Molecular biology of the deadliest cancer -glioblastoma: what do we know?

Aly Ismailov ¹ Aldo Spallone ^1,2 Alexey Belogurov ^2,3 Alan Herbert ^1,4 Maria Poptsova ^1*

• ¹ National Research University Higher School of Economics, Moscow, Russia
• ² Institute of Bioorganic Chemistry (RAS), Moscow, Moscow Oblast, Russia
• ³ Russian University of Medicine, Moscow, Russia
• ⁴ InsideOutBio, Charlestown, MA, United States

Glioblastomas are the most prevalent primary brain tumors and are associated with a dramatically poor prognosis. Despite an intensive treatment approach, including maximal surgical tumor removal followed by radio-and chemotherapy, the median survival for glioblastoma patients has remained around 18 months for decades. Glioblastoma is distinguished by its highly complex mechanisms of immune evasion and pronounced heterogeneity. This variability is apparent both within the tumor itself, which can exhibit multiple phenotypes simultaneously, and in its surrounding microenvironment. Another key feature of glioblastoma is its "cold" microenvironment, characterized by robust immunosuppression. Recent advances in single-cell RNA sequencing have uncovered new promising insights, revealing previously unrecognized aspects of this tumor. In this review, we consolidate current knowledge on glioblastoma cells and its microenvironment, with an emphasis on their biological properties and unique patterns of molecular communication through signaling pathways. The evidence underscores the critical need for personalized poly-immunotherapy and other approaches to overcome the plasticity of glioblastoma stem cells. Analyzing the tumor microenvironment of individual patients using single-cell transcriptomics and implementing a customized immunotherapeutic strategy could potentially improve survival outcomes for those facing this formidable disease.