Neuro-Oncology

Background and ObjectivesIntramedullary spinal cord tumors (IMSCTs) are rare, and the extent of surgical resection may influence overall survival (OS). Gross total resection (GTR) may offer superior outcomes compared to subtotal resection (STR) or biopsy. Our study seeks to quantify the benefits of resection extent on OS in patients with spinal gliomas (SGs). MethodsA systematic review was conducted using the following databases: Scopus, Embase, and PubMed. Studies reporting OS in patients who underwent GTR, STR, or biopsy for low- or high-grade SG. We used a random-effects model to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs); this was performed separately for low-grade (WHO grade I-II) and high-grade (III-IV) SGs. Subgroup analysis was performed for radiotherapy. I2 statistic and Cochrans Q tests evaluated study heterogeneity, Eggers and funnel plot asymmetry tests assessed publication bias, and Risk Of Bias In Non-randomized Studies of Exposure (ROBINS-E) evaluated individual study bias. ResultsIn a pooled analysis of 5 studies, GTR was not associated with improvement in OS compared to STR or biopsy in high grade SGs (HR=0.48, 95% CI: 0.19 -1.26). However, low-grade SGs revealed significant benefit in overall survival with GTR (HR=0.27, 95% CI: 0.15-0.46). Patients treated with radiotherapy were associated with worse outcomes following GTR in low-grade SGs (HR=1.48, 95% CI: 1.30-1.69) but no survival differences in high-grade SGs (HR=1.21, 95% CI: 0.52-2.83). ROBINS-E determined only 1 study with high risk of bias. ConclusionGTR for intramedullary spinal gliomas may not confer a significant benefit in overall survival for high-grade lesions but may provide benefit in lower grades. Radiotherapy confers a worse survival in lower-grade tumors, potentially due to their infiltrative nature. Future studies should stratify outcomes based on tumor biology, as well as follow functional outcomes overtime.

Importance: Glioblastoma (GBM) cells integrate into neuronal circuits, and preclinical work implicates multiple neurotransmitter (NT) networks as key drivers of invasion and treatment resistance. Whether the integration of GBM within NT-defined large-scale brain networks conveys prognostic information for overall survival (OS) is unknown. Objective: To determine whether NT-specific network involvement of GBM is associated with OS in patients with newly diagnosed Isocitrate dehydrogenase (IDH)-wildtype(wt) GBM. Design, Setting, and Participants: In this observational multicenter cohort study, we analyzed two independent cohorts of adults with histopathologically confirmed IDH-wt GBM. Cohort 1 included 153 patients treated at the University Medical Center Hamburg-Eppendorf, Germany (2012-2024), and cohort 2 comprised 264 patients from the University of Pennsylvania Health System, USA (2006-2018). Preoperative contrast-enhanced MRI was used to derive individual tumor masks, which were spatially mapped onto normative NT-informed structural connectomes spanning 19 receptor and transporter systems. Exposures: Preoperative contrast-enhancing GBM lesions, quantified as patient-specific involvement scores (0-1) within each NT-defined brain network. Statistics: We used partial least-squares regression for variable selection and multivariable Cox proportional-hazards models alongside regularized logistic regression with out-of-sample prediction, adjusted for age, methylguanine methyltransferase (MGMT) promoter methylation, and extent of resection, to test associations between NT-specific GBM network involvement and OS. Results: Across 417 patients in two cohorts, greater GBM involvement within cholinergic networks, defined by normative vesicular acetylcholine transporter (VAChT)-weighted as well as dopaminergic D2 receptor involvement, was consistently associated with reduced OS, independent of age, MGMT status, and resection extent. Further, cholinergic network involvement showed the strongest contribution to the prediction models. Other NT networks did not show reproducible prognostic effects across cohorts. Tumor-intrinsic hypomethylation of acetylcholine receptor-associated regions correlated with imaging-based cholinergic network involvement and mirrored its prognostic relevance. Conclusion and Relevance: Tumor integration into neurotransmitter-specific brain networks is an independent predictor of poorer survival in GBM. By combining routine clinical MRI with normative NT-informed connectome data, this approach delineates a novel systems-level marker of tumor aggressiveness and supports cholinergic inhibition as a putative therapeutic target in GBM.

