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Myelonets define spatiotemporal immunosuppressive programs in ovarian cancer

Niemiec, I.; Shabanova, A.; Ruuska, E.; Tissarinen, M.; Liang, Z.; Anandagoda, G.; Shah, S.; Kang, Z.; Junquera, A.; Salko, M.; Haltia, U.-M.; Virtanen, A.; Farkkila, A.

2026-08-31 oncology
10.64898/2026.08.26.26361128 medRxiv
Show abstract

High-grade serous ovarian carcinoma (HGSC) responds poorly to immune checkpoint blockade, partly due to a macrophage-dominated immunosuppressive microenvironment. We integrated single-cell spatial proteomics and spatial transcriptomics across 50 HGSC tumors and applied SPACEstat to resolve higher-order immune communities and their transcriptional programs. We identified six immune community types, with macrophage-dominated Myelonets representing the predominant spatial pattern of immune organisation. In chemotherapy-exposed tumors, Myelonets showed coordinated lipid metabolism-immunosuppression and inflammation-MHC-II macrophage transcriptional programs, with SPP1, C1Q, VEGF, MMPs, and CCL18 linked to immunosuppressive states and fibroblasts emerging as key mediators of macrophage communication. Chemotherapy contracted large Myelonets while increasing CD8+ T-cell organization into Lymphonets. Persistent macrophage dominance within Myelonets was associated with adverse outcomes among patients who achieved a complete response to treatment. Together, we identify Myelonets as clinically relevant, multicellular immunoregulatory niches sustained by spatiotemporally coordinated macrophage programs and stromal crosstalk.

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