Clonal History Research Articles

Abstract 5659: Origin of synchronous or metachronous multiple pancreatic cancers

Abstract [Introduction] The majority of patients with pancreatic cancer are inoperable at the time of diagnosis and even those cases with successful tumor resection for early-stage tumors frequently had second tumors within the remaining pancreas shortly after the surgery, contributing to a poor clinical outcome. Additionally, synchronous multiple pancreatic cancers have been frequently documented. One of the long-standing issues about such synchronous and/or metachronous multiple pancreatic cancers is their clonal origins. This study is designed to elucidate the origin of multiple pancreatic cancers through an unbiased detection of somatic mutations in primary and metachronous cancers, along with adjacent precursor lesions. [Methods] Serially obtained formalin-fixed paraffin-embedded surgical specimens from 20 patients who had undergone curative surgery for an early-stage pancreatic cancer were subjected to laser microdissection for the enrichment of tumor and precancerous lesions, from which DNA was extracted and analyzed for somatic mutations using whole-exome sequencing (WES) with matched normal DNA. The investigation into the shared and private mutations across different samples aimed to unveil the clonal evolution history of these lesions. [Results] We analyzed 20 patients with multiple pancreatic cancers of 2 metachronous and synchronous, 16 metachronous, and 2 synchronous tumors. In metachronous cases, all patients exhibited margin-negative pathology for the primary cancer, with a median interval of 38.9 months (ranging from 7 to 85 months) between the initial and second surgery. In addition, a total of 20 pancreatic intraepithelial neoplasia (PanIN) from 5 of these cases were analyzed. We identified a median of 66 (range: 31-232) and 20 (14-42) somatic mutations in cancer and PanIN lesions, respectively. None of the patients have known pathogenic germline variants. All samples had one or more driver mutations. In most cases (N=19), sharing many somatic mutations, multiple tumors had a common clonal origin. In another synchronous case, the synchronous tumors shared only one mutation, suggesting that they were clonally independent tumors. By contrast, none of the mutations other than hotspot KRAS mutations were shared between precursor and cancer lesions. While multiple independent clones were observed in precancerous lesions, most of multiple cancers originated from a common ancestor. Moreover, negative pathology of the margins at the initial surgery suggested that those multiple lesions arose from distant dissemination or metastasis, rather than contiguous, intraductal invasion. [Conclusions] In conclusion, our study suggests that even in early pancreatic cancer, dissemination within the pancreas may occur, contributing to the development of synchronous and metachronous cancers. Citation Format: Tomonori Hirano, Nobuyuki Kakiuchi, Yasuhide Takeuchi, Takayuki Anazawa, Kazuyuki Nagai, Toshihiko Masui, Sachiko Minamiguchi, Hironori Haga, Takeshi Tanaka, Atsuhiro Masuda, Yuzo Kodama, Norimitsu Uza, Hiroshi Seno, Satoru Miyano, Hiroko Tanaka, Seishi Ogawa. Origin of synchronous or metachronous multiple pancreatic cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5659.

Abstract PR005: Tracing the clonal dynamic of metastatic castration-resistant prostate cancer over immunotherapy using circulating tumor DNA

Abstract Human cancer tissues are known to release their own DNA into body fluids such as plasma. These DNA molecules derived from tumors, collectively known as circulating tumor DNA (ctDNA), contain genetic information about disease progression at the time of sampling. Importantly, ctDNA has recently been utilized for capturing the whole-body disease profile and when sampled at various time points over the treatment, can inform the dynamic of clonal heterogeneity and its contribution to therapy failures. Metastatic castration-resistant prostate cancer (mCRPC) is a class of cancerous diseases with a high degree of clonal heterogeneity and high mortality which is largely due to the frequent emergence of therapy resistance. Therefore, reconstructing the clonal history for mCRPC diseases using ctDNA has great potential in identification of novel and targetable molecular mechanisms that drive mCRPC progression. To assess this possibility, we hypothesize that tumor clones that are responsible for therapy resistance carry distinct genomic profiles, which are captured in plasma ctDNA and could be computationally resolved through genomic sequencing and clonal reconstruction. To address this question, we obtained plasma cell-free DNA (cfDNA), a mixture of ctDNA and other tissue-derived DNA, from 38 individuals treated with combination PD-L1 and PARP inhibition involved in a recent clinical trial (NCT02484404). Whole-genome sequencing was performed using cfDNA and fragmented buffy coat DNA as germline control. cfDNA samples with a tumor fraction of lower than 10% were excluded. Various computational strategies were used to model the clonal structures of diseases and estimate the temporal order in which small and large structural variants emerged. Through this approach, we observed a negative association between cfDNA tumor fraction and therapy response. Multiple clonal evolutionary patterns leading to therapy failures were observed. For example, both gain and loss of activating androgen receptor mutations were detected in different cases following the treatment, which represents two distinct mechanisms of evading immunotherapy targeting. As a result, changes in the relevant transcriptional activities were also detected through ctDNA fragment-based computational inference. Additionally, clonal persistence was detected in multiple cases that exhibited stable diseases upon the treatment, which involves loss-of-function mutations in p53, ATM, and CDK12. To estimate the potential contribution to plasma ctDNA by metastatic diseases, multi-region whole genome and exome sequencing data of the tumors that are available for some cases prior to the treatment were also analyzed. Clones resolved from analyzing ctDNA were computationally mapped to the primary disease or metastatic tissue with a shared set of mutations in a subset of cases and may explain the patterns of treatment response. Our novel findings from this study will fill in a critical gap of knowledge about the complex genetic mechanisms driving mCRPC immunotherapy resistance. Citation Format: Chennan Li, Anna Baj, Clara C. Y. Seo, Nicholas T. Terrigino, John R. Bright, S. Thomas Hennigan, Isaiah M. King, Scott Wilkinson, Shana Y. Trostel, William D. Figg, William L. Dahut, Jung Min Lee, David Y. Takeda, Fatima Karzai, Adam G. Sowalsky. Tracing the clonal dynamic of metastatic castration-resistant prostate cancer over immunotherapy using circulating tumor DNA [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr PR005.

