Differential expression of individual transcript variants of PD-1 and PD-L2 genes on Th-1/Th-2 status is guaranteed for prognosis prediction in PCNSL.

In current molecular medicine, next-generation sequencing (NGS) for transcript variant detection and multivariable analyses are valid methods for evaluating gene expression, cancer mechanisms, and prognoses of patients. We conducted RNA-sequencing on samples from patients with primary central nervous system lymphoma (PCNSL) using NGS and performed multivariable analysis on gene expression data and correlations focused on Th-1/Th-2 helper T cell balance and immune checkpoint to identify diagnosis/prognosis markers and cancer immune pathways in PCNSL. We selected 84 transcript variants to limit the analysis range for Th-1/Th-2 balance and stimulatory and inhibitory checkpoints in 31 PCNSLs. Of these, 21 highly-expressed transcript variants were composed of the formulas for prognoses based on Th-1/Th-2 status and checkpoint activities. Using formulas, Th-1, Th-2, and stimulatory checkpoint resulted in poor prognoses. Further, Th-1Th-2 was associated with good prognoses. On the other hand, CD40-001 and CD70-001 as stimulatory genes, and LAG3-001, PDCD1 (PD-1)-001/002/003, and PDCD1LG2 (PD-L2)-201 as inhibitory genes were associated with poor prognoses. Interestingly, Th-1Th-2 and Th-1Th-2 were correlated with stimulatory checkpoint as CD70-001 and inhibitory checkpoint as HAVCR2 (TIM-3)-001 and PDCD1LG2-001/201, respectively. Focused on the inhibitory checkpoint, specific variants of CD274 (PD-L1)-001 and PDCD1-002 served severe hazard ratios. In particular, PDCD1-002 by a cut off score was associated with poor prognoses, in addition to PDCD1-001/003, PDCD1LG2-201, and LAG3-001. These results mainly suggest that expression of transcript variants of PDCD1 and PDCD1LG2 on the Th-1/Th-2 balance enable prognostic prediction in PCNSL. This study provides insights for development of molecular target therapies and identification of diagnosis/prognosis markers in PCNSL.