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Mischkulnig M, Kiesel B, Rötzer-Pejrimovsky T, Borkovec M, Lang A, Millesi M, Wadiura LI, Hervey-Jumper S, Penninger JM, Berger MS, Widhalm G, Erhart F. P11.44.A The impact of heme biosynthesis regulation on glioma aggressiveness: correlations with most recent diagnostic molecular markers. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognosis of patients with diffusely infiltrating gliomas is dismal but varies greatly between individuals. While characterization of gliomas was primarily relied on typical histopathological features, specific molecular markers increasingly gained importance and play a key role in the recently published 5th edition of the World Health Organization (WHO) classification. Heme biosynthesis represents a crucial pathway due to its key role in oxygen transport, energy production or drug metabolism. Recently, we described a “heme biosynthesis mRNA expression signature” that correlates with histopathological glioma grades and patient survival. The aim of the current study was to correlate the heme biosynthesis mRNA expression signature with the most recent diagnostic molecular markers for glioma stratification.
Material and Methods
In this study, patient data were derived from the “The Cancer Genome Atlas” (TCGA) lower-grade glioma and glioblastoma cohorts. We identified diffusely infiltrating gliomas correlating molecular tumor diagnosis according to the most recent WHO classification with heme biosynthesis mRNA expression. The following molecular markers were analyzed: EGFR amplification, TERT promoter mutation, CDKN2A/B homozygous loss, concurrent chromosome 7 gain/10 loss, MGMT methylation, IDH mutation, ATRX loss, p53 mutation and 1p19q co-deletion. Subsequently, we calculated the heme biosynthesis mRNA expression signature and correlated this signature with distinct molecular glioma markers as well as the resulting molecular subgroups.
Results
A total of 649 patients with available data on up-to-date molecular markers and heme biosynthesis mRNA expression were included. According to analysis of individual molecular markers, we found a significantly higher heme biosynthesis mRNA expression signature in gliomas with IDH wildtype (p<0.0005), without 1p19q co-deletion (p<0.0005), with homozygous CDKN2A/B loss (p<0.0005) and with EGFR amplification (p=0.001). Furthermore, we observed that the heme biosynthesis mRNA expression signature increased with the aggressiveness of the molecular subgroups (p<0.0005), being lowest in WHO grade 2 oligodendrogliomas and highest in WHO grade 4 glioblastomas.
Conclusion
Our data demonstrate a significant correlation between diagnostic molecular markers and heme biosynthesis regulation in diffusely infiltrating gliomas. Consequently, heme biosynthesis expression is a promising biomarker for glioma aggressiveness and might constitute a potential target for novel therapeutic approaches.
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Affiliation(s)
| | - B Kiesel
- Medical University of Vienna , Vienna , Austria
| | | | - M Borkovec
- Medical University of Vienna , Vienna , Austria
| | - A Lang
- Medical University of Vienna , Vienna , Austria
| | - M Millesi
- Medical University of Vienna , Vienna , Austria
| | - L I Wadiura
- Medical University of Vienna , Vienna , Austria
| | | | - J M Penninger
- University of British Columbia, Vancouver , BC , Canada
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences , Vienna , Austria
| | - M S Berger
- Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Medical University of Vienna , Vienna , Austria
| | - F Erhart
- Medical University of Vienna , Vienna , Austria
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Lang A, Jeron RL, Kiesel B, Mischkulnig M, Bergmeister-Berghoff AS, Ricken G, Wöhrer A, Rössler K, Lötsch-Gojo D, Rötzer-Pejrimovsky T, Hainfellner JA, Höftberger R, Widhalm G, Erhart F. P13.04.B Dissecting high-grade glioma immune infiltration in samples from fluorescence-guided surgery: digital pathology with automated image analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) is a widely used technique to conduct maximum safe resection of high-grade gliomas (HGG). 5-ALA accumulates in malignant tumor tissue where it is metabolized to Protoporphyrin IX (PpIX), an agent with fluorescence properties. It helps neurosurgeons to distinguish between tumor-infiltrated tissue and healthy brain parenchyma. Even though fluorescence-guided surgery is clinically well established, the biological properties of different fluorescence levels are not comprehensively studied yet. A relevant current gap in that respect is the pattern of immune cell infiltration in fluorescent versus non-fluorescent tissue samples. In light of future research, reliable, standardized histopathology methods that allow high-throughput analysis are desirable and digital pathology with automated image analysis is an attractive option to explore.
Material and Methods
128 formalin-fixed paraffin-embedded (FFPE) tissue blocks of 39 patients who underwent fluorescence-guided surgery of a HGG were included. Samples were selected based on their documented 5-ALA fluorescence intensity status (strong, vague, negative). Microtome-cut sections of the tissue were stained with antibodies against CD8, CD68, CD163 and FOX P3, representing immune cell populations of specific interest (cytotoxic T cells, glioma-associated macrophages, regulatory T cells). A total of 512 stained slides were then available for assessment. In addition to a classical, semi-quantitative analysis by two independent human reviewers, the immune infiltration intensity was measured via automated image analysis with the digital pathology software QuPath Version 0.3.2.
Results
Across all stained FFPE samples CD68 showed the overall highest intensity, followed by CD163. CD8 and FoxP3 showed generally lower average intensities. In 5-ALA negative and positive high-grade glioma samples the immune cell infiltration pattern was the same. Quantitative automatic digital pathology correlated well with the classical human histopathological analysis for the majority of markers evaluated.
Conclusion
We successfully explored and established novel digital pathology technologies for the study of immune cell infiltration patterns in neurooncology, specifically in the context of fluorescence-guided resection. Leveraging this platform could allow parallelized and high-throughput analysis of immune cell infiltration also in other contexts.
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Affiliation(s)
- A Lang
- Medical University Vienna , Vienna , Austria
| | - R L Jeron
- Medical University Vienna , Vienna , Austria
| | - B Kiesel
- Medical University Vienna , Vienna , Austria
| | | | | | - G Ricken
- Medical University Vienna , Vienna , Austria
| | - A Wöhrer
- Medical University Vienna , Vienna , Austria
| | - K Rössler
- Medical University Vienna , Vienna , Austria
| | | | | | | | | | - G Widhalm
- Medical University Vienna , Vienna , Austria
| | - F Erhart
- Medical University Vienna , Vienna , Austria
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