Nephroblastoma (Wilms' tumor): a model system of aberrant renal development

Wilms' tumor, or nephroblastoma, is a developmental malignancy of the kidney that affects approximately 1 in 10,000 children between 1 and 6 years of age. Typically, the histology of nephroblastoma reveals a disorganized renal developmental process showing blastema and epithelia randomly interspersed in varying amounts of stroma. This developmental disruption is associated with the loss of function of the tumor suppressor gene WT-1. This gene, located on chromosome 11 at band p13, codes for a zinc finger protein that may act as a transcriptional repressor. Familial cases of Wilms' tumor fit Knudson's "two hit" model, according to which a germ line mutation of one WT-1 allele predisposes to the tumor while an additional somatic mutation of the other allele causes malignant transformation. Originally proposed for retinoblastoma, this model defines the nature of the tumor suppressor gene as a gene that is tumorigenic when inactivated. However, not all Wilms' tumor cases fit this model because the majority of Wilms' tumors do not show a mutation of WT-1. For Wilms' tumor, the loss of tumor suppression appears to be more complex than for retinoblastoma. Some of the mechanisms recognized to date involve dominant negative WT-1 mutations, interaction of the WT-1 gene product with other mutated transcription factors such as p53, loss of imprinting, and mutations of other tumor suppressor genes at 11p15 or other loci. Although classic Wilms' tumor is associated with good prognosis (85% survival), its anaplastic form is often fatal. Despite the plethora of knowledge gained in recent years, Wilms' tumor remains the center of attention for further investigation because it offers opportunities for studying normal kidney development, for understanding the molecular basis for clinically important anaplastic forms, as well as for elucidating the molecular mechanisms of tumor suppressor genes. To facilitate this task, Wilms' tumor heterotransplants have been established in nude mice. This provides an indefinite source of tumor tissue and a means to test their growth properties in response to drug treatments or molecular genetic manipulations. Furthermore, the establishment of stable Wilms' tumor cell lines is essential to investigating further the molecular basis of tumorigenesis using recombinant DNA technology.