Defining the transition from benign to malignant tissue is fundamental to improving early diagnosis of cancer(1). Here we use a systematic approach to study spatial genome integrity in situ and describe previously unidentified clonal relationships. We used spatially resolved transcriptomics(2) to infer spatial copy number variations in >120,000 regions across multiple organs, in benign and malignant tissues. We demonstrate that genome-wide copy number variation reveals distinct clonal patterns within tumours and in nearby benign tissue using an organ-wide approach focused on the prostate. Our results suggest a model for how genomic instability arises in histologically benign tissue that may represent early events in cancer evolution. We highlight the power of capturing the molecular and spatial continuums in a tissue context and challenge the rationale for treatment paradigms, including focal therapy.

The molecular mechanisms underlying lethal castration-resistant prostate cancer remain poorly understood, with intratumoral heterogeneity a likely contributing factor. To examine the temporal aspects of resistance, we analyze tumor heterogeneity in needle biopsies collected before and after treatment with androgen deprivation therapy. By doing so, we are able to couple clinical responsiveness and morphological information such as Gleason score to transcriptome-wide data. Our data-driven analysis of transcriptomes identifies several distinct intratumoral cell populations, characterized by their unique gene expression profiles. Certain cell populations present before treatment exhibit gene expression profiles that match those of resistant tumor cell clusters, present after treatment. We confirm that these clusters are resistant by the localization of active androgen receptors to the nuclei in cancer cells post-treatment. Our data also demonstrates that most stromal cells adjacent to resistant clusters do not express the androgen receptor, and we identify differentially expressed genes for these cells. Altogether, this study shows the potential to increase the power in predicting resistant tumors. Spatial heterogeneity in prostate cancer can contribute to its resistance to androgen deprivation therapy (ADT). Here, the authors analyse prostate cancer samples before and after ADT using Spatial Transcriptomics, and find heterogeneous pre-treatment tumour cell populations and stromal cells that are associated with resistance.

Background: Interest in studying the spatial distribution of gene expression in tissues is rapidly increasing. Spatial Transcriptomics is a novel sequencing-based technology that generates high-throughput information on the distribution, heterogeneity and co-expression of cells in tissues. Unfortunately, manual preparation of high-quality sequencing libraries is time-consuming and subject to technical variability due to human error during manual pipetting, which results in sample swapping and the accidental introduction of batch effects. All these factors complicate the production and interpretation of biological datasets.

Results: We have integrated an Agilent Bravo Automated Liquid Handling Platform into the Spatial Transcriptomics workflow. Compared to the previously reported Magnatrix 8000+ automated protocol, this approach increases the number of samples processed per run, reduces sample preparation time by 35%, and minimizes batch effects between samples. The new approach is also shown to be highly accurate and almost completely free from technical variability between prepared samples.

Conclusions: The new automated Spatial Transcriptomics protocol using the Agilent Bravo Automated Liquid Handling Platform rapidly generates high-quality Spatial Transcriptomics libraries. Given the wide use of the Agilent Bravo Automated Liquid Handling Platform in research laboratories and facilities, this will allow many researchers to quickly create robust Spatial Transcriptomics libraries.

Every cancer tumor is unique, with characteristics that change over time. The evolution of a full-blown malignancy from a single cell that gives rise to a heterogeneous population of cancer cells is a complex process. The use of spatial information makes a big contribution to understanding the progression of tumors and how patients respond to treatment. Currently, the scientific community is taking a step further in order to understand gene expression heterogeneity in the context of tissue spatial organization to shed light on cell- to-cell interactions. Technological advances in recent years have increased the resolution at which heterogeneity can be observed. Spatial transcriptomics (ST) is an in situ capturing technique that uses a glass slide containing oligonucleotides to capture mRNAs while maintaining the spatial information of histological tissue sections. It combines histology and Illumina sequencing to detect and visualize the whole transcriptome information of tissue sections. In Paper I, an AI method was developed to create a computerized tissue anatomy. The rich source of information enables the AI method to identify genetic patterns that cannot be seen by the naked eye. This study also provided insights into gene expression in the environment surrounding the tumor, the tumor microenvironment, which interacts with tumor cells for cancer growth and progression. In Paper II, we investigate the cellular response of treatment. It is well known that virtually all patients with hormone naïve prostate cancer treated with GnRH agonists will relapse over time and that the cancer will transform into a castration-resistant form denoted castration-resistant prostate cancer. This study shows that by characterizing the non-responding cell populations, it may be possible to find an alternative way to target them in the early stages and thereby decrease the risk of relapse. In Paper III, we deal with scalability limitations, which in the ST method are represented by time- consuming workflow in the library preparation. This study introduces an automated library preparation protocol on the Agilent Bravo Automated Liquid Handling Platform to enable rapid and robust preparation of ST libraries. Finally, Paper IV expands on the first work and illustrates the utility of the ST technology by constructing, for the first time, a molecular view of a cross-section of a prostate organ.

