Evidence for Virus-Mediated Oncogenesis in Bladder Cancers Arising in Solid Organ Transplant Recipients

Gabriel J. Starrett, Kelly Yu, Yelena Golubeva, Petra Lenz, Mary L. Piaskowski, David Petersen, Michael Dean, Ajay Israni, Brenda Y. Hernandez, Thomas C. Tucker, Iona Cheng, Lou Gonsalves, Cyllene R. Morris, Shehnaz K. Hussain, Charles F. Lynch, Reuben S. Harris, Ludmila Prokunina-Olsson, Paul Meltzer, Christopher B. Buck, Eric A. Engels

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


A small percentage of bladder cancers in the general population have been found to harbor DNA viruses. In contrast, up to 25% of tumors of solid organ transplant recipients, who are at an increased risk of developing bladder cancer and have overall poorer outcome, harbor BK polyomavirus (BKPyV). To better understand the biology of the tumors and the mechanisms of carcinogenesis from potential oncoviruses, we performed whole genome and transcriptome sequencing on bladder cancer specimens from 43 transplant patients. Nearly half of tumors from this patient population contained viral sequences. The most common were from BKPyV (N=9, 21%), JC polyomavirus (N=7, 16%), carcinogenic human papillomaviruses (N=3, 7%), and torque teno viruses (N=5, 12%). Immunohistochemistry revealed variable Large T antigen expression in BKPyV-positive tumors ranging from 100% positive staining of tumor tissue to less than 1%. In most cases of BKPyV-positive tumors, the viral genome appeared to be clonally integrated into the host chromosome consistent with microhomology-mediated end joining and coincided with focal amplifications of the tumor genome similar to other virus-mediated cancers. Significant changes in host gene expression consistent with the functions of BKPyV Large T antigen were also observed in these tumors. Lastly, we identified four mutation signatures in our cases with those attributable to APOBEC3 and SBS5 being the most abundant. Mutation signatures associated with the antiviral drug, ganciclovir, and aristolochic acid, a nephrotoxic compound found in some herbal medicines, were also observed. The results suggest multiple pathways to carcinogenesis in solid organ transplant recipients with a large fraction being virus-associated.

Original languageEnglish
Article numbere82690
StatePublished - Mar 2023

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  • Bladder cancer
  • papillomavirus
  • polyomavirus
  • solid organ transplant recipient
  • torque teno virus

ASJC Scopus subject areas

  • General Neuroscience
  • General Biochemistry, Genetics and Molecular Biology
  • General Immunology and Microbiology


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