Subtypes and proliferation patterns of small intestine neuroendocrine tumors revealed by single cell RNA sequencing

Reviewer #1 (Public review):

Summary:

The authors have assembled a cohort of 10 SiNET, 1 SiAdeno, and 1 lung MiNEN samples to explore the biology of neuroendocrine neoplasms. They employ single-cell RNA sequencing to profile 5 samples (siAdeno, SiNETs 1-3, MiNEN) and single-nuclei RNA sequencing to profile seven frozen samples (SiNET 4-10).

They identify two subtypes of siNETs, characterized by either epithelial or neuronal NE cells, through a series of DE analyses. They also report findings of higher proliferation in non-malignant cell types across both subtypes. Additionally, they identify a potential progenitor cell population in a single-lung MiNEN sample.

Strengths:

Overall, this study adds interesting insights into this set of rare cancers that could be very informative for the cancer research community. The team probes an understudied cancer type and provides thoughtful investigations and observations that may have translational relevance.

Weaknesses:

The study could be improved by clarifying some of the technical approaches and aspects as currently presented, toward enhancing the support of the conclusions:

(1) Methods: As currently presented, it is possible that the separation of samples by program may be impacted by tissue source (fresh vs. frozen) and/or the associated sequencing modality (single cell vs. single nuclei). For instance, two (SiNET1 and SiNET2) of the three fresh tissues are categorized into the same subtype, while the third (SiNET9) has very few neuroendocrine cells. Additionally, samples from patient 1 (SiNET1 and SiNET6) are separated into different subtypes based on fresh and frozen tissue. The current text alludes to investigations (i.e.: "Technical effects (e.g., fresh vs. frozen samples) could also impact the capture of distinct cell types, although we did not observe a clear pattern of such bias."), but the study would be strengthened with more detail.

(2) Results:
Heterogeneity in the SiNET tumor microenvironment: It is unclear if the current analysis of intratumor heterogeneity distinguishes the subtypes. It may be informative if patterns of tumor microenvironment (TME) heterogeneity were identified between samples of the same subtype. The team could also evaluate this in an extension cohort of published SiNET tumors (i.e. revisiting additional analyses using the SiNET bulk RNAseq from Alvarez et al 2018, a subset of single-cell data from Hoffman et al 2023, or additional bulk RNAseq validation cohorts for this cancer type if they exist [if they do not, then this could be mentioned as a need in Discussion])

(3) Proliferation of NE and immune cells in SiNETs: The observed proliferation of NE and immune cells in SiNETs may also be influenced by technical factors (including those noted above). For instance, prior studies have shown that scRNA-seq tends to capture a higher proportion of immune cells compared to snRNA-seq, which should be considered in the interpretation of these results. Could the team clarify this element?

(4) Putative progenitors in mixed tumors: As written, the identification of putative progenitors in a single lung MiNEN sample feels somewhat disconnected from the rest of the study. These findings are interesting - are similar progenitor cell populations identified in SiNET samples? Recognizing that ideally additional validation is needed to confidently label and characterize these cells beyond gene expression data in this rare tumor, this limitation could be addressed in a revised Discussion.

Reviewer #2 (Public review):

Summary:

The research identifies two main SiNET subtypes (epithelial-like and neuronal-like) and reveals heterogeneity in non-neuroendocrine cells within the tumor microenvironment. The study validates findings using external datasets and explores unexpected proliferation patterns. While it contributes to understanding SiNET oncogenic processes, the limited sample size and depth of analysis present challenges to the robustness of the conclusions.

Strengths:

The studies effectively identified two subtypes of SiNET based on epithelial and neuronal markers. Key findings include the low proliferation rates of neuroendocrine (NE) cells and the role of the tumor microenvironment (TME), such as the impact of Macrophage Migration Inhibitory Factor (MIF).

Weaknesses:

However, the analysis faces challenges such as a small sample size, lack of clear biological interpretation in some analyses, and concerns about batch effects and statistical significance.

Reviewer #3 (Public review):

Summary:

In this study, the authors set out to profile small intestine neuroendocrine tumors (siNETs) using single-cell/nucleus RNA sequencing, an established method to characterize the diversity of cell types and states in a tumor. Leveraging this dataset, they identified distinct malignant subtypes (epithelial-like versus neuronal-like) and characterized the proliferative index of malignant neuroendocrine cells versus non-malignant microenvironment cells. They found that malignant neuroendocrine cells were far less proliferative than some of their non-malignant counterparts (e.g., B cells, plasma cells, epithelial cells) and there was a strong subtype association such that epithelial-like siNETs were linked to high B/plasma cell proliferation, potentially mediated by MIF signaling, whereas neuronal-like siNETs were correlated with low B/plasma cell proliferation. The authors also examined a single case of a mixed lung tumor (neuroendocrine and squamous) and found evidence of intermediate/mixed and stem-like progenitor states that suggest the two differentiated tumor types may arise from the same progenitor.

