Previous CHECT research
Previous CHECT funded retinoblastoma research projects
These projects have previously been funded by CHECT. For latest research please have a look at our current retinoblastoma research page.
Developing an evidence-based psycho-educational intervention for teenagers and young adults who have had retinoblastoma
Project leader Dr Bob Phillips
Award £73,799
Duration three years, September 2021
Summary
There is little guiding evidence about the specific challenges that teenagers who have had retinoblastoma face as they transition towards young adulthood. Understanding the psycho-educational needs of teenagers and young adults as they transition into adulthood is therefore essential if we are to offer effective interventions to support them. This PhD studentship aims to develop an evidence-based intervention for teenagers and young adults with retinoblastoma that offers relevant, accessible and effective psycho-educational support.
Status: Completed, awaiting final report
Evaluation of PRELP function using retinoblastoma samples
Project leader Professor Ohnuma
Award £50,000
Duration two years, April 2022
Summary
Previous research by Professor Ohnuma has found that whilst PRELP protein is highly expressed in normal retinal tissues, it is not expressed in retinoblastoma. Preliminary data from cell cultures indicate that administration of PRELP to the established laboratory retinoblastoma cell lines inhibited cancer progression. Now, this team wants to confirm that these results have clinical application, by applying PRELP protein to the human retinoblastoma tissues and examining the effect on retinoblastoma development. The advantage of such an approach over some current methods is that only affected cells will be impacted by the treatment, with no expected toxicity to surrounding normal, unaffected retinal cells, thereby preserving more of the child’s vision.
Status: Project closed, final report
Further investigation into intra-ocular fluid as a liquid biopsy in retinoblastoma
Project leader Dr Amy Gerrish
Award £14,851.26 joint award with Fight for Sight
Duration one year, August 2021
Summary
This group is developing a form of liquid biopsy, using cell-free DNA (cfDNA) found in ocular fluid to discover if an patient has the heritable or non-heritable form of Rb, and so whether they are at risk of developing further Rb tumours. This information is vital in identifying at risk individuals, and in excluding those not at risk from potentially unnecessary examinations under anaesthetic (EUAs).
Status: Project completed – final report
Comparing blood to aqueous humor as a liquid biopsy for retinoblastoma: determining the superiority of the aqueous humour as a source of tumor DNA
Project leader Professor Jesse Berry
Award £50,000
Duration two years, December 2019
Summary
A liquid biopsy for retinoblastoma is especially critical because unlike other cancers, retinoblastoma cannot be biopsied due to risk of spread outside the eye. To overcome this problem, this team has demonstrated that tumor DNA is present in the aqueous, the clear fluid in front of the eye, which is safe to extract. However, the question remains whether blood, which is less invasive, can be used as a liquid biopsy for retinoblastoma as it can with other cancers. The team aims to directly compare blood to aqueous to determine which is a superior source of tumor DNA and thus a better liquid biopsy for retinoblastoma. This critical research has potential to change paradigms of diagnosis, prognosis and future treatment protocols for affected children.
Status: Project completed – final report
Assessing the feasibility of pluripotent stem cell derived retinal organoids as a model system to test the safety and efficacy of chemotherapeutic agents in retinoblastoma
Project leader Professor Majlinda Lako
Award £50,000
Duration 18 months, May 2020
Summary
The recent advances in local delivery of chemotherapy to the eye (intra-arterial or intravitreal injection) have significantly improved the success of eye conserving treatment, with reduction in the need for enucleation. However, there is inevitably some toxicity associated with treatment, which can affect visual function in the eyes that are saved. Further refinements in these techniques and trials of new drugs are essential to maximise efficacy and minimise toxicity, to preserve useful vision. The recent development of retinal organoids by our group provides us with a unique laboratory model of human retina and retinoblastoma. This study is designed to test the safe and effective dose of current as well as novel drugs on the laboratory model (retinal organoids), and to study the toxic effects on the retina. This valuable information will help shape treatment strategies such as new drug combinations and new dosage schedules to treat effectively retinoblastoma tumours while minimising damage to vision.
Status: Project Completed – final report
Next generation sequencing analysis of retinoblastoma samples
Project leader Professor Shin-Ichi Ohnuma
Award £55,000
Duration 18 months, March 2019
Summary
Despite knowing the RB1 mutation it is difficult to predict the outcome of treatment. This project proposes to study the genetic changes that occur in retinoblastoma, using whole genome sequencing (the process of determining the complete DNA sequence) to detect those variants associated with good and bad prognosis or with a favourable treatment outcome. This new level of diagnosis could potentially make a significant contribution to the selection of treatment, and avoid the loss of one or both eyes. Also, identification of new cancer modifying genes may provide new targets for treatment. Furthermore, this study aims to establish a new system to diagnose Rb in the clinical setting, which includes detailed examination of patient genome sequencing/analysis.