BackgroundGlioblastoma (GB) is a highly aggressive brain tumor with a median survival of approximately 14 months, primarily due to its ability to infiltrate healthy brain tissue both as single cells and in collectives. A deeper understanding of GB cell motility, both individual and collective, is crucial for developing patient-specific therapies. We aimed to characterize migration in patient-derived GB cells using advanced modeling to identify stratification markers and therapeutic vulnerabilities. MethodsWe developed Single-Cell Behavior Live Imaging (ScBLI), an approach integrating live imaging with computational analysis, applied to 30 GB primary cell cultures. Trajectories and morphological features were tracked and analyzed. Diffusion Entropy Analysis (DEA) was applied to classify trajectories based on the Delta Scaling parameter ({delta} scaling). We evaluated functional responses correlating all findings with clinical outcomes and transcriptomic profiles. ResultsWe analyzed 4,279 cell trajectories. Based on {delta} scaling (range 0.28-0.837), we defined three distinct motility groups: Low (L, {delta} scaling [&le;]0.5), Medium (M, 0.5 < {delta} scaling [&le;] 0.7), and High (H, {delta} scaling >0.7). Functional assays demonstrated that Group H cells are more performant in both positive and negative chemotaxis. Clinically, the three groups showed a clear linear progression with patient survival: High {delta} scaling correlated with the shortest survival (poorer prognosis), while Low {delta} correlated with the longest survival, suggesting that structured motility drives invasiveness. Integrative multi-omic analysis, encompassing both exome and transcriptome profiling, demonstrated that these groups are defined by distinct molecular landscapes rather than poor behavioral traits. Moreover, exome data revealed that Group H is significantly enriched in PTEN alterations (75% vs. 8% in Group L), with PTEN gain-of-function (GoF) mutations exclusively restricted to this group (100% vs 0% in Group L). Notably, within our extended cohort (n=51) currently characterized by whole-exome sequencing, we observed that specific PTEN GoF mutations were associated with a significantly shorter survival compared to PTEN wild-type cases (median OS 6.4 vs 16.6 months; p=0.02), which typically harbor the canonical loss of chromosome 10q. A similar clinical trend was observed when comparing directly GoF carriers to patients with truncating (Ter) alterations (median OS 6.4 vs 14.3 months; p=0.09). Conversely, no survival difference was found between truncating (Ter) mutations and wild-type cases. ConclusionOur findings demonstrate for the first time that migratory efficiency, quantified through DEA, represents a powerful predictor of glioblastoma aggressiveness. Tumor cells adopting highly efficient exploration strategies are strongly associated with poor clinical outcomes and are characterized by distinct molecular signatures, notably PTEN gain-of-function alterations. Statement of significanceOur multi-scale computational framework elucidates emergent behavioral phenotypes as pivotal drivers of glioblastoma progression. By demonstrating a correlation between enhanced migratory efficiency, PTEN gain-of-function, and significantly reduced overall survival, we establish a foundational paradigm for deciphering the emergent complexity governing tumor invasiveness.

Atypical teratoid rhabdoid tumor (ATRT) is a malignant brain tumor of children that has an overall survival of less than 40 percent even with aggressive therapy. We identified upregulation of the mitogen activated protein (MAP) kinase pathway in ATRT. The novel, brain-penetrant MEK inhibitor mirdametinib inhibited the growth of ATRT cell lines in culture at nanomolar concentrations. Mirdametinib suppressed proliferation as measured by BrdU incorporation and induced apoptosis as measured by cPARP and Annexin V staining. Monotherapy with mirdametinib extended the life of mice bearing orthotopic xenografts. Combination therapy with the brain-penetrant cyclin dependent kinase 4/6 inhibitor abemaciclib further suppressed growth and BrdU incorporation in ATRT cell lines representing all molecular subgroups. Mirdametinib and abemaciclib combined to extend survival of mice bearing orthotopic ATRT xenografts. In conclusion, mirdametinib has single agent activity against ATRT and combines with abemaciclib to decrease proliferation and extend survival in orthotopic xenograft models of ATRT.

We studied the effect of stimulating innate immune function in tumor-associated myeloid cells (TAMs) in medulloblastoma (MB) and diffuse midline glioma (DMG), using a polyoxazoline nanoparticle formulation of the TLR7/8 agonist resiquimod (ResiPOx). Children with MB and DMG need novel therapeutic strategies to improve outcomes and reduce recurrence. We investigated the effect of systemically administered ResiPOx on TAMs in MB and DMG using endogenous MB and DMG models in immune-competent mice and identified multiple mechanisms of anti-tumor effect. We packaged resiquimod into polyoxazoline micelles to generate ResiPOx. We studied ResiPOx efficacy as a single agent or paired with radiation therapy (RT). We determined ResiPOx pharmacokinetics (PK) using tritium-labeled resiquimod and mass spectroscopy imaging (MSI). We determined ResiPOx pharmacodynamics (PD) using flow cytometry immunohistochemistry, bulk and single-cell RNA-seq and immunoblotting. We then studied ResiPOx safety and PD in a non-human primate model using rhesus macaques. ResiPOx formulation improved the blood-brain barrier penetration and anti-tumor efficacy of resiquimod. ResiPOx treatment extended progression-free survival (PFS) in mice with MB and DMG. In both tumor types, ResiPOx expanded TAM populations and reprogrammed TAMs toward anti-tumoral states, characterized by activation of IFN{beta} and extrinsic apoptosis pathway signaling, antigen presentation, and T cell activation signatures. In rhesus macaques, systemic ResiPOx administration was well tolerated and induced brain transcriptional responses that resembled ResiPOx responses in DMG and MB mouse models, indicating common effects across species from mice to non-human primates, and highlighting potential for similar effects in patients. ResiPOx is a brain-penetrant immunomodulatory therapeutic that reshapes the immune-privileged brain tumor microenvironment. Systemic administration activates myeloid-driven anti-tumoral immunity mediated by microglial and macrophage TAMs, and improves survival in preclinical models of DMG and MB.