Invasive clonal plants possess greater capacity for division of labor than natives in high patch contrast environments.

Invasion success of clonal plants is closely related to their unique clonal life history, and clonal division of labor is a crucial clonal trait. However, so far, it is unclear whether invasive alien clonal species generally possess a greater capacity for division of labor than native species and whether this pattern is affected by environmental conditions. To test whether patch contrast affects the differences in the capacity for division of labor between invasive alien and native clonal plants, we selected five pairs of exotic invasive and native clonal plant species that are congeneric and co-occurring in China as experimental materials. We grew the clonal fragment pairs of these invasive and native plants under high, low, or no contrast of reciprocal patchiness of light and nutrient, respectively, with ramet connections either severed (division of labor prevented) or kept intact (division of labor allowed). The results showed that connection significantly decreased the proportion of biomass allocated to roots in distal (younger) ramets, whereas it increased in proximal (older) ramets of all studied plants under high -contrast treatments. This clear pattern strongly indicated the occurrence of division of labor. Furthermore, the connection had a more pronounced effect on the pattern of biomass allocation of invasive alien plants, resulting in a greater increase in biomass for invasive alien plants compared to native plants. These findings suggest that the invasive alien plants possess a greater capacity for division of labor, which may confer a competitive advantage to them over natives, thus facilitating their invasion success in some heterogeneous habitats such as forest edges where light and soil nutrients show a high negative correlation.

Molecular evolution in different subtypes ofmultifocal hepatocellular carcinoma.

Multifocal hepatocellular carcinoma (MF-HCC) accounts for > 40% of HCCs, exhibiting a poor prognosis than single primary HCCs. Characterizing molecular features including dynamic changes of mutational signature along with clonal evolution, intrahepatic metastatic timing, and genetic footprint in the preneoplastic stage underlying different subtypes of MF-HCC are important for understanding their molecular evolution and developing a precision management strategy. We conducted whole-exome sequencing in 74 tumor samples from spatially distinct regions in 35 resected lesions and adjacent noncancerous tissues from 11 patients, 15 histologically confirmed preneoplastic lesions, and six samples from peripheral blood mononuclear cells. A previously published MF-HCC cohort (n = 9) was included as an independent validation dataset. We combined well-established approaches to investigate tumor heterogeneity, intrahepatic metastatic timing, and molecular footprints in different subtypes of MF-HCCs. We classified MF-HCCs patients into three subtypes, including intrahepatic metastasis, multicentric occurrence, and mixed intrahepatic metastasis and multicentric occurrence. The dynamic changes in mutational signatures between tumor subclonal expansions demonstrated varied etiologies (e.g., aristolochic acid exposure) underlying the clonal progression in different MF-HCC subtypes. Furthermore, the clonal evolution in intrahepatic metastasis exhibited an early metastatic seeding at 10-4-0.01cm3 in primary tumor volume (below the limits of clinical detection), further validated in an independent cohort. In addition, mutational footprints in the preneoplastic lesions for multicentric occurrence patients revealed common preneoplastic arising clones, evidently being ancestors of different tumor lesions. Our study comprehensively characterized the varied tumor clonal evolutionary history underlying different subtypes of MF-HCC and provided important implications for optimizing personalized clinical management for MF-HCC.

Abstract P5-13-04: Clonal evolution of mammary epithelial cells into breast cancers