Status: Project completed – final report
Investigation of the mutational landscape of retinoblastoma
Project leader: Dr Carmel McConville
Award: £15,000 joint funding CHECT and Fight for Sight; additional £14,200 CHECT
Duration: One year, May 2014
Extension funding awarded: £6,500 CHECT
Duration: 14 months, November 2018
Summary
We have established cell lines from 15 different retinoblastomas and these represent one of the largest collections of retinoblastoma cell lines worldwide.
We will use the latest technology, known as ‘next generation sequencing’, to look at the DNA sequence of every active gene in these retinoblastoma cell lines. This sequence will be compared to a normal reference sequence in order to identify genes which are mutated. The sequence analysis will indicate which genes which are most frequently mutated in retinoblastoma and will also show how the overall cellular genetic activity is influenced by these mutated genes.
All of this information is essential to inform future research into the development of novel targeted therapeutics capable of reversing the effects of mutated genes in retinoblastoma.
Status: Project completed – final report and tables and figures
Modelling retinoblastoma using human induced pluripotent stem cells (iPSC)
Project leader Dr Sandy Hung
Award £34,315
Duration 18 months, June 2015
Summary
It has been a challenge to develop a good cell model system for retinoblastoma (Rb), despite it being the first cancer to have its gene identified. Model systems are important tools which enable scientists to better understand the diseases and develop more effective treatments. However, current models for RB (e.g. mouse), cannot accurately reproduce what is observed in RB patients due to differences in disease mechanisms between species.
This project proposes to make induced pluripotent stem cells (iPSCs) from skin cells of Rb survivors with known heritable Rb mutations, to make different cell types, including the retinal (eye) cells that become cancerous in Rb. Ultimately, this model system could enable researchers to test potential treatments. A successful human Rb model would also, in the future, enable researchers to gain insight into the development of second cancers commonly seen in Rb survivors.
Status: Project completed – final report here
Autonomic reflexes and cardio-respiratory instability during super-selective intra-arterial chemotherapy in the management of children with retinoblastoma
Project Leader: Dr S P McGuirk et al. at Great Ormond Street Hospital and Birmingham Children’s Hospital.
Award: £18,000
Duration: One year from May 2014.
Summary
Intra-arterial chemotherapy is an effective treatment for retinoblastoma. However, we have observed that a significant proportion of children developed severe adverse cardio-respiratory responses during the procedure. None of the children had any adverse sequelae following these events.
We do not currently understand why these responses occur, why they occur in some children but not others, or why they are only clinically evident during the second catheterisation procedure. We propose to undertake this prospective case-controlled study to examine the pathophysiological events in detail. Ultimately, this information may allow us to identify adverse responses before they become clinically apparent. The findings of this study are, therefore, of potentially immediate clinical application.
Status: Latest update here.
Targeted antibody-drug conjugates for retinoblastoma
Project leader Dr Gail Seigel
Award £25,000
Duration One year, Sept 2017
Summary
The overall goal of this project is to improve upon current therapy for retinoblastoma by targeting toxic molecules (ADCs) directly to the retinoblastoma tumour. The ADCs are designed to kill retinoblastoma tumour cells, but spare surrounding normal cells. In turn, this will result in a more efficient eradication of the RB tumour with fewer side effects for the patient. Our experiments are designed to test the effectiveness of ADCs through the study of retinoblastoma tumour cells in test tubes, as well as in actual tumours. By the end of this project, we will know whether ADCs designed for retinoblastoma have potential to move toward clinical trials and human patients.
Status: Project completed – final report here
Support the development of a national system to collect and audit data on children diagnosed with retinoblastoma within the national cancer registration service
Project leader Dr Helen Jenkinson
Award £8,841.36
Duration Six months, Sept 2015
Summary
The national Rb register will replace existing in-house databases used at Birmingham Children’s Hospital and the Royal London Hospital, thus providing a single national resource for understanding and addressing concerns such as:
- the effectiveness of treatment plans; through comparison between treatment centres
- the impact and efficacy of specialised commissioning
- the link between the heritable form and individual genotype on the risks of disease progression and secondary cancers in later life
It will provide a template for the creation of other site-specific registers for other rare childhood cancers, such as Wilms disease and neuroblastoma.