Meningiomas are the most common primary central nervous system tumors in adults, posing a significant burden to society. Although a large percentage of lower-grade meningiomas are curable by surgery or radiation alone, high-grade and a subset of low-grade meningiomas demonstrate recurrences and complications from treatment. Systemic therapies for meningioma remain ineffective, and no targeted treatments are approved. Despite the central role of YAP1/TAZ-TEAD signaling in NF2-deficient/mutant tumors, no studies have systematically examined TEAD inhibition across molecularly defined meningioma subtypes or investigated mechanisms of resistance in this disease. We have recently shown that YAP1/TAZ signaling is an oncogenic driver of meningioma. Here, using established and patient-derived meningioma cell lines, we demonstrate that genetic ablation of YAP1/TAZ suppresses growth in both NF2 mutant and NF2 wild type cell lines, establishing YAP1/TAZ-TEAD signaling as a shared oncogenic dependency. Pharmacologic TEAD inhibition suppressed growth of benign NF2 mutant and a subset of higher-grade NF2 mutant meningiomas, whereas NF2 wild type meningiomas were generally more resistant. RNA-Seq and Western Blot analysis identified compensatory activation of MEK-ERK, mTOR-S6, and FAK signaling in resistant lines exhibit. Importantly, co-targeting these pathways was able to overcome resistance to TEADi and was superior to MEK/mTOR/FAK inhibition alone. These studies provide a compelling proof-of-concept that TEADi represents a novel therapeutic vulnerability in meningioma and reveal adaptive signaling responses that can be therapeutically exploited.

Intratumor heterogeneity (ITH) is one of the main reasons for the lack of effective targeted therapies for glioblastoma (GBM). Imaging-guided surgical navigation allows for tumor-wide sampling to account for variation across distant regions of the tumor, but typical drug screening is performed on cell lines derived from a single biopsy and does not account for GBM heterogeneity. Here we profiled matching MRI-guided multi-region primary tumor biopsies from 6 GBM cases (n=40 biopsies) and corresponding neurosphere cultures (n=30) derived from these spatially distinct tumor samples. We found that in vitro cultures derived from distinct regions of the same tumor display divergent phenotypes, proliferative capacity and ability to accumulate 5-aminolevulinic acid, used to visualize cancer cells during surgery. The differential drug response of the multi-region neurospheres remains linked to the gene expression of the original tumor biopsies. Thus, studies with multiregion-derived neurospheres are essential to faithfully model GBM ITH for therapeutic testing. KEY POINTSO_LIMulti-region biopsy-derived neurospheres represent distinct spatial locations in the GBM tumor. C_LIO_LICultures derived from different regions of the tumor retain phenotypic diversity. C_LIO_LIParental biopsy phenotype predicts drug response better than to in vitro phenotype. C_LI IMPORTANCE OF THE STUDYCell lines developed from spatially distinct regions of glioblastoma capture its intratumor heterogeneity. We show that while the transcriptional output of these cell lines is not connected to their spatial origin, their drug response can be linked to it. Thus, spatial heterogeneity reflected in our neurosphere collection provides a new paradigm for drug screening in these highly heterogenous and difficult to treat tumors.