Abstract [Introduction] Proliferative lesions in the breast have been implicated in the development of breast cancer. Previous studies showed that some proliferative lesions and adjacent breast cancers shared common genetic alterations, suggesting that these originated from the same ancestral cell. However, the clonal structure of normal epithelia and their clonal history during evolution to cancer are poorly understood. In this study, we analyzed genetic profiles of normal epithelia and proliferative lesions in the cancer-borne breast to illustrate the clonal evolution of cancer from a normal epithelial cell. [Methods] Single cell-derived organoids (n=47) were established from breast milk of 4 healthy women aged 22–36 and normal breast tissue of 15 breast cancer patients aged 29–83 to evaluate somatic mutation rate in normal epithelial cells. Multiple normal lobules and proliferative lesions together with cancer lesions were collected using laser-capture micro-dissection (LCM) from fresh frozen (n=3) or formalin-fixed paraffin-embedded (n=5) surgical specimens in 9 premenopausal breast cancer patients. Somatic mutations and copy number alterations were evaluated using whole-genome sequencing. [Results] The mutation profile of single cell-derived organoids suggests that somatic mutations accumulate in normal mammary epithelial cells at a constant rate of 19.4/genome/year before menopause, and the mutation rate decreases to 6.9/genome/year after menopause. Parity was negatively associated with mutation number (-49.3 per life birth). In total, we analyzed 143 LCM samples, including those from 72 normal lobules, 43 proliferative lesions, and 19 non-invasive and 9 invasive cancer samples. Five cases showed a large expansion of proliferative lesions sharing a substantial number of somatic mutations with cancer. These lesions expanded over a distance of 35-90 mm, sharing tens to hundreds of mutations including those in breast cancer-related driver genes, such as PIK3CA, AKT1, GATA3, CBFB and PTEN, while harboring private mutations or copy number alterations of their own. Of interest, the cancers in 4 out of these 5 cases was luminal-A type invasive ducal carcinoma or ER-positive HER2-negative ductal carcinoma in situ, and characterized in common by the presence of der(1;16), concurrent whole-arm 1q gain and 16q loss, in both cancer and proliferative lesions. Phylogenetic analysis adapted with the mutation rate in normal cells predicted that der(1;16) had been acquired between puberty and early 20’s, and the common ancestors of non-cancerous and cancerous lesions emerged by early 30’s, >10 years earlier than at the time of cancer diagnosis. By contrast, analysis of non-cancerous lobules unrelated to cancer showed that der(1;16)-negative non-cancer clones that had emerged after puberty stayed within a single lobule or spatially confined to adjacent lobules and rarely expanded to a large area as observed for those carrying der(1;16), even if the clones had acquired mutations in driver genes such as PIK3CA and PIK3R1, which highlighted the role of der(1;16) in wide clonal expansion. [Conclusions] Our results suggest that in some breast cancer cases, particularly in those with der(1;16), a highly recurrent translocation accounting for the major subset of Luminal A breast cancer, the clones with the funder driver alterations expanded macroscopically long before the onset of cancer, in which further clonal evolutions recursively occur multi-focally, giving rise to multiple proliferative lesions and ultimately, invasive cancers. Our findings provide new insight into the early development of breast cancer. Citation Format: Tomomi Nishimura, Nobuyuki Kakiuchi, Kenichi Yoshida, Takaki Sakurai, Tatsuki R. Kataoka, Eiji Kondoh, Yoshitsugu Chigusa, Masahiko Kawai, Morio Sawada, Takuya Inoue, Yasuhide Takeuchi, Hirona Maeda, Satoko Baba, Yusuke Shiozawa, Ryunosuke Saiki, Masahiro M. Nakagawa, Yasuhito Nannya, Yotaro Ochi, Tomonori Hirano, Yukiko Inagaki-Kawata, Kosuke Aoki, Masahiro Hirata, Eiji Suzuki, Masahiro Takada, Masahiro Kawashima, Kosuke Kawaguchi, Kenichi Chiba, Yuichi Shiraishi, Junko Takita, Satoru Miyano, Masaki Mandai, Kengo Takeuchi, Hironori Haga, Masakazu Toi, Seishi Ogawa. Clonal evolution of mammary epithelial cells into breast cancers [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-13-04.

Simulating life history trade-offs of clonal plants in drought

This study investigates responses of clonal plants and non-clonal plants to drought and their competition results using a spatial simulator based on clonal and nonclonal life history strategies. The clonal and non-clonal plants are designed as two phenotypes of one generic species with facultative clonal growth. Therefore, both phenotypes share the same life histories beside their allocation to aboveground and belowground growth, resulting in differences in leaf biomass, underground storage, and seed reproduction. Clonal plants tend to store biomass underground which would boost survival in the long-term, while non-clonal plants invest towards aboveground growth and thus more seed reproduction in the short-term. It is shown that allocation to storage in clonal plants provide them with an advantage when faced with severe drought since they can resprout from belowground. In comparison, non-clonal plants do better when there is no drought as they allocate more to aboveground growth and seeds. The simulations results have demonstrated how clonal life histories might impact plant population dynamics under drought, which might increase in frequency and extent as anthropogenic climate change continues. It also can be easily parameterized to investigate other species of interest under other environmental conditions.

450 Clonal history of skin adnexal neoplasms inferred by multi-sampling, whole exome sequencing

Eccrine porocarcinoma is a rare malignant skin tumor that often presents as the transformation of an underlying poroma. Nevus sebaceous is a benign skin hamartoma, from which various secondary neoplasm may arise. Since these tumors arise from long-standing precursor benign lesions, multi-sampling, genomic analysis of these tumors may provide us with insight into the life history of these tumors. Whole exome sequencing analysis of porocarcinoma showed high intra-tumor heterogeneity. The reconstructed phylogenetic tree showed a short trunk having the KRAS p.G12V mutation, and showed long branches, which may or may not have secondary driver mutations.

Life histories of myeloproliferative neoplasms inferred from phylogenies

Brief summary: This study performed whole-genome sequencing (WGS) of 1013 clonal haematopoietic cell colonies from 12 adult patients aged 20–81 years with myeloproliferative neoplasms, a form of blood cancer. They identified 580 133 somatic mutations and used these to reconstruct haematopoietic clonal histories. Key somatic (i.e. non-germline) driver mutations were estimated to have occurred early in life, including fetal life and early childhood.