Status: The national Rb register is now complete and expected to go live in the autumn 2019
Understanding and overcoming barriers to living with an artificial eye
Project leaders: Tara Shea and Laura Rouse
Funding awarded: £14,339
Duration: One year from April 2014
Summary
Understanding the experiences of children and their families following enucleation will help to develop some clear best practice guidelines regarding clinical management of this population. We hope to promote innovation in the development of clinical resources to support adaptation to living with an artificial eye. By better understanding the scope of the barriers (physical, mental and emotional) that may be encountered the research team can explore the support services and strategies used by children and their families in order to address these barriers.
In order to understand the experiences of children and their families following enucleation the study will involve conducting interviews with three groups: children over five years of age who have experienced a unilateral enucleation; parents of children who have experienced enucleation; and teachers of children who have experienced enucleation.
Status: Project completed – final report here
Validation of Molecular Targets Characterizing Invasive Retinoblastoma
Project leader: Richard L. Hurwitz, MD, FARVO
Award: £39,756
Duration: Three years, May 2014
Summary
Although almost all children with retinoblastoma have mutations in the RB1 gene, not all children have invasive disease, a precursor to the development of metastatic disease. We hypothesize that by comparing gene expression in tumours derived from children with invasive retinoblastoma to tumours derived from children with noninvasive retinoblastoma, we can gain an understanding of the metabolic steps after the mutation of RB1 that lead to tumour invasion and subsequent metastatic disease.
We have studied gene expression in both invasive and noninvasive retinoblastoma tumours using next generation RNA-Seq technology and have identified 50 candidate genes that are more highly expressed in invasive retinoblastoma tumours when compared to noninvasive retinoblastoma tumours. We propose to validate these candidate genes by examining differences between non-invasive and invasive retinoblastoma tumours using in vitro and in vivo models of retinoblastoma as well as tumour samples from children. The advantages of studying retinoblastoma are 1) lack of complications caused by age or environmental exposures, 2) known molecular initiating events and 3) relatively rapid tumour initiation and progression.
The results obtained will help stratify risk for metastasis, identify new therapeutic targets for retinoblastoma and improve approaches to genetic counselling of affected families.
Status: Project completed – final report here
Role of SLRP family members in malignant progression of retinoblastoma.
Project Leader Professor: Shin-ichi Ohnuma Co-investigator: Dr Mandeep Sagoo
Award: £15,000 Joint funding CHECT and Fight for Sight
Duration: One year from April 2014
Summary
This project will investigate the role of a family of genes, which produce secreted proteins around the cancer cells, because this family of proteins is highly produced in the normal eye and known to be involved in formation of non-eye cancers. Moreover, our previous studies using cells isolated from retinoblastoma patients showed that amounts of some members of this protein family are altered in association with retinoblastoma development.
Firstly, we will examine the change of gene expression in the process of retinoblastoma development using human retinoblastoma tissues. Then we will examine their function and how they affect retinoblastoma progression using cells isolated from retinoblastoma tissues.
If we can prove the importance of the gene family in retinoblastoma, it may become possible to develop new methods of diagnosis and treatment for retinoblastoma.
Status: Project complete – final report here
Retinal vessel architecture in retinoblastoma patients – a predictor of progression?
Project Leader: Dr Clare Wilson
Award: £10,500
Duration: August 2013
Summary
Retinoblastoma treatment has developed leading to vastly improved survival rates. However, detecting early disease progression is challenging for experienced retinoblastoma surgeons who see over 20 new patients a year. It is even more problematic for surgeons working in countries with smaller populations. An objective assessment that can alert the surgeon to progression of the cancer would be of great benefit.
New software can measure changes in blood vessels at the back of the eye. Eye cancer doctors have made the clinical observation that these vessels change when disease worsens, and so could be used to detect eye needing more treatment. At The Royal London Hospital we have a large set of digital images from children who have had eye cancer and we are analysing them with new software to see if the vessel changes can be used to accurately detect progression of the tumour.
If we get positive results, we could make the follow up visits for these children with eye cancer a more pleasant experience, yet just as accurate.
Status: Project complete – final report here
Use of aptamers to increase the efficacy of HMGA2 targeted therapy in retinoblastoma
Project Leader: Dr S Krishnakumar
Award: £47,298
Duration: Two years, April 2014
Summary
With advancements in molecular biology, targeted therapy is gaining importance in the treatment of Rb. Aptamers have immense potential in targeted therapy because of their ability to bind to the target with high affinity and specificity. Previous findings show over-expression of the transcription factor HMGA2 in retinoblastoma transformation. Our previous work also showed the contribution of HMGA2 in cell proliferation and G1/S phase transition in Rb.