PURPOSE: Newly-diagnosed glioblastoma (nGBM) is a devastating tumor with median survival of only 14-18 months despite aggressive standard of care (SOC). Dendritic cell (DC) homologous antigenic double-loading provides a powerful pattern-based signal that initiates cDC1-like skewing of monocytic precursors, inducing downstream development of CD8+ memory effectors. Here we report phase I results for DOC1021 (dubodencel), a novel DC vaccine regimen integrated with SOC. METHODS: In this dose-escalating study, DC prepared from mobilized peripheral blood were doubly loaded with autologous tumor lysate and amplified tumor mRNA and administered bilaterally near the deep cervical node chains in three biweekly courses given with weekly peg-IFN after conclusion of chemoradiation. Four dose levels from 3.5x106 to 3.6x107 total cells were tested. Patients with subtotal resection or tumor progression prior to vaccination were not excluded. RESULTS: Eighteen patients (median age 61 years (range 47-73), 94% MGMT unmethylated, 25% subtotal/partial resected) completed vaccination (16 nGBM, 2 recurrent) with no dose-limiting toxicities. Attributable AE were mostly mild and flu-like or injection-site reactions. Twelve-month OS among the newly-diagnosed cohort was 88% compared to an expected ~60% for SOC alone. Patients who received observation rather than reoperation in response to worsening MRI contrast-enhancement demonstrated gradual lesional resolution and improved OS. Immunophenotyping revealed post-vaccination elevations in CD4 and CD8 memory T-cells in peripheral blood, and spatial transcriptomic analysis revealed foci of activated inflammatory complexes at the primary tumor site. CONCLUSIONS: DOC1021 was safe, feasibly integrated within SOC, and associated with more favorable outcomes in this challenging patient population. Patients who received observation rather than reoperation for worsening MRI contrast-enhancement exhibited superior survival, suggesting an immune-reactive tumor microenvironment manifesting as pseudo-progression. These data supported initiation of a randomized Phase II trial (NCT06805305) for nGBM.

BackgroundTumor vasculature is a key driver of glioma progression, yet routine quantification depends on subjective histopathologic assessment or resource-intensive ancillary immunohistochemistry. A scalable, objective method for vascular phenotyping from routine histology remains an unmet need. MethodsWe leveraged 10x Genomics Xenium spatial transcriptomics data from a glioblastoma specimen to generate molecularly resolved annotations of GBM-associated endothelial cells and pericytes across 809,041 cells. These annotations were transferred to matched H&E-stained sections to train a DINO-DETR-based object detection model using a binary classification scheme (vascular vs. other). The model was validated on four independent Xenium patient slides and applied to a retrospective cohort of 119 diffuse gliomas spanning WHO grades 2-4 (oligodendroglioma, astrocytoma, and glioblastoma) with linked survival data. ResultsBinary vascular cell detection achieved a precision of 0.78, a recall of 0.63, and an F1 score of 0.70, with an overall accuracy of 98.6%. Orthogonal spatial validation confirmed that predicted vascular cells were preferentially localized within annotated blood vessel regions. In subtype-stratified survival analysis, high AI-derived vascular cell proportion was significantly associated with worse overall survival in astrocytoma patients (log-rank p < 0.019). ConclusionCross-modal AI training using spatial transcriptomics enables scalable, molecularly informed vascular quantification directly from routine H&E slides. Within the astrocytoma subtype, where tumor grade is most heterogeneous and vascular phenotype most variable, objective vascular quantification provides independent prognostic information demonstrating the potential of spatially supervised deep learning to extract clinically meaningful microenvironmental signals from universally available histologic material.

Boys experience an overall increased incidence of several childhood cancers, including medulloblastoma, a clinically heterogeneous cerebellar tumor. In subtypes of Group 3 and Group 4 medulloblastoma, males are three times more prevalent than females. As medulloblastoma is suspected to initiate during fetal development, we hypothesized that this sex bias reflects a combination of prenatal, sex-specific developmental processes and somatic alterations. To test these hypotheses, we compiled a large multi-omics dataset from children with medulloblastoma, which revealed sex-specific alterations, including frequent loss of the inactive X chromosome in females with Group 4. Generation of a sex-matched single-cell transcriptome atlas of the developing murine cerebellum enabled investigation of putative developmental factors underlying sex bias. Progenitors giving rise to Group 3/4 subgroups were more abundant, more proliferative, and harbored more open chromatin for recruitment of LMX1A and OTX2, master transcription factors defining Group 3/4 identity. Advanced genetically engineered mouse models and human cerebellar organoids were leveraged to determine whether sexual dimorphism arises from intrinsic or extrinsic factors. These models showed that the XY genotype contributed to the phenotype, but the predominant effect was driven by presence of the male gonadal hormone testosterone. Our findings provide a sex-specific genetic and neurodevelopmental explanation for male bias in an aggressive pediatric brain tumor. Outcomes from this study may inform novel treatment strategies delivered according to sex and are likely to be broadly applicable to other sex-biased malignancies arising in early life. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=79 SRC="FIGDIR/small/714163v1_ufig1.gif" ALT="Figure 1"> View larger version (18K): org.highwire.dtl.DTLVardef@3a06faorg.highwire.dtl.DTLVardef@1a01bb7org.highwire.dtl.DTLVardef@7bc9c2org.highwire.dtl.DTLVardef@fb206d_HPS_FORMAT_FIGEXP M_FIG C_FIG

