Hypoxia increases the tempo of evolution in glioblastoma

ABSTRACT Background Low oxygen in tumours have long been associated with poor prognosis and metastatic disease, precise reasons for which remain poorly understood. Somatic evolution drives cancer progression and treatment resistance. This process is fuelled not only by genetic and epigenetic mutation, but by selection resulting from the interactions between tumour cells, normal cells and physical microenvironment. The ecological habitat tumour cells inhabit influences evolutionary dynamics but impact on tempo of evolution is less clear. Methods We explored this complex dialogue with a combined clinical-theoretical approach. Using an agent-based-model, we simulated proliferative hierarchy under heterogeneous oxygen availability. Predictions were compared against clinical data derived from histology samples taken from glioblastoma patients, stained to elucidate areas of hypoxia / necrosis, and p53 expression heterogeneity. Results Simulation results indicate cell division in hypoxic environments is effectively upregulated, and that low-oxygen niches provide new avenues for tumour cells to spread. Analysis of human data indicates cell division isn’t decreased in low-oxygen regions, despite evidence of significant physiological stress. This is consistent with simulation, suggesting hypoxia is a crucible that effectively warping evolutionary velocity, making deleterious mutations more likely than in well-oxygenated regions. Conclusions Results: suggest hypoxic regions alter evolutionary tempo, driving mutations which fuel tumour heterogeneity..