Abstract Background Colitis-associated carcinoma (CAC) is a major complication that arises in patients with a long-standing ulcerative colitis (UC) and Crohn’s disease (CD). Albeit numerous studies report mutational landscape of CAC, its transcriptomic landscape is poorly understood. Thus, to interrogate the tumour ecology & mechanisms behind CAC development, we adopted a muti-modal approach utilizing FFPE tissues from human CAC patients and colon organoids. We leveraged immunology bulk gene expression and spatial gene expression to derive a robust gene signature of CAC at a single cell resolution. Methods To comprehensively profile the CAC immune microenvironment, we created a comprehensive dataset (Nanostring) covering relevant clinical FFPE samples encompassing 40 patients suffering from either IBD or CAC, alongside inflammation-free healthy controls (10 patients/group). We observed a robust upregulation of the SPP1 (Secreted Phosphoprotein 1) gene encoding osteopontin (OPN) in CAC. Subsequently, we extended our methodology to spatially resolved transcriptomics (Xenium) using 5μm FFPE sections from CAC & UC patients (3 patients/group). This provided insights into the spatial and single cell expression of SPP1 and its target receptors at a subcellular resolution. Furthermore, we mapped the ligand-receptor pairs onto cell types to uncover SPP1 signalling in CAC. These findings were validated at a protein level by whole FFPE section confocal microscopy. Results Immunology gene expression (Nanostring) dataset revealed a strong upregulation of SPP1 gene encoding OPN in CAC as compared to UC and CD. Spatially resolved transcriptomics (Xenium) unveiled the spatial heterogeneity of SPP1 expression in CAC, that is primarily arising from CD68+ CD163+ macrophages in CAC (Fig 1B), validated through OPN/CD68 immunostainings. Ligand-receptor (LR) analysis revealed a distinct LR pairing focusing on SPP1, that is secreted (outgoing signal) macrophages to T cells (as incoming signal) via upregulated integrin and CD44-receptors (Fig 1D/E). Furthermore, CAC tumour cells surrounding the SPP1+ macrophages exhibited a distinct gene expression signature associated with T cell exclusion and immunosuppression in CAC (Fig 1C/FG). Conclusion We identified a CAC specific upregulation of SPP1 at both RNA and protein levels, expressed by CD68+ CD163+ macrophages. Mutually exclusive spatial location of SPP1/OPN+ macrophages and CD8+ T cells suggests a crucial indirect role of SPP1/OPN in mediating an immunosuppressive tumour microenvironment. We further uncovered CAC specific, single cell gene expression signature that has the potential to identify pre-malignant stages of CAC.
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