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NAR Cancer

Oxford University Press (OUP)

Preprints posted in the last 30 days, ranked by how well they match NAR Cancer's content profile, based on 36 papers previously published here. The average preprint has a 0.01% match score for this journal, so anything above that is already an above-average fit.

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Retroelement Hypomethylation Links Hypoxia Signaling, Immune Phenotypes, and Survival in Clear Cell Renal Cell Carcinoma

Nnam, C. F.; Salas, L.; Mboya, E. A.; Li, Y.; Zhang, M.; Kolling, F.; Perrard, L.; Palys, T. J.; Pflugradt, E.; Pioli, P. A.; Ernstoff, M. S.; Seigne, J. D.; Pettus, J. R.; Ren, B.; Song, L.; Christensen, B. C.

2026-05-06 cancer biology 10.64898/2026.05.01.722263 medRxiv
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BackgroundRetrotransposable elements (RE) comprise approximately 45% of the human genome and are typically repressed by DNA methylation to preserve genomic integrity. In cancer, global DNA hypomethylation can lead to RE derepression, resulting in genomic instability and activation of innate immune pathways through viral mimicry. While individual RE classes have been examined in clear cell renal cell carcinoma (ccRCC), the integrated epigenetic landscape of multiple RE families and their clinical relevance remain incompletely characterized. MethodsWe performed a genome-wide prediction of DNA methylation across three major RE classes (Alu, LINE-1, and LTR elements) using a validated computational framework applied to Illumina methylation array data from two independent ccRCC tumor cohorts. Integrated unsupervised clustering of RE methylation profiles was used to define the epigenetic subtypes. Associations with clinicopathologic variables, tumor immune microenvironment composition (DNA Methylation-derived), hypoxia signaling, innate immune activation, and overall survival were evaluated. Prognostic relevance was assessed using multivariable Cox regression models adjusting for age, sex, AJCC stage or AUA risk group, and immune and angiogenic tumor microenvironment features. Key findings were then externally validated in CPTAC-ccRCC and independently replicated in an institutional Dartmouth Cancer Center (DCC) cohort with matched methylation and RNA-sequencing data. ResultsIntegrated clustering identified three reproducible RE methylation subtypes, Repressed, Transient, and Active. In the discovery cohort, the Active subtype showed significantly worse overall survival than the Repressed subtype, with a graded survival pattern across RE methylation states that persisted after multivariable adjustment. RE hypomethylation was associated with reduced EPAS1 (HIF2A) expression, increased immune infiltration, elevated PD-1 expression, and heightened cGAS-STING and interferon signaling, consistent with an immune-inflamed yet immunosuppressed tumor state. In the external CPTAC validation cohort, RE methylation subtypes recapitulated key molecular features and showed supportive survival trends. In the independent DCC replication cohort, an Active RE state was again associated with poorer survival, lower EPAS1 expression, increased PD-1 expression, greater CD8 T-cell and Treg infiltration, and elevated T-cell exhaustion signatures, supporting the reproducibility of the prognostic and immune-exhausted phenotype across cohorts. ConclusionsWe identified RE methylation subtypes with distinct molecular, immunologic, and prognostic features in ccRCC. External validation in CPTAC and independent replication in DCC support the robustness of this RE methylation framework across large-scale and institutional cohorts. These findings highlight the prognostic potential of RE methylation profiles and support their integration into molecular classification strategies to improve risk stratification in ccRCC.

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LEO1 loss promotes ER stress-adapted migration and cholesterol dependency in colorectal cancer

Park, S. C.; Lee, J.-Y.; Kwon, S. H.; Park, E. J.; Lee, J. M.

2026-05-20 cancer biology 10.64898/2026.05.17.725800 medRxiv
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The RNA polymerase-associated factor 1 complex (PAF1C) is an evolutionarily conserved transcription elongation complex that regulates RNA polymerase II-mediated transcription and chromatin modification. LEO1, a core subunit of PAF1C, has been implicated in developmental gene regulation, WNT signaling, and leukemogenesis; however, its role in solid tumor progression remains poorly understood. In this study, we found that although LEO1 expression is generally elevated in colorectal cancer (CRC), its expression is reduced in stage IV tumors and is associated with poor clinical outcomes. To investigate its function, we established LEO1 -deficient HCT116 cell line and performed transcriptomic analyses. Loss of LEO1 suppressed epithelial differentiation and developmental gene programs while inducing cell cycle delay. Despite these changes, LEO1-deficient cells exhibited aggressive phenotypes, including enlarged nuclei and increased expression of migration-associated genes, which were further enhanced under glucose deprivation. Motif analysis identified FOXM1 as a key regulator of these migration-related genes. Mechanistically, LEO1 deficiency promoted accelerated transcriptional activation of GRP78, a central regulator of endoplasmic reticulum (ER) stress adaptation. GRP78 was required for survival under ER stress conditions, and its inhibition suppressed both migration and migration-associated gene expression. In addition, transcriptomic analyses revealed upregulation of cholesterol metabolism-related genes in LEO1-deficient cells. Consistently, treatment with the HMG-CoA reductase inhibitor atorvastatin selectively impaired their survival, indicating cholesterol metabolic dependency. Collectively, these findings demonstrate that LEO1 loss promotes ER stress-adapted migration and cholesterol metabolic dependency in CRC, suggesting that these pathways may represent therapeutic vulnerabilities in metastatic LEO1-low CRC.

