Bladder cancer is the sixth most common cancer in humans. This heterogeneous set of lesions including urothelial carcinoma (Uca) and squamous cell carcinoma (SCC) arise from the urothelium, a stratified epithelium composed of K5-expressing basal cells, intermediate cells and umbrella cells. Superficial Uca lesions are morphologically distinct and exhibit different clinical behaviours: carcinoma in situ (CIS) is a flat aggressive lesion, whereas papillary carcinomas are generally low-grade and non-invasive. Whether these distinct characteristics reflect different cell types of origin is unknown. Here we show using lineage tracing in a murine model of carcinogenesis that intermediate cells give rise primarily to papillary lesions, whereas K5-basal cells are likely progenitors of CIS, muscle-invasive lesions and SCC depending on the genetic background. Our results provide a cellular and genetic basis for the diversity in bladder cancer lesions and provide a possible explanation for their clinical and morphological differences.
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We thank W. Finstad for help with data collection, D. Metzger and P. Chambon for the Krt5CreERT2 line, F. H. Li for technical assistance, the Herbert Irving Comprehensive Cancer Center Histology Core facility for paraffin embedding and the Herbert Irving Comprehensive Cancer Center Microscopy Core for help with confocal microscopy. We thank C. Abate-Shen for critical reading of the manuscript and M. Benson, T. Owczarek and J. Mckiernan for helpful discussions. This work was funded by The TJ Martell Foundation (C.M.) and a Dean’s Research Fellowship from Columbia University (T.Y.).
The authors declare no competing financial interests.
Integrated supplementary information
A bar graph showing the percentage of labelled cells after Tamoxifen (Tm)-induction in Upk2LZ, Krt5Tom and Krt5LZ mice. Tamoxifen dependent recombination in Upk2LZ mice was on average 29% (SD = 8.5,n = 3 mice); 39% on average in K5Tom mice (SD = 15,n = 8), and 28% in K5LZ mice (SD = 10,n = 3). Analysis of Tamoxifen-treated adult Upk2CreERT2;LacZ;p53+/− (Upk2LZ mice) revealed Cre-dependent recombination in 29% of the Intermediate and Superficial cell populations (n = 3 animals, SD = 8.5), and labelled cells were rare in the basal layer (less than or equal to 0.05%; 9/17,454, n = 15). Analysis of Krt5CreERT2LacZ;p53+/− (K5LZ) and Krt5CreERT2;mTom(K5Tom) lines indicates that in both, recombination was Tamoxifen-dependent and specific (Fig. 1g, h, k, l). We observed expression of the lineage tag on average in 39% of the K5-basal cell population in K5Tom mice (n = 8, SD = 15) and 28% of K5-basal cells in K5LZ mice (n = 3, SD = 10). Analysis of the distribution of labelled K5-basal cells and their descendants in Tamoxifen-induced K5Tom and K5LZ mice revealed that Cre-dependent recombination was selectively localized; rare labelled cells were present in the intermediate layer and no detectable labelled cells in the superficial layer (2/13352, labelled Intermediate cells, 0.01%; 0/13352 Superficial cells, n = 16).
Supplementary Figure 2 Characteristic response to BBN treatment separated by weeks of BBN exposure, sex and p53 status.
(A-F) H&E stained section through p53+/− male mice demonstrating CIS at 16 weeks (A, B), a high grade papillary lesion at 20 weeks (C, D) and invasion at 24 weeks (E, F). (G-L) H&E stained section through p53+/− female mice demonstrating dysplasia at 16 weeks (G, H), CIS at 20 weeks (I, J) and invasion at 24 weeks (K, L). (M-R) H&E stained section through p53+/+ male mice demonstrating squamous metaplasia at 16 weeks (M, N), SCC at 20 weeks (O, P) and invasive SCC at 24 weeks (Q, R). (S-X) H&E stained section through p53+/+ female mice demonstrating squamous metaplasia and SCC at 16 weeks (S, T), papillary SCC at 20 weeks (U, V) and SCC invasion into the muscle and fat at 24 (W, X) weeks. Abbreviations: CIS = Carcinoma in situ; SCC = Squamous cell carcinoma. Magnifications: A, C, E, G, I, K, M, O, Q, S, U, W X04; B, H, J X20 zoomed; D, F, N, P, R, T, V, X X20; L X10. Scale bars: A, C, E, G, I, K, M, O, Q, S, U, W 500 μm; B, H, J: 50 μm; D, F, N, P, R, T, V, X: 100 μm; L: 200 μm.
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Van Batavia, J., Yamany, T., Molotkov, A. et al. Bladder cancers arise from distinct urothelial sub-populations. Nat Cell Biol 16, 982–991 (2014). https://doi.org/10.1038/ncb3038
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