Discussion
Rhabdomyosarcomas continue to be a formidable challenge in pediatric
oncology. Especially patients with FOXO1- rearranged or metastatic
RMS face extremely poor outcomes. In recent years, significant research
efforts have provided insights into possible new therapeutic strategies
. Also, molecular characterization of tumor tissue, aimed at identifying
targets for individualized treatment of patients with refractory
disease, has proven feasible . There is an increasing need for RMS model
systems that faithfully recapitulate the human disease and provide
rapid, cost-efficient estimates of anti-tumor efficacy of candidate
drugs.
Zebrafish represent an extremely cost-efficient model organism, that is
used in many laboratories all over the world, easy to handle and
well-suited for high-throughput experiments. In optimized conditions,
female zebrafish can lay up to 200 eggs per clutch , allowing for large
numbers of experimental animals and thereby reducing the statistical
risk of incorrect measurements. RMS xenografts in zebrafish were
previously reported in the literature. Chuan et al used ERMS and ARMS
xenografts, established in 2 months-old zebrafish by injecting cells
into the peri-ocular muscle and intraperitoneal spaces, to observe the
effects of drugs, which were administered by oral gavage, at
environmental temperatures of 37°C over a period of 28 days post
injection. Xenograft induction in zebrafish embryos offers a number of
advantages over xenotransplants in adult fish, including faster
turnaround time, better scalability, easier drug application , and ease
of repetitive imaging including time-lapse microscopy to assess
xenograft dynamics. In this study, we set out to establish RMS
xenografts in zebrafish embryos. Due to the small size of the zebrafish
embryos, only few tumor cells were required to establish xenografts, and
relatively small amounts of drugs were sufficient for testing.
The zebrafish platform established here allows for reliable induction of
RMS xenografts, derived from the embryonal RMS cell line RD, in 3
hours-old zebrafish embryos. To reconcile viability and normal
development of the embryos with engraftment of human cells, we selected
optimized temperature conditions based on our own data (Fig. 1A) and
previous reports . Temperatures higher than 33.5°C during early
embryonic development are associated with abnormal embryonic development
and higher mortality . Post gastrulation, higher temperatures at 35°C
are tolerated more easily by the embryos. Indeed, we successfully kept
embryos at temperatures of 33°C from 3 hpf to 48 hpf, followed by a
temperature rise to 35°C until 120 hpf.
Proof-of-principle experiments revealed dose-dependent inhibitory
effects of vincristine and dactinomycin - two chemotherapy drugs with
long-established anti-RMS efficacy – on RMS xenografts in zebrafish
embryos, validating the reliability of the model system in assessing
antitumor effects of established anti-RMS drugs. The MEK inhibitor
trametinib also led to a significant reduction in the size of
xenografts, derived from NRAS Q61H -mutated RD cells . Of note, in
the experiments reported here, PAX3:FOXO1 fusion-positive Rh30 cells did
not engraft under the conditions described above. This corresponded to
slower proliferation of Rh30 cells in vitro at lower
environmental temperatures. Interestingly, lower temperatures did not
exert any adverse effects on the in vitro growth of RD cells.
Future experiments will determine if RMS cells, derived from other
PAX3:FOXO1 fusion-positive cell lines or fresh patient-derived tumor
tissue, are capable of engrafting in zebrafish embryos. Also, it will be
interesting to observe possible differences in the location of primary
tumors and patterns of metastases between xenografts derived from
genetically distinct RMS tumors.
Zebrafish embryos as model organisms are generally associated with
certain limitations. While there are substantial functional homologies
between the zebrafish and the human genome , fundamental differences
between these two vertebrate organisms must not be neglected. For
example, the temperature requirements of zebrafish differ from those of
mammalians. The application of water-soluble chemicals to the embryo
medium is remarkably easy, but the exact chemical dose that is absorbed
into the embryo remains unclear, and larger or non-water-soluble
molecules need to be injected into the embryo’s yolk sac, necessitating
more complex experimental procedures comparable to drug application
procedures used in mice or older zebrafish. Furthermore, the development
of the mature immune system in zebrafish embryos takes 4-6 weeks .
A xenotransplant model similar to the system described here has recently
been published and is based on injection of ERMS patient-derived
xenograft (PDX) tumor cells into the yolk sac of zebrafish embryos at 48
hpf, with first addition of drugs in the medium at 72 hpf and continued
exposure until 120 hpf. Embryos were kept at 28°C prior to injection of
tumor cells and at 34 °C after injection of tumor cells . These
observations are in line with those obtained from our experiments and
confirm the potential of the zebrafish embryo xenograft platform.
Important differences lie in the timing of transplantation and drug
treatment with our model offering a longer treatment and observation
period. Also, we argue that transplantation into the embryo itself
compared to transplantation into the yolk sac offers the advantage of a
cellular milieu.
In conclusion, the zebrafish embryo-based platform described here is
very fast, cost-efficient, and easy to handle. It takes only 120 hours,
low numbers of viable tumor cells and relatively small amounts of
chemicals to obtain estimates on the anti-tumor efficacy of
water-soluble chemicals. Laboratory requirements are easily accessible,
and regulatory thresholds are low. By contrast, turnaround times range
from weeks to months if xenografts are established in mice/ older
zebrafish or if tumor cells are expanded in tissue culture. These
demands increase when experiments are designed to cover replicate
measurements and therefore require large numbers of cells. We argue that
RMS xenograft models in zebrafish embryos lift rapid pre-clinical drug
testing to a new level and henceforth could serve as a valuable addition
to cell culture and mammalian models of this devastating cancer.