Identification, molecular characterization, clinical prognosis, and therapeutic targeting of human bladder tumor-initiating cells

Keith Syson Chan, Inigo Espinosa, Mark Chao, David Wong, Laurie Ailles, Max Diehn, Harcharan Gill, Joseph Presti, Howard Y. Chang, Matt Van De Rijn, Linda Shortliffe, Irving L. Weissman

Research output: Contribution to journalArticlepeer-review

521 Scopus citations


Major clinical issues in bladder cancer include the identification of prediction markers and novel therapeutic targets for invasive bladder cancer. In the current study, we describe the isolation and characterization of a tumor-initiating cell (T-IC) subpopulation in primary human bladder cancer, based on the expression of markers similar to that of normal bladder basal cells (Lineage-CD44+CK5+CK20-). The bladder T-IC subpopulation was defined functionally by its enriched ability to induce xenograft tumors in vivo that recapitulated the heterogeneity of the original tumor. Further, molecular analysis of more than 300 bladder cancer specimens revealed heterogeneity among activated oncogenic pathways in T-IC (e.g., 80% Gli1, 45% Stat3, 10% Bmi-1, and 5% β-catenin). Despite this molecular heterogeneity, we identified a unique bladder T-IC gene signature by gene chip analysis. This T-IC gene signature, which effectively distinguishes muscle-invasive bladder cancer with worse clinical prognosis from non-muscle-invasive (superficial) cancer, has significant clinical value. It also can predict the progression of a subset of recurring non-muscle-invasive cancers. Finally, we found that CD47, a protein that provides an inhibitory signal for macrophage phagocytosis, is highly expressed in bladder T-ICs compared with the rest of the tumor. Blockade of CD47 by amAbresulted in macrophage engulfment of bladder cancer cells in vitro. In summary, we have identified a T-IC subpopulation with potential prognostic and therapeutic value for invasive bladder cancer.

Original languageEnglish (US)
Pages (from-to)14016-14021
Number of pages6
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number33
StatePublished - Aug 18 2009


  • Antibody therapy
  • Bladder cancer
  • CD44
  • CD47
  • Cancer stem cell

ASJC Scopus subject areas

  • General


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