%0 Journal Article
%A Lin, Wan-Hsin
%A Kosari, Farhad
%A Smadbeck, James B.
%A Barrett, Michael T.
%A Feathers, Ryan W.
%A Hall, Jamie
%A Sadeghian, Dorsay
%A Sotiriou, Sotiris
%A Johnson, Sarah H.
%A Harris, Faye R.
%A Berry, Taylor
%A McCune, Alexa F.
%A Murphy, Stephen James
%A Kinsella, Lindsey
%A Haydu, Lauren E.
%A Moniz-Garcia, Diogo
%A Fortin Ensign, Shannon P.
%A Yang, Lin
%A Emanuel, Angela R.
%A Jones, Leila A.
%A Schaefer-Klein, Janet L.
%A Ida, Christiane M.
%A Salomao, Marcela A.
%A Sherman, Wendy J.
%A Porter, Alyx B.
%A Rosenfeld, Steven S
%A Kizilbash, Sani H.
%A Jaeckle, Kurt A.
%A Mrugala, Maciej M.
%A Mansfield, Aaron S
%A Borad, Mitesh S
%A Bendok, Bernard R.
%A Burns, Terry C.
%A Quinones-Hinojosa, Alfredo
%A Cheville, John C.
%A Vasmatzis, George
%A Anastasiadis, Panos Z
%T Functional genomics identifies therapeutic options, biomarkers, and resistance mechanisms for high-grade gliomas
%D 2026
%R 10.64898/2026.02.01.701806
%J bioRxiv
%P 2026.02.01.701806
%X High-grade gliomas (HGGs) are aggressive tumors with poor outcomes and limited treatment options. Here, we combined genomic and transcriptomic tumor profiling with drug testing in a patient-derived 3-dimensional culture model to identify individualized treatments and predictive biomarkers. Activity of single agents targeting frequently dysregulated glioma pathways was relatively poor ex vivo and generally reflected historical patient data. However, compounds targeting PI3K, epigenetic, and survival/senescence signaling were effective in some cases. Drug sensitivity correlated with transcriptional rather than genomic features and suggested heterogeneity as a resistance mechanism. Bromodomain and extraterminal domain inhibition was particularly effective in tumors enriched in the mesenchymal transcriptional subtype, promoted proneural transition, and was overcome by upregulated PI3K signaling. Notably, combinations were largely effective, with 6 strategies exhibiting stronger efficacy than corresponding single agents in most cases (58-77%). This study identifies HGG vulnerabilities and associated biomarkers, resistance mechanisms, and effective combination strategies that warrant further clinical validation.Competing Interest StatementDr. George Vasmatzis is the owner of WholeGenome, LLC. Drs. Vasmatzis and Anastasiadis are listed as co-inventors of patent #11,845,084, recently licensed to Pathway Bio. The other authors declare no competing interests.National Institute of Neurological Disorders and Stroke, https://ror.org/01s5ya894, R01 NS101721National Cancer Institute, https://ror.org/040gcmg81, P30 CA15083United States Food and Drug Administration, https://ror.org/034xvzb47, R01 FD-R-07288
%U https://www.biorxiv.org/content/biorxiv/early/2026/02/03/2026.02.01.701806.full.pdf