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The miR-221-5p/RAD18/RAD51 axis regulates DNA damage tolerance and homologous recombination to drive platinum resistance in ovarian cancer.

Omy, T. R.; Sah, N.; Kairamkonda, S.; Mani, C.; Islam, M. A.; Reedy, M. B.; Palle, K.

2026-05-14 cancer biology 10.64898/2026.05.11.724004 medRxiv
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Platinum resistance remains a major barrier in Ovarian cancer (OC) treatment[1]. While hyperactivation of DNA damage response (DDR) is a hallmark of chemoresistance[2], the underlying epigenetic mechanisms driving this adaptation remain poorly understood. Here, we identify a novel post-transcriptional regulatory axis involving miR-221-5p that governs two critical DDR effectors: RAD18, which mediates DNA damage tolerance through trans-lesion synthesis (TLS)[3][4], and RAD51, the central recombinase for homologous recombination (HR)[5][6]. Although the miR-221/222 cluster is traditionally categorized as oncogenic[7][8], we demonstrate that the miR-221-5p arm functions as a potent tumor suppressor in OC. Bioinformatic and luciferase reporter assays confirmed that miR-221-5p directly targets the 3'UTRs of both RAD18 and RAD51. In OC clinical specimens and cell lines, miR-221-5p downregulation inversely correlates with RAD18/RAD51 expression. Functionally, miR-221-5p restoration suppressed platinum-induced PCNA mono-ubiquitination and HR, inducing a "functional BRCAness" that sensitized both established and patient-derived primary OC cells to carboplatin and PARP inhibition. Furthermore, in vivo disseminated xenograft models demonstrated that stable miR-221-5p expression significantly reduced tumor burden. Collectively, our results delineate a novel regulatory mechanism where loss of miR-221-5p drives chemoresistance by derepressing the RAD18/RAD51 axis, identifying this axis as a promising therapeutic target.

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ARHGEF7 S-glutathionylation promotes cancer cell migration through Rac1 activation

Schiff, W. H.; Shivamadhu, M. C.; Mashhadi Ramezani, F.; Kukulage, D. S. K.; Padmavathi, R.; Ahn, Y.-H.

2026-05-06 biochemistry 10.64898/2026.05.01.722049 medRxiv
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Reactive oxygen species (ROS) are central signaling molecules in many biological processes by inducing oxidative modifications of protein cysteine residues, including S-glutathionylation. Increasing evidence supports that ROS contribute to cancer progression via promoting cancer cell migration, invasion, and metastasis. Nevertheless, the protein targets of S-glutathionylation that regulate cancer cell motility remain ill-defined. In this study, we report on the redox regulation of ARHGEF7, a guanine nucleotide exchange factor highly expressed in metastatic cancer cells, that plays a major role in regulating cell migration. Our data demonstrates that ARHGEF7 is selectively glutathionylated at the highly conserved C312 residue in its PH domain, which is implicated in regulating its enzymatic activity. Breast cancer cell lines showed increased cell migration and invasion upon glutathionylation of ARHGEF7 at C312 in response to both oxidative stress and epidermal growth factor (EGF). Mechanistically, upon C312 glutathionylation, ARHGEF7 exhibited significantly enhanced binding to Rac1 and increased Rac1 recruitment to the cell membrane and lamellipodia. ARHGEF7 S-glutathionylation also increased its enzymatic rate of GDP-GTP nucleotide exchange, resulting in Rac1 activation. Consequently, ARHGEF7 C312 S-glutathionylation induced Rac1-PAK1 activation and their downstream pathways, including LIMK1 and MEK1, thereby enhancing migration and invasion. Our data reveal a new redox player in cell migration, with its potential implications for ROS-induced cancer progression.

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Tumoral Switch in NUMB splicing changes essential transcription pathways and induces malignant properties in tumour cells

Garcia-Heredia, J. M.; Carnero, A.; Ortega-Campos, S.

2026-05-19 cancer biology 10.64898/2026.05.15.725391 medRxiv
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BackgroundRecent evidence suggests that cancer can exhibit splicing alterations that give rise to tumour-specific isoforms. One example is NUMB, which produces four isoforms (p72, p71, p66, and p65) through alternative splicing of exons 3 and 9. Traditionally considered a tumour suppressor, it also has been considered an oncogene. We propose that this duality is due to isoform-specific expression. ResultsUsing public databases, we identified a tumour-associated switch in NUMB isoform expression: p72/p71 are upregulated in tumours, whereas p66/p65 are more expressed in non-tumour tissues. These isoforms correlate differently with cellular processes. NUMBL, a NUMB homolog, behaves similarly to p65. We identified two transcriptional clusters: one characterized by high expression of p72/p71, and another by p66/p65/NUMBL. Each group was associated differently with the Notch, WNT/{beta}-catenin, Hedgehog, and Hippo signalling pathways, suggesting isoform-specific regulatory roles. Analysis of breast cancer cell lines (CCLE) led to a NUMB score based on isoform expression, which classified cell lines into biologically distinct groups. The p72/p71-enriched group showed distinct signatures, pathway activity, and drug sensitivity. Applying this score to TCGA-BRCA samples revealed a significant link between high NUMB-score and poor survival, confirmed by Kaplan-Meier analysis. ConclusionsNUMB emerges as a potential oncogenic contributor and biomarker in splicing-based personalised medicine, highlighting isoform-specific expression as a clinically relevant determinant of tumour behaviour, pathway activity, and therapeutic response.

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Failure of Bacillus Calmette-Guerin Therapy in Patients with Bladder Cancer is Characterized by Immune Dysfunction Associated with Activator Protein 1

Garven, A.; Pare, J.-F.; Robins, A.; Vera-Rodriguez, A.; Sampy, R.; Bennett, A.; Nauman, R. W.; Craig, A. W.; Greer, P. A.; Koti, M.; Cotechini, T.; Berman, D. M.; Simpson, A.; Postovit, L.-M.; Siemens, D. R.; Graham, C. H.

2026-05-10 cancer biology 10.64898/2026.05.06.723215 medRxiv
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The standard-of-care for patients with higher-risk non-muscle invasive bladder cancer (NMIBC) after tumour resection is intravesical administration of Bacillus Calmette-Guerin (BCG). While this form of adjuvant immunotherapy has improved recurrence-free and progression-free survival, a large proportion of patients experience recurrences within a year of diagnosis. The reasons for this high rate of early recurrence following BCG therapy remain unclear; however, inadequate activation of systemic immunity may be a contributing factor. To address this, we analysed the transcriptomic and chromatin accessibility profiles of peripheral blood mononuclear cells obtained from patients with NMIBC at single-cell resolution before BCG immunotherapy and after five induction doses of BCG. Monocytes from patients who experienced disease recurrence within a year of initiation of BCG therapy (BCG non-responders) exhibited a pro-inflammatory phenotype consistent with age-related immunosenescence prior to BCG immunotherapy. Moreover, inflammation-associated pathways that were active before initiation of BCG therapy in the BCG non-responders were down-regulated after five instillations of BCG. In contrast, these pathways were quiescent before BCG therapy in patients who remained disease-free for at least a year but were markedly up-regulated after five doses of BCG. Genomic regions with accessible chromatin were enriched in activator protein 1 (AP-1) binding sequences in monocytes from BCG-non-responders prior to BCG therapy. AP-1 is a central regulator of the inflammatory phenotype associated with immunosenescence. Our findings indicate that a pre-existing state of innate immunosenescence underlies early disease recurrence following BCG. Patients unlikely to benefit from BCG may be offered alternative therapies early in their disease journey. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=176 SRC="FIGDIR/small/723215v1_ufig1.gif" ALT="Figure 1"> View larger version (46K): org.highwire.dtl.DTLVardef@1f7c844org.highwire.dtl.DTLVardef@7cea65org.highwire.dtl.DTLVardef@1008d23org.highwire.dtl.DTLVardef@131f973_HPS_FORMAT_FIGEXP M_FIG C_FIG

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TransXplorer: An automated translational discovery platform for RNA-seq data

Verma, V. M.; Oler, E.; Syed, H.; Han, S.; Berjanskii, M.; Mason, A. L.; Wishart, D. S.; Wong, G. K.-S.

2026-05-16 bioinformatics 10.64898/2026.05.15.724657 medRxiv
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RNA-seq experiments routinely identify thousands of differentially expressed genes, but translating these into biological insights and therapeutic hypotheses often requires integrating multiple tools. Existing web platforms such as iDEP, NetworkAnalyst, and GEPIA2 address individual steps, differential expression, network visualization, or TCGA queries, but lack a unified environment spanning raw data processing to clinical and pharmacological interpretation. TransXplorer (https://transxplorer.org) is a freely available web platform that addresses this limitation by integrating the complete RNA-seq analytical workflow. It supports processing from raw FASTQ files using HISAT2 or Salmon, as well as direct GEO dataset import with automated metadata handling. Differential expression analysis is implemented via DESeq2, edgeR, and limma-voom, followed by functional enrichment across more than 1,800 species using Bioconductor resources. Batch effects are automatically detected and corrected using a composite of PVCA, kBET, and Silhouette metrics without requiring predefined batch annotations. Downstream analyses include co-expression network construction (WGCNA), protein-protein interaction mapping (STRING), cell-type deconvolution, and transcription factor inference using integrated DoRothEA and TFLink resources. The platform further links gene signatures to drug candidates through DGIdb and OpenTargets and enables survival and tumour-normal comparisons across TCGA cohorts. Application to cardiac endothelial differentiation (GSE151427) and kidney renal papillary cell carcinoma (TCGA-KIRP) datasets demonstrates accurate batch correction, biologically consistent pathway enrichment, recovery of expected cell-type proportions, and identification of clinically relevant genes and drug candidates. TransXplorer is freely available without a login.

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Developmental plasticity of cancer-associated fibroblasts contributes to the malignant progression of gastric cancers

Lee, S.; Cho, S.; Han, D.-S.; Kim, J.; Hur, H.; Kim, H. H.; Cheong, J.-H.; Kim, T.-M.

2026-05-22 cancer biology 10.64898/2026.05.21.726806 medRxiv
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Withdrawal StatementThe authors have withdrawn this manuscript to address issues related to data-use permission and authorship review. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

9
Temporal regulation of G2 phase avoids therapy-induced senescence caused by DNA replication stress-inducing drugs and provides synergistic cytotoxicity

Nonaka, K.; Wakasa, T.; Ochiiwa, H.; Kataoka, Y.; Ando, K.; Oki, E.; Yoshizumi, T.; Maehara, Y.; Kitao, H.; Iimori, M.

