2.1 Patient data
Case 1
The donor patient was a 32-year-old man with a GCTB. The patient had no relevant medical history. He experienced pain in his left knee while exercising, but it was untreated for a year. The pain gradually worsened, prompting the patient to visit a hospital. Imaging studies revealed findings suggestive of a bone tumor in the proximal tibia. He was then referred to the National Cancer Center Hospital in Tokyo, Japan, for further evaluation and treatment. Radiography and computed tomography (CT) scans showed an osteolytic lesion with marginal sclerosis in the proximal tibia (Fig. 1A, B). Magnetic resonance imaging (MRI) confirmed the presence of a neoplastic lesion in the proximal tibia, showing heterogeneous low signal intensity on the T2-weighted image (Fig. 1C) and heterogeneous high signal intensity on the gadolinium-enhanced T1-weighted image (Fig. 1D). The tumor was diagnosed as a GCTB based on open biopsy, and no distal or lymph node metastases were detected. The patient underwent aggressive curettage of the lesion, with reinforcement using autologous bone graft implantation and plate fixation. Tumor tissues obtained during the surgery were used to establish cell lines. Histologically, the tumor consisted of numerous osteoclast-like giant cells and mononuclear non-atypical tumor cells with hemosiderin-laden macrophages and hemorrhages (Fig. 1E). The neoplastic cells showed nuclear immunohistochemical expression of H3-3A G34W (Fig. 1F). The patient experienced an uneventful postoperative course, and neither local recurrence nor metastasis were observed. The use of clinical materials for this study was approved by the ethics committee of the National Cancer Center, and written informed consent was obtained from the donor patient.
Case 2
The donor patient was a 33-year-old woman who was diagnosed with GCTB. The patient had no relevant medical history. She presented with right ankle pain and sought medical attention. Imaging revealed findings suggestive of a bone tumor in the distal tibia. Subsequently, she was referred to the National Cancer Center Hospital in Tokyo, Japan, for further evaluation and treatment. Radiography and CT revealed an osteolytic lesion with destructive changes in the distal tibia (Fig. 2A, B). MRI confirmed the presence of a neoplastic lesion in the distal tibia, displaying heterogeneous low-signal intensity on the T2-weighted image (Fig. 2C) and iso-signal intensity on the T2-weighted fat saturation image (Fig. 2D). The tumor was diagnosed as a GCTB based on a needle biopsy under imaging guidance. No distant or lymph node metastases were observed. The patient underwent aggressive curettage of the lesion with reinforcement using autologous and artificial bone graft implantation and plate fixation. Histologically, the tumor consisted of uniform round-to-oval neoplastic cells and osteoclast-like multinucleated giant cells (Fig. 2E). Immunohistochemical examination revealed that the mononuclear cells were diffusely positive for H3-3A G34W (Fig. 2F). The patient experienced an uneventful postoperative course, and neither local recurrence nor metastasis were observed. The use of clinical materials for this study was approved by the ethics committee of the National Cancer Center, and written informed consent was obtained from the donor patient.
2.2 Histological analysis
A histological assessment was conducted on 4 µm-thick sections derived from a typical tumor sample and embedded in paraffin. The slices were deparaffinized and stained with hematoxylin and eosin (H & E). Further staining with the H3-3A G34W antibody (1:1000, RM263; RevMAb Biosciences USA, Inc., CA, USA) was performed to investigate the expression of H3-3A G34W.
2.3 Establishment of cell lines
Primary GCTB tumor cells were obtained from surgically removed tumor tissues and subsequently cut into small fragments using scissors. The gentleMACS™ Octo Dissociator with Heaters (Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany) was used to digest and homogenize the dissected tissues within the gentleMACS™ C Tube (Miltenyi Biotec) for 30 min at 37°C using the Tumor Cell Dissociation Kit, human (Miltenyi Biotec). The derived cells were then placed on 60 mm collagen type I-coated culture plates (Sumitomo Bakelite Co. Ltd., Tokyo, Japan). Sustenance of the cells was achieved through DMEM/F-12 medium (Thermo Fisher Scientific Inc., MA, USA) enriched with GlutaMAX (Thermo Fisher Scientific Inc.), 5% heat-inactivated fetal bovine serum (FBS) (Thermo Fisher Scientific Inc.), and other specified compounds. The culture medium was replaced every two–three days. A microscope (Carl Zeiss AG, Land Baden-Württemberg, Germany) was used to monitor cell confluence. Once subconfluency was attained, the cultured cells were washed with phosphate-buffered saline (–) (Nacalai Tesque Inc., Kyoto, Japan) and subsequently dissociated with trypsin–EDTA solution (Nacalai Tesque Inc.). The cells were placed in tissue culture plates and maintained at 37°C in an atmosphere containing 5% carbon dioxide.
2.4 Authentication and quality control of the cell lines
For authentication and quality assurance of the developed cell lines, DNA was extracted from the tumor tissues and cell lines. The Wizard® Genomic DNA Purification Kit (Promega Co., WI, USA) and the Qiagen DNeasy Blood and Tissue Kit (QIAGEN N.V., Hilden, Germany) were used for DNA extraction. The DNA concentration was determined using the NanoDrop 8000 (Thermo Fisher Scientific Inc.). The established cell lines were verified via short tandem repeat (STR) analysis across 10 loci using the GenePrint 10 system (Promega Co.) and a 3500xL Genetic Analyzer (Thermo Fisher Scientific Inc.).
