Extracellular vesicles (EVs) play an important role in cell-cell communication, and tumor-derived EVs circulating in patient blood can serve as biomarkers. Here, we investigated the potential role of plasma EVs in meningioma patients for tumor detection and determined whether EVs secreted by meningioma cells reflect epigenetic, genomic, and proteomic alterations of original tumors.EV concentrations were quantified in patient plasma (n = 46). Short-term meningioma cultures were established (n = 26) and secreted EVs were isolated. Methylation and copy number profiling was performed using 850k arrays, and mutations were identified by targeted gene panel sequencing. Differential quantitative mass spectrometry was employed for proteomic analysis.Levels of circulating EVs were elevated in meningioma patients compared to healthy individuals, and the plasma EV concentration correlated with malignancy grade and extent of peritumoral edema. Postoperatively, EV counts dropped to normal levels, and the magnitude of the postoperative decrease was associated with extent of tumor resection. Methylation profiling of EV-DNA allowed correct tumor classification as meningioma in all investigated cases, and accurate methylation subclass assignment in almost all cases. Copy number variations present in tumors, as well as tumor-specific mutations were faithfully reflected in meningioma EV-DNA. Proteomic EV profiling did not permit original tumor identification but revealed tumor-associated proteins that could potentially be utilized to enrich meningioma EVs from biofluids.Elevated EV levels in meningioma patient plasma could aid in tumor diagnosis and assessment of treatment response. Meningioma EV-DNA mirrors genetic and epigenetic tumor alterations and facilitates molecular tumor classification.
Abstract Spatiotemporal heterogeneity is a major factor contributing to the devastating prognosis of isocitrate-dehydrogenase (IDH)-wildtype glioblastoma. Genome-wide DNA methylation profiling allows the stratification into several DNA methylation subgroups of IDH-wildtype glioblastoma, which were shown to have a spatial heterogeneity in newly diagnosed tumors. However, the temporal heterogeneity and its clinical relevance of DNA methylation subgroups remains inconclusive. Tumor tissue obtained from first and recurrence surgery of 31 patients diagnosed with IDH-wildtype glioblastoma was subjected to DNA methylation profiling. DNA methylation profiles were analyzed for temporal heterogeneity and correlated with clinical data, survival outcome and copy number variations. In addition, deconvolution of immune cells and unsupervised hierarchical clustering using pairwise Pearson correlation coefficients of the 10.000 most variable CpG features was performed. Of all patients with matched tumor tissue, 4 (12.9%) patients had a non-matching brain tumor classifier output at recurrence. Within the remaining 27 patients, a transition of the dominant DNA methylation subclass was observed in 8 (29.6%) glioblastomas with a most frequent transition to the mesenchymal subclass (62.5%). A subclass transition was more likely after incomplete removal of contrast-enhanced tumor parts at first surgery (p = 0.04). Tumor location, adjuvant treatment, and time between primary and recurrence surgery did not influence the transition. Immune cell proportions from deconvolution data, tumor purity or specific CpG sites were not correlated with a subclass transition. Survival analyses revealed a comparable outcome for patients with or without subclass transition. Our findings demonstrate the temporal heterogeneity of DNA methylation subclasses in 29.6% of IDH-wildtype glioblastoma. We identified clinical factors and showed that a subclass transition did not impact the survival outcome. However, a possible DNA methylation subclass transition must be taken into consideration for future targeted therapies at recurrence.
Abstract Interactions of neural cells with glioma cells drive tumor growth. In this study, we identified an epigenetically-defined, malignant neural signature of IDH-wildtype glioblastoma (GBM) that significantly influenced patients’ outcome. We used DNA methylation-based reference signatures of neural cells to deconvolve 1.058 primary patient GBM samples. Samples were classified based on the neural reference signature and annotated as low or high neural GBM. A high neural GBM was linked to hypomethylation of CpG sites associated with invasiveness, neuron-to-glioma-interactions, and transsynaptic signaling. Through spatially resolved, single cell transcriptomic and proteomic profiling, we discovered a correlation between the high neural signature and the upregulation of early development programs in OPC and NPC-like cells. These traits were accompanied by diminished immune infiltration and immunological response, further highlighting the distinctive neural-like nature of GBM. High neural GBM demonstrated increased connectivity as evidenced by magnetoencephalography and resting state magnet resonance imaging. Spatiotemporal tumor sampling showed a homogeneous and stable neural signature in newly diagnosed and recurrent GBM. In newly diagnosed GBM, a high neural signature correlated with decreased survival in 306 patients (median OS 15.0 versus 20.0 months, p< 0.001). Patient-derived xenograft models corroborated the aggressive nature of high neural GBM, showing a significantly reduced median OS of 58 days compared to 73 days (p< 0.01). These high neural GBM xenografts also exhibited an elevated tumor burden and an increase in neuron-glioma synapse formation. Consideration of the extent of resection showed a dependency on the neural subgroup as high neural GBM had an increased benefit from a complete contrast enhancing tumor removal when compared to low neural GBM. As a preoperative biomarker, the concentration of BDNF was increased in serum of high neural GBM patients (p < 0.01). Overall, we present an epigenetically-defined malignant neural signature in GBM that is associated with an unfavorable patient survival.