2026-05-09 cell biology 10.64898/2026.05.06.723184 medRxiv
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The cellular response to DNA replication stress (DRS) provoked by anticancer drugs involves activation of the G2/M checkpoint (which promotes transient cell cycle arrest at G2 phase) and DNA repair, followed by induction of apoptosis or senescence. Here, we activated the p53-p21 pathway and ATR using DRS-inducing drugs, and found that that the transition to senescence depends on the duration of the G2 phase. Shortening of G2 duration by G2/M checkpoint inhibitors led not only to a switch in cell fate from senescence to mitotic entry, but also to effective cell death through carry-over of chromosomal aberrations (generated by DRS-inducing drugs) into mitosis and subsequent mitotic progression. Such enhanced cell death was also observed in p53 deficient cells, which do not normally undergo senescence. Thus, we propose that temporal regulation of G2 phase is an approach to enhancing the effects of DRS-inducing drugs in a manner that is independent of p53 status.

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Deciphering the Genomic Landscape of Renal Cell Carcinoma Brain Metastases

Gok Yavuz, B.; Li, P.; Ovando-Ricardez, J. A.; La Ferlita, A.; Tse, J. W. T.; Hanalioglu, S.; Babaoglu, B.; Baylarov, B.; Norberg, L. M.; Chancoco, H. D.; Thompson, E. J.; Mut, M.; Soylemezoglu, F.; Huse, J. T.; Osunkoya, A. O.; Bilen, M. A.; Hasanov, M.; Jonasch, E.; Shih, D. J. H.; Hasanov, E.

2026-05-06 genetics 10.64898/2026.05.02.722447 medRxiv
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Brain metastases from renal cell carcinoma (RCC) remain a major cause of morbidity and mortality, yet the genomic features associated with metastatic dissemination remain poorly understood. Whole-exome sequencing was performed on 72 RCC brain metastasis samples with matched normal. To identify candidate genomic alterations associated with brain metastasis, the genomic alterations detected in the brain metastases were compared against alterations in extracranial metastases from the MSK-ECM cohort (n=137) and primary RCC tumors from TCGA (n=432) by case-control analyses. Candidate alterations were also identified through matched-pair analyses comparing brain metastases with matched primary tumors or extracranial metastases from the same patient (n=25). A random survival forest model incorporating the candidate CNA events was developed to predict overall survival. The candidate CNAs were further evaluated using functional experimental data from MetMap and DepMap. Survival analyses were conducted to assess the prognostic relevance of these alterations. We identified recurrent CNAs enriched in RCC brain metastases, including 4q loss, 7p gain, 7q gain, 8p loss, 8q gain, 9p21.3 deletion, 12q15 amplification, and 14q loss. These alterations were associated with significantly poorer patient survival among RCC patients. A random survival forest model based on these CNA events stratified TCGA-KIRC patients into prognostically distinct risk groups (C-index = 0.64). Among the recurrent CNAs, 8p loss, 8q gain, 9p21.3 deletion were associated with increased incidence of brain metastases across multiple primary cancer types in xenograft mouse models. These alterations were also strongly associated with metastatic progression and poor prognosis across RCC, lung adenocarcinoma, breast cancer, and melanoma. These findings indicate a shared genomic basis for brain tropism and highlight the potential utility of copy-number alterations as biomarkers for risk stratification and clinical decision-making.

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Convergent suppression of nuclear-encoded mitochondrial fatty acid oxidation genes defines a pan-subtype signature in breast cancer: a multi-cohort transcriptomic study

Gomosani, A. A.; Marghalani, H.; Al Matar, L.

2026-05-20 cancer biology 10.64898/2026.05.17.725700 medRxiv
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BackgroundBreast cancer exhibits extensive molecular heterogeneity across intrinsic subtypes, yet convergent metabolic reprogramming may represent an obligate feature of tumour initiation. We hypothesised that suppression of nuclear-encoded mitochondrial fatty acid oxidation (FAO) constitutes such a convergence point, defining a shared metabolic phenotype independent of subtype. MethodsRNA-seq data from 1,106 primary breast tumours and 113 normal-adjacent tissues (TCGA-BRCA) were intersected with 1,079 nuclear-encoded mitochondrial genes from MitoCarta 3.0. Differential expression was assessed using Welch t-test with Benjamini-Hochberg correction at all tumour stages, at Stage I specifically, and stratified across PAM50 subtypes. A 55-gene core FAO signature was derived by three-way intersection. Ten candidate genes were selected by pre-specified objective scoring, locked before any clinical testing. Gene set enrichment analysis (GSEA) was performed using MitoCarta 3.0 pathway annotations. Diagnostic performance, clinical associations, survival, and mutation independence were characterised. External validation used two independent GEO cohorts (GSE42568, n = 121; GSE109169, n = 50); prognostic validation used METABRIC (Molecular Taxonomy of Breast Cancer International Consortium; n = 1,980). DESeq2 was applied as methodological cross-validation. ResultsAmong 126 differentially expressed mitochondrial genes, fatty acid oxidation was the most significantly depleted pathway (normalised enrichment score -2.130; false discovery rate 0.001). The 55-gene core signature replicated in both external cohorts with 100% directional concordance (hypergeometric p < 10-{superscript 1}). All 10 candidate genes discriminated tumour from normal tissue (area under the curve 0.915-0.979) and demonstrated broad clinical associations. The composite FAO suppression score predicted overall survival in METABRIC (log-rank p = 7.82 x 10-) and MAOA achieved independent prognostic significance in multivariable Cox regression (hazard ratio 0.890; adjusted p = 0.009). DESeq2 cross-validation confirmed Spearman {rho} = 0.980 concordance. ConclusionsNuclear-encoded FAO suppression is a robust, pan-subtype feature of breast cancer detectable at Stage I and validated across independent platforms and cohorts. These 10 candidate genes constitute a consistent initiation-phase mitochondrial signature, implicating FAO suppression as a potential convergence point in breast cancer oncogenesis and motivating targeted functional investigation.

