Synovial sarcoma is an aggressive mesenchymal neoplasm, driven by the SS18-SSX fusion, and characterized by immunogenic antigens expression and exceptionally low T cell infiltration levels.To study the cancer-immune interplay in this disease, we profiled 16,872 cells from 12 human synovial sarcoma tumors using single-cell RNA-sequencing (scRNA-Seq). Synovial sarcoma manifests antitumor immunity, high cellular plasticity and a core oncogenic program, which is predictive of low immune levels and poor clinical outcomes. Using genetic and pharmacological perturbations, we demonstrate that the program is controlled by the SS18-SSX driver and repressed by cytokines secreted by macrophages and T cells in the tumor microenvironment. Network modeling predicted that SS18-SSX promotes the program through HDAC1 and CDK6. Indeed, the combination of HDAC and CDK4/6 inhibitors represses the program, induces immunogenic cell states, and selectively targets synovial sarcoma cells. Our study demonstrates that immune evasion, cellular plasticity, and cell cycle are co-regulated and can be co-targeted in synovial sarcoma and potentially in other malignancies. epithelial-like malignant cells (in biphasic tumors), suggestive of pluripotential differentiation or mesenchymal to epithelial transitions.Studies of human SyS to date have either relied on bulk tissue (21,22) or on established cellular models (11,18,19), masking important aspects of the tumor ecosystem. Moreover, given this cancer's rarity, even concerted efforts, such as TCGA, profiled only limited numbers of tumors (21-23). Here, we leveraged single-cell RNA-Seq (scRNA-Seq), imaging, functional perturbations, and computational modeling, to study the cancer-immune interplay in SyS. We profiled 16,872 cells from 12 human SyS tumors by scRNA-seq and demonstrate that SyS tumors invariably include a subpopulation of cells expressing a novel core oncogenic program, associated with T cell exclusion. The core oncogenic program is predictive of poor prognosis and is repressed by the genetic inhibition of the SS18-SSX fusion, and by cytokines expressed by T cells and macrophages in the tumor microenvironment. HDAC1 and CDK6 are a key regulator and target of this aggressive cell program, respectively, and their combined inhibition synergistically represses it in SyS cells, triggering antigen presentation and cell autonomous immune responses.Collectively, our findings demonstrate a strong connection between SyS development and immune evasion, and strengthen the notion that de-differentiation, immune evasion, and cell cycle are coregulated, such that cellular immunity can be targeted through modulation of cell cycle and epigenetic processes.
RESULTS
Cell type inference from expression and genetic features in scRNA-seq of SySTo comprehensively interrogate the SyS ecosystem, we used full-length (24) and droplet-based (25) scRNA-Seq to profile 16,872 high quality malignant, immune, and stromal cells from 12 human SyS tumors ( Fig. 1A,B, Supp. Fig. 1A,B, Supp. Table 1, Methods). We assigned...