Podocyte lineage marker expression is preserved across Wilms tumor subtypes and enhanced in tumors harboring the SIX1/2 p.Q177R mutation

Wilms tumors present as an amalgam of varying proportions of three tissues normally located within the developing kidney, one being the multipotent nephron progenitor population. While incomplete differentiation of the nephron progenitors is widely-considered the underlying cause of tumor formation, where this barrier occurs along the differentiation trajectory and how this might promote therapeutic resistance in high-risk blastemal-predominant tumors is unclear. Comprehensive integrated analysis of genomic datasets from normal human fetal kidney and high-risk Wilms tumors has revealed conserved expression of genes indicative of podocyte lineage differentiation in tumors of all subtypes. Comparatively upregulated expression of several of these markers, including the non-canonical WNT ligand WNT5A, was identified in tumors with the relapse-associated mutation SIX1/2 p.Q177R. These findings highlight the shared progression of cellular differentiation towards the podocyte lineage within Wilms tumors and enhancement of this differentiation program through promotion of non-canonical WNT/planar cell polarity signaling in association with SIX1/2 p.Q177R.