is free, alkylated or acylated; 1H-indolyl or 1H-imidazolyl bonded at a five-membered ring carbon atom; or unsubstituted or lower alkyl-substituted pyridyl bonded at a ring carbon atom and unsubstituted or substituted at the nitrogen atom by oxygen; R 2 and R 3 are each independently of the other hydrogen or lower alkyl; one or two of the radicals R 4 , R 5 , R 6 , R 7 and R 8 are each nitro, fluoro-substituted lower alkoxy or a radical of formula II
  • R 9 is hydrogen or lower alkyl
  • X is oxo, thio, imino, N-lower alkyl-imino, hydroximino or O-lower alkyl-hydroximino
  • Y is oxygen or the group NH
  • n is 0 or 1
  • R 10 is an aliphatic radical having at least 5 carbon atoms, or an aromatic, aromatic-aliphatic, cycloaliphatic, cycloaliphatic-aliphatic, heterocyclic or heterocyclic-aliphatic radical, and the remaining radicals R 4 , R 5 , R 6 , R 7 and R 8 are each independently of the others hydrogen, lower alkyl that is unsubstituted or substituted by free or alkylated amino, piperazinyl, piperidinyl, pyrrolidinyl or by morpholinyl, or lower alkanoyl, trifluoromethyl, free, etherified or esterified hydroxy, free, alkylated or acy
  • the compounds of Formula 1 are generically and specifically disclosed in the U.S. Pat. No. 5,521,184, in particular in the compound claims and the final products of the working examples, the subject-matter of which is herein incorporated by reference in its entirety.
  • the radicals and symbols have the meanings as provided in U.S. Pat. No. 5,521,184, which is incorporated herein in its entirety.
  • Imatinib may be applied in the form of its mono-mesylate salt.
  • Imatinib mono-mesylate can be prepared in accordance with the processes disclosed in U.S. Pat. No. 6,894,051, which is herein incorporated by reference in its entirety. Comprised are likewise the corresponding polymorphs, e.g. crystal modifications, which are disclosed therein.
  • Imatinib mono-mesylate can be administered in dosage forms as described in U.S. Pat. No. 5,521,184, U.S. Pat. No. 6,894,051, US 2005/0267125 or WO2006/121941, all of which are incorporated herein in their entirety as if each were separately incorporated.
  • Imatinib mesylate 4-(4-methylpiperazin-1-ylmethyl)-N-[4-methyl-3-(4-(pyridin-3-yl)pyrimidin-2-ylamino)phenyl]-benzamide
  • Imatinib can, e.g., be prepared in accordance with the processes disclosed in WO03/066613.
  • One pharmaceutically acceptable salt of the compound is imatinib mesylate shown in Formula 3 as follows:
  • Imatinib mesylate is a potent inhibitor of the c-Kit, PDGF-BB, and e-abl tyrosine kinases. This compound is marketing in under the trademark protected name Gleevec. It has been approved in the United States for the treatment of patents with Kit-expressing (CD117+). According to the National Guideline Clearinghouse (www.guidline.gov) the initial recommended dose level in adult human patients in 400 mg administered twice daily. The actual therapeutically effective dosage is patient specific and to be determined by the prescribing physician based on various factors including the patients weight, age, gender, age, overall health and responsiveness to the drug.
  • mice model One limitation of the mouse model is the animal's short lifespan, given this one cannot predict on the basis of mouse studies how long-lived tumors might be expected to respond. However, these results with the mouse model strongly suggest that treatment with these compounds can and will have a beneficial effect on humans affected with some tumors. Additional support for this hypothesis comes from the unexpectedly good result when obtained when treatment of a human patient with imatinib mesylate successfully reduced the size of the tumor in the human patient.
  • non-cell autonomous contributors to a co-opted permissive process of tumor formation are neo-angiogenesis, participation of the local stroma, and inflammation among other cell types.
  • the understanding of the precise order of paracrine interactions, the relative importance, and the molecular basis of the nontumorigenic environment interaction, remains in infancy.
  • the therapeutic uses of the compounds disclosed herein are in no way limited by any of the hypothesized modes of action or proposed molecular etiologies of the various diseases or condition that can adventurously treated or controlled using the materials and/or methods described herein.
  • the instant disclosure provides an example of a physiologically relevant mouse model of a human cancer that provides concrete insights into complex interactions between a tumor cell of origin and the microenvironment. While, investigations using the mouse as a model for the human disease suggests a potential therapeutic approach for treating heretofore untreatable tumor by targeting the microenvironment for tumor formation rather than the tumorigenic cell. Because of the considerable cellular and physiological differences between human and mice, the efficacy of using compound such as imatinib mesylate to treat neurofibroma in humans can only be “proved” by successfully treating humans with the compound.