Strengths:

The strengths of the paper include the unique dataset, which is the largest to date for siNETs, and the potentially clinically relevant hypotheses generated by their analysis of the data.

Weaknesses:

The weaknesses of the paper include the relatively small number of independent patients (n = 8 for siNETs), lack of direct comparison to other published single-cell NET datasets, mixing of two distinct methods (single-cell and single-nucleus RNA-seq), lack of direct cell-cell interaction analyses and spatially-resolved data, and lack of in vitro or in vivo functional validation of their findings.

The analytical methods applied in this study appear to be appropriate, but the methods used are fairly standard to the field of single-cell omics without significant methodological innovation. As the authors bring forth in the Discussion, the results of the study do raise several compelling questions related to the possibility of distinct biology underlying the epithelial-like and neuronal-like subtypes, the origin of mixed tumors, drivers of proliferation, and microenvironmental heterogeneity. However, this study was not able to further explore these questions through spatially-resolved data or functional experiments.

Author response:

Reviewer #1 (Public review):

Summary:

The authors have assembled a cohort of 10 SiNET, 1 SiAdeno, and 1 lung MiNEN samples to explore the biology of neuroendocrine neoplasms. They employ single-cell RNA sequencing to profile 5 samples (siAdeno, SiNETs 1-3, MiNEN) and single-nuclei RNA sequencing to profile seven frozen samples (SiNET 4-10).

They identify two subtypes of siNETs, characterized by either epithelial or neuronal NE cells, through a series of DE analyses. They also report findings of higher proliferation in non-malignant cell types across both subtypes. Additionally, they identify a potential progenitor cell population in a single-lung MiNEN sample.

Strengths:

Overall, this study adds interesting insights into this set of rare cancers that could be very informative for the cancer research community. The team probes an understudied cancer type and provides thoughtful investigations and observations that may have translational relevance.

Weaknesses:

The study could be improved by clarifying some of the technical approaches and aspects as currently presented, toward enhancing the support of the conclusions:

(1) Methods: As currently presented, it is possible that the separation of samples by program may be impacted by tissue source (fresh vs. frozen) and/or the associated sequencing modality (single cell vs. single nuclei). For instance, two (SiNET1 and SiNET2) of the three fresh tissues are categorized into the same subtype, while the third (SiNET9) has very few neuroendocrine cells. Additionally, samples from patient 1 (SiNET1 and SiNET6) are separated into different subtypes based on fresh and frozen tissue. The current text alludes to investigations (i.e.: "Technical effects (e.g., fresh vs. frozen samples) could also impact the capture of distinct cell types, although we did not observe a clear pattern of such bias."), but the study would be strengthened with more detail.

We thank the reviewer for the thoughtful and constructive review. Due to the difficulty in obtaining enough SiNET samples, we used two platforms to generate data - single cell analysis of fresh samples, and single nuclei analysis of frozen samples. We opted to combine both sample types in our analysis while being fully aware of the potential for batch effects. We therefore agree that this is a limitation of our work, and that differences between samples should be interpreted with caution.

Nevertheless, we argue that the two SiNET subtypes that we have identified are very unlikely to be due to such batch effect. First, the epithelial SiNET subtype was not only detected in two fresh samples but also in one frozen sample (albeit with relatively few cells, as the reviewer correctly noted). Second, and more importantly, the epithelial SiNET subtype was also identified in analysis of an external and much larger cohort of bulk RNA-seq SiNET samples that does not share the issue of two platforms (as seen in Fig. 2f). Moreover, the proportion of samples assigned to the two subtypes is similar between our data and the external data. We therefore argue that the identification of two SiNET subtypes cannot be explained by the use of two data platforms. However, we agree that the results should be further investigated and validated by future studies, as is often done in research on rare tumors.

The reviewer also commented that two samples from the same patient which were profiled by different platforms (SiNET1 and SiNET6) were separated into different subtypes. We would like to clarify that this is not the case, since SiNET6 was not included in the subtype analysis due to too few detected Neuroendocrine cells, and was not assigned to any subtype, as noted in the text and as can be seen by its exclusion from Figure 2 where subtypes are defined. We apologize that our manuscript may have gave the wrong impression about SiNET6 classification (it is labeled in Fig. 4a in a misleading manner). In the revised manuscript, we will correct the labeling in Fig. 4a and clarify that SiNET is not assigned to any subtype. We will further acknowledge the limitation of the two platforms and the arguments in favor of the existence of two SiNET subtypes.