The central nervous system (CNS) is a common site of metastatic spread for both non-small cell and small cell lung cancer, yet the therapeutic strategies to prevent and decrease lung cancer brain metastases remain limited. Tyrosine kinase inhibitors have shown promising results in increasing the overall response in brain metastases, owing to their brain penetrance and increased effectiveness; however, their use is limited to the small group of tumors carrying specific oncogenic drivers. Among these, inhibitors with activity against neurotrophic tyrosine receptor kinases (NTRKs) are showing promising effects in reducing CNS metastases in cancers driven by gene rearrangements of these drugs targets. However, wild-type NTRKs are susceptible to activation by their canonical ligands, which are expressed throughout the brain metastatic niche and can, in a paracrine manner, activate NTRK function in cancer cells. Here we show that NTRKs are expressed in primary tumors, brain metastases, and lung cancer cells with various driver mutations expressing wild-type NTRK2 (WT-TrkB). We demonstrate that WT-TrkB activates downstream signaling and proliferation in response to exogenous BDNF and conditioned media from reactive astrocytes known to secrete BDNF in the brain niche. Importantly, the FDA-approved NTRK inhibitor entrectinib blocked BDNF and astrocyte-induced survival pathways in multiple lung cancer cell lines, decreased their proliferation in vitro, and effectively prevented brain metastatic colonization and progression in vivo without significant effects on extracranial disease. Thus, these studies suggest that brain-dependent activation of NTRK is critical for brain metastases of WT-NTRK+ lung cancers, and therefore, NTRK inhibitors can be used to target non-fusion NTRK function to prevent or decrease brain metastases. SIGNIFICANCEThese studies demonstrate that NTRK wild-type receptors are important drivers of brain metastatic colonization and progression in different subtypes of lung cancer, independent of their driver alterations. Thus, they provide rationale to expand the use of FDA-approved NTRK inhibitors with brain penetrance for the prevention of CNS metastases.

BackgroundNon-invasive electromagnetic field (EMF)-based therapies offer a potential route to modulate local tumor-immune interactions but their mechanistic basis remains poorly defined. MethodsWe evaluated Asha therapy, a proprietary low-intensity (50khz, 2 mT, 25% duty cycle) alternating magnetic-field treatment in preclinical breast cancer models. Cellular responses in human triple negative breast cancer cell lines (MDA-MB-231 and MDA-MB-468) were evaluated using bulk RNA sequencing, quantitative proteomics, flow cytometry, and cytokine analysis and proteomics analysis. Tumor microenvironment responses in mouse 4T1 breast cancer model was characterized using single-cell CITE-seq analysis. Functional efficacy was assessed in vivo using the murine 4T1 triple-negative breast cancer model, both as monotherapy and in combination with anti-PD1 checkpoint blockade. Clinical relevance was assessed by deriving a 19-gene neutrophil activation signature from Asha-induced transcriptional changes and projecting it onto two independent TNBC patient cohorts (METABRIC n=338, SCAN-B n=874) for survival analysis. ResultsAsha therapy induced endoplasmic reticulum (ER) stress and activated an adaptive unfolded-protein response in tumor cells, triggering robust NF-{kappa}B and interferon signaling and time-dependent secretion of inflammatory cytokines. In vivo, these tumor-intrinsic changes propagated to the tumor microenvironment (TME), reprogramming fibroblasts from contractile states to immune-recruiting, interferon-responsive phenotypes and enriching for interferon-stimulated, metabolically active neutrophils and macrophages. These coordinated innate immune changes occurred without overt cytotoxicity and were associated with significant reductions in metastasis and improved survival. Combination with anti-PD1 therapy markedly enhanced efficacy, reducing lung metastasis and mortality by 88% compared with control. The neutrophil activation signature derived from Asha-treated tumors was associated with improved overall survival in both METABRIC (log-rank p=0.036) and SCAN-B (p=0.048) TNBC cohorts by Kaplan-Meier analysis, with pooled multivariable Cox regression confirming significant survival benefit (HR=0.75, 95% CI 0.59-0.94, p=0.01). ConclusionsAsha therapy triggers a controlled ER stress response in tumor cells that drives interferon-mediated cytokine release and immune reprogramming of the TME, resulting in anti-metastatic and survival benefits. These findings identify electromagnetic-field exposure as a potential non-pharmacologic strategy to activate innate immunity and sensitize tumors to checkpoint blockade, supporting further clinical development of EMF-based immunotherapy.