Varje cancertumör är unik med egenskaper som förändras över tid. Utvecklingen av en fullständig malignitet från en enda cell som ger upphov till en heterogen population av cancerceller är en komplex process. Att få tillgång till spatial information är viktigt för att förstå utvecklingen av tumörer och hur patienter svarar på behandling. För närvarande har forskare världen över tagit ett steg längre för att förstå gener och heterogenitet genom att titta på alla komponenter inom en vävnad för att belysa interaktion mellan celler. Under de senaste åren har tekniska framsteg ökat upplösningen vid vilken heterogenitet kan observeras. Spatial transcriptomics (ST) är en in situ-teknik, som använder sig av en array av glas. Den innehåller oligonukleotider för att fånga mRNA, samtidigt som den spatiella informationen om histologin bibehålls. Kombinationen av histologi och Illumina-sekvensering gör att man kan visualisera hela transkriptomet inom ett vävnadssnitt. I den första studien utvecklades en AI-metod för att skapa en datoriserad vävnads anatomi. Den rika informationskällan gör det möjligt för AI-metoden att identifiera genetiska mönster som inte kan ses med blotta ögat. Denna studie gav också insikter om genuttryck i miljön omkring tumören; tumörens mikromiljö, som interagerar med tumörceller för att cancern ska växa och sprida sig till andra organ. I papper II undersöker vi hur patienter svarar på behandlingen. Det är välkänt att praktiskt taget alla patienter med avancerad prostatacancer som behandlas med GnRH-agonist kommer över tid att få återfall. Denna studie visar; genom att karakterisera de icke-svarande celler så kan det vara möjligt att hitta ett alternativt sätt att behandla tidigt och därmed minska risken för återfall. I papper III vill vi förbättra de tidigare tidskrävande delarna i ST protokollet som krävs för att förbereda proverna för sekvensering. Denna studie introducerar ett automatiserat protokoll för på den så kallade “Agilent Bravo Automated Liquid Handling Platform” och möjliggör snabb och robust preparering av ST- bibliotek. Papper IV bygger vidare på det första arbetet och illustrerar ST- teknikens användbarhet genom att för första gången konstruera en atlas av ett tvärsnitt från ett helt organ (prostata).

Intra-tumor heterogeneity is one of the biggest challenges in cancer treatment today. Here we investigate tissue-wide gene expression heterogeneity throughout a multifocal prostate cancer using the spatial transcriptomics (ST) technology. Utilizing a novel approach for deconvolution, we analyze the transcriptomes of nearly 6750 tissue regions and extract distinct expression profiles for the different tissue components, such as stroma, normal and PIN glands, immune cells and cancer. We distinguish healthy and diseased areas and thereby provide insight into gene expression changes during the progression of prostate cancer. Compared to pathologist annotations, we delineate the extent of cancer foci more accurately, interestingly without link to histological changes. We identify gene expression gradients in stroma adjacent to tumor regions that allow for re-stratification of the tumor micro- environment. The establishment of these profiles is the first step towards an unbiased view of prostate cancer and can serve as a dictionary for future studies.

High-throughput sequencing platforms mainly produce short-read data, resulting in a loss of phasing information for many of the genetic variants analysed. For certain applications, it is vital to know which variant alleles are connected to each individual DNA molecule. Here we demonstrate a method for massively parallel barcoding and phasing of single DNA molecules. First, a primer library with millions of uniquely barcoded beads is generated. When compartmentalized with single DNA molecules, the beads can be used to amplify and tag any target sequences of interest, enabling coupling of the biological information from multiple loci. We apply the assay to bacterial 16S sequencing and up to 94% of the hypothesized phasing events are shown to originate from single molecules. The method enables use of widely available short-read-sequencing platforms to study long single molecules within a complex sample, without losing phase information.

Defining the transition from benign to malignant tissue is fundamental to improve early diagnosis of cancer. Here, we provide an unsupervised approach to study spatial genome integrity in situ to gain molecular insight into clonal relationships. We employed spatially resolved transcriptomics to infer spatial copy number variations in >120 000 regions across multiple organs, in benign and malignant tissues. We demonstrate that genome-wide copy number variation reveals distinct clonal patterns within tumours and in nearby benign tissue. Our results suggest a model for how genomic instability arises in histologically benign tissue that may represent early events in cancer evolution. We highlight the power of an unsupervised approach to capture the molecular and spatial continuums in a tissue context and challenge the rationale for treatment paradigms, including focal therapy.