Developing nerve cells outside the brain is where neuroblastoma, a common childhood disease, starts. Over 40 per cent of patients with high-risk neuroblastoma currently do not survive, despite the fact that patient's chances of survival have increased with more aggressive treatments.

A new treatment strategy for neuroblastoma may involve focusing on RNA alterations linked to the condition, according to recent study from the University of Chicago.

Researchers have shown in a new study that was published in Cell Reports that the proliferation of neuroblastoma cells was inhibited by a pharmacological molecule that is intended to block proteins that modify RNA transcripts. The medication appeared to be a promising therapeutic approach, as it also inhibited the growth of neuroblastoma tumours in the experimental models.

"High-risk neuroblastoma remains very difficult to cure with current approaches, and survivors are at high risk for treatment-related toxicities, including severe chronic health conditions and second cancers," said Susan Cohn, MD, Professor of Pediatrics, and senior author of the new study.

"We are testing a completely different therapeutic strategy using drugs that change gene expression by inhibiting RNA modifying proteins. If future studies validate our findings, this strategy may transform our approach for treating neuroblastoma patients."

Advances in genetic sequencing, data analysis, and chemical biology have identified countless genetic links to cancer, yet DNA doesn't tell the whole story.

Sometimes, molecules are added to DNA bases and RNA transcripts, affecting the way genes are expressed or how they get translated into proteins.

These modifications to DNA and RNA act as molecular switches, determining whether a gene is turned on or off, thus influencing cellular processes, tissue development, and disease progression.

Cohn and her team partnered with Chuan He, PhD, the John T. Wilson Distinguished Service Professor of Chemistry and Professor of Biochemistry and Molecular Biology at UChicago, to study these effects in neuroblastoma.

He is a pioneer in the fields of RNA and DNA modification research, known as epi transcriptomics and epigenetics, respectively. His lab has uncovered new regulatory pathways through RNA methylation.

One of the most common messenger RNA modifications is N6-methyladenosine (m6A), which gets added to an RNA transcript by "writer" proteins, including a complex formed between methyltransferase-like 3 (METTL3) and methyltransferase-like 14 (METTL14).

High levels of METTL3 and METTL14 are known to drive the growth of many adult cancers, so Cohn and He wanted to look at its effects on neuroblastoma.

The team, led by Monica M. Pomaville, MD, a former pediatric resident who trained with Cohn and He and is now a fellow at the Children's Hospital of Philadelphia, showed that high levels of METTL3 expression in neuroblastoma tumours were associated with significantly lower survival rates in patients. This suggests that METTL3 may drive tumour growth.

To investigate how METTL3 affects neuroblastoma, the team created a genetically modified version of neuroblastoma cells in which METTL3 expression was knocked down, or diminished.

They also tested an inhibitor called STM2457 that inhibits the function of METTL3, synthesised by He's team based on a published molecule structure.

Both approaches decreased neuroblastoma cell growth. METTL3 inhibition also increased the expression of genes that regulate the differentiation of neurons, or development into mature cells.

They even saw this increased the extension of neurites, which eventually develop into axons and dendrites, a hallmark of neuroblastoma differentiation. The team also tested the STM2457 inhibitor in the experimental models with neuroblastoma and found that it decreased tumour growth there as well.

Recently, inhibitors of METTL3 have been shown to enhance the anti-tumour effects of immunotherapy in adult cancers by promoting tumour infiltration of immune cells. When tumours are infiltrated with immune cells, they become inflamed, or "hot." Neuroblastoma is a non-T cell inflamed, or "cold," tumour that is resistant to immunotherapy like checkpoint blockade drugs.