Abstract BACKGROUND Glioblastoma IDH-wildtype (GBM) treatment involves a combination of surgical resection, radiation therapy, and chemotherapy with temozolomide. Despite the aggressive standard of care, 90% of patients experience recurrence a few months after treatment, typically marked by the regrowth of highly invasive cells spreading from the peritumoral brain resection zone. The impact of chemoradiotherapy has been studied, but the impact of microsurgical resection on the tumor microenvironment (TME) and the plasticity of GBM cells remains unknown. Hence, the objective of this work was to study histopathological and transcriptomic changes induced by microsurgical resection on residual tumor cells and TME. MATERIAL AND METHODS Syngeneic GBM cell lines CT2A and GL261 were orthotopically implanted in C57Bl6j mice brains meanwhile P3 xenografts were injected in immunosuppressed nude mice. We developed an optimized microsurgical resection protocol for GBM in mice, mirroring the steps performed in patients. In a size-matched study, mice were randomly assigned to four groups: control (pre-surgery) and 1, 3, and 7 days post-surgery. Tumor tissues were studied with a multilevel strategy composed of time-resolved bulk and single-cell RNA sequencing, immunohistochemistry and intravital multiphoton microscopy (IVM). RESULTS Our analyses showed that microsurgical resection induced pronounced proneural-to-mesenchymal transition (PMT) and stimulation of hypoxia-driven pathways in residual GB cells. Further, we detected significant changes in the TME relative to the immune response and vascular function in line with ischemia exposure, which could humper the response to treatment by altering the adequate effect and distribution of the subsequent chemoradiotherapy. CONCLUSION Microsurgical resection consequences play a crucial role in shaping the phenotypic landscape of GBM tumor cells and the TME, marked by a transient ischemic TME triggering PMT in GBM cells and potentially preventing the effective response to chemoradiotherapy.
Read full abstract