  • imatinib mesylate is thought to act directly on the leukemic cell and aimed at a mutated constitutively active tyrosine kinase oncoprotein (Bcr-abl).
  • Bcr-abl constitutively active tyrosine kinase oncoprotein
  • anti-c-kit agents such as imatinib mesylate on neurofibromas
  • WT proteins for which there may not be a ready route for the selection for drug resistance
  • bone marrow transplants were performed. Briefly, two million, syngeneic WT or Nf1 +/ ⁇ bone marrow cells from WT GFP or Nf1 +/ ⁇ GFP mice per recipient were adoptively transferred into young adult Krox20; Nf1 flox/flox mice and Krox20; Nf1 flox/ ⁇ mice after treating them with 1100 rads of ionizing radiation administered over two split doses.
  • [ 18 F] fluorodeoxyglucose ([ 18 F] FDG) PET and x-ray CT imaging were performed.
  • a template was placed over regions lateral to obtain on a standardized volume of interest (VOI) thereby enabling the researcher to quantify FDG uptake.
  • VOI volume of interest
  • Registered and overlaid CT image data was used to identify specific vertebrae (e.g., landmarks from L1 to S1). The operator then chose points along the spinal cord to determine the path of the spinal cord through between L1 and S1.
  • three circular regions-of-interest (ROI) are placed at interpolated points along the spinal cord to capture the spinal cord and the dorsal root ganglion regions.
  • FDG images are acquired at 45 minutes post injection of about 0.5-1.0 mCi of FDG via tail vein injection. All animals are given injections of FDG while awake and isoflurane anesthesia about 40 minutes post injection in order to immobilize the animals for imaging.
  • mice Immediately after sacrificing them postmortem mice are perfused and fixed in 4% paraformaldehyde. The dorsal root ganglia and peripheral nerves are then dissected out under a dissection microscope. Mice whose tissue will be analyzed by electron microscopy analysis are perfusion fixed with 2% paraformaldehyde, 2.5% glutaraldehyde, and 0.1M cacodylate (pH7.4).
  • an anatomic measurement of the dorsal root ganglia size is performed following measuring the largest possible width and length of the proximal dorsal root ganglia using a caliper.
  • the volume of tumors is determined by establishing the approximate volume for a spheroid (e.g. 0.52 ⁇ (width) 2 ⁇ length).
  • paraffin sections were stained with hematoxylin and eosin (H&E). Given collagen accounts for approximately 60% of the dry weight of human plexiform neurofibromas, the tissue sections were also stained with Masson trichrome. To determine the existing of mast cells in the tumors, Alcian blue staining was performed.
  • FIG. 1 the schematic illustrates the genotypes of recipient mice, the genotypes of adoptively transferred cells following ionizing radiation of the recipients, and measurements obtained following transplantation.
  • Nf1 heterozygous bone marrow into mice harboring two Krox20-Cre transgene ablated Nf1 alleles in approximately 10% of Schwann cells (Krox20; Nf1 flox/flox ).
  • Krox20; Nf1 flox/flox mice are functionally wild type in all cell lineages and no neurofibromas are observed.
  • WT bone marrow cells were transplanted into mice containing a germline nullizygous allele of Nf1 and a foxed allele susceptible to recombination in the Schwann cell lineage as above (Krox20; Nf1 flox/ ⁇ ).
  • Krox20; Nf1 flox/ ⁇ mice uniformly develop plexiform neurofibromas as previously described (Zhu et al., 2002).
  • a portion of the Nf1 +/ ⁇ or WT bone marrow was adoptively transferred into recipients following ionizing radiation, and the development of plexiform neurofibromas and mortality associated with these tumors was monitored until 1 year of age.
  • mice were sacrificed once they exhibited clear signs of major morbidity.
  • the Y-axis shows the percentage of the surviving mice.
  • FIG. 2C photographs of dissections of dorsal root ganglia and peripheral nerves of Krox20; Nf1 flox/flox mice transplanted with either WT or Nf1 +/ ⁇ bone marrow.
  • Arrowheads identify tumors in dorsal root ganglia and proximal peripheral nerves.
  • Necropsy of the brains and spinal cords of the morbid mice revealed that 21 of 22 Nf1 +/ ⁇ bone marrow transplant recipients had an increased thickness of the entire spinal cord as compared to the spinal cords of non-symptomatic mice transplanted with WT bone marrow. This abnormal morphology resembles that of the tumorigenic Krox20; Nf1 flox/ ⁇ mice.