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ATF4 programs proline-dependent immune evasion in β-Catenin-driven hepatocellular carcinoma

Infante, S.; Santa Maria, E.; Finnemore, A.; Arcelus, S.; Barace, S.; Martinez-Montes, A.; Garcia-Porrero, G.; Hosseini-Giv, N.; Miraval, E.; de Andrea, C. E.; Llopiz, D.; Reig, M.; Finkelstein, Y.; Sangro, B.; Sarobe, P.; Fortes, P.; Uriz-Huarte, A.; Bayo, J.; Argemi, J.

2026-05-16 cancer biology 10.64898/2026.05.12.724215 medRxiv
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Background & AimsHepatocellular carcinoma (HCC) frequently exhibits resistance to immune checkpoint inhibitors (ICIs), particularly in {beta} -catenin-driven tumors characterized by immune exclusion. While the Unfolded Protein Response (UPR) and the Integrated Stress Responses (ISR) enable tumor adaptation to metabolic stress their role in shaping tumor immunogenicity remains incompletely understood. We investigated whether ATF4, a central effector of the integrated stress response, couples metabolic reprogramming to suppression of anti-tumor immunity in HCC. MethodsWe combined transcriptomic analyses across three independent human HCC cohorts with mechanistic studies using an immunotherapy-resistant MYC/{beta}-catenin-driven murine HCC model. We integrated CRISPR/Cas9-mediated deletion of Atf4 with RNA-sequencing and targeted metabolomics. The impact of tumor-derived metabolites on macrophage differentiation and polarization was evaluated using primary bone marrow-derived cells. Therapeutic responses were evaluated in orthotopic and subcutaneous models treated with anti-PD-1 and anti-VEGFA. ResultsATF4 and XBP1 transcriptional signatures are selectively enriched in human HCC and associate with poor prognosis, vascular invasion, and an immunosuppressive myeloid-enriched tumor microenvironment. Genetic ablation of Atf4 markedly suppressed tumor growth in immunocompetent but not immunodeficient hosts, establishing a requirement for immune-mediated tumor control. Mechanistically, Atf4 loss downregulated Aldh18a1 and disrupted proline biosynthesis, resulting in extracellular proline depletion. This proline-deficient environment abrogated monocyte-to-macrophage differentiation and decreased M2 polarization, thereby reshaping the tumor microenvironment toward enhanced T cell infiltration and activation. Functionally, Atf4-deficient tumors exhibited restored sensitivity to anti-PD-1 monotherapy and showed pronounced responses to combined anti-PD-1/anti-VEGFA treatment in aggressive orthotopic models. ConclusionATF4 programs a proline-dependent metabolic axis that sustains macrophage-mediated immunosuppression and immune evasion in {beta}-catenin-driven HCC. Disruption of this pathway converts immune-excluded tumors into T cell-inflamed states and restores responsiveness to immunotherapy. By governing proline homeostasis and macrophage-mediated immunosuppression, ATF4 is a key metabolic checkpoint for immune evasion, linking stress adaptation to immune escape and a candidate therapeutic target in HCC. Impact and implicationsWe identify ATF4 as a crucial metabolic-immune orchestrator that sustains myeloid-driven immune evasion in {beta}-catenin-dependent HCC through proline-dependent circuitry. Disrupting the ATF4-proline axis converts immune-desert tumors into T cell-inflamed lesions by blocking macrophage differentiation, thereby sensitizing tumors to immune checkpoint therapy. This work positions ATF4 as a tractable therapeutic target to overcome immunotherapy resistance in HCC. Graphical abstract Highlights- ATF4 orchestrates an immunosuppressive tumor microenvironment in HCC by coupling metabolic stress adaptation to immune evasion. - Ablation of ATF4 disrupts proline biosynthesis, leading to a marked depletion of extracellular proline. - Cancer cell-derived proline availability contributes to macrophage differentiation and M2 polarization; its loss restores T cell-mediated anti-tumor surveillance and sensitizes beta-catenin-driven HCC to immune checkpoint blockade.

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Hydrogen Peroxide induces resistance to DNA damage in a localization and p53 dependent manner.

Keijer, J. P.; Polderman, P. E.; Alcaraz-Sobrevals, P.; van Es, R. M.; Montiel Gonzalez, D.; Kok, R. N. U.; El Baghdadi, S.; Gülersönmez, C.; Stigter, E. C. A.; Vos, H. R.; Burgering, B. M. T.; van Boxtel, R.; Dansen, T. B.

2026-05-15 cancer biology 10.64898/2026.05.13.724825 medRxiv
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Organisms need to be able to adapt to a changing environment in order to survive. The adaptive response invoked by a low dose of a stressor resulting in resistance to high levels of that stressor is known as hormesis and can even lead to lifespan extension of organisms. The exact mechanisms underlying stress-induced hormesis are unknown, although multiple studies pose mitochondria-derived Reactive Oxygen Species (ROS, e.g. H2O2) as an important contributor. Here we used chemo-genetic H2O2 production as a model to study ROS-dependent adaptive responses in a localization-dependent manner. We found that brief, sublethal H2O2 production at the nucleosomes provides p53-dependent resistance to a subsequent high dose of H2O2, whereas mitochondrial H2O2 production, surprisingly, does not. A multi-omics approach revealed that p53-induced hormesis is accompanied by metabolic rewiring that boosts reductive capacity, and that the increased stress resistance can mostly be attributed to its downstream target p21. Importantly, brief p53 stabilization also mounted protection against chemotherapy-induced DNA damage, suggesting that p53-dependent hormesis could be exploited to selectively protect healthy, p53-wildtype tissue from chemotherapy in the treatment of patients with p53 mutant tumors.

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HES3-dependent regulatory functions in development and fusion-positive rhabdomyosarcoma

Kucinski, J.; Kent, M. R.; Silvius, K. M.; Kumar, A.; Taslim, C.; Kendall, G. C.

2026-05-08 cancer biology 10.64898/2026.05.05.723070 medRxiv
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HES3/Her3 is a transcription factor that functions in non-canonical STAT3 signaling to promote the renewal of neural stem cells and has roles in multiple cancer contexts. To study its role in development and disease, we previously generated a CRISPR/Cas9 zebrafish knockout of her3, the ortholog to human HES3. HES3 is also a cooperating gene in fusion-positive rhabdomyosarcoma, an aggressive pediatric cancer, where HES3 prevents terminal myogenic differentiation, and high expression correlates with worse patient outcomes. Here, we utilize our her3/HES3 knockout model with chromatin and transcriptional profiling techniques to assess its role during early zebrafish gastrulation with the goal of understanding the function of this transcription factor and how these activities are co-opted in cancer. We found that the Her3/HES3 preferential binding motif is distinct from other HES-family members, including a CG-rich E-box motif, that it leverages to modulate the expression of genes involved in neurogenesis and WNT signaling. We also determined that motif preferences of Her3/HES3 altered its interactions with DNA, allowing it to function canonically as a transcriptional repressor with additional duality as an activator. In the context of PAX3::FOXO1, a monogenic driver of fusion-positive rhabdomyosarcoma, we find that Her3/HES3 plays an influential role in modulating the initial activities of this core oncogenic transcription factor. Upon expressing PAX3::FOXO1 in early developing zebrafish embryos, her3 knockout allowed for enhanced activation of neural programs, which are observed in the human disease, along with alterations to cell adhesion programs. Patient tumor samples could be clustered and stratified based on HES3 expression alone. We saw that patient PAX3::FOXO1-positive tumors with high levels of HES3 contained a more neural identity than those with low levels of HES3, altogether suggesting HES3 plays a critical role in regulating this neural signature during both the initial functions of PAX3::FOXO1 and in established tumors.

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Cross-assay RNA modeling reveals cancer biomarkers

Townsend, H. A.; Jordan, K. R.; Wolsky, R. J.; Van Kleunen, L. B.; Davidson, N. R.; Behbakht, K.; Sikora, M. J.; Dowell, R. D.; Clauset, A.; Bitler, B. G.

2026-05-05 bioinformatics 10.64898/2026.04.30.722009 medRxiv
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The clinical heterogeneity of cancer poses a major challenge for precision medicine. Limited cohort sizes across evolving assay platforms impede reliable biomarker discovery. Here, we systematically evaluate how to integrate data from four transcriptomics platforms: bulk and single-cell (sc) RNA sequencing (RNA-seq), NanoString, and microarray for predictive modeling in cancer. We use high-grade serous carcinoma (HGSC) of tube-ovarian origin as a model system, as it is highly heterogeneous in both biology and assay data. We find that using fold-change of gene expression in patients with matched pre- and post-neoadjuvant chemotherapy samples reduces inter-patient and inter-assay variability but is insufficient to overcome platform-specific biases. Microarray and scRNA-seq data exhibit systematic biases, while RNA-seq and NanoString show the most promise for combination into a single training cohort. To mitigate inter-assay limitations, we generate a new data set of HGSC tumor samples profiled with both RNA-seq and NanoString, and use it to identify the limits of detection and optimal harmonization strategies. Our approaches enable integration of cohorts for separate and combined RNA-seq and NanoString predictive models of disease recurrence (test-set AUROCs > 0.8), validated in external microarray cohorts. We leverage single-cell and bulk RNA-seq network-based analyses to provide mechanistic context for genes in the predictive models. Our models indicate that GBP4 expression is a key predictor of recurrence and marks immune remodeling towards cytotoxicity. We provide an interactive web portal to facilitate exploration of data and results. These findings guide cross-assay harmonization of transcriptomic data and enable improved predictive modeling in heterogeneous cancers. Statement of SignificanceWe present a framework for integrating RNA-seq, NanoString, microarray, and single-cell transcriptomic data for predictive modeling, enabling robust biomarker discovery in heterogeneous cancers and identifying GBP4 as a marker of immune remodeling.

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Machine Learning Analysis to Define Cell Lineage in Leiomyosarcoma

van IJzendoorn, D. G. P.; Przybyl, J.; Hastie, T.; Bovee, J. V. M. G.; Matusiak, M.; van de Rijn, M.

2026-05-12 cancer biology 10.64898/2026.05.08.723931 medRxiv
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IntroductionCellular differentiation and lineage commitment are known to be associated with differences in DNA methylation. Leiomyosarcoma (LMS) is a tumor thought to originate from smooth muscle cells in the walls of vessels in the soft tissue (STLMS) or from the uterine myometrium (ULMS). Here, we identify the methylation signatures of normal smooth muscle cells from blood vessels and the uterine wall and compare these with those found in STLMS and ULMS. We hypothesized that these methylation signatures could be used to assign a smooth muscle subtype of origin to individual leiomyosarcomas, and that tumors of different origin would show biological differences with potential therapeutic relevance. MethodsTo define methylation profiles for smooth muscle from vessel walls versus those found in myometrium, EPIC methylation profiling was performed on DNA from 49 formalin-fixed paraffin-embedded (FFPE) normal smooth muscle samples. A supervised machine learning algorithm (Random Forest) was used to distinguish the methylation patterns of normal smooth muscle cells in vessel walls from those in the myometrium. The resulting classifier was applied to methylation data on 67 cases of LMS with corresponding bulk RNAseq data to identify which tumors showed a methylation signature most consistent with either blood vessel wall (LMSvessel) or myometrial smooth muscle (LMSwall). A custom signature matrix derived from scRNAseq data from 6 samples of LMS was used in CIBERSORTx analysis to compare the cellular composition of LMS cases with a vessel or uterine wall methylation signature. ResultsA high degree of correlation was found between the known site of origin for LMS (STLMS vs ULMS) and the methylation signature derived from different types of normal smooth muscle. LMSwall tumors compared to LMSvessel tumors had significantly higher activation of the PD-1 checkpoint pathway in RNAseq analysis. Digital flow cytometry by CIBERSORTx analysis showed an increased expression of transcriptomic signatures of several immune cell subtypes in LMSvessel tumors. ConclusionUsing a supervised machine learning approach we classified LMS samples as either showing a high similarity in methylation patterns to normal smooth muscle cells of either the vessel wall or the myometrium. We found a correlation between LMS showing either a "vessel" or "muscle wall" methylation signature and their site of origin, but notably we also identified some exceptions. When classified based on their methylation signature LMSwall and LMSvessel differed in their PD-1 pathway activation and in their predicted immune cell populations, suggesting potential implications for immunotherapeutic approaches.

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Comprehensive Molecular Characterization of High-Grade Endometrial Cancer in an Ancestrally-Diverse Cohort

Frimer, M.; Gee, D.; Goldstein, Z. R.; Hooper, W. F.; Founta, K.; Deschenes, A.; Geiger, H.; Belleau, P.; Kramer, M.; Yueh, B.; Chu, T.; Oku, A.; Vaksman, Z.; Grether, V.; Steinsnyder, Z.; Araneo, A. L.; Chung, C.; Kapedani, A.; Nizam, A.; Eskiocak, O.; Ozler, K.; Goldberg, G. L.; Krasnitz, A.; McCombie, W. R.; Barbi, M.; Winterkorn, L.; Robine, N.; Beyaz, S.; Chambwe, N.

2026-05-05 cancer biology 10.64898/2026.05.01.721962 medRxiv
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Endometrial cancer (EC) exhibits one of the most striking racial disparities in oncology with black women disproportionately affected by aggressive high-grade subtypes that have poorer outcomes. While social and environmental factors undoubtedly contribute, the molecular underpinnings of these disparities remain critically understudied. To bridge this knowledge gap, we performed matched tumor-normal whole-genome sequencing and tumor transcriptome sequencing on 71 predominantly high-grade EC patient samples from an ancestrally diverse cohort of women recruited at a large hospital system in the New York metropolitan area. Our analysis characterized the germline and somatic mutation landscape, identifying ancestry-associated molecular differences. Notably, focal amplification of the EVI1 transcription factor (encoded at the MECOM locus) was significantly more frequent in African ancestry patients and associated with poorer clinical outcomes in an external validation cohort. Additionally transcriptome analysis revealed decreased CD8+ T cell infiltration with increasing African ancestry, suggesting tumor immune microenvironment differences with potential therapeutic implications. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=163 SRC="FIGDIR/small/721962v1_ufig1.gif" ALT="Figure 1"> View larger version (63K): org.highwire.dtl.DTLVardef@12125b9org.highwire.dtl.DTLVardef@133c787org.highwire.dtl.DTLVardef@707af0org.highwire.dtl.DTLVardef@97615c_HPS_FORMAT_FIGEXP M_FIG C_FIG HighlightsO_LIThis study represents the most ancestrally diverse whole-genome sequencing characterization of high-grade endometrial cancer, with 62% of patients of African ancestry. C_LIO_LIMECOM focal amplification preferentially targets the oncogenic short isoform (EVI1) and is more frequent in patients of African ancestry. C_LIO_LIAfrican ancestry is associated with reduced CD8+ T cell infiltration and differential activation of immune and metabolic pathways in copy-number high endometrial tumors. C_LI

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Elevated Expression of MALAT1 Contributes to the Survival of Drug-Tolerant Persister Cells Following Targeted Therapy in Lung Adenocarcinoma

Davis, W. J. H.; Thompson, M.; Farry, S. M.; McKinney, C.; Gimenez, G.; Hatley, M.; Kumar, R.; Rodger, E. J.; Chatterjee, A.; Diermeier, S. D.; Drummond, C. J.; Reid, G.

