Open Access Case report

Irresponsiveness of two retinoblastoma cases to conservative therapy correlates with up- regulation of hERG1 channels and of the VEGF-A pathway

Pina Fortunato1, Serena Pillozzi2, Angela Tamburini3, Liliana Pollazzi4, Alessandro Franchi5, Agostino La Torre6 and Annarosa Arcangeli2*

Author Affiliations

1 Department of Pediatric Ophthalmology Meyer Hospital of Florence - Viale Pieraccini, 24 - 50139 Florence - Italy

2 Department of Experimental Pathology and Oncology, University of Florence Viale G.B. Morgagni, 50 - 50134 Florence - Italy

3 Department of Pediatric Oncohaematology and Domiciliary Care Meyer Hospital of Florence - Viale Pieraccini, 24 - 50139 Florence - Italy

4 Orthoptist Ophthalmology Assistant, Florence. P.O. box 30 -50032 - Borgo San Lorenzo, Florence - Italy

5 Department of Human Pathology and Oncology, University of Florence, - 50134 Florence - Italy

6 Department of Specialistics Surgical Sciences, University of Florence - Viale Morgagni, 85 - 50134 Florence - Italy

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BMC Cancer 2010, 10:504  doi:10.1186/1471-2407-10-504

Published: 22 September 2010



Treatment strategies for Retinoblastoma (RB), the most common primary intraocular tumor in children, have evolved over the past few decades and chemoreduction is currently the most popular treatment strategy. Despite success, systemic chemotherapeutic treatment has relevant toxicity, especially in the pediatric population. Antiangiogenic therapy has thus been proposed as a valuable alternative for pediatric malignancies, in particolar RB. Indeed, it has been shown that vessel density correlates with both local invasive growth and presence of metastases in RB, suggesting that angiogenesis could play a pivotal role for both local and systemic invasive growth in RB. We present here two cases of sporadic, bilateral RB that did not benefit from the conservative treatment and we provide evidence that the VEGF-A pathway is significantly up-regulated in both RB cases along with an over expression of hERG1 K+ channels.

Case presentation

Two patients showed a sporadic, bilateral RB, classified at Stage II of the Reese-Elsworth Classification. Neither of them got benefits from conservative treatment, and the two eyes were enucleated. In samples from both RB cases we studied the VEGF-A pathway: VEGF-A showed high levels in the vitreous, the vegf-a, flt-1, kdr, and hif1-α transcripts were over-expressed. Moreover, both the transcripts and proteins of the hERG1 K+ channels turned out to be up-regulated in the two RB cases compared to the non cancerous retinal tissue.


We provide evidence that the VEGF-A pathway is up-regulated in two particular aggressive cases of bilateral RB, which did not experience any benefit from conservative treatment, showing the overexpression of the vegf-a, flt-1, kdr and hif1-α transcripts and the high secretion of VEGF-A. Moreover we also show for the first time that the herg1 gene transcripts and protein are over expressed in RB, as occurs in several aggressive tumors. These results further stress the relevance of the VEGF-A pathway in RB and the correlation with hERG1, making aggressive and recurrent RB cases good candidates for antiangiogenesis therapies based on the targeting of VEGF-A.