Cnsc-25. neural signature of gbm exhibits synaptogenic and opc-like features and independently predicts patient survival

Abstract Interactions of neural cells with glioma cells drive tumor growth. In this study, we identified an epigenetically-defined, malignant neural signature of IDH-wildtype glioblastoma (GBM) that significantly influenced patients’ outcome. We used DNA methylation-based reference signatures of neural cells to deconvolve 1.058 primary patient GBM samples. Samples were classified based on the neural reference signature and annotated as low or high neural GBM. A high neural GBM was linked to hypomethylation of CpG sites associated with invasiveness, neuron-to-glioma-interactions, and transsynaptic signaling. Through spatially resolved, single cell transcriptomic and proteomic profiling, we discovered a correlation between the high neural signature and the upregulation of early development programs in OPC and NPC-like cells. These traits were accompanied by diminished immune infiltration and immunological response, further highlighting the distinctive neural-like nature of GBM. High neural GBM demonstrated increased connectivity as evidenced by magnetoencephalography and resting state magnet resonance imaging. Spatiotemporal tumor sampling showed a homogeneous and stable neural signature in newly diagnosed and recurrent GBM. In newly diagnosed GBM, a high neural signature correlated with decreased survival in 306 patients (median OS 15.0 versus 20.0 months, p< 0.001). Patient-derived xenograft models corroborated the aggressive nature of high neural GBM, showing a significantly reduced median OS of 58 days compared to 73 days (p< 0.01). These high neural GBM xenografts also exhibited an elevated tumor burden and an increase in neuron-glioma synapse formation. Consideration of the extent of resection showed a dependency on the neural subgroup as high neural GBM had an increased benefit from a complete contrast enhancing tumor removal when compared to low neural GBM. As a preoperative biomarker, the concentration of BDNF was increased in serum of high neural GBM patients (p < 0.01). Overall, we present an epigenetically-defined malignant neural signature in GBM that is associated with an unfavorable patient survival.