Extensive heterogeneity in somatic mutation and selection in the human bladder
Abstract
The extent of somatic mutation and clonal selection in the human bladder remains unknown. We sequenced 2097 bladder microbiopsies from 20 individuals using targeted ( n = 1914 microbiopsies), whole-exome ( n = 655), and whole-genome ( n = 88) sequencing. We found widespread positive selection in 17 genes. Chromatin remodeling genes were frequently mutated, whereas mutations were absent in several major bladder cancer genes. There was extensive interindividual variation in selection, with different driver genes dominating the clonal landscape across individuals. Mutational signatures were heterogeneous across clones and individuals, which suggests differential exposure to mutagens in the urine. Evidence of APOBEC mutagenesis was found in 22% of the microbiopsies. Sequencing multiple microbiopsies from five patients with bladder cancer enabled comparisons with cancer-free individuals and across histological features. This study reveals a rich landscape of mutational processes and selection in normal urothelium with large heterogeneity across clones and individuals.
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Somatic mutations are common in most individuals, and mutation burden increases with age and chronic tissue damage.
“Somatic mutations are common in most individuals, and there is accumulating evidence that mutation burden increases with age and chronic tissue damage1-4.”
From Positive selection of somatically mutated clones identifies adaptive pathways in metabolic liver disease (2023) · cites this paper as [4]
Across most, if not all, tissues, after an initial expansion of the stem cell pool during early life, clonal heterogeneity tends to diminish over time.
“A consistent pattern has been observed across most, if not all, tissues: after an initial expansion of the stem cell pool during early life, clonal heterogeneity tends to diminish over time (Figure 1).17-24”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [21]
Selected and more fit clones may share genomic events such as nonsynonymous mutations initially thought to be restricted to cancer.
“Interestingly, these selected and more fit clones may share genomic events such as nonsynonymous mutations initially thought to be restricted to cancer.17-24”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [21]
A group of already transformed tumors can remain stable and controlled for years before progressing into symptomatic disease.
“This evidence reinforces the idea that a group of already transformed tumors can remain stable and controlled for years before progressing into symptomatic disease.21,100,101”
From Evolution of Multiple Myeloma from a Genomic Perspective (2026) · cites this paper as [21]
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Alterations of Chromatin Regulators in the Pathogenesis of Urinary Bladder Urothelial Carcinoma
Hoffmann, M. J., & Schulz, W. A. (2021) · Cancers · doi:10.3390/cancers13236040 · Cited by 37 · see citing works
Cancer-Causative Mutations Occurring in Early Embryogenesis
Pareja, F. G., Ptashkin, R. N., Brown, D. N., Derakhshan, F. N., Selenica, P., da Silva, E. M., Gazzo, A. M., Paula, A. D. C., Breen, K. E., Shen, R., et al. (2021) · Cancer Discovery · doi:10.1158/2159-8290.cd-21-1110 · Cited by 33 · see citing works
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- Authors
- Lawson, A. R. J., Abascal, F., Coorens, T. H. H., Hooks, Y., O’Neill, L., Latimer, C., Raine, K., Sanders, M. A., Warren, A. Y., Mahbubani, K. T. A., Bareham, B., Butler, T. M., Harvey, L. M. R., Cagan, A., Menzies, A., Moore, L., Colquhoun, A. J., Turner, W., Thomas, B., Gnanapragasam, V., Williams, N., Rassl, D. M., Vöhringer, H., Zumalave, S., Nangalia, J., Tubío, J. M. C., Gerstung, M., Saeb-Parsy, K., Stratton, M. R., Campbell, P. J., Mitchell, T. J., & Martincorena, I.
- Affiliations
- Wellcome Sanger Institute (GB)
- Erasmus MC (NL)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- University of Cambridge (GB)
- The Royal Melbourne Hospital (AU)
- Papworth Hospital NHS Foundation Trust (GB)
- European Bioinformatics Institute (GB)
- Universidade de Santiago de Compostela (ES)
- Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, UK.
- Corresponding author
- Martincorena, Iñigo
- ORCID
- Lawson, Andrew R. J.
- Abascal, Federico
- Coorens, Tim H. H.
- Latimer, Calli
- Raine, Keiran
- Sanders, Mathijs A.
- Warren, Anne Y.
- Mahbubani, Krishnaa T. A.
- Bareham, Bethany
- Butler, Timothy M.
- Harvey, Luke M. R.
- Cagan, Alex
- Menzies, Andrew
- Moore, Luiza
- Thomas, Benjamin
- Gnanapragasam, Vincent
- Williams, Nicholas
- Rassl, Doris M.
- Vöhringer, Harald
- Zumalave, Sonia
- Nangalia, Jyoti
- Tubío, José M. C.
- Gerstung, Moritz
- Saeb-Parsy, Kourosh
- Stratton, Michael R.
- Campbell, Peter J.
- Mitchell, Thomas J.
- Martincorena, Iñigo
- Venue
- Science
- Published
- 2020-10-02
- Volume
- 370
- Issue
- 6512
- Pages
- 75-82
- ISSN
- 0036-8075 (ISSN-L)
- 1095-9203
- OpenAlex
- W3089590915
- Cited by
- 311
- References
- 77
- Citations by year
- 2026: 34 · 2025: 46 · 2024: 55 · 2023: 56 · 2022: 61 · 2021: 52 · 2020: 6 · 2019: 1
- FWCI
- 14.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Science (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Wellcome
- Cancer Research UK (C57387/A21777, C63474/A27176, C20/A20917, C60346/A23917)
- Ministerio de Economía y Competitividad (RYC-2014-14999)
- Xunta de Galicia (ED481A-2018/199)
- NIHR Cambridge Biomedical Research Centre
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
- Health Sciences › Medicine › Surgery › Bladder and Urothelial Cancer Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Nephrotoxicity and Medicinal Plants
- Keywords
- bladder cancer, urothelium, somatic mutations, mutational heterogeneity, mutational landscape, carcinogen exposure, aristolochic acid, tobacco, mutational processes, positive selection, tumor heterogeneity
- MeSH terms
- APOBEC Deaminases, Adult, Aged, Biopsy, Urinary Bladder, Urinary Bladder Neoplasms, Female, Humans, Male, Middle Aged, Mutagens, Mutation, Selection, Genetic, Mutagenesis, Urothelium, Chromatin Assembly and Disassembly, Genes, Neoplasm
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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