Doctor of Philosophy, Case Western Reserve University, 2024, Molecular Medicine
Glioblastoma (GBM) is the most common primary malignant brain tumor with a median survival of 15-20 months, despite standard of care treatment: maximally safe resection, radiation, and chemotherapy. The incidence of GBM is 1.6 times higher in males and their survival can be up to 10 months shorter. Females are more responsive to treatment, but the mechanism behind these differences is unclear. The immune system is suppressed in GBM, and there are sex differences in the immune response. While preclinical GBM models are used to interrogate pathophysiology, few of these models include surgery, despite its pivotal role in the standard of care. For my thesis, I developed a preclinical GBM resection model to evaluate whether there is a sex bias in survival and interrogate post-operative, sex-specific immune changes. I found that mice implanted with syngeneic GBM demonstrate a sex bias after resection, with females surviving longer. Bulk RNA sequencing of tumors from mice who underwent either resection, sham surgery, or no surgery revealed no significant differences between male and female resection cohorts, indicating that the main driver underlying these survival differences is likely to not be intrinsic to the tumor. Gene ontology analysis revealed a stronger immune signature in differences found between female resection versus sham surgery groups compared to males. To evaluate the role of the immune system, I repeated survival experiments in NSG mice and found the sex bias was abrogated. Using flow cytometry, I found that female mice who underwent resection had higher levels of immune cell infiltration in the tumor microenvironment compared to sham surgery controls, while resected males had lower levels. Male mice who underwent resection had lower levels of regulatory T cells (Tregs) than their sham surgery counterparts. When survival studies were repeated in Foxp3DTR mice with Treg depletion, the survival sex bias was abrogated, indicating a protective role for Tregs (open full item for complete abstract)
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Committee: Justin Lathia (Advisor); Jacob Scott (Committee Chair); Matthew Grabowski (Committee Member); Shideng Bao (Committee Member); Jessica Williams (Committee Member)
Subjects: Oncology