Temozolomide (TMZ) resistance remains a major obstacle in glioblastoma (GBM) therapy, yet the metabolic adaptations underlying this phenotype are incompletely understood. Here, we performed integrative lipidomic, ultrastructural, and pathway analyses to define lipid metabolic reprogramming associated with TMZ resistance and failure of statin-mediated sensitization. Targeted LC-MS lipidomics quantified 322 lipid species across 25 lipid classes in TMZ-sensitive and TMZ-resistant U251 cells under basal conditions and following TMZ, simvastatin, or combination treatment. Multivariate analyses (PCA, PLS-DA, and volcano plots) revealed a robust and treatment-resilient lipidomic signature in resistant cells characterized by enrichment of lysophospholipids, sphingolipids, and cholesteryl esters, alongside depletion of glycerolipid and phospholipid pools. Complementary univariate analysis confirmed these changes at the species level, demonstrating consistent elevation of lysophosphatidylcholine/ethanolamine, glycosphingolipid subclasses, and cholesteryl esters, together with reductions in phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, and diacylglycerol intermediates across multiple treatment conditions. In contrast, sensitive cells displayed dynamic lipid remodeling, including phosphatidylinositol and phosphatidylethanolamine enrichment associated with autophagic membrane expansion. KEGG pathway analysis linked the resistant phenotype to Rap1, PI3K-Akt, and phospholipase D signaling networks regulating vesicle trafficking and membrane homeostasis. Transmission electron microscopy confirmed a vesicle-rich intracellular architecture consistent with persistent autophagy flux blockade in resistant cells. Collectively, these findings define a stable lipid metabolic program characterized by lysophospholipid expansion and cholesteryl ester accumulation that supports membrane integrity and therapeutic resistance. Targeting lipid buffering and cholesterol storage pathways may represent a promising strategy to overcome chemoresistance in glioblastoma. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=134 HEIGHT=200 SRC="FIGDIR/small/712341v1_ufig1.gif" ALT="Figure 1"> View larger version (78K): org.highwire.dtl.DTLVardef@178acd7org.highwire.dtl.DTLVardef@19b6a79org.highwire.dtl.DTLVardef@6b3904org.highwire.dtl.DTLVardef@16c3d01_HPS_FORMAT_FIGEXP M_FIG C_FIG Lipidomic and autophagy differences between non-resistant (NR) and temozolomide-resistant (R) glioblastoma cells. NR cells show dynamic lipid remodeling and treatment-dependent autophagy responses, whereas R cells maintain blocked autophagy flux and persistent enrichment of LPC, SM, and cholesteryl esters across treatments.

Introduction: Glioblastoma multiforme (GBM) remains the most lethal primary brain tumor with median survival of 14-15 months. Current prognostic markers inadequately stratify patient outcomes. PINK1 (PTEN-induced putative kinase 1), a mitochondrial kinase regulating mitophagy and cellular stress responses, has emerged as a promising prognostic candidate. Our preliminary analysis of 20 GBM cases demonstrated significant PINK1 expression with correlation to aggressive phenotypes (Turizo Smith et al., 2025). This multicenter study aims to prospectively validate PINK1 as a prognostic biomarker for survival and functional outcomes in a Latin American cohort. Methods and analysis: PINK1-GBM Colombia is a multicenter, observational cohort study across four tertiary hospitals in Bogota, Colombia (Hospital de Kennedy, Hospital El Tunal, Hospital Santa Clara and Hospital Universitario de la Samaritana). We will enroll at least 26-50 adults (18+ years) with newly diagnosed IDH-wild type GBM undergoing surgical resection. PINK1 expression will be quantified by immunohistochemistry (IHC) on formalin-fixed paraffin embedded (FFPE) tissue using standardized protocols. Primary outcomes: overall survival (OS) and progression-free survival (PFS). Secondary outcomes: functional status trajectories (KPS/ECOG). Follow-up extends 24 months with clinical, imaging (RANO 2.0), and telephone assessments. Survival analyses will employ Kaplan-Meier methods, log-rank tests, and Cox proportional hazards models adjusted for established prognostic factors. Ethics and dissemination: Approved by Universidad Nacional de Colombia Ethics Committee (Acta 001, February 5, 2026; Ref: 2.FM.1.002-CE-002-26), Subred Sur Occidente (P-AP-19-2025, July 11, 2025), and Subred Centro Oriente (CEI 067/2025, October 24, 2025). Conducted per Declaration of Helsinki and Colombian Resolution 8430/1993. Results will be disseminated via peer-reviewed publication, international conferences, and thesis submission.

