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.