Deep learning-based prediction of gene expression from histopathology identifies NR5A1 as a candidate biomarker and druggable target in high-grade serous ovarian carcinoma

<h4>Background</h4>High-grade serous ovarian cancer (HGSOC) is the most lethal ovarian cancer subtype, responsible for ~ 70% of ovarian cancer-related deaths and marked by late-stage diagnosis and frequent platinum resistance. Although transcriptomic profiling enables molecular stratification and prediction of therapeutic response; routine clinical use of this approach is limited by cost and logistical constraints. Computational pathology analysis offers a scalable alternative by inferring transcriptional states directly from routine hematoxylin and eosin (H&E) whole-slide images (WSIs).<h4>Methods</h4>Paired H&E WSIs and RNA-sequencing data from the TCGA-OV cohort, including 1,371 diagnostic H&E WSIs retrieved for preprocessing and quality control, were used to develop a self-supervised virtual-transcriptomics framework based on Momentum Contrast v2 (MoCo v2) and multi-output Random Forest regression. Model performance was assessed using patient-level five-fold cross-validation. Candidate genes were evaluated by reverse transcription quantitative polymerase chain reaction (RT-qPCR) in an independent cohort of 10 HGSOC tumors, including 4 platinum responders and 6 non-responders.<h4>Results</h4>The model predicted expression of approximately 6,400 protein-coding genes, achieving a genome-wide mean Pearson correlation of r = 0.36, with more than 300 genes showing stronger image-expression coupling (r > 0.44). RT-qPCR analysis of 18 candidate genes revealed substantial inter-patient heterogeneity. NR5A1 exhibited the highest expression variability (coefficient of variation [CV] = 1.486) and significantly higher expression in platinum-responsive tumors than in non-responders (mean 2^⁻ΔCt = 0.263 vs. 0.013; p < 0.05). Exploratory in silico docking and molecular dynamics (MD) analyses suggested structurally stable binding interactions between Steroidogenic Factor-1 (SF-1/NR5A1) and the natural plant compound cubebin.<h4>Conclusion</h4>This study demonstrates that histological architecture contains measurable transcriptomic information that can support scalable biomarker prioritization from routine diagnostic histology in HGSOC. NR5A1 represents a hypothesis-generating candidate biomarker and structurally tractable target for future experimental studies. Future validation in larger, multi-center cohorts will be essential to confirm model robustness, biological relevance, and potential clinical utility.