Cell-Free DNA Sequencing Uncovers the Longitudinal Consequences of Temozolomide Treatment and Host Co-Culture in Glioblastoma

ABSTRACT Glioblastoma (GBM) is a highly aggressive brain tumor with limited options for longitudinal monitoring. We evaluated the potential of cell-free DNA (cfDNA) as a real-time biomarker of tumor burden under tightly controlled conditions. We measured the cfDNA release dynamics, fragmentation sizes, and variant allele frequencies (VAF) in patient-derived GBM cell cultures. Time series of cfDNA were collected and analyzed in treatment-naïve monocultures, during temozolomide (TMZ) treatment, and in co-culture with normal human astrocyte (NHA) cells. Longitudinal collection of media from individual cultures demonstrated that cfDNA yield increased, indicating the ability to use cfDNA to track tumor burden over time. Using a co-culture system, we deconvoluted cfDNA admixtures by analyzing yield, fragment size patterns, and cell line–specific variants. The exclusive detection of NHA- and GBM-specific mutations confirmed the distinct contributions of each cell type. Finally, TMZ treatment of GBM cells prompted an increase in cfDNA yield and VAF, suggesting that the effects of therapy could be measured using cfDNA. These findings support cfDNA as a non-invasive biomarker for real-time monitoring of GBM progression and treatment response, with clinical potential as a liquid biopsy tool in glioblastoma management. KEY POINTS cfDNA yield and variant allele frequencies (VAFs) correlate with GBM tumor burden. cfDNA properties can be used to differentiate between cell types in a mixed population. TMZ treatment increases cfDNA yield and VAFs, reflecting treatment response. IMPORTANCE OF THE STUDY This study highlights the potential of cell-free DNA (cfDNA) as a non-invasive biomarker for monitoring glioblastoma (GBM) progression and treatment response. By utilizing in-vitro models, we demonstrate that cfDNA yield, fragmentation patterns, and variant allele frequencies (VAFs) can effectively identify treatment-induced changes, such as those induced by temozolomide (TMZ) treatment, providing insights into therapeutic response. These results have significant translational implications, as cfDNA could serve as a real-time liquid biopsy tool for monitoring GBM progression, assessing treatment efficacy, and identifying early signs of treatment resistance in clinical settings. The ability to track tumor dynamics non-invasively holds great promise for improving GBM patient management and guiding personalized therapeutic approaches.