  • FIG. 2C photomicrographs of the dorsal root ganglia of mice with different genetic compositions the arrowheads identify ganglia serving limbs that exhibit motor paralysis.
  • Panels 2 and 3 of FIG. 2C show the existence of discrete tumors arising from the dorsal root ganglia of Krox20; Nf1 flox/ ⁇ mice transplanted with Nf1 +/ ⁇ bone marrow and these tumors were particularly prevalent in the sciatic nerves.
  • Volumetric analysis of the tumors revealed a 3-6 fold increase in volume compared to unaffected dorsal root ganglia in mice that did not develop tumors.
  • Panels 1 and 6 are sections from a Krox20; Nf1 flox/flox mouse transplanted with WT BM.
  • Panels 2, 3, 7, 8 are from Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ BM.
  • Panels 4, 5, 9, 10 are from Krox20; Nf1 flox/ ⁇ mice transplanted with WT BM.
  • the photos in upper Panels were taken with a light microscopy under 100 ⁇ , whereas the photographs in the lower Panels were taken under 200 ⁇ .
  • FIG. 7 Panels 1-4, 750 ⁇ , Panels 5-8, 1500 ⁇ .
  • the nerves from either Krox20; Nf1 flox/flox or Krox20; Nf1 flox/ ⁇ mice transplanted with WT marrow exhibited normal appearing, evenly distributed, nuclei throughout sections of the dorsal root ganglia and proximal peripheral nerves, (see, for example, FIG. 3A , Panels 1, 4-6, and 9-10) and no evidence of collagen deposition.
  • Tumors isolated from Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ bone marrow have histologic features of plexiform neurofibromas.
  • Neurofibromas are complex tumors comprising multiple cell types in which LOH is uniquely present in Schwann cell lineage (Zhu et al., 2002). Mast cell infiltration is characteristic of human and murine plexiform neurofibromas (Zhu et al., 2002). In the murine model for this condition used herein, we observe peripheral nerve infiltration by mast cells preceding tumor appearance. Accordingly, the heterozygous bone marrow of reconstituted Krox20; Nf1 flox/flox mice also exhibited extensive mast cell infiltration ( FIG. 3C , Panels 2-3).
  • Fluorescence cytometry is used to purify the endothelial cells (CD31), fibroblasts (Col1A), and hematopoietic cells (c-Kit, CD117) in the neurofibromas of Krox20; Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ bone marrow.
  • arrowheads identify the amplified DNA products of the indicated alleles from the respective phenotypic lineages.
  • subsequent genotyping showed that only the c-Kit population, that also express Fc ⁇ RI (not shown), harbored the Nf1 null allele ( FIG. 3D ).
  • These data are consistent with the appearance of bona fide plexiform neurofibromas in the reconstituted Krox20; Nf1 flox/flox including homing of the transplanted heterozygous mast cells to the sites of Nf1 nullizygous Schwann cells.
  • bone marrow (BM) band 1- and tumor cells (panel 2) are isolated and sorted by EGFP+; CD45, 2 positive populations.
  • Tumor associated CD45.2 cells are further separated in order to mast cells (panel 3), macrophages (panel 4), B-lymphocytes (panel 4) and t-lymphocytes (panel 5).
  • the graphs indicate the populations of each hematoporetic cell population within the tumor.
  • FIG. 3F the genotypes of lineages isolated by FACS from tumors of Krox20; Nf1 flox/flox mice transfected with Nf1 +/ ⁇ Bone Marrow (BM).
  • the arrows in FIG. 3F point to bands on the gel formed by amplified DNA products of the identical alleles isolated from the indicated phenotypic lineages.
  • Nf1 +/ ⁇ bone marrow mediated tumor formation requires c-Kit.
  • Nf1 heterozygous cells detected in the reconstituted plexiform neurofibromas were derived from bone marrow. This finding is consistent with our previous in vitro and in vivo observations implicating a mast cell haploinsufficiency requirement in tumor formation.
  • the c-kit receptor tyrosine kinase (RTK) is thought to control many aspects of mast cell development and function.
  • RTK c-kit receptor tyrosine kinase
  • Nf1 +/ ⁇ bone marrow prevents the genesis of plexiform neurofibromas in recipient Krox20; Nf1 flox/flox mice.
  • Nf1 +/ ⁇ mice were independently intercrossed with two hypomorphic strains of mice that have inhibited mast cell mobilization by virtue of point mutations in the c-kit receptor that reduce kinase activity 85% (W41/W41) to 95% (Wv/Wv), respectively.
