O-264 Profiling Tumor-Initiating Cells in Uterine Leiomyoma through Single-Cell Multi-omics
Authors: Machado-Lopez A , Punzon-Jiménez P , Llera-Oyola J , Pérez-Moraga R , Gálvez-Viedma M , Grases D , Satorres E , Porta-Pardo E , Schooff E , Roson B , Simon C , Mas A 
Published: July 2024

Abstract

Study question
What are the molecular and cellular features that contribute to the transformation of myometrial stem cells into tumor-initiating cells within uterine leiomyoma?

Summary answer
Transformative changes in differentiation and genetic processes, in a distinct subset of M/LM cells drives their progression into a tumorigenic state.

What is known already
Uterine leiomyomas (LM), which are benign smooth muscle-derived tumours of myometrium, impact approximately 75% of women, causing significant physical and psychological challenges and imposing substantial healthcare costs. The widespread consensus postulates a monoclonal origin for LM, implying their derivation from a dysregulated single multipotent stem cell that could give rise to tumor-initiating cells (TICs). While previous studies have shown cellular heterogeneity in both myometrium (M) and LM, the precise identity of the originating cells is unknown.

Study design, size, duration
Prospective, observational, and biomedical study conducted at Hospital La Fe (Valencia, Spain) for one year. Eight sample pairs of LM and M underwent single-nuclei RNAseq (snRNA-seq; n = 16) and single-cell proteomic (scP; n = 16) analyses, to generate a detailed transcriptomic and proteomic map decoupled from cell type, state, and spatial location. We further employed single-cell RNA velocity inference for differentiation trajectory [BR1] analysis of mesenchymal cells, followed by the identification of potential driver genes in LM tumorigenesis.

Participants/materials, setting, methods
Upon obtaining informed consent, we procured LM and M samples from eight patients aged 35-50 undergoing hysterectomies. Part of these samples were preserved in paraffin for spatial transcriptomics utilizing VISIUM (10x Genomics). The remaining tissues were dissociated into single-cell suspensions and underwent scRNA-seq and scP using Chromium Controller and Orbitrap Eclipse Tribid mass spectrometry, respectively. The analysis of the collected data was carried out using publicly accessible R/Python tools.

Main results and the role of chance
Analysis of snRNAseq (∼52,000 cells) revealed similar cellular compositions in M and LM, including endothelial, perivascular, smooth muscle cells (SMC), fibroblasts, and immune cells. Further trajectory analysis unveiled a subset of myometrial cells with potential as TICs, exhibiting reduced expression of hormone receptors like PGR. Analysis of these cells [BR1] suggested differentiation into two distinct cell types -fibroblasts and SMCs- with elevated hormone expression over pseudotime. Differential analysis between M and LM also showed a dysregulated transcriptomic profile in the TICs within the tumor, as evidenced by upregulation of RAD51B and HMGA2 and downregulation PGR among other genes. These genes are indicative markers, underscoring their significant roles in the tumorigenesis of LM by influencing hormone response and disrupting DNA repair mechanisms. Spatial transcriptomic analysis confirmed these findings and suggested that the distribution of TICs could be ubiquitous, since the expression of potential myometrial-stem markers, was markedly increased only on certain spots within the tissue across both LM and M. Lastly, scProt profiling (∼5,000 cells) also allowed the identification of putative TICs, which showed upregulation in LM of specific proteins involved in replication, transcription, and translation.

Limitations, reasons for caution
Our study sets the basis for TICs isolation in LM, yet functional validation studies need to be performed to address the clinical potential of our findings. Further studies including more patients, and addressing racial disparities will help to generalize these findings to a broader population.

Wider implications of the findings
Our findings indicate the presence of a particular subset of M/LM cells whose changes in differentiation path and genetic processes seem to drive the transformation of these cells into a tumorigenic state to develop LM. Targeting these markers might show promise for effectively treating these tumors.

Trial registration number
NCT04214457