2026-05-12 cancer biology 10.64898/2026.05.07.723110 medRxiv
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Lung adenocarcinomas frequently harbour actionable oncogenic mutations that are vulnerable to treatment with targeted therapies. While responses to targeted therapies are often initially dramatic, relapse is almost inevitable and prevents durable responses in advanced-stage patients. Relapse is, in part, caused by drug tolerant persister cells (DTPs) which are able to survive treatment by entering a reversible, dormant state. Although long non-coding RNAs (lncRNAs) regulate processes thought to allow DTPs to survive and become stably resistant, the potential roles of lncRNAs in DTPs are largely unknown. In this study, we sought to investigate the expression of lncRNAs in in vitro DTP models of lung adenocarcinoma. We found that the lncRNAs Metastasis-Associated Lung Adenocarcinoma Transcript 1 (MALAT1) and Nuclear Paraspeckle Assembly Transcript 1 (NEAT1) were enriched in DTPs and that knocking down MALAT1 enhanced the effect of targeted therapies in both EGFR- and KRAS-mutant DTP models. To better understand pathways that MALAT1 might regulate in DTPs, bulk RNA-sequencing was performed and several pathways that may contribute to the actions of MALAT1 in DTPs were identified. Overall, our work describes a role for the lncRNA MALAT1 in DTPs in NSCLC and suggests that MALAT1 may be a novel target for the prevention of drug tolerance and subsequent resistance to targeted therapy in NSCLC.

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Identification of rare pseudouridylated microRNA by comprehensive small RNA bisulfite sequencing of mouse and human tissues

Fagre, C.; Gilbert, W. V.

2026-05-15 molecular biology 10.64898/2026.05.14.725264 medRxiv
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Pseudouridine ({Psi}) is an important post-transcriptional modification of many noncoding RNAs that is under-characterized in microRNA (miRNA) due to historical limitations in pseudouridine mapping methods. {Psi} modification stabilizes RNA duplex structures and could therefore play an important role in miRNA target binding and repression. To investigate the extent to which mammalian miRNAs are modified with {Psi}, we profiled the modification landscape of short (<30 nt) RNA in human cells and mouse tissues using bisulfite sequencing. Our approach was powered to detect small RNA pseudouridylation based on robust detection of known {Psi} positions in tRNA fragments (tRFs), some of which show tissue-specific patterns of modification. In contrast with tRFs, we find that miRNA pseudouridylation is exceedingly rare, with a single modified miRNA (miR-3068-5p) identified in mouse tissues. Pseudouridylated miR-3068-5p diSerentially repressed predicted miRNA targets with less stable miRNA:mRNA pairing modes. This study fills a long-standing gap in transcriptome-wide {Psi} profiling and reveals a new potential function for {Psi} as a modulator of activity of small regulatory RNAs.

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SLD5/GINS4 controls dynein-dependent centrosome maturation and exposes a candidate mitotic vulnerability in cancer.

Kumar, V.; Singh, V.; Singh, R.; Kumar, P.; Ghosh, T.

2026-05-11 cancer biology 10.64898/2026.05.07.723511 medRxiv
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Faithful proliferation requires coordinated DNA replication with centrosome maturation and spindle-pole integrity. SLD5, encoded by GINS4, is a core component of the GINS replication complex and is frequently elevated in tumors, but whether it links replication-associated cancer states to centrosome control has remained unclear. Here, we show that GINS4/SLD5 is recurrently upregulated across human cancers at transcript and protein levels and marks tumor programs enriched for DNA replication, chromosome segregation, and mitotic control. In cancer cells, Sld5 depletion dispersed PCM1, AZI1, and CEP290-positive centriolar satellites without eliminating these satellite proteins, reduced dynein heavy chain expression, and destabilized dynein-dynactin localization at spindle poles. Direct depletion of dynein heavy chain, co-depletion analyses, and pharmacological inhibition of dynein motor activity with ciliobrevin D phenocopied Sld5 loss, causing satellite dispersion, defective recruitment of PLK1, Aurora A, CEP192, and CEP215 to centrosomes, and multipolar spindle formation. These defects occurred without detectable DNA damage or checkpoint activation, indicating a non-canonical Sld5 function beyond its role in the replisome. Cancer dependency and kinase network analyses further nominate SLD5-associated mitotic and checkpoint pathways as therapeutic targets. Our findings identify SLD5/GINS4 as a regulator of dynein-dependent centrosome maturation and a candidate vulnerability in replication-driven cancers, with potential value for biomarker-guided therapeutic stratification. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=136 SRC="FIGDIR/small/723511v1_ufig1.gif" ALT="Figure 1"> View larger version (53K): org.highwire.dtl.DTLVardef@e845d8org.highwire.dtl.DTLVardef@141719aorg.highwire.dtl.DTLVardef@1895e1corg.highwire.dtl.DTLVardef@181aa16_HPS_FORMAT_FIGEXP M_FIG C_FIG