  • the bone marrow from either Nf1 +/ ⁇ ; Wv/Wv or Nf1 +/ ⁇ ; W41/W41 doubly mutant mice was transplanted into five and ten Krox20; Nf1 flox/flox mice respectively. Morbidity of mice engrafted with Nf1 +/ ⁇ ; W mutant marrow was significantly reduced as compared to Nf1 flox/flox mice transplanted with Nf1 +/ ⁇ bone marrow Krox20; Nf1 flox/flox mice were transplanted with Nf1 +/ ⁇ or Nf1 +/ ⁇ ; W mutant bone marrow were followed for 1 year. The genotypes and statistical significance between the two groups are indicated.
  • FIG. 4C a graph of the volume of individual dorsal root ganglia (DRG) from the sciatic nerves of Krox20; Nf1 flox/flox mice as a function of genotype are shown.
  • Each individual dot represents the volume of an individual DRG and the lines represent the mean volume from the respective experimental groups.
  • Recipients reconstituted with Nf1 +/ ⁇ bone marrow cells have significantly higher mean sciatic nerve DRG volumes than mice that were reconstituted with Nf1 +/ ⁇ bone marrow that also contains a mutation in the c-kit receptor that inactivates the c-kit pathway (Nf1 +/ ⁇ ; W/W).
  • FIG. 4D the sections shown in Panels 1-3 are H&E stained.
  • the sections in Panels 4-6 are stained with Alcian blue.
  • the arrow heads highlight mast cells.
  • the genotypes of the adoptively transferred bone marrow are indicated below the respective columns of Panels.
  • the regions of interest, the temporal sequence of scans in 3 individual mice, and the experimental treatment groups are identified.
  • FDG-PET imaging studies followed to evaluate the evolution of the tumors. Representative FDG-PET axial slices of affected nerves from three mice imaged before and after treatment with imatinib mesylate or PBS for three weeks are shown.
  • FIG. 5A Three dimensional ROIs in the shape of cylinders were utilized to encapsulate the areas lateral to the spinal column with the ROI cylinders and specific vertebrae landmarks from L1 to S1 were used in all cases to assure consistency.
  • FIG. 5B a summary of PET imaging results presented in graphic form for the sciatic nerve region ROIs of one cohort of 12 experimental mice are plotted. Overall, the mice treated with imatinib mesylate had a mean 50% reduction in FDG-PET uptake after treatment (p ⁇ 0.035).
  • FIG. 5D representative sections are shown following H&E staining, Alcian blue staining, and Masson's trichrome staining.
  • the experimental therapy, the stains utilized to prepare the specimens, is indicated on the left side of the figure.
  • the magnification of the images in each set of Panels is shown across the bottom of the figure.
  • samples shown in Panels 1-6 were obtained from mice treated with imatinib mesylate; samples shown in Panels 7-12 are obtained from mice treated with only a placebo.
  • the arrowheads in Panel 10 identify mast cells found on the respective sections.
  • FIG. 5D Panels 3, 4 vs. Panels 9, 10
  • the PET, gross anatomic and histological data identify the potential for imatinib mesylate to reduce tumor volume in Krox20; Nf1 flox/ ⁇ mice.
  • FIG. 5E a bar graph illustrating a dramatic difference in the number of mast cells between mice treated with imatinib and mice that were not treated with the compound.
  • FIG. 5F a bar graph illustrating a that there are fewer Tunnel Positive Cells/HPF in samples taken from mice treated with imatinib mesylate versus mice not treated with the compound.
  • Plexiform neurofibromas primarily present in infants and young children with NF1 are frequently characterized by rapid growth and invasion into adjacent organs often resulting in impairment of normal organ function. In addition, these tumors have a high likelihood of progressing to malignancy for which there is no cure. Even when benign, these tumors can be life threatening and present major clinical challenges as surgical treatment has limited effectiveness and there are no widely acceptable alternative therapies.
  • FIG. 6 evaluation of imatinib mesylate efficacy in an index patient with a plexiform neurofibroma.
  • the periphery of the tumor is traced in both Panels by a thick dark line.
  • MRI scans before and after three months of treatment revealed a remarkable approximately 70% reduction in tumor volume ( FIG. 6 ). Following treatment for six months with no observed side effects, the patient went off treatment for six months without a recurrence of symptoms.
  • the Panels in rows A, B are Coronal MRI T1 weighted STIR sequence images; pre-imatinib-mesylate (row A) and 6 months following treatment with imatinib mesylate, respectively (row B). These images demonstrate show evidence of a profound decrease in tumor size before and after treatment.

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