HMGA2 was also found to regulate many oncogenic and tumour suppressive miRNAs in Rb. siRNA and aptamer targeting HMGA2 were able to bring down the proliferation in Rb. But these biomolecules targeting HMGA2 should reach the tumour cells to modulate HMGA2 function with minimal uptake and damage to the normal cells.
In the present proposal, we would like to develop strategies for delivering the HMGA2 siRNA and aptamer targeting HMGA2 to the retinoblastoma cells. Tumour cell specific delivery of the aptamer and siRNA sparing the non-cancerous cell would be the first parameter to be evaluated. We would also investigate that the delivery strategies do not compromise the affinity, stability and functional effect of the siRNA and aptamer targeting HMGA2.
The two novel strategies proposed in this project are: delivery of HMGA2 siRNA through aptamer-siRNA chimeras into the retinoblastoma cells; and developing a novel antibody mediated delivery of aptamer into Rb cells.
Status: Project completed – final report summary and in full.
Epigenetic Mechanisms in Retinoblastoma Tumourigenesis
Project Leader: Dr Carmel McConville at the CRUK Institute for Cancer Studies at the University of Birmingham.
Award: £50,500
Duration: One year from February 2012
Summary
It is known that a gene called ‘DEK’ is present at abnormally high levels in approximately 50% of cases of retinoblastoma. It is possible that DEK might contribute to the growth of the retinoblastoma and perhaps also to its spread outside the eye. It could therefore be a target for therapy in these retinoblastomas.
he purpose of this research is firstly to find out what effect DEK has on retinoblastoma cells and exactly how it works. This will be the key to developing new drugs to block its action.
Status: Project completed – final report here.
Development of a next generation sequencing analytical pathway for improved test sensitivity and enhanced detection of low level RB1 mutations in retinoblastoma patients.
Project Leader: Dr Simon Ramsden Co-investigator: Dr Sarah Waller
Award £13,810 Joint funding CHECT and Fight for Sight
Duration: One year from December 2013
Summary
Mutations in the retinoblastoma gene RB1 cause retinoblastoma. Traditional Sanger sequencing technology reliably detects mutations in RB1 in tumour tissue in the majority of patients from whom tumour is available, and detection of a germline mutation permits predictive testing of at risk family members. In our laboratory Sanger sequencing detects germline mutations in ~92% of patients with bilateral tumours and ~16% of patients with unilateral tumours.
Whilst Sanger sequencing offers appropriate test sensitivity for most cases there remain a small number of undetected familial mutations and also it has limited utility when trying to detect mosaicism. Emerging sequencing technologies (so called “Next Generation”) are showing great promise in both the academic and service environment and offer significant advantages over conventional Sanger testing. We feel that Next Generation Sequencing could offer us a means of overcoming both of these obstacles.
Status: Project completed – final report here.
Identification of molecular tools
Project Leader: Dr Carmel McConville at the CRUK Institute for Cancer Studies at the University of Birmingham.
Award: £70,000
Duration: Three years from Oct 2009
Summary
Survival rates for retinoblastoma in the UK are well in excess of 90% and the challenge in treating this disease is to maximize preservation of sight whilst minimizing the risk of recurrent disease and treatment-related toxicity. The purpose of this project is to provide a molecular characterisation of retinoblastoma which will allow a more informed approach to balancing these twin objectives.
Status: Project completed – summary of final report here.
Audit of clinical genetic and molecular genetic information and reproductive issues known to retinoblastoma families.
Project Leader: Dr Trevor Cole, Consultant Clinical Geneticist, Birmingham Women’s Hospital
Award: £30,000
Duration: Two years from October 2008.
Summary
The differing and complex genetics underlying the majority of unilateral and bilateral retinoblastoma means that many families have to be given genetic counselling advice on an ongoing and rather piecemeal basis. We therefore suggest that we need to work with families currently undergoing treatment and, families discharged from follow up, to see if further genetic counselling input is necessarily to ensure families have the best information we are currently able to provide.
We would suggest that this is important baseline data and would facilitate periodic review or audit that is likely to be necessary until all families are able to have a “definitive genetic explanation” to all at risk family members. Evidence on the practical benefits perceived by patients, in addition to the theoretical medical and cost benefits reported by Richter et al 2003, from molecular studies could then be assessed. This study would be timely as it could collect data prospectively from families yet to have definitive molecular answers and subsequent to these answers becoming available.
