Abstract

Abstract Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Despite aggressive treatment, the median survival for patients with GBM remains approximately 1 year. Recent evidence demonstrates GBM is a sexually dimorphic disease, and that females have greater overall survival. We previously showed expression levels of HFE, an iron-regulating gene, significantly impacts survival in GBM. Moreover, this effect is sex-specific: females with low HFE expressing tumors have significantly longer survival than males with similar HFE expression. Moreover, HFE expression and survival appeared to correlate with markers of immune activity within the tumors. To further explore the impact of HFE expression on the immune infiltration of GBM, we utilized available TCGA GBM data for analysis by EstimateMe and DeconvuluteMe. These platforms utilize expression data to estimate the magnitude and cellular composition of immune cell infiltrates in tumors, respectively. We sought to correlate these computational measures with HFE expression levels and survival. We confirmed that immune and stromal cell infiltration of tumors is negatively correlated to survival. Consistent with our findings that high HFE levels have a negative impact on survival, high HFE expressing tumors possessed higher levels of both immune and stromal cell infiltration. Additionally, sex of the patient, but not MGMT methylation status, was significantly correlated with immune and stromal infiltration, with males displaying higher levels of infiltration. High HFE tumors were composed of greater numbers of all immune cell types than low HFE tumors. In both HFE groups, monocytes and macrophages comprised the greatest fraction of cells. At low HFE and positive MGMT methylation (where we previously noted the greatest survival differences), we find females have lower monocyte and M2 macrophage markers compared to males with similar features. Collectively, these data suggest that an HFE-immune cell infiltrate axis contributes to sex differences in GBM survival.

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