Malignant peripheral nerve sheath tumours (MPNSTs) are high grade soft-tissue sarcomas with an unmet need for novel therapies. Tumour antigen-based approaches, including neoantigen and tumour-associated antigen (TAA) directed therapies, offer potential opportunities for immunotherapy. Here, we integrated public domain tumour DNA and RNA sequencing data with in-silico prediction to systematically characterise the (neo)antigenic landscape of MPNST. We stratified the predictions across the two known sub-groups of MPNST, those associated without and with Polycomb Repressor Complex 2 (PRC2) loss of function variants (PRC2-Loss). Using computational pipelines including pVACtools, we identified high-confidence neoantigens based on pMHC affinity derived from somatic mutations and gene fusions, as well as recurrently overexpressed cell-surface TAAs. All predicted neoantigens were private to individual MPNST cases, with different neoantigens across both tumour subtypes. PRC2-Loss tumours showed reduced immune infiltration with downregulation of antigen processing and presentation pathways compared to PRC2-WT, confirming intrinsic constraints to effective neoantigen-directed immune priming. Moreover, PRC2-Loss MPNSTs demonstrated recurrent copy number driven overexpression of cell surface TAAs (chromosome 8), providing alternative immunotherapeutic targets that are pMHC independent. These findings confirm a PRC2-independent private immuno-antigenic peptide repertoire with an immune resistant MPNST microenvironment in PRC-Loss. These data provide further impetus for rational development of complementary immune based treatment strategies, including personalised neoantigen vaccines and cell surface protein TAA-directed therapies dependent on PRC2 status.

BackgroundNeoadjuvant chemoimmunotherapy (nCIT) has become a standard treatment for locally advanced resectable non-small cell lung cancer (NSCLC), yet the spatial biology underlying treatment resistance remains poorly understood. We used spatial transcriptomics to define the microenvironmental architecture of residual cancers in patients who did not achieve major pathologic response (non-MPR) compared with those who did (MPR). MethodsSpatial transcriptomics was performed on 10 formalin-fixed paraffin-embedded (FFPE) tumor blocks (5 MPR, 5 non-MPR) obtained from 8 patients treated with nCIT. A deep learning algorithm was applied to detect viable residual cancer spots from treatment-induced fibrosis and necrosis. Spatial deconvolution, distance modeling, ligand-receptor analysis, and functional pathway scoring were integrated to characterize niche-specific programs. ResultsMPR cancer core displayed an immune-permissive remodeling environment with deep infiltration of cytotoxic CD8+ T cells, mature dendritic cells (LAMP3+, CCR7+), and active efferocytosis signaling (APOE-TREM2), alongside robust MHC class II expression. Non-MPR cancer core, by contrast, exhibited spatial immune exclusion: a dense fibroblast barrier reinforced by TIMP1-CD63 signaling and Treg-enriched boundaries physically restricted effector T cell access to the cancer core. Residual cancer cells in non-MPR samples maintained active cell cycling and independently upregulated cytochrome P450-mediated drug detoxification and DNA damage response pathways without inducing MHC class II expression -- effectively decoupling intrinsic survival from immune recognition. The non-MPR core also showed a hyper-metabolic profile, including elevated glutathione metabolism consistent with antioxidant buffering against chemotherapy-induced oxidative stress. TROP2 was broadly expressed across the non-MPR cancer core and co-localized with DNA damage response and nuclear factor erythroid 2-related factor 2 resistance signatures. ConclusionsResidual cancer cores in non-MPR tumors appear to represent evolved resistant niches sustained by structural immune exclusion, metabolic rewiring, and DNA repair proficiency. These findings highlight the spatial co-localization of epithelial anchors, such as TROP2, with intrinsic resistance pathways, providing a structural rationale for developing novel precision therapeutic strategies to bypass stromal barriers and overcome the cancer cores intrinsic repair capacity.

BackgroundHead and neck squamous cell carcinoma (HNSCC) comprises a heterogeneous group of epithelial malignancies associated with poor survival ({approx}50%), limited therapeutic options, and a lack of predictive biomarkers. Concurrent chemoradiotherapy (CRT) remains the standard treatment for advanced disease; however, many patients fail to respond, develop resistance, or eventually relapse. The development of three-dimensional organoid technology has enabled the generation of patient-derived organoids (PDOs), offering a promising platform for personalized therapeutic testing. MethodsWe established a biobank of HNSCC PDOs from fresh laryngeal and pharyngeal tumor samples, including human papillomavirus-positive (HPV+) cases. Organoid formation and expansion rates were analyzed in relation to clinical parameters. Selected representative PDOs were histologically and molecularly characterized. Additionally, several models were exposed to cisplatin and radiation to evaluate treatment response, and a subset was assessed for tumorigenicity in subcutaneous mouse models. ResultsFifty-seven PDO models were successfully established, long-term expanded, and cryopreserved. Prior chemotherapy and/or radiotherapy was identified as an independent negative predictor of organoid outgrowth and expansion capacity compared with treatment-naive samples. Histological features, including differentiation grade and immunohistochemical markers, were largely preserved and strongly correlated with the original tumors. PDOs displayed heterogeneous responses to cisplatin and radiotherapy, with HPV-positive models showing greater sensitivity, consistent with clinical observations. Global transcriptomic profiling revealed molecular subtypes concordant with established HNSCC classifications and suggested an additional subtype characterized by low MYC and mTORC1 transcriptional activity. ConclusionHNSCC PDOs faithfully recapitulate tumor histology and molecular diversity, providing a robust platform to investigate tumor biology and therapeutic response.