Progress report (As written by Dr T Cole): In early 2012 attempts to contact the remaining list of people was drawn to a close and we decided at this stage all remaining contact would be via letters to the participants’ GPs. Since this time several hundred further patient replies have been reviewed and letters to GPs are being produced and sent out to the remaining families.
Status: Project complete, published article here.
The role of HMGA1 and HMGA2 in retinoblastoma
Project leader: Mr A M Reddy, Royal London Hospital
Duration: Six months 2005
Award: £4,817.33
Summary
The aim is to investigate the expression of HMGA1 and HMGA2 proteins in archival retinoblastoma tumours and whether the protein HMGA2 is expressed uniformly throughout the Rb tumours or there is a heterogeneous expression in the tumour samples. Also HMGA2 expression will be correlated with invasion of the tumours. The study will also generate data whether the HMGA1 protein is expressed in non-neoplastic retinal tissues. This has implications in damage to the non-neoplastic retinal tissues.
Status: Project completed. The results from this project led to the funding of a subsequent project entitled ‘To study the RNAi mediated HMGA2 gene expression profile of y79 cells’ (see below)
To study the RNAi mediated HMGA2 gene expression profile of y79 cells
Project Leader: Prof Krishnakumar from the Sankara Nethralaya Centre in India and Mr Ashwin Reddy from the Royal London Hospital.
Award: £15,000
Duration: Three years
Summary
We still do not understand why some retinoblastoma tumours grow slowly and some are very aggressive. The more aggressive retinoblastoma tumours (invasive retinoblastoma) invade into the outer layers of the eye. We are aware that loss of the retinoblastoma protein initiates events with tumour development, but other proteins are also implicated.
This team has already shown that a protein called HMGA2 (High Mobility Group A2 protein) is produced more in tumours that are invasive (above).This project gives an explanation for this. When this protein is not produced, retinoblastoma cells stop growing. Therefore this protein appears to be very important for the growth of the tumour-forming cells.
The genes that make proteins for tumour effectiveness such as ‘stickiness’ to blood vessels are affected. A tumour with more ‘sticky’ proteins is likely to be more aggressive. Other genes that are important for tumours to work are also affected. This is more evidence that stopping HMGA2 from working may be beneficial for patients as the retinoblastoma tumours may stop growing. It also shows how complex the biological pathways are for retinoblastoma.
Status: Complete. Abstract of final report here – full free paper here.
Epidemiological studies of retinoblastoma with particular reference to the incidence of multiple primary tumours
Project leader Dr Gerald Draper, Childhood Cancer Research Group, Oxford
Award: £34,879 in collaboration with University of Oxford, Childhood Cancer Research Group
Duration: Three years April 2003 – March 2006.
Summary
The Childhood Cancer Research Group (CCRG) has records of virtually every case of retinoblastoma occurring in Great Britain during the past forty years, together with records of selected groups of cases in earlier years. This database is linkable to laboratory records relating to many of these cases, including, in particular, those held at the Retinoblastoma Screening Unit at St Bartholomew’s Hospital.
In addition, the group has access to pedigree data collected by other research workers and to international data on the incidence of retinoblastoma. It is proposed, within the CCRG’s ongoing programme of epidemiological research, to update earlier analyses of these data and to initiate others in three areas:
1. Multiple primary tumours
2. Risks to offspring and siblings
3. Incidence rates of retinoblastoma
Status: Two of the three stages complete, final report here.
Psychological consequences of treatment for Rb in young children
Project leader: Dr S Norgate
Duration: One year from October 2002
Award: £31,136.23
Summary
This project seeks to examine the psychological consequences of retinoblastoma and associated treatment in the under-fives.
Status: Project completed – final report here.
Retinoblastoma treated with primary chemotherapy alone: The significance of tumour size, location and age
Project lead: Mr D S Gombos
Duration: 10 months from January 2000
Awarded: £10,152
Summary
This project will evaluate how tumour size, retinal location and patient age affect the outcome of retinoblastoma foci treated with chemotherapy.
Status: Project completed 2001 – final report here.
Retinoblastoma RB1 gene mutation analysis: Molecular Genetic Study of Hereditary Retinoblastoma
Project leader: Dr Z Onadim
Duration: Three years from December 1997
Awarded: £91,989 in collaboration with Queen Mary & Westfield College
Summary
The aim of the study was to analyse mutations in patients predisposed to Rb to gain an insight into the mechanism of mutagenesis and to offer screening for carrier status.
Status: Project complete – lay summary of the final report here.
Development of retinoblastoma database
Project leader: Prof G Draper & Dr J Kingston
Duration: One year from May 1997
Awarded: £19,528
Status: Project completed – final report here.
