Abstract

BACKGROUND

Diffuse Intrinsic Pontine Glioma (DIPG), the most common subtype of Diffuse Midline Glioma (DMG), is a brainstem high-grade glioma arising in young children and always proves fatal. Major challenges include the disease’s intratumoural genetic and cellular heterogeneity as well as its diffusely invasive phenotype. Research of the last few years has highlighted that interactions between cancer cells, the nervous system and immune cells crucially contribute to tumour cell invasion and disease malignancy. Hence, a better understanding of cancer-promoting interactions is a key requirement to elucidate novel strategies for the treatment of this devastating disease.

METHOD

We performed spatial transcriptomic sequencing on 10 sequential tumour-infiltrated DIPG patient brainstem regions, using the 10x Genomics Visium platform.

RESULTS

Spatially-informed analysis and cell type clustering overall highlighted the molecular intratumoural heterogeneity present in the disease. We assessed cell cluster interactions as well as receptor-ligand (RL) pairing, illustrating communication between neuronal, immune cell and tumour clusters. We further determined respective RL pairs involved in such. To address the question whether invasive edges genetically differ from the tumour core, we evaluated genes that are significantly correlated with distal brainstem regions compared to tumour proximal sites. Results revealed gene signatures that are highly associated with neuronal signalling and communication, validating previous findings emphasising the importance of neuron-to-glioma interactions driving DIPG disease progression.

CONCLUSION

DIPG is a lethal paediatric brainstem glioma for which more durable therapeutic modalities remain to be found. In-depth analysis of this disease is often hampered due to the lack of patient tissue suitable for laboratory studies. Our patient autopsy specimen, spanning the entire tumour-infiltrated brainstem provided a platform to study this aggressive disease in a spatio-temporal manner. This analysis elucidates how DIPG is driven by the tumour microenvironment, including associated receptor-ligand interactions. This has the potential to ultimately discover new treatment targets.

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