Single-nucleus profiling of postmortem diffuse midline gliomas identifies mitochondrial biogenesis as a resistance mechanism to imipridone therapy

Diffuse midline glioma, H3 K27-altered (DMG), remains a lethal pediatric brain tumor with limited therapeutic options, and imipridone therapy produces only temporary responses before recurrence. To investigate resistance mechanisms, we performed single-nucleus RNA and chromatin accessibility profiling on 22 postmortem DMG specimens treated with imipridones and/or standard care, alongside functional assays of imipridone sensitivity and mitochondrial activity in DMG cell lines. Imipridone-treated tumors showed reduced mesenchymal transition, decreased myeloid-derived suppressor cells, and downregulation of aberrant enhancer activity associated with H3 K27 alterations. Mechanistically, treatment selected for increased mitochondrial density, turnover, and membrane potential. Together, these findings identify mitochondrial biogenesis as a key marker and driver of imipridone resistance, providing a rationale for combination strategies to improve therapeutic efficacy.

• Type: Cancer Genomics
• Archive: European Genome-phenome Archive (EGA)