Abstract 6085: Clonal evolution of mammary epithelial cells into breast cancers

Abstract [Introduction] Previous studies suggested that breast cancers (BCs) and some adjacent atypical proliferative lesions evolved from the same ancestral cell. However, the clonal structure of normal epithelial cells and their clonal history during evolution to cancer are poorly understood. In this study, we analyzed genetic profiles of normal epithelia and proliferative lesions in the cancer-borne breast to illustrate the clonal evolution of cancer from a normal epithelial cell. [Methods] Single cell-derived normal epithelial organoids (n=47) were established from breast milk of 4 healthy women aged 22-36 and surgical specimens of 15 BC patients aged 29-83 to evaluate somatic mutation rate. Multiple normal lobules or proliferative lesions together with cancer cells were collected using laser-capture micro-dissection (LCM) from fresh frozen (n=3) or formalin-fixed paraffin-embedded (n=6) surgical specimens in 9 premenopausal BC patients. Somatic mutations and copy number alterations were evaluated using whole-genome sequencing. [Results] On the basis of single cell-derived mammary gland-derived organoids, somatic mutations increased in mammary gland cells at a constant rate of 19.4/genome/year before menopause, which then decreased to 6.9/genome/year after menopause. Parity was negatively associated with mutation number (-49.3 per life birth). In total, we analyzed 113 LCM samples, including those from 66 normal lobules, 28 proliferative lesions, and 14 non-invasive and 5 invasive cancer samples. Phylogenetic analysis showed that most of the neighboring normal lobules (53/66) from 3 BC patients shared no somatic mutations with each other and therefore were clonally independent. In other 13 normal lobules, shared mutations including a PIK3CA mutation were observed across multiple adjacent samples, although they were still confined to <10 mm regions. By contrast, we found a large expansion of proliferative lesions sharing a substantial number of somatic mutations with cancer in 5 out of the 6 remaining BC cases. They were expanded over a distance of 25-85 mm, sharing tens to hundreds of mutations including those in BC-related driver genes, such as PIK3CA, AKT1, GATA3, CBFB and PTEN. Of interest, Tumors in 4 out of these 5 cases was Luminal-A type and characterized in common by the presence of 1q gain and 16q loss (1q+/16q-) in both cancer and proliferative lesions. Phylogenetic analysis adapted with the mutation rate in normal cells predicted that 1q+/16q- had been acquired during adolescence to mid-20s, where the clonal expansion had occurred years to decades before the onset of cancer. [Conclusions] Our results suggest that in some BC cases, particularly in those with 1q+/16q-, the clones with the founder driver mutations expanded macroscopically long before the onset of cancer, in which further clonal evolutions recursively occur multi-focally, giving rise to multiple proliferative lesions and ultimately, invasive cancers. Citation Format: Tomomi Nishimura, Nobuyuki Kakiuchi, Kenichi Yoshida, Yasuhide Takeuchi, Hirona Maeda, Yusuke Shiozawa, Masahiro M. Nakagawa, Ryunosuke Saiki, Yotaro Ochi, Tomonori Hirano, Yukiko Kawata, Kosuke Aoki, Masahiro Hirata, Tatsuki R. Kataoka, Takaki Sakurai, Satoko Baba, Yuichi Shiraishi, Kenichi Chiba, Kengo Takeuchi, Hironori Haga, Satoru Miyano, Masakazu Toi, Seishi Ogawa. Clonal evolution of mammary epithelial cells into breast cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6085.

Deciphering clonal dynamics and metastatic routines in a rare patient of synchronous triple-primary tumors and multiple metastases with MPTevol

Multiple primary tumor (MPT) is a special and rare cancer type, defined as more than two primary tumors presenting at the diagnosis in a single patient. The molecular characteristics and tumorigenesis of MPT remain unclear due to insufficient approaches. Here, we present MPTevol, a practical computational framework for comprehensively exploring the MPT from multiregion sequencing (MRS) experiments. To verify the utility of MPTevol, we performed whole-exome MRS for 33 samples of a rare patient with triple-primary tumors and three metastatic sites and systematically investigated clonal dynamics and metastatic routines. MPTevol assists in comparing genomic profiles across samples, detecting clonal evolutionary history and metastatic routines and quantifying the metastatic history. All triple-primary tumors were independent origins and their genomic characteristics were consistent with corresponding sporadic tumors, strongly supporting their independent tumorigenesis. We further showed two independent early monoclonal seeding events for the metastases in the ovary and uterus. We revealed that two ovarian metastases were disseminated from the same subclone of the primary tumor through undergoing whole-genome doubling processes, suggesting metastases-to-metastases seeding occurred when tumors had similar microenvironments. Surprisingly, according to the metastasis timing model of MPTevol, we found that primary tumors of about 0.058-0.124cm diameter have been disseminating to distant organs, which is much earlier than conventional clinical views. We developed MPT-specialized analysis framework MPTevol and demonstrated its utility in explicitly resolving clonal evolutionary history and metastatic seeding routines with a rare MPT case. MPTevol is implemented in R and is available at https://github.com/qingjian1991/MPTevol under the GPL v3 license.

