DNA methylation subtypes dictate metastatic heterogeneity of osteosarcoma via distinct tumor-stromal interactions: Multi-omics profiling and decitabine validation

Osteosarcoma (OS), the most prevalent primary bone malignancy in adolescents, is characterized by aggressive progression and early metastasis. However, the epigenetic drivers of its metastatic heterogeneity remain poorly understood. Herein, we integrated bulk DNA methylation profiling and single-cell RNA sequencing (scRNA-seq) to elucidate the epigenetic mechanisms driving OS metastatic heterogeneity. Consensus clustering identified two methylation subtypes (K = 2) with distinct survival outcomes, where hypermethylated (MSO-high) tumors exhibited poor prognosis. Weighted gene co-expression network analysis (WGCNA) revealed methylation-associated modules enriched in metabolic and immune pathways, pinpointing key genes such as CAMK1G and SLC11A1. Single-cell profiling uncovered MSO-high myeloid cells associated with inflammatory and oxidative phosphorylation pathways, while MSO-high OS cells displayed transdifferentiation toward fibroblasts via pseudotime trajectories, remodeling the extracellular matrix (ECM) to facilitate lung metastasis. Conversely, MSO-low tumors activated HLA-B–mediated neutrophil-CD8+ T cell interactions, promoting lymphatic metastasis via CXCR4/CXCL12 signaling. Furthermore, functional validation using the DNA demethylating agent decitabine demonstrated reduced fibroblastic transdifferentiation and suppressed invasive capacity in MSO-high osteosarcoma cells, supporting the therapeutic potential of targeting methylation dysregulation. These findings establish a model where DNA methylation dictates metastatic phenotypes through differential tumor-stromal crosstalk, providing novel targets for epigenetic therapy to disrupt fibrotic-immune networks and metastatic colonization.