6.0 Conclusion and future perspective
Urothelial cell carcinoma (UCC) is among the prime causes of
malignancy-associated deaths globally and its aetiology is poorly
understood. The bladder cancer progression is a multifaceted process
that is extremely heterogeneous and complicated. Thus, requiring the use
of advanced transcriptome technology like RNA-sequencing (RNA-Seq) to
better understand the disease phenotypes. The RNA-Seq studies of bladder
cancer reviewed in this paper reveal genome-wide changes among different
classes of bladder cancer and its pathogenicity that includes;
dysregulated genes and pathways. Moreover, the possibilities to better
understand the molecular mechanism underlying UCC progression has been
successful through application of RNA-sequencing as this helps in
understanding pathogenesis, discovering biomarkers and uncovering the
mechanism of drