von Hippel-Lindau disease-related neoplasia with an emphasis on renal manifestations

Multiomics in Renal Cell Carcinoma: Current Landscape and Future Directions for Precision Medicine

PURPOSE OF REVIEW

Renal cell carcinoma (RCC) is a prevalent and increasingly diagnosed malignancy associated with high mortality and recurrence rates. Traditional diagnostic and therapeutic approaches have limitations due to the disease's molecular heterogeneity. This review aims to explore how the integration of omics sciences-genomics, transcriptomics, proteomics, and metabolomics-can enhance the diagnosis, prognosis, and treatment of RCC.

RECENT FINDINGS

Genomic analyses have uncovered critical mutations, including VHL, PBRM1, and BAP1, which support improved risk stratification and the development of targeted therapies. Transcriptomic and spatial transcriptomic studies have provided deeper insights into RCC heterogeneity and tumor microenvironment dynamics. Proteomic investigations have revealed potential biomarkers, while metabolomic approaches have highlighted RCC-specific metabolic shifts. Despite these advancements, several challenges persist, including intratumoral heterogeneity, difficulties in multi-omics data integration, and the limited clinical validation of biomarkers. Omics-driven approaches hold significant promise for advancing precision medicine in RCC. These technologies can facilitate earlier diagnosis, guide individualized therapies, and enhance prognostic evaluations. Future research must focus on validating multi-omic biomarkers and leveraging artificial intelligence to manage complex datasets, thereby supporting more informed clinical decision-making and personalized treatment strategies.

Renal Neoplasia: Rare Subtypes and Uncommon Clinical Presentations

Herein, the authors have discussed a series of uncommon familial kidney cancer syndromes (including hyperparathyroidism-jaw tumor syndrome and PTEN hamartoma tumor syndrome), sporadically occurring tumors (BRAF and MTOR pathway-mutated tumors, and juxtaglomerular cell tumors), and uncommon patterns of well-established subtypes of kidney cancer (mucinous tubular spindle cell carcinoma, fumarate hydratase-deficient, and TFE3-rearranged renal cell carcinoma). The rarity of these tumors often leads to diagnostic odysseys for pathologists and patients. Appropriate classification of these rare tumors has implications for screening at-risk family members in the case of hereditary tumor predisposition syndromes, accurate prognostication, and appropriate patient selection for clinical trials.

Primary cilia and actin regulatory pathways in renal ciliopathies

Ciliopathies are a group of rare genetic disorders caused by defects to the structure or function of the primary cilium. They often affect multiple organs, leading to brain malformations, congenital heart defects, and anomalies of the retina or skeletal system. Kidney abnormalities are among the most frequent ciliopathic phenotypes manifesting as smaller, dysplastic, and cystic kidneys that are often accompanied by renal fibrosis. Many renal ciliopathies cause chronic kidney disease and often progress to end-stage renal disease, necessitating replacing therapies. There are more than 35 known ciliopathies; each is a rare hereditary condition, yet collectively they account for a significant proportion of chronic kidney disease worldwide. The primary cilium is a tiny microtubule-based organelle at the apex of almost all vertebrate cells. It serves as a "cellular antenna" surveying environment outside the cell and transducing this information inside the cell to trigger multiple signaling responses crucial for tissue morphogenesis and homeostasis. Hundreds of proteins and unique cellular mechanisms are involved in cilia formation. Recent evidence suggests that actin remodeling and regulation at the base of the primary cilium strongly impacts ciliogenesis. In this review, we provide an overview of the structure and function of the primary cilium, focusing on the role of actin cytoskeleton and its regulators in ciliogenesis. We then describe the key clinical, genetic, and molecular aspects of renal ciliopathies. We highlight what is known about actin regulation in the pathogenesis of these diseases with the aim to consider these recent molecular findings as potential therapeutic targets for renal ciliopathies.