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Neuroblastoma (NB) accounts for 15% of cancer-related deaths in childhood despite considerable therapeutic improvements. While several risk factors, including  MYCN  amplification and alterations in RAS and p53 pathway genes, have been defined in NB, the clinical outcome is very variable and difficult to predict. Since genes of the mechanistic target of rapamycin (mTOR) pathway are upregulated in  MYCN -amplified NB, we aimed to define the predictive value of the mTOR substrate-encoding gene eukaryotic translation initiation factor 4E-binding protein 1 ( EIF4EBP1 ) expression in NB patients. Using publicly available data sets, we found that  EIF4EBP1  mRNA expression is positively correlated with  MYCN  expression and elevated in stage 4 and high-risk NB patients. In addition, high  EIF4EBP1  mRNA expression is associated with reduced overall and event-free survival in the entire group of NB patients in three cohorts, as well as in stage 4 and high-risk patients. This was confirmed by monitoring the clinical value of 4EBP1 protein expression, which revealed that high levels of 4EBP1 are significantly associated with prognostically unfavorable NB histology. Finally, functional analyses revealed that  EIF4EBP1  expression is transcriptionally controlled by MYCN binding to the  EIF4EBP1  promoter in NB cells. Our data highlight that  EIF4EBP1  is a direct transcriptional target of MYCN whose high expression is associated with poor prognosis in NB patients. Therefore,  EIF4EBP1  may serve to better stratify patients with NB.

EIF4EBP1 is transcriptionally upregulated by MYCN and associates with poor prognosis in neuroblastoma