Integrative analysis of the MDM2 promoter switch and cellular lineage plasticity in colorectal cancer: a contrast between the autonomous-proliferation type (CIN/CMS2) and the environment-adaptive type (MSI/gastric metaplasia)
Tsukui, T.; Tsuda, K.; Yao, R.; Shin, K.
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Background: Biopsy-measurable biomarkers that stratify colorectal cancer (CRC) by therapeutic responsiveness remain scarce. We asked whether dual MDM2 promoter (P1/P2) usage acts as a molecular switch separating two opposed CRC phenotypes: a chromosomal instability type and an environment-adaptive type (microsatellite instability-like/serrated pathway with gastric metaplasia). Methods: Sixty three organoid samples from 22 CRC patients were classified by deep-learning morphology (VGG16) and an array based MDM2 Splicing Index. P1 and P2 signatures were evaluated in TCGA-COAD/READ (n = 624) and GSE39582 (n = 519), and drug responses were examined in cell lines (GDSC2, DepMap) and 65 independent CRC organoid lines. Statistics used Wilcoxon, Kruskal Wallis and Spearman tests (Benjamini Hochberg-corrected) and patient-level mixed models. Results: Deep earning classification reached 98.5% test accuracy; morphology corresponded to isoform usage: Type1 (compact glandular) morphology predominated in P1-dominant samples (median Type1 fraction 0.826 versus
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