Your new experience awaits. Try the new design now and help us make it even better

ORIGINAL RESEARCH article

Front. Oncol.

Sec. Hematologic Malignancies

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1592441

This article is part of the Research TopicAntibody-based Novel Target Immunotherapy in Hematological MalignancyView all 4 articles

Unveiling Hypoxic Regulatory Networks by Bioinformatics: Mechanisms of Hypoxia-Related Hub Genes Driving Rituximab Resistance and Poor Prognosis in DLBCL

Provisionally accepted
Jiayi  YaoJiayi Yao1,2Zizhen  XuZizhen Xu1,2,3*Yuanfei  MaoYuanfei Mao1,3*
  • 1School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 2Department of Laboratory Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Shanghai Municipality, China
  • 3Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, Beijing, China

The final, formatted version of the article will be published soon.

Background Diffuse large B-cell lymphoma (DLBCL), an aggressive subtype of non-Hodgkin lymphoma, exhibits heterogeneous clinical outcomes. While rituximab, a CD20 inhibitor, combined with chemotherapy has improved survival in some patients, resistance remains prevalent, particularly in hypoxic tumor microenvironments. Understanding hypoxia-related genes (HRGs) and their role in rituximab resistance is critical to addressing therapeutic challenges in high-risk DLBCL. Methods Gene expression profiles from GEO datasets (GSE56315: DLBCL tumor vs. normal; GSE104212: hypoxia-treated DLBCL cell lines) were analyzed to identify overlapping genes between DLBCL-signature genes (DSGs) and HRGs. protein interaction network topology analysis and Lasso regression modeling of TCGA-DLBC dataset were employed to screen regulator and hub genes. Hub genes linked to rituximab response and survival were validated in DLBCL patients receiving rituximab therapy. Functional enrichment analysis was used to explore associated pathways. The expression of the identified regulator and hub genes was validated using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Results 58 overlapping genes were identified between DSGs and HRGs. PPI network and Lasso regression revealed 5 MS4A1 regulator genes and 10 hub genes. Among these, LGALS1 (HR = 0.588, p = 0.00085), TIMP1 (HR = 0.591, p = 0.00098), ANXA1 (HR=0.614, p=0.0024) and STAP1 (HR=0.633, p=0.0035) were significantly associated with overall survival and GPNMB (AUC=0.869), CDCA7 (AUC=0.686), and STAP1 (AUC=0.663) associated with treatment response in rituximab-treated patients. Functional analysis implicated these genes in B-cell receptor (BCR) and PI3K-AKT signaling pathways, suggesting their mechanistic roles in therapeutic resistance. Conclusions This study identifies hypoxia-associated genes critical to rituximab resistance in DLBCL, highlighting potential therapeutic targets. Their involvement in BCR and PI3K-AKT pathways underscores novel vulnerabilities for overcoming refractory disease. Our findings provide a foundation for developing strategies to improve outcomes in high-risk DLBCL patients with hypoxic microenvironments.

Keywords: Diffuse large B-cell lymphoma, hypoxia, rituximab, Drug Resistance, B cell receptor signaling pathway, bioinformatics

Received: 12 Mar 2025; Accepted: 07 Oct 2025.

Copyright: © 2025 Yao, Xu and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Zizhen Xu, xuzizhen@shsmu.edu.cn
Yuanfei Mao, morfycell@163.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.