2.5 Genetic analysis
Using the QIAzol Lysis Reagent (QIAGEN) and miRNeasy Mini Kit (QIAGEN), GCTB cells were subjected to total RNA extraction to identify gene mutations. The extracted RNA was then converted to complementary DNA using SuperScript III reverse transcriptase (Invitrogen, MA, USA) as per manufacturer’s instructions. The H3-3A gene was amplified via polymerase chain reaction (PCR) using the H3-3A forward primer H3-3A_F (5′-TAA AGCACCCAGGAAGCAAC-3′), H3-3A reverse primer H3-3A_R (5′-CAAGAGAGACTTTGTCCCATTTTT-3′), and Platinum Taq DNA Polymerase High Fidelity (Life Technologies Co., CA, USA). PCR products were purified using the Wizard SV Gel and PCR Clean-Up System (Promega Co.), followed by direct sequencing using the BigDye Terminator v3.1 Cycle Sequencing Kit (Applied Biosystems, MA, USA) and Applied Biosystems 3130xL Genetic Analyzer (Thermo Fisher Scientific Inc.) as conducted by GENEWIZ. Sequence results were analyzed using A Plasmid Editor v2.0.61.
2.6 Inspection of Mycoplasma contamination
For the assessment of Mycoplasma contamination, cellular DNA was analyzed using the conventional method of cell line establishment as defined by the international cell line authentication committee (The International Cell Line Authentication Committee 2018) [20]. Cellular DNA was amplified using an e-Myco Mycoplasma PCR Detection Kit (Intron Biotechnology, Gyeonggi-do, Korea). Thereafter, the DNA was separated on a 1.5% agarose gel via electrophoresis, marked with SYBR Safe DNA gel stain (Invitrogen), and subsequently assessed using Amersham Imager 600 (GE Healthcare Biosciences, Uppsala, Sweden).
2.7 Cell proliferation assay
The cell proliferation ability was assessed using Cell Counting Kit-8 (DOJINDO LABORATORIES, Kumamoto, Japan) every 24 h for four days. The cells were seeded at a density of 1.25 × 104 cells/well into DMEM/F12 enriched with GlutaMAX, 5% FBS, 10 µM Y-27632, 10 ng/mL basic fibroblast growth factor, 5 ng/mL epidermal growth factor, 5 µg/mL insulin, 0.4 µg/mL hydrocortisone, 100 µg/mL penicillin, and 100 µg/mL streptomycin. Doubling time was calculated based on the growth curve.
2.8 Spheroid formation assay
Spheroid formation was evaluated as described previously [21]. The established cells were seeded at a density of 1.0 × 105 cells/well into a 96-well Clear Round Bottom Ultra-Low Attachment Microplate (Corning Inc., NY, USA), and spheroid formation was confirmed via microscopic examination (KEYENCE Co., Osaka, Japan). After a three-day cultivation period, spheroids were retrieved from the plate, encapsulated in a gel using iPGell (GenoStaff Co. Ltd., Tokyo, Japan) and fixed with a 10% solution of neutral formalin buffer. To create paraffin sections of the crafted spheroids, gel-covered formations were enveloped in paraffin and segmented into 4 µm-thick sections. These divided spheroids were then subjected to H & E staining, and subsequently, microscopic inspection was performed.
2.9 Invasion assay
The invasive capabilities of the GCTB cell lines NCC-GCTB8-C1 and NCC-GCTB9-C1 were measured using the real-time cell analyzer xCELLigence (Agilent Technologies Inc., CA, USA). A mixture of DMEM/F12 supplemented with GlutaMAX, 5% FBS, 10 µM Y-27632, 10 ng/mL basic fibroblast growth factor, 5 ng/mL epidermal growth factor, 5 µg/mL insulin, 0.4 µg/mL hydrocortisone, 100 µg/mL penicillin, and 100 µg/mL streptomycin was introduced to the lower chamber. The Matrigel basement membrane matrix (Corning Inc.) was used to coat the membrane in the upper chamber, along with 4.0 × 104 cells suspended in DMEM/F12 devoid of supplements. Cell movement from the upper to lower chamber occurred via the membrane, attaching to the electronic sensors on its underside. The electrical impedance influencing the electronic sensors was monitored using a real-time cell analyzer, with readings taken every 15 min over 72 h. The MG-63 osteosarcoma cell line (Japanese Collection of Research Bioresources Cell Bank, Osaka, Japan) was used as control [22].
2.10 Drug screening assay
The antitumor properties of 214 compounds were evaluated (Supplementary Table 2). Cells were dispersed at a density of 5.0 × 103 cells/well in 384-well plates and incubated for a day. On the second day, each agent was spread into two wells of the plate and incubated for three days. A Cell Counting Kit-8 (DOUJINDO LABORATORIES) was used to calculate cell viability. The acquired data were consistent with the findings of previous studies on NCC-GCTB1-C1 [6], NCC-GCTB2-C1 [23], NCC-GCTB3-C1 [23], NCC-GCTB4-C1 [21], NCC-GCTB5-C1 [24], NCC-GCTB6-C1 [22], and NCC-GCTB7-C1 [22]. Quantile normalization was performed using R (version 4.0.3, limma package version 3.46.0, Bioconductor), and unsupervised hierarchical clustering was performed using the gplots package (version 3.1.0, CRAN, https://cran.r-project.org).
To determine the half-maximal inhibitory concentration (IC50), 24 compounds exhibiting superior antiproliferative activity based on the initial drug screening test were selected. The cells were treated with each compound at ten distinct concentrations. The IC50 value was derived from logistic regression analysis of the relationship between the common logarithm of the concentration and cell viability for each compound.