Gene-Expression Programs in Salivary Gland Adenoid Cystic Carcinoma Analyzed Using Single-Cell and Spatial Transcriptomics

Adenoid cystic carcinoma of the salivary gland (SGACC) is a highly aggressive malignancy characterized by poor patient survival outcomes. While several studies have analyzed the transcriptome of the salivary gland at the bulk and single-cell level, no spatial transcriptomic analyses of this tissue have been published. Most of the existing publications on SGACC have predominantly relied on bulk and single cell RNA sequencing approaches, which do not resolve the spatially localized transcriptional heterogeneity nor have the resolution for defining molecular markers within tumor subpopulations. SGACC is clinically notable for the presence of multiple tumor clones, distinct spatial phenotypes, and its indolent yet invasive nature coupled with a high propensity for distant metastasis. These features may reflect co-expression of tumor-associated markers across diverse cellular niches, and a resultant biological complexity which causes standard treatment such as surgical resection, radiation therapy, and chemotherapy to be largely ineffective in significantly improving long-term survival, and highlights the need for more precise, targeted therapeutic strategies. Herein, we analyzed single cell (n = 4) and high-resolution spatial transcriptomics samples (n = 5) to characterize cancer cell populations in MYB- and non-MYB-expressing cell states, delineated gene expression signatures, and identified critical molecular interactions specific to SGACC. We used Visum HD to obtain spatial transcriptomics data at 2µm squared high resolution. This allowed a multi-omics approach comprising single cell and spatial transcriptomic methods to enable the discovery of novel transcriptional signatures and microenvironmental features not captured by conventional methods. Spatial mapping revealed marked cellular heterogeneity and demonstrated how tissue environments influence cellular transcriptomics. To tumor heterogeneity, we focused on tumorigenic cell populations, profiled plasma and T cell enrichment within the tumor microenvironment and identified key pathways and transcriptional drivers including the MYB-NFIB fusion underlying the tumor cluster formation. Our findings indicate an upregulation of genes involved in extracellular matrix remodeling, autophagy, and reactive stromal cell populations. We further found evidence of partial epithelial-mesenchymal transition (P-EMT) programming within MYB-expressing tumor clusters. Pathway analysis revealed that mutations in the spatial query sample prominently affect the PI3K-AKT and IL-17 signaling pathways, together with a downregulation of canonical Wnt signaling in some regions of the tissue architecture adjacent to immune cells. Collectively, these results underscore the complex regulatory landscape of SGACC and offer insights into its cellular dynamics and possible therapeutic vulnerabilities.