Jean-Philippe Guegan1, Jean-Michel Coindre2, Carine Ngo3, Antoine Bougoüin4, Christophe Rey5, Catherine SAUTÈS-FRIDMAN6, Wolf Herve Fridman6, Armelle Dufresne7, Alban Bessede5, Antoine Italiano8
1Immunospot, Cleveland, OH,2Institute Bergonié, Bordeaux, France,3Carine Ngo (Individual),4Sorbonne University, Paris, France,5ImmuSmol, Pessac, France,6INSERM U1138 (Centre de Recherche des Cordeliers), Paris, France,7Léon Bérard Center, Lyon, France,8Institute Bergonié, Bordeaux cedex, France
摘要 Abstract
Background:
The tumor microenvironment (TME) is a key determinant of progression and treatment response in gastrointestinal stromal tumors (GIST). Oncogenic KIT mutations in different exons (exon 9 vs exon 11) are clinically relevant, but their impact on immune and stromal architecture in situ remains insufficiently understood. We hypothesized that KIT exon 9 and exon 11 mutations drive distinct spatial transcriptional programs and immune cell compositions.
Methods:
FFPE samples from KIT‑mutated GIST (exon 9 and exon 11) were profiled using the NanoString GeoMx® Whole Transcriptome Atlas (18,695 protein‑coding genes). Eleven areas of illumination per case were selected in tumor and peritumoral regions and segmented into CD45⁺ (immune‑enriched) and CD45⁻ (tumor/stromal) compartments. Cell‑type abundances in CD45⁺ segments were estimated with SpatialDecon. In parallel, three multiplex immunofluorescence (mIF) panels (DOG1/CD11c/CD11b/CD68/CD45/HLA‑DR; DOG1/CD45RO/CD56/CD4/CD8/CD20; DOG1/CD45/CD16/CD56) were applied to independent retrospective GIST cohorts (n=170), and cell densities were quantified in tumor and stromal compartments using QuPath‑based segmentation and FACS‑like phenotyping.
Results:
GeoMx analysis identified 2315 differentially expressed genes in CD45⁺ tumor regions between exon 9 and exon 11 tumors, indicating exon‑specific immune transcriptional programs. SpatialDecon deconvolution revealed that exon 11-mutant tumors exhibited higher NK‑cell scores (adjusted p≈6×10⁻⁶), whereas exon 9-mutant tumors showed higher fibroblast (adjusted p≈6×10⁻⁶) and CD8⁺ memory T‑cell signals (adjusted p≈1.9×10⁻⁴). In the large mIF cohorts, unsupervised analyses of DOG1‑gated tumor regions confirmed robust technical performance of all three panels and demonstrated genotype‑segregated TME patterns KIT-mutant cases, and within them exon 9 vs exon 11 tumors, occupied distinct regions in PCA space, with exon 11 tumors showing higher CD56⁺ (NK/NKT) and myeloid (CD11b⁺/CD68⁺/HLA-DR⁺) densities, whereas CD8⁺CD45RO⁺ memory T cells were more abundant in exon 9 tumors, independently of PDGFRA-mutant GIST. Across panels, these phenotypic differences aligned with the GeoMx‑derived enrichment of NK cells in exon 11 tumors and of and CD8⁺ memory T cells in exon 9 tumors.
Conclusions:
Integrated spatial transcriptomics and multiplex IF demonstrate that KIT exon 9 and exon 11 mutations are associated with distinct immune and stromal microenvironments in GIST, characterized by an NK‑cell-enriched, myeloid cells , less fibroblast‑ and CD8⁺ memory T‑cell-dense niche in exon 11 tumors and the converse pattern in exon 9 tumors. These data support the concept that the precise KIT exon mutated imprints the TME and should be considered when designing genotype‑adapted combinations of kinase inhibition and immunotherapy.