(2) Results:
Heterogeneity in the SiNET tumor microenvironment: It is unclear if the current analysis of intratumor heterogeneity distinguishes the subtypes. It may be informative if patterns of tumor microenvironment (TME) heterogeneity were identified between samples of the same subtype. The team could also evaluate this in an extension cohort of published SiNET tumors (i.e. revisiting additional analyses using the SiNET bulk RNAseq from Alvarez et al 2018, a subset of single-cell data from Hoffman et al 2023, or additional bulk RNAseq validation cohorts for this cancer type if they exist [if they do not, then this could be mentioned as a need in Discussion])

We agree that analysis of an independent cohort will assist in defining the association between TME and the SiNET subtype. However, the sample size required for that is significantly larger than the data available. In the revised manuscript we will note that as a direction for future studies.

(3) Proliferation of NE and immune cells in SiNETs: The observed proliferation of NE and immune cells in SiNETs may also be influenced by technical factors (including those noted above). For instance, prior studies have shown that scRNA-seq tends to capture a higher proportion of immune cells compared to snRNA-seq, which should be considered in the interpretation of these results. Could the team clarify this element?

We agree that different platforms could affect the observed proportions of immune cells, and more generally the proportions of specific cell types. However, the low proliferation of Neuroendocrine cells and the higher proliferation of immune cells (especially B cells, but also T cells and macrophages) is consistently observed in both platforms, as shown in Fig. 4a, and therefore appears to be reliable despite the limitations of our work. We will clarify this consistency in the revised manuscript.

(4) Putative progenitors in mixed tumors: As written, the identification of putative progenitors in a single lung MiNEN sample feels somewhat disconnected from the rest of the study. These findings are interesting - are similar progenitor cell populations identified in SiNET samples? Recognizing that ideally additional validation is needed to confidently label and characterize these cells beyond gene expression data in this rare tumor, this limitation could be addressed in a revised Discussion.

We agree with this comment and will add the need for additional validation for this finding in the revised Discussion.

Reviewer #2 (Public review):

Summary:

The research identifies two main SiNET subtypes (epithelial-like and neuronal-like) and reveals heterogeneity in non-neuroendocrine cells within the tumor microenvironment. The study validates findings using external datasets and explores unexpected proliferation patterns. While it contributes to understanding SiNET oncogenic processes, the limited sample size and depth of analysis present challenges to the robustness of the conclusions.

Strengths:

The studies effectively identified two subtypes of SiNET based on epithelial and neuronal markers. Key findings include the low proliferation rates of neuroendocrine (NE) cells and the role of the tumor microenvironment (TME), such as the impact of Macrophage Migration Inhibitory Factor (MIF).

Weaknesses:

However, the analysis faces challenges such as a small sample size, lack of clear biological interpretation in some analyses, and concerns about batch effects and statistical significance.

Reviewer #3 (Public review):

Summary:

In this study, the authors set out to profile small intestine neuroendocrine tumors (siNETs) using single-cell/nucleus RNA sequencing, an established method to characterize the diversity of cell types and states in a tumor. Leveraging this dataset, they identified distinct malignant subtypes (epithelial-like versus neuronal-like) and characterized the proliferative index of malignant neuroendocrine cells versus non-malignant microenvironment cells. They found that malignant neuroendocrine cells were far less proliferative than some of their non-malignant counterparts (e.g., B cells, plasma cells, epithelial cells) and there was a strong subtype association such that epithelial-like siNETs were linked to high B/plasma cell proliferation, potentially mediated by MIF signaling, whereas neuronal-like siNETs were correlated with low B/plasma cell proliferation. The authors also examined a single case of a mixed lung tumor (neuroendocrine and squamous) and found evidence of intermediate/mixed and stem-like progenitor states that suggest the two differentiated tumor types may arise from the same progenitor.

Strengths:

The strengths of the paper include the unique dataset, which is the largest to date for siNETs, and the potentially clinically relevant hypotheses generated by their analysis of the data.

Weaknesses:

The weaknesses of the paper include the relatively small number of independent patients (n = 8 for siNETs), lack of direct comparison to other published single-cell NET datasets, mixing of two distinct methods (single-cell and single-nucleus RNA-seq), lack of direct cell-cell interaction analyses and spatially-resolved data, and lack of in vitro or in vivo functional validation of their findings.

The analytical methods applied in this study appear to be appropriate, but the methods used are fairly standard to the field of single-cell omics without significant methodological innovation. As the authors bring forth in the Discussion, the results of the study do raise several compelling questions related to the possibility of distinct biology underlying the epithelial-like and neuronal-like subtypes, the origin of mixed tumors, drivers of proliferation, and microenvironmental heterogeneity. However, this study was not able to further explore these questions through spatially-resolved data or functional experiments.