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Background  Medulloblastomas are malignant childhood brain tumors that arise due to the aberrant activity of developmental pathways during postnatal cerebellar development and in adult humans. Transcriptome analysis has identified four major medulloblastoma subgroups. One of them, the Sonic hedgehog (SHH) subgroup, is caused by aberrant Hedgehog signal transduction due to mutations in the  Patched1  ( PTCH1 ) receptor or downstream effectors. Mice carrying a  Patched-1  null allele ( Ptch1   ∆/+ ) are a good model to study the alterations underlying medulloblastoma development as a consequence of aberrant Hedgehog pathway activity.    Results  Transcriptome analysis of human medulloblastomas shows that  SERPINE2 , also called  Protease Nexin-1  ( PN-1 ) is overexpressed in most medulloblastomas, in particular in the SHH and WNT subgroups. As siRNA-mediated lowering of  SERPINE2/PN-1  in human medulloblastoma DAOY cells reduces cell proliferation, we analyzed its potential involvement in medulloblastoma development using the  Ptch1   ∆/+  mouse model. In  Ptch1   ∆/+  mice, medulloblastomas arise as a consequence of aberrant Hedgehog pathway activity. Genetic reduction of  Serpine2/Pn-1  interferes with medulloblastoma development in  Ptch1   ∆/+  mice, as ~60% of the pre-neoplastic lesions (PNLs) fail to develop into medulloblastomas and remain as small cerebellar nodules. In particular the transcription factor  Atoh1 , whose expression is essential for development of SHH subgroup medulloblastomas is lost. Comparative molecular analysis reveals the distinct nature of the PNLs in young  Ptch1   ∆/+   Pn-1   Δ/+  mice. The remaining wild-type  Ptch1  allele escapes transcriptional silencing in most cases and the aberrant Hedgehog pathway activity is normalized. Furthermore, cell proliferation and the expression of the cell-cycle regulators  Mycn  and  Cdk6  are significantly reduced in PNLs of  Ptch1   ∆/+   Pn-1   Δ/+  mice.    Conclusions  Our analysis provides genetic evidence that aberrant  Serpine2/Pn-1  is required for proliferation of human and mouse medulloblastoma cells. In summary, our analysis shows that Serpine2/PN-1 boosts malignant progression of PNLs to medulloblastomas, in which the Hedgehog pathway is activated in a SHH ligand-independent manner.

Serpine2/PN-1 Is Required for Proliferative Expansion of Pre-Neoplastic Lesions and Malignant Progression to Medulloblastoma