DIPG-50. TARGETING VULNERABILITIES IN PAEDIATRIC DIFFUSE MIDLINE GLIOMAS: LEVERAGING PLK1 INHIBITION TO EXPLOIT RAS/PI3K PATHWAY DEPENDENCY

Diffuse Midline Gliomas (DMGs), characterised by prevalent H3K27M mutations, exhibit epigenetic modifications that drive a proliferative state resistant to conventional therapies. The interplay of the cell cycle with PI3K and RAS/MYC growth signalling pathways, pivotal in the context of the H3K27M mutation, is yet to be fully understood. The aim of this study was to assess the efficacy of the inhibition of Polo-like kinase 1 (PLK1), a critical regulator of mitosis and cell cycle progression, identify mechanisms of action, and to develop effective combination strategies against DMG.

PLK1 inhibition demonstrated significant anti-tumour activities both in vitro and within aggressive in vivo orthotopic DMG models, notably doubling the median survival of mice bearing tumours. High-throughput RNA-seq analysis of DMG samples particularly sensitive to PLK1 inhibition, revealed a distinct pattern of negative enrichment in ribosomal genes, indicating a marked reduction in ribosomal function-associated gene expression. This alteration suggests a potential for innovative drug combination strategies targeting the PI3K/mTOR and RAS/MYC pathways, crucial for ribosomal and RNA processing. Subsequently, our in vitro drug sensitivity assays demonstrated that PLK1 inhibition in combination with PI3K/mTOR and MEK inhibitors, exhibit strong drug synergies, evidenced by high Bliss synergy scores.

Our findings underscore the efficacy of simultaneous targeting of PI3K/mTOR and RAS/MYC pathways with PLK1 inhibition as an attractive strategy to mitigate DMG tumorigenesis. Furthermore this research not only sheds light on the crucial interplay between cell cycle and signalling pathways in DMG but also facilitates novel intervention strategies for a range of other paediatric CNS malignancies with similar characteristic molecular drivers.