Although clinically aggressive meningiomas (MGMs) are rare tumors, more effective therapies are urgently needed. As a prerequisite for successful immunotherapy we determined the infiltration and activation status of T cells in primary (p-) and recurrent (r-) MGMs and their impact on survival. Presence of tumor-infiltrating lymphocytes (TILs) was assessed in a large, clinically well-annotated study sample of 202 cases (n=123 pMGMs, and n=79 rMGMs) with a substantial proportion of higher-grade MGMs (n=43 WHO°I, n=97 WHO°II, n=62 WHO°III). TIL quantification was performed by a semi-automated analysis on whole tissue sections stained by multi-color immunofluorescence for CD3, CD8, FOXP3, and PD-1. Ranging from 0.01–24.88 %, median T cell infiltration accounted for 0.59 TILs per total cell count (TCC). Although there were no significant changes for the proportion of helper and cytotoxic T cells in pMGM of different WHO grades, higher numbers of cytotoxic T cells were associated with an improved progression-free survival (PFS) independent of prognostic confounders. rMGM were characterized by significantly lower numbers of TILs in general (median: 0.33 % per TCC), helper and cytotoxic T cells and a significant increase of regulatory T cells. As for the activation of TILs, about one third expressed the immune checkpoint molecule PD-1 and predominantly were CD8-positive. We observed a significant WHO-dependent decrease of PD-1+/CD8+ TILs which in univariate and multivariate analyses were associated with a poorer PFS. In line with these findings proportions of PD-1+/CD8+ TILs were significantly lower in rMGM arguing for PD-1 as an activation rather than an exhaustion marker. In summary, we were able to identify intratumoral cytotoxic TILs as well as of PD-1-expressing cytotoxic TILs as novel and easy applicable biomarkers for a better survival, which might facilitate the selection of patients who could benefit from immunotherapeutic approaches and mandates for an intervention in primary rather than recurrent tumors.
Aerobic glycolysis confers several advantages to tumor cells, including shunting of metabolites into anabolic pathways. In glioblastoma cells, hypoxia induces a flux shift from the pentose phosphate pathway toward glycolysis and a switch from proliferation to migration. The mechanistic link between glycolysis and migration is poorly understood. Since glucose-6-phosphate isomerase (GPI) is identical to the secreted cytokine autocrine motility factor (AMF), we investigated whether GPI/AMF regulates glioblastoma cell invasion.The expression and hypoxic regulation of GPI/AMF and its receptor AMFR were analyzed in glioblastoma tissue and cell lines. Functional effects were studied in vitro and in xenograft models.High GPI/AMF expression in glioblastomas was found to be associated with a worse patient prognosis, and levels were highest in hypoxic pseudopalisades. Hypoxia upregulated both GPI/AMF and AMFR expression as well as GPI/AMF secretion in vitro. GPI/AMF stimulated cell migration in an autocrine fashion, and GPI/AMF expression was upregulated in migratory cells but reduced in rapidly proliferating cells. Knockdown or inhibition of GPI/AMF reduced glioblastoma cell migration but in part stimulated proliferation. In a highly invasive orthotopic glioblastoma model, GPI/AMF knockdown reduced tumor cell invasion but did not prolong survival. In a highly proliferative model, knockdown tumors were even larger and more proliferative than controls; however, perivascular invasion, provoked by simultaneous bevacizumab treatment, was reduced.GPI/AMF is a potent motogen for glioblastoma cells, explaining in part the association between glycolysis and migration. Targeting GPI/AMF is, however, problematic, since beneficial anti-invasive effects may be outweighed by unintended mitogenic effects.1.Increased glycolysis is linked with increased cell migration and invasion in glioblastoma cells. 2.The glycolysis enzyme GPI/AMF may serve as a target for antimetabolic and anti-invasive therapy. 3.Despite reducing tumor invasion, GPI/AMF targeting may have unwanted growth stimulatory effects.
Immunotherapeutic strategies are increasingly important in neuro-oncology, and the elucidation of escape mechanisms that lead to treatment resistance is crucial. We investigated the impact of immune pressure on the clonal dynamics and immune escape signature by comparing glioma growth in immunocompetent versus immunodeficient mice. Glioma-bearing WT and Pd-1-/- mice survived significantly longer than immunodeficient Pfp-/- Rag2-/- mice. While tumors in Pfp-/- Rag2-/- mice were highly polyclonal, immunoedited tumors in WT and Pd-1-/- mice displayed reduced clonality with emergence of immune escape clones. Tumor cells in WT mice were distinguished by an IFN-γ-mediated response signature with upregulation of genes involved in immunosuppression. Tumor-infiltrating stromal cells, which include macrophages/microglia, contributed even more strongly to the immunosuppressive signature than the actual tumor cells. The identified murine immune escape signature was reflected in human patients and correlated with poor survival. In conclusion, immune pressure profoundly shapes the clonal composition and gene regulation in malignant gliomas.
