Department of Traditional Chinese Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Med. 2024 Dec;56(1):2412831. doi: 10.1080/07853890.2024.2412831. Epub 2024 Oct 10.
BACKGROUND: Cell death modulates the biological behaviors of tumors. However, the comprehensive role of the multiple forms of cell death in lower-grade glioma (LGG) is unknown. METHODS: We collected the transcriptional data of LGG patients from public repositories to comprehensively examine six cell death patterns (autophagy, apoptosis, cuproptosis, necroptosis, ferroptosis, and pyroptosis) in LGG samples and systematically correlated these patterns with patient survival, underlying biological processes, and drug sensitivity using serial bioinformatics analysis, clinical sample validation and assays. RESULTS: We identified and independently validated three reproducible cell death-based clusters associated with distinct clinical outcomes and tumor microenvironment characteristics. The Tumor Immune Dysfunction and Exclusion algorithm was applied for predicting how these three clusters would respond to immune checkpoint blockade (ICB) therapy; we found potential resistance of cluster B to ICB therapy. We also performed drug screening to identify cluster-specific drugs. Furthermore, a scoring system, designated as the CDPM score, was developed to estimate the cell death patterns of patients with LGG; this system could predict both LGG patients' prognosis and immunotherapy efficacy. By performing multiplex immunofluorescence staining, we validated the correlations of GNAL expression with the molecular and clinical features of LGG in an independent LGG cohort. Finally, assays showed that GNAL promoted apoptosis and inhibited the proliferation of LGG cells. CONCLUSION: The new cell death-based subtype system indicates several features of LGG biology and reveals novel insights into the use of precision medicine for treating LGG. The CDPM score could be used to predict the immunotherapy response and prognosis of LGG patients; moreover, it could indicate a novel direction for improving LGG management.
背景:细胞死亡调节肿瘤的生物学行为。然而,多种形式的细胞死亡在低级别胶质瘤(LGG)中的综合作用尚不清楚。
方法:我们从公共数据库中收集了 LGG 患者的转录组数据,以综合检查 LGG 样本中的六种细胞死亡模式(自噬、细胞凋亡、铜死亡、坏死性凋亡、铁死亡和细胞焦亡),并使用一系列生物信息学分析、临床样本验证和实验,系统地将这些模式与患者生存、潜在生物学过程和药物敏感性相关联。
结果:我们确定并独立验证了三个可重复的基于细胞死亡的聚类,这些聚类与不同的临床结局和肿瘤微环境特征相关。使用肿瘤免疫功能障碍和排斥算法预测了这三个聚类对免疫检查点阻断(ICB)治疗的反应;我们发现了聚类 B 对 ICB 治疗潜在的耐药性。我们还进行了药物筛选,以确定聚类特异性药物。此外,开发了一种评分系统,命名为 CDPM 评分,用于评估 LGG 患者的细胞死亡模式;该系统可以预测 LGG 患者的预后和免疫治疗疗效。通过进行多重免疫荧光染色,我们在一个独立的 LGG 队列中验证了 GNAL 表达与 LGG 的分子和临床特征的相关性。最后,实验表明 GNAL 促进了 LGG 细胞的凋亡并抑制了其增殖。
结论:新的基于细胞死亡的亚型系统表明了 LGG 生物学的几个特征,并为使用精准医学治疗 LGG 提供了新的见解。CDPM 评分可用于预测 LGG 患者的免疫治疗反应和预后;此外,它可能为改善 LGG 管理提供了新的方向。
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