Detection of acquired TERT amplification in addition to predisposing p53 and Rb pathways alterations in EGFR-mutant lung adenocarcinomas transformed into small-cell lung cancers

IntroductionAmong the different mechanisms of acquired resistance to EGFR tyrosine kinase inhibitors (TKIs) reported in EGFR-mutated lung adenocarcinoma (EGFR-LUAD) patients, histological transformation into small cell carcinoma (SCLC) occurs in 3–14% of resistant cases, regardless of the generation of EGFR-TKI. In recent studies, bi-allelic inactivation of TP53 and RB1 has been identified in a vast majority of transformed SCLCs. However, the molecular mechanisms driving this histologic transformation remain largely unknown, mainly due to the rarity of samples. Patients and methodsOut of an initial cohort of 64 patients, tumor tissues of adequate quality and quantity for whole exome sequencing (WES) analysis were available for nine tumors for six patients: paired pre- and post-SCLC transformation samples for three Patients and post-SCLC transformation samples for three other patients. ResultsMutational analyses showed concurrent TP53 mutations and Rb pathway alterations in five of the six patients analyzed, confirming their suggested role as predisposing genetic alterations to SCLC transformation. In addition, TERT amplification was detected in four of the six patients and found to be an event acquired during SCLC transformation. Clonal history evolution analyses from the paired LUAD/SCLC samples showed different evolution patterns. In two patients, a large proportion of mutations were present in the most recent common ancestor cell of the initial LUAD and the transformed SCLC clones, whereas in the third patient, few clonal mutations were common between the LUAD and SCLC samples and the ancestor clone that lead to SCLC was present at low frequency in the initial LUAD. ConclusionDespite varied clinical presentations and clonal history evolution patterns, in addition to p53 and Rb pathways alterations, TERT amplification emerged as another common genetic mechanism of EGFR-LUAD to SCLC transformation in our cohort, and could represent a candidate therapeutic target in this subset of SCLC tumors.

Life histories of myeloproliferative neoplasms inferred from phylogenies.

Mutations in cancer-associated genes drive tumour outgrowth, but our knowledge of the timing of driver mutations and subsequent clonal dynamics is limited1-3. Here, using whole-genome sequencing of 1,013 clonal haematopoietic colonies from 12 patients with myeloproliferative neoplasms, we identified 580,133 somatic mutations to reconstruct haematopoietic phylogenies and determine clonal histories. Driver mutations were estimated to occur early in life, including the in utero period. JAK2V617F was estimated to have been acquired by 33 weeks of gestation to 10.8 years of age in 5 patients in whom JAK2V617F was the first event. DNMT3A mutations were acquired by 8 weeks of gestation to 7.6 years of age in 4 patients, and a PPM1D mutation was acquired by 5.8 years of age. Additional genomic events occurred before or following JAK2V617F acquisition and as independent clonal expansions. Sequential driver mutation acquisition was separated by decades across life, often outcompeting ancestral clones. The mean latency between JAK2V617F acquisition and diagnosis was 30 years (range 11-54 years). Estimated historical rates of clonal expansion varied substantially (3% to 190% per year), increased with additional driver mutations, and predicted latency to diagnosis. Our study suggests that early driver mutation acquisition and life-long growth and evolution underlie adult myeloproliferative neoplasms, raising opportunities for earlier intervention and a new model for cancer development.

Clonotype pattern in T-cell lymphomas map the cell of origin to immature lymphoid precursors

AbstractMature T-cell lymphomas (TCLs) are rare, clinically heterogeneous hematologic cancers with high medical need. TCLs have an inferior prognosis which is attributed to poor understanding of their pathogenesis. On the basis of phenotypic similarities between normal and neoplastic lymphocytes, it has been assumed that TCLs develop in the periphery, directly from various subtypes of normal T cells. To address the debated question of the cell of origin in TCLs, we attempted to identify the highly variable complementarity-determining regions (CDRs) of T-cell receptors (TCRs) to trace the clonal history of the T cells. We have collected previously published whole-genome, whole-exome, and whole-transcriptome sequencing data from 574 patients with TCL. TCR clonotypes were identified by de novo assembly of CDR3 regions of TCRα, TCRβ, and TCRγ. We have found that the vast majority of TCLs are clonotypically oligoclonal, although the pattern of oligoclonality varied. Anaplastic large-cell lymphoma was the most diverse comprising multiple clonotypes of TCRα, TCRβ, and TCRγ, whereas adult TCL or leukemia and peripheral TCLs often showed monoclonality for TCRβ and TCRγ but had diverse TCRα clonotypes. These patterns of rearrangements indicated that TCLs are initiated at the level of the lymphoid precursor. In keeping with this hypothesis, TCR rearrangements in TCLs resembled the pattern seen in the human thymus, which showed biased usage of V (variable) and J (joining) segments of high combinatorial probability resulting in recurrent public CDR3 sequences shared across unrelated patients and different clinical TCL entities. Clonotypically diverse initiating cells may seed target tissues that are then responsible for disease relapses after therapy.

