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Recent progress in the molecular stratification of medulloblastoma has revealed striking heterogeneity that has led to stratification into several genetically distinct clinical subgroups (WNT, SHH, Group 3, Group 4) which respond differently to current therapies [ 6].
Box plots showing relative expression of ARNT (A ) and GDI2 (B ) in normal adult cerebella (CB; n = 10) and medulloblastoma samples (n = 187) from the COG consortium profiled on Affymetrix exon arrays and classified according to molecular subtype (WNT, SHH, Group 3, Group 4).
As medulloblastoma has been classified into Wnt, sonic hedgehog (SHH), Group 3 and Group 4 subgroups, according to molecular features [169], SHH antagonists represent exciting novel prospects for treating a sub-set of medulloblastoma patients.
SHH, Group 3 and Group 4 MBs exhibited a higher H-Score compared to WNT and normal cerebellum.
The four principal subgroups of medulloblastoma were named as follows: Wnt, Shh, Group 3, and Group 4 (Fig. 2).
Discussants at the conference came to a consensus that the evidence supported the existence of four main subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4).
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As expected from previous subgrouping studies, the discordant cases involved switches between Group 3 and Group 4, while the WNT and SHH groups were clearly distinct (Fig. 1c, d).
Both WNT and SHH groups have been classified based on their characteristic activated oncogenic pathways, yet much less is known about the drivers of Group 3 and 4 MB [ 4, 5].
Meis1 expression was seen in both WNT and Shh groups.
Another more recent study even identified four subgroups within the Non-WNT/Non-SHH group with subgroups c2 and c4 corresponding to the previously identified subgroups C and D [ 9], respectively [ 1].
Other promising candidate drugs identified targeted BET bromodomains in MYC-driven tumors and DDX3X in WNT-group and SHH-group tumors.
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