ABSTRACT: Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. GBM growth
and therapeutic resistance are driven by a combination of self-renewing cancer stem cells (CSCs) and an aging-
induced tumor-supportive microenvironment. CSCs are regulated by cell intrinsic genetic and epigenetic
networks, extrinsic cellular interactions with the surrounding microenvironment, and the interaction between
those intrinsic and extrinsic regulatory programs. While multiple molecular mechanisms that drive self-renewal
have been identified, the effects of advanced age on CSC maintenance has yet to be explored. Specifically, it is
unclear how advanced age alters CSC maintenance and GBM growth. A recently recognized hallmark of
advanced age is the shift in sulfur amino acid metabolism that suppresses enzyme-dependent hydrogen sulfide
(H2S) generation, signaling, and bioavailability. H2S is a redox-active metabolite that signals through protein S-
sulfhydration (R-SSnH) and impacts metabolism, immune activation, and longevity. Its enzymatic production by
cystathionine γ-lyase (CGL) is repressed by thyroid hormone (TH). H2S has both pro- and anti-tumorigenic
functions that are tumor-type dependent. However, there is limited information on cell intrinsic and tumor
microenvironment functions of H2S in GBM. Recently, we modulated H2S levels through dietary and
pharmacological interventions and found that H2S functions as a tumor suppressor in GBM and attenuates CSC
self-renewal and tumor growth in pre-clinical models. H2S generation and sulfhydration were decreased in human
GBM specimens as compared to non-tumor controls. While the data support the hypothesis that H2S functions
as a tumor suppressor in GBM, the effects of aging-induced H2S declines on GBM progression and CSCs, and
how to reverse this for clinical use, are unexplored. Based on our published findings and new preliminary data,
we hypothesize that decreased H2S production during aging promotes CSC initiation, immune
suppression, and drives GBM growth but can ultimately be reversed by anti-TH based H2S boosting
approaches. We will test this hypothesis through the following aims by integrating our newly developed H2S and
sulfhydration detection assays in combination with in vitro and in vivo GBM models that manipulate H2S
production via genetic and pharmacological interventions with human samples to provide clinical relevance. Aim
1 tests the hypothesis that aging-induced suppression of CGL-derived H2S accelerates GBM progression. Aim
2 tests the hypothesis that chemically-induced hypothyroidism stimulates CGL to increase systemic and neural
H2S production resulting in reduced GBM progression, CSC enrichment, and improved survival in preclinical
GBM models. The long-term goal of this project is to interrogate the function of H2S as a GBM tumor suppressor
that is lost during aging, while also studying the therapeutic effects of hypothyroid-induced H2S production and
signaling to reduce CSC maintenance and immune suppression. Leveraging this axis represents a new strategy
for the management of GBM that may synergize with standard of care chemo-, radio-, and immunotherapies.