Single-Cell Proteogenomic Sequencing Allows Early Detection of Relapse Clone with CN-LOH at FLT3-ITD Locus from Initial Diagnosis in AML

IntroductionFLT3-ITD is one of the most common and clinically relevant mutations in acute myeloid leukemia (AML). A high FLT3-ITD allelic ratio (AR) (>0.5) is strongly associated with poor prognosis. FLT3-ITDs are heterogeneous mutations, varying in sizes and locations with some patients having multiple FLT3-ITDs. Unfortunately, conventional clinical techniques are often not adequate in measuring these characteristics at sufficient resolution. The current study aimed to characterize an AML case with 2 FLT3-ITDs at diagnosis, map the multi-omic evolution of AML clones, and understand genetic patterns underlying AML relapse using single-cell proteogenomic sequencing (ScPGseq).MethodsLeukemic samples from a 46-year old female patient diagnosed with de novo AML obtained at initial diagnosis and relapse were archived and used in this study. Based on the 2017 ELN risk stratification, the patient was classified into a low-risk group due to normal karyotype/low FLT3-ITD AR/NPM1+. The patient achieved complete remission (CR) after induction chemotherapy in combination with midostaurin. The patient relapsed 2 months after 4 cycles of consolidation, with a CR duration of 6 months. After relapse, the disease was refractory despite reinduction and salvage therapies, even with gilteritinib (Fig A). ScPGseq was performed using the Mission Bio's AML panel and antibody oligoconjugates for 16 cell surface proteins. Raw sequencing reads were processed using Mission Bio's Tapestri pipeline and results were exported from Tapestri Insights (v3.0.2). All downstream computational and statistical analyses were performed using R and Python.ResultsConsistent with clinical sequencing (R 2 = 0.997) and PCR, ScPGseq identified 5 mutations in FLT3 (21bp and 39bp ITDs and D835Y), NPM1, and WT1 at diagnosis (2367 cells). At relapse, 1 FLT3-ITD (21bp) and mutations in NPM1 and WT1 were detected while the other FLT3-ITD (39bp) and FLT3 D835Y were absent (2611 cells). Clonal analyses of mutation patterns identified 4 AML clones at diagnosis (C1-4) and 1 at relapse (C3R; Fig B). Two closely related clones, C3 and C3R (WT1+/NPM1+/21bp FLT3-ITD+) differed in zygosity of 21bp FLT3-ITD, where nearly all cells in C3R carries homozygous FLT3-ITD. SNP array confirmed the presence of copy neutral loss of heterozygosity (CN-LOH) in chr13q.Analysis of 16 cell surface proteins along with clonal information identified 3 clusters including one devoted to non-leukemic fractions (i.e., no mutations) (top) and another nearly exclusively consisting of mutant cells from diagnosis, which we termed “monocyte-like signature” (right bottom). The other cluster was composed of nearly all mutant cells from the relapse sample and about 1/3 of mutant cells from diagnosis, which we termed “immature myeloid cell signature” (left) (Fig C).When investigating further, C3 cells with immature myeloid cell signature (98/287 cells, 34.1%) exhibited much higher allelic burden of (mean 73% vs. 56%, adj. p < 1.1e-6) and were significantly enriched with homozygous 21bp FLT3-ITDs compared to C3 cells with monocyte-like signature (189/287 cells, 65.9%) (41/98 cells, 42% vs. 11/189 cells, 5.8%, adj. p = 2.7e-13). No other mutations showed similar patterns. It indicates that C3R existed from the initial diagnosis at low frequency, instead of losing heterozygosity during relapse. Without the single cell proteogenomic analyses, C3R cells, present in <5% cells at the initial diagnosis could have not been detected.The multi-omic information elucidates the complete clonal history of this AML (Fig D). Starting with WT1 and NPM1 mutations (C1), 3 FLT3 mutations (2 ITDs and D835Y) were subsequently acquired in 3 subclones (C2-4). A subset of C3 cells (WT1+/NPM1+/21bp FLT3-ITD+) further gained CN-LOH in chr13q (C3R at diagnosis). When treated, AML cells without homozygous 21bp FLT3-ITD were cleared. Cells with homozygous 21bp FLT3-ITD survived/escaped from the treatment and became the dominant clone at relapse (C3R at relapse).ConclusionThe current study demonstrates that ScPGseq allows1) simultaneous and comprehensive analyses of multiple FLT3-ITDs at the single-cell level2) early detection of relapse clone with subclonal homozygous 21bp FLT3-ITD from the initial diagnosis, which explains one of the mechanisms of relapse in AML cases with low FLT3-ITD AR3) multi-omic clonal analyses, which further refine clonal models relying only on mutation profiles. [Display omitted] DisclosuresMinden: Astellas: Consultancy. Kim: Pfizer: Honoraria, Research Funding; Bristol-Meier Squibb: Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Paladin: Honoraria, Research Funding.

Tumor immunology in the age of single-cell genomics.

Immunotherapies that were developed based on our understandings of tumor immunology have revolutionized cancer treatment. However, the success of immunotherapy is eclipsed by several grand challenges, including low response rate, intrinsic/acquired resistance and adverse effects. While a deeper understanding of the interaction between tumor and our immune system, especially the tumor immune niche, is essential to overcome those challenges, we are limited by the fact that most of our knowledge about tumor immunology is based on studies analyzing bulk populations of cells, which are often unable to fully characterize the various cell types and states engaged in immune cell functions. The advent of cutting single-cell genomic technologies empowers us to dissect the tumor immune niche in a genome-wide and spatially resolved manner in single cells, trace their clonal histories, and unveil their regulatory circuits. Future studies on tumor immunology in the age of single-cell genomics, therefore, hold the promise to develop more effective and precise immunotherapies for human cancers. In this perspective, we will discuss how advanced single-cell genomics approaches will revolutionize tumor immunology research and immunotherapies by catering the demand in the field of tumor immunology.

