Upregulated protein synthesis and proteasome degradation in recurrent tumors. (a) Gene set enrichment analysis (GSEA) demonstrated that gene sets related to protein translation and rRNA processes were upregulated in recurrent PDX tumors compared with primary tumors. (b) Visualization of the significantly enriched pathway (FDR < 0.05) in recurrent PDX tumors compared with the pathways in primary tumors. (c,d) RNA-seq heatmap indicated increased expression of the Reactome translation gene set (c) and proteasome-encoding genes in recurrent patient samples (d). (e) mRNA expression levels of proteasome-encoding genes in human ATRTs (n = 24) were higher than those in normal brain tissues (n = 4). These data are presented in the box-and-whisker plot (min–max values), * p < 0.05, ns: nonsignificant, Mann–Whitney U test. (f,g) Comparison of IHC staining for PSMD4 (f) and PSMB4 (g) in normal brain tissues and the patient tumor samples. The patient’s recurrent ATRTs exhibited higher levels of PSMD4 (f) and PSMB4 (g) compared with the primary ATRTs and normal brain tissues. Scale bar, 50 µm.