Aberrant neurotransmitter signaling and transcriptional dysregulation are hallmarks of gliomagenesis and represent potential therapeutic targets. Monoamine neurotransmitters such as dopamine and serotonin primarily activate GPCRs but can also function epigenetically as histone H3 modifications. Here, we uncover mechanisms of crosstalk between monoamine neurotransmitter signaling, H3 dopaminylation, and RNA polymerase II (Pol2) transcription in diffuse midline glioma (DMG). We find that co-treatment with Pol2-targeting CDK9 inhibitors (CDK9i) and FDA-approved neuropsychiatric drugs, including selective serotonin reuptake inhibitors (SSRIs), synergistically reduces DMG growth. Mechanistically, CDK9i+SSRI treatment alters H3 dopaminylation patterns and represses synaptic and neurodevelopmental gene transcription associated with CDK9i resistance. Further phospho-proteomic analyses show that CDK9i monotherapy activates pro-survival CaMKII signaling, which can be suppressed by co-treatment with neuromodulatory drugs. These studies establish roles for H3 dopaminylation and neurotransmitter signaling in DMG gene regulation and response to CDK9i, suggesting that monoamine neurotransmitter pathways may be exploited as a therapeutic strategy for DMG.

Diffuse midline gliomas (DMGs) are a deadly class of pediatric high-grade brain cancers. Approximately 80% of pontine DMGs feature a dominant, somatic, heterozygous point mutation in the non-canonical histone H3.3-coding gene H3-3A. This dominant-negative mutation replaces lysine 27 with methionine (K27M) and prevents global K27 di- and tri-methylation of all wild-type histone H3 proteins. We aimed to target the H3.3K27M onco-histone pre-mRNA with splice-switching antisense oligonucleotides (ASOs) designed to promote skipping of H3-3A exon 2, as this constitutive exon comprises both the K27M mutation and the natural in-frame start codon of the gene. The lead ASO identified in a systematic screen specifically induced H3-3A exon 2 skipping, did not affect expression or splicing of the paralog gene H3-3B--which also encodes histone H3.3--and restored global H3K27me3 marks in patient-derived DMG cells grown as neurospheres. In a patient-derived orthotopic xenograft tumor mouse model, the lead ASO reduced proliferation and extended survival. Our results show the potential of exon-skipping ASOs targeting H3-3A exon 2 as a therapeutic option for H3.3K27M-altered DMG. More generally, they exemplify the strategy of using ASOs to induce skipping of a constitutive exon to effectively achieve gene downregulation.

Long-term follow-up of the CASSIOPEIA trial (NCT02541383) demonstrated superior progression-free survival (PFS) with daratumumab, both in combination with bortezomib, thalidomide, and dexamethasone during induction and consolidation, and during maintenance therapy, in transplant- eligible patients newly diagnosed with multiple myeloma (MM). However, outcomes among CASSIOPEIA patients remain heterogeneous across treatment groups. Measurable residual disease (MRD) is a strong indicator of the depth and duration of therapeutic response and is independently associated with both PFS and overall survival (OS), but it does not fully capture the biological diversity of MM. We performed a risk prediction analysis based on transcriptomic subgroups in CASSIOPEIA patients. A subset of 628 patients was characterized using RNA sequencing and consensus clustering identified five transcriptomic subtypes of MM. Long-term follow-up allowed the definition of three transcriptomic risk categories, with estimated 72-month PFS rates of 70%, 51%, and 27% for low, intermediate, and high-risk groups, respectively, among patients who received daratumumab in at least one treatment phase. In these patients, MRD negativity rates after consolidation and six months later were significantly higher in the low and high-risk groups compared with the intermediate-risk group. In the high-risk group, MRD status was not associated with PFS or OS. This suggests that, although daratumumab administered during both the induction/consolidation and maintenance phases improves the clinical outcomes of patients with activation of NSD2 or overexpressing members of the MAF family, highly aggressive minor clones may rapidly expand. These findings emphasize the need for novel therapeutic strategies in this high-risk population.