Charlton, J; (2014) DNA methylation analysis of the evolution of Wilms tumour from its precursor nephrogenic rests. Doctoral thesis , UCL (University College London).

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Abstract

Recurrent loss of imprinting at 11p15, paucity of recurrent genetic mutations and associated nephrogenic rests (NR; precursor lesions that resemble embryonic kidney (EK)) implicate aberrant DNA methylation in tumourigenesis of paediatric Wilms tumour (WT) and predict that interrogation of the methylome, rather than the genome, is more likely to reveal tumour-specific biomarkers To test if aberrant DNA methylation is implicated in tumourigenesis, methylome analysis was performed on 36 normal kidney (NK), 22 NR, 36 WT and 4 EK, including 20 matched trios and 34 matched NK-WT pairs, using Illumina 450k arrays. Findings were validated with bisulfite-sequencing and RNA sequencing. This thesis describes the successful identification of changes in methylation that distinguish between tissue types. Through analysis of DNA methylation, NR formation was associated with gain of methylation at developmental loci related to Polycomb target binding sites. Evolution to WT was associated with increase in methylation variability in a subset of WTs (group-1), which also showed common changes in methylation in comparison to their associated NR, including silencing of novel tumour suppressor genes. Group-1 WTs were significantly enriched for bilateral cases whereas those in group-2 showed no differences in methylation compared to their associated NR. Comparison between NK and WT identified three DMRs of genome-wide significance (P<5x10-8) for use as tumour-specific biomarkers. As proof of principle for clinical utility, DMR-2 was successfully used in a case study to monitor tumour burden during treatment in cell-free serum DNA. This thesis concludes that methylation levels vary during WT evolution. As group-1 WT included all bilateral cases, our data suggests that methylation analysis could aid treatment planning in bilateral disease and that some WT may be candidates for epigenetic-modifier therapy. These findings define the first cell-free epigenetic biomarker for WT with potential for clinical utility.

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