Abstract High-risk neuroblastoma (HR-NB) presented with hematogenous metastasis is one of the most difficult cancers to cure with poor patient survival. Aggressive tumors contain populations of rapidly proliferating clonogens that exhibit stem cell properties, cancer stem cells (CSCs). Conceptually, CSCs that evade intensive multimodal therapy dictates tumor progression, relapse/recurrence and poor clinical outcomes. Herein, we investigated the plasticity and stem-cell related molecular response of aggressive metastatic neuroblastoma cells that fits CSC model. Well characterized clones of ‘metastatic site derive aggressive cells’ (MSDACs) from the manifold of metastatic tumors of clinically translatable HR-NB were characterized for their CSC fit. Alternated, yet stabilized (three generations) microenvironment simulation experiments with ‘serum-free stem cell medium’ to ‘growth medium with serum’ and vice versa identified flexible revocable plasticity. Signatures stem-cell related molecular responses consistent with phenotypic conversions are observed. Successive reintroduction to the favorable niche not only regained identical EMT, self-renewal capacity, pluripotency maintenance, and other stem-cell related signaling events, but also instigated additional events depicting the aggressive adaptive plasticity. Together, these results demonstrated the flexible plasticity of HR-NB MSDACs that typically fits in CSC model and further identified the intrinsic adaptivness of the successive phenotype switching that clarify the heterogeneity of HR-NB. Moreover, the continuous ongoing acquisition of stem-cell related molecular rearrangements may hold the key for the switch from favorable disease to HR-NB. Citation Format: Satish Kumar Ramraj, Faizan H. Khan, Sheeja Aravindan, Mohan Natarajan, Terence S. Herman, Natarajan Aravindan. Metastatic neuroblastoma cancer stem cells exhibit flexible plasticity and adaptive stemness signaling. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1398. doi:10.1158/1538-7445.AM2015-1398
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