Assessing the Subclonal Genetic Landscape of KMT2A -Rearranged Infant Acute Lymphoblastic Leukemia By Single-Cell Genomics

Acute lymphoblastic leukemia (ALL) arising in infants less than 1 year of age is characterized by genetic rearrangements of the KMT2A gene (previously MLL) and an exceedingly poor prognosis. We have previously shown that infant KMT2A -rearranged (KMT2A -R) ALL has one of the lowest numbers of somatic mutations of any sequenced cancer with a mean of only 1.3 non-silent mutations being present in all leukemia cells per patient (Andersson et al., Nat Genet, 2017). Despite the paucity of mutations, activating mutations within the PI3K/RAS signaling pathway were present in about half of cases, most of which were subclonal with a mutant allele frequency (MAF) <0.30. In addition, some patients harbored multiple activating mutations at varying MAFs, suggesting the presence of multiple low-frequency leukemia clones. Based on these findings, we hypothesized that the genetic landscape of infant KMT2A -R ALL is more clonally heterogeneous than other pediatric leukemias, which might contribute to its poor prognosis as current treatment regimens may not eliminate all clones.To test our hypothesis, high coverage bulk and single-cell genomics were used to study the mutation profiles of subclones in diagnostic samples from four infants younger than 6 months of age with KMT2A -R ALL. This included patients with t(4;11)(q21;q23) KMT2A-AFF1 (n=3) of which two relapsed and a patient with t(11;19)(q23;p13.3) KMT2A - MLLT1 (n=1) that remains in remission. DNA was isolated from bulk leukemia cells and high-depth paired-end whole-genome sequencing was performed on paired diagnostic and remission samples at an average haploid coverage of 160x and 35x, respectively. In addition, whole-exome sequencing was performed on the diagnostic samples at an average exon coverage of 375x. Somatic alterations, including single-nucleotide variations (SNVs), insertions-deletions (indels), structural variations (SVs), and copy number alterations, were detected using multiple analytical pipelines. In parallel, approximately 75 viable single cells from each diagnostic sample were isolated and the DNA from the cells underwent whole genome amplification using the Fluidigm C1 system.Analyses of the whole-genome sequencing data from the four infant cases revealed an average of 715 putative sequence variants (range of 54-1199) per case across the genome. Using the combined data from whole-genome- and exome sequencing, an average of 55 (range 51-65) non-silent mutations affecting coding genes or non-coding RNAs were identified, with 83% having support by both sequencing methods, validating their presence. An average of 63% and 92% of the non-silent mutations detected by whole-genome and exome sequencing, respectively, were subclonal, demonstrating the enhanced ability to detect low frequency variants with higher sequencing depth.Subclonal mutations in genes within the PI3K/RAS signaling pathway were detected in 2/4 cases with each patient harboring both a KRASG12D and a FLT3V491L as well as an additional NRASG13D for one of the cases. The recurrent FLT3V491L mutation is present in COSMIC and has been previously detected in leukemia, but to the best of our knowledge, it has not been experimentally verified to be activating.We are now performing high-throughput amplicon-based sequencing at the single cells from those patients using 150 targets/cell to determine the number of distinct clones into which the bulk mutations segregate. The targets include a mixture of coding, intergenic variants and SVs. In addition, we are determining if each cell contains a mutation at a selected number of loci that are leukemia-associated mutational hotspots. After acquiring the data, we will reconstruct the clonal architecture of the samples, enabling us to assess the clonal heterogeneity and mutational histories of the leukemias.Taken together, these data will provide a unique look into the underlying biology of infant KMT2A -R ALL by providing new details about the population genetic diversity and temporal genetic changes that occur during KMT2A -R infant leukemogenesis. These data may also provide insight into the universally poor prognosis of patients with KMT2A -R infant ALL. DisclosuresNo relevant conflicts of interest to declare.

Imaging cell lineage with a synthetic digital recording system.

During multicellular development, spatial position and lineage history play powerful roles in controlling cell fate decisions. Using a serine integrase-based recording system, we engineered cells to record lineage information in a format that can be read out in situ. The system, termed integrase-editable memory by engineered mutagenesis with optical in situ readout (intMEMOIR), allowed in situ reconstruction of lineage relationships in cultured mouse cells and flies. intMEMOIR uses an array of independent three-state genetic memory elements that can recombine stochastically and irreversibly, allowing up to 59,049 distinct digital states. It reconstructed lineage trees in stem cells and enabled simultaneous analysis of single-cell clonal history, spatial position, and gene expression in Drosophila brain sections. These results establish a foundation for microscopy-readable lineage recording and analysis in diverse systems.

Myeloproliferative Neoplasms: The Long Wait for JAK2-Mutant Clone Expansion

Myeloproliferative neoplasms (MPNs) are hematological malignancies caused by somatic mutations originating from a single hematopoietic stem cell (HSC). In this issue of Cell Stem Cell,Van Egeren etal. (2021) used whole-genome sequencing of hematopoietic colonies to reconstruct the clonal history and time of acquisition of the disease-initiating gene mutation.

Integrated Genomic, Functional, and Prognostic Characterization of Atypical Chronic Myeloid Leukemia.

