Abstract A008: Cancer predisposition signaling pathways drive Beckwith-Wiedemann syndrome Wilms tumor oncogenesis
Authors: Nirgude Snehal Dinkar , Naveh Natali Sobel , Kavai Sanam , Kalish Jennifer 
Published: August 2023

Abstract
Wilms Tumor (WT), or nephroblastoma, is the most common pediatric renal cancer. The most prevalent epigenetic alterations in WT occur on chromosome 11p15, accounting for at least two-thirds of WT. These same changes on chromosome 11p15 also cause Beckwith-Wiedemann Syndrome (BWS). BWS is a pediatric overgrowth disorder affecting numerous tissues, including the kidney, and up to 28% of patients with BWS develop cancer. As patients with BWS have the same 11p15 epigenetic and structural changes that arise in some sporadic WT, BWS-WT provides a unique opportunity to investigate the specific molecular drivers by which 11p15 alterations induce oncogenesis. Using clinical data and patient samples from the International BWS Registry and Biorepository, we used whole exome sequencing, methylation array, and RNA-sequencing technologies to examine the genomic and epigenomic landscape of BWS-WT compared to control kidney samples. We found several large-scale recurrent copy number alterations (CNAs) in the BWS-WT cohort across cancer-associated chr1p36, WT-associated chr16q, and at a novel chr15q site. Two BWS-WT presented with an above average number of genomic alterations; one had mutations in telomere maintenance genes, and the other had mutations in mismatch repair genes. Recurrent mutations in genes associated with sporadic WT, such as TP53, CTNNB1, and WT1 were not present in BWS samples. We found other single nucleotide variants (SNVs) in BCORL1, ASXL1, ATM and AXL genes in the BWS cohort. We further compared the BWS data to publicly available non-syndromic/nonBWS data, stratified based on 11p15 status (normal or altered), and the molecular signaling differences were investigated. Differential methylation studies showed enrichment of biological processes related to the Wnt signaling, integrin signaling, insulin receptor signaling, and BMP signaling pathways in BWS-WT. Altered-11p15 nonBWS-WT showed enrichment of cell cycle and DNA damage checkpoint processes, as well as TORC1/TOR signaling and Wnt signaling pathways, as assayed by differential methylation. RNA sequencing data showed differential gene expression of Wnt signaling along with other distinct pathways including Notch, BMP, PPAR and, NIK/NF-kappaB signaling pathways in BWS-WT. Based on an interactome study, CTNNB1 exhibited the broadest range of interactions, and its overexpression was observed in BWS-WT, although not specifically mutated in the BWS samples. Weighted gene coexpression network analysis (WGCNA) showed that cell cycle-related processes and DNA repair mechanisms are shared features of WT with alterations in chromosome 11p15. While BWS-WT predisposition and 11p15 alterations in nonBWS-WT are well-established, this study is the first to focus on stratifying tumors by this characteristic. Data presented herein suggest a mechanism in which 11p15-altered genomes predispose cells to oncogenic transitions. Further investigation of our findings may serve to identify novel diagnostic or therapeutic targets in WT oncogenesis.
Citation Format: Snehal Dinkar Nirgude, Natali Sobel Naveh, Sanam Kavai, Jennifer Kalish. Cancer predisposition signaling pathways drive Beckwith-Wiedemann syndrome Wilms tumor oncogenesis [abstract]. In: Proceedings of the AACR Special Conference: Advances in Kidney Cancer Research; 2023 Jun 24-27; Austin, Texas. Philadelphia (PA): AACR; Cancer Res 2023;83(16 Suppl):Abstract nr A008.