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- HAND1 and BARX1 Act as Transcriptional and Anatomic Determinants of Malignancy in Gastrointestinal Stromal Tumor

# HAND1 and BARX1 Act as Transcriptional and Anatomic Determinants of Malignancy in Gastrointestinal Stromal Tumor

Hemming ML, Coy S, Lin JR, Andersen JL, Przybyl J, Mazzola E, et al.

Clinical Cancer Research . 2021;27(6):1706-1719. DOI [10.1158/1078-0432.CCR-20-3538](https://doi.org/10.1158/1078-0432.CCR-20-3538). PMID 33451979. PMCID PMC7956056.

How to cite

### AMA

Hemming ML, Coy S, Lin JR, Andersen JL, Przybyl J, Mazzola E, et al. HAND1 and BARX1 Act as Transcriptional and Anatomic Determinants of Malignancy in Gastrointestinal Stromal Tumor. Clin Cancer Res . 2021;27(6):1706-1719. doi:10.1158/1078-0432.CCR-20-3538

### APA

Hemming, M. L., Coy, S., Lin, J. R., Andersen, J. L., Przybyl, J., Mazzola, E., et al. (2021). HAND1 and BARX1 Act as Transcriptional and Anatomic Determinants of Malignancy in Gastrointestinal Stromal Tumor. Clinical Cancer Research , 27(6), 1706-1719. https://doi.org/10.1158/1078-0432.CCR-20-3538

### BibTeX

@article{hemming2021hand1,
title = {HAND1 and BARX1 Act as Transcriptional and Anatomic Determinants of Malignancy in Gastrointestinal Stromal Tumor},
author = {Hemming, M. L. and Coy, S. and Lin, J. R. and Andersen, J. L. and Przybyl, J. and Mazzola, E. and others},
journal = {Clinical Cancer Research},
volume = {27},
number = {6},
pages = {1706--1719},
year = {2021},
doi = {10.1158/1078-0432.CCR-20-3538},
pmid = {33451979}
}

Gastrointestinal stromal tumor behaves very differently depending on where it starts: gastric tumors are often indolent, while small-intestine tumors are more aggressive, and standard risk scoring does not fully explain why. This study traces that split to two accessory transcription factors, HAND1 and BARX1, which mark aggressive and indolent disease respectively.

To see how those programs play out cell by cell, the authors ran tissue-based cyclic immunofluorescence on a RareCyte CyteFinder microscope across 87 tumors, co-measuring HAND1, BARX1 and proliferation markers at single-cell resolution. HAND1-positive cells were consistently more proliferative, and rare HAND1-positive sub-clones turned up inside otherwise indolent gastric tumors, giving a cell-level picture of how GIST can evolve toward recurrence.

[Read publication at Clinical Cancer Research](https://pmc.ncbi.nlm.nih.gov/articles/PMC7956056/)

## Key findings

- Single-cell imaging of 87 GIST tumors tied HAND1 to proliferation. Tissue-based cyclic immunofluorescence on a RareCyte CyteFinder microscope co-measured HAND1, BARX1, Ki-67 and PCNA per cell, showing HAND1-positive cells carry higher Ki-67 and PCNA than BARX1-positive cells across the 87-tumor cohort.

- HAND1 and BARX1 expression outperformed standard risk stratification for relapse-free survival. Stratifying patients by HAND1 or BARX1 expression separated relapse-free survival (P = 0.0092; hazard ratio 2.62, 95% CI 1.14 to 6.00), while standard High Risk versus Non-High Risk grouping did not (P = 0.1171).

- Rare HAND1-positive cells were hidden inside histologically indolent gastric GIST. Single-cell analysis of localized gastric tumors found a proliferative HAND1-positive subpopulation (3,273 of 24,859 tumor cells; 13%) expressing higher Ki-67 and PCNA than surrounding BARX1-positive cells, pointing to sub-clones primed to drive later recurrence.

## CyteFinder in the methods

“Tissue-based cyclic immunofluorescence (t-CyCIF) consisted of iterative cycles of antibody incubation, imaging, and fluorophore inactivation, and was performed on FFPE specimens as previously described ( 33 , 34 ) using antibodies listed ( Table S2 ). c-KIT signal using this protocol was non-specific and inadequate to detect differences between GIST subsets. Slides were initially prepared as described above for HAND1 and BARX1 IHC. Image acquisition was performed with a RareCyte CyteFinder Slide Scanning Fluorescence Microscope.”

— Hemming et al., Clinical Cancer Research (2021), Materials and Methods, “Tumor Samples, Immunohistochemistry and CyCIF”

Disclosure: RareCyte is named in the competing-interests statement of the publication cited above.

## Why it matters for CyteFinder users

If you are planning multiplexed tissue imaging, this study shows the kind of question a RareCyte CyteFinder microscope is built to answer. The authors used it to acquire tissue-based cyclic immunofluorescence (t-CyCIF), running iterative rounds of antibody staining, whole-slide imaging, and fluorophore inactivation so that HAND1, BARX1, PDGFRA, SDHB, Ki-67, PCNA and additional cell-state markers could be read on the same 87 tumors. Because the readout is single-cell and spatially resolved, the team could move past average staining to ask which individual cells were proliferating and where they sat, cross-validating immunohistochemistry and bulk RNA-seq and then finding rare high-risk sub-clones that bulk methods would miss. That is the CyteFinder's role here: a slide-scanning fluorescence microscope that builds marker depth over successive cycles rather than committing to one fixed panel. When your question is which cell states are present, how proliferative they are, and whether that arrangement forecasts outcome, this is the single-cell dataset the CyteFinder was built to generate.

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