Atypical chronic myeloid leukemia (aCML) is a BCR-ABL1-negative clonal disorder, which belongs to the myelodysplastic/myeloproliferative group. This disease is characterized by recurrent somatic mutations in SETBP1, ASXL1 and ETNK1 genes, as well as high genetic heterogeneity, thus posing a great therapeutic challenge. To provide a comprehensive genomic characterization of aCML we applied a high-throughput sequencing strategy to 43 aCML samples, including both whole-exome and RNA-sequencing data. Our dataset identifies ASXL1, SETBP1, and ETNK1 as the most frequently mutated genes with a total of 43.2%, 29.7 and 16.2%, respectively. We characterized the clonal architecture of 7 aCML patients by means of colony assays and targeted resequencing. The results indicate that ETNK1 variants occur early in the clonal evolution history of aCML, while SETBP1 mutations often represent a late event. The presence of actionable mutations conferred both ex vivo and in vivo sensitivity to specific inhibitors with evidence of strong in vitro synergism in case of multiple targeting. In one patient, a clinical response was obtained. Stratification based on RNA-sequencing identified two different populations in terms of overall survival, and differential gene expression analysis identified 38 significantly overexpressed genes in the worse outcome group. Three genes correctly classified patients for overall survival.

Co-Occurring Mutation Clusters Predict Drug Sensitivity in Acute Myeloid Leukemia

Background The molecular origin of cancer drug resistance is not apparent for most cases of acute myeloid leukemia (AML). Clonal evolution appears to be associated with increasing drug resistance. We sought to determine whether the mutation patterns are associated with drug susceptibility in AML. Methods Seventy-two patient blood or marrow samples were enriched for CD34+ blasts by immunomagnetic bead selection. High throughput drug sensitivity screens were performed for 223 drugs after a 72-hour exposure to 8-12 customized drug concentrations (within the range of 5pM to 100µM) of each drug spanning 4-5 logs. Post exposure viability was determined using CellTiter Glo luminescent reagent. XLFit was used to analyze the data and generate dose response curves based on a standard 4-parameter logistic fit. Mutation analysis was performed by MyAML™ utilizing next generation sequencing (NGS) to analyze the 3' and 5' UTRs and exonic regions of 194 AML-associated genes and genomic breakpoints. Co-mutation and mutual exclusivity scores of gene aberrations were computed using three different statistical methods on three large publicly available datasets: 1) TCGA-AML, 2) BeatAML, and 3) data from 1540 patients (Moritz Gerstung, et al., Nat Genet. 2017). The scores for each co-mutation or mutually exclusive gene pair were then logarithmically transformed from the aggregated p-value using a robust rank aggregation method and used to construct a graph from which communities of co-mutated genes could be detected, resulting in higher mutual exclusivity between modules and higher co-occurrence within modules. Results We identified five main groups of co-mutations, including the following: 1) RUNX1 group, 2) CEBPA group, 3) NPM1 group, 4) TP53 group, and 5) RAS group (see Fig 1A). The co-mutation community in the RUNX1 group is featured with transcriptional dysregulation (RUNX1, ASXL1 and EZH2), and dysregulation in splicing (U2AF1, SRSF2 or SF3B1). The TP53 and CEBPA groups exhibit transcriptional dysregulation, and transcription factor alterations. The NPM1 and RAS groups exhibit signaling alteration, particularly the Ras/MAPK signaling pathway. Among each co-mutation community, the variant allele frequencies (VAFs) exhibited differences for specific mutations. For example, in the NPM1 group, FLT3 exhibits the lowest VAF, followed by NPM1 while DNMT3A shows the highest VAF. The five co-mutation groups are associated with different overall survival, including better survival for the CEBPA group and poorer survival for the TP53 group. Within each co-mutation group, specific associations with overall survival were detected, including better survival for NPM1-RAD21 co-mutated vs. wild type (WT), better survival for WT vs. ASXL1-RUNX1 co-mutated, worse survival for DNMT3A-FLT3 co-mutated vs. WT, and others. We also found that the co-mutation clusters were different between the de novo and relapse groups. Most importantly, we found significant correlations with drug sensitivity for the different co-occurring mutation groups. Cells from patients with mutations in the NPM1 co-mutation group show higher sensitivity to most of the drugs, including the tyrosine kinases inhibitors and PI3K-AKT-MTOR inhibitors. Cells from patients with mutations in the RAS cluster exhibited sensitivity to MEK inhibitors (Fig 1B), while cells from patients with mutations in the TP53 cluster show resistance to many drugs, including the MDM2 inhibitor AMG232 (Fig 1C). By mapping the mutated genes and drug targets into signaling pathways, we found that mutations in downstream signaling of the drug target exhibited resistance, while mutations in upstream signaling conferred higher sensitivity. We also constructed drug sensitivity prediction models based on the co-mutation groups. Conclusion We detected co-mutation groups through integrative analysis of large publicly available AML data sets. Patients with mutations in different groups of genes show different overall survival, while cells from patients with mutations in different co-mutation groups show different drug sensitivity. The co-mutation groups may not only reflect the clonal evolution history of AML, but also serve as important features for drug sensitivity prediction. Disclosures Carson: Invivoscribe, Inc: Current Employment. Patay:Invivoscribe, Inc: Current Employment. Becker:Cardiff Oncology: Research Funding; Novartis: Research Funding; SecuraBio: Research Funding; JW Pharmaceutical: Research Funding; Glycomimetics: Research Funding; Abbvie: Research Funding; Bristol Myers Squibb: Research Funding; Pfizer: Research Funding; Invivoscribe: Research Funding; Accordant Health Services/Caremark: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: There are ~200 drugs on the screening panel, and many would be off label for acute myeloid leukemia.