A multi-omics R-loop-linked risk program highlights CKS2-positive proliferative tumor cells as drivers of glioma...

To develop a generalizable glioma risk signature derived from an R-loop-associated transcriptional program, assess its prognostic and immunotherapy-predictive utility, and define its cellular and regulatory determinants.

We quantified R-loop activity (ssGSEA) and defined subtypes by consensus clustering across bulk multi-omics glioma cohorts. A prognostic model was trained in TCGA and validated in CGGA/GEO, with immunotherapy relevance, cellular localization, and key drivers/therapeutics assessed through integrative multi-omics analyses and targeted experiments.

R-loop activity was elevated in glioma relative to normal tissue, increased with WHO grade, and consistently predicted poorer survival. Consensus clustering identified an R-loop-high subtype characterized by the worst prognosis and immune-evasive features. The resulting risk score robustly stratified survival across multiple cohorts, suggested a lower probability of immunotherapy benefit, and outperformed 145 published glioma signatures. Single-cell and spatial analyses mapped the high-risk program predominantly to proliferative (cycling) tumor-cell states. Among signature genes, CKS2 was the top contributor: it was upregulated at both mRNA and protein levels, associated with adverse outcomes, and functionally promoted glioma proliferation and clonogenicity while suppressing apoptosis; CKS2 silencing inhibited xenograft growth and reduced Ki-67 staining. Regulon inference and ChIP-qPCR supported MYBL2 as an upstream transcriptional regulator of CKS2. Drug-sensitivity analyses prioritized GSK269962A, which showed greater in vitro activity in CKS2-high cells, and molecular dynamics simulations supported stable binding of GSK269962A to CKS2.

An R-loop-anchored risk signature enables robust prognostic and immunotherapy stratification in glioma and nominates the MYBL2-CKS2 axis and associated vulnerabilities as potential translational targets.