Genotype-phenotype correlations and de novo induction of cancer stem cells in Wilms tumor initiation.

Wilms tumor, the most common pediatric kidney cancer, arises from abnormal embryonic kidney development. Therapy resistance and tumor recurrence remain major challenges, likely driven by the presence of Cancer Stem Cells (CSCs). Here, we elucidate the earliest pathogenic events in genetically engineered mouse models exhibiting loss of Wt1 or LIN28B overexpression, two Wilms tumor driver genes. Loss of Wt1 leads to a disturbance of lineage identity of the mutant cells, whereas LIN28B leads to a disturbed transition between uninduced and induced NPC (nephron progenitor cell) state. In both cases the appearance of cells positive for all four Wilms tumor cancer stem cell markers is the result of the tumor initiating mutation. The existence of genotype-phenotype correlations in primary developmental phenotypes and cancer stem cell expression patterns has important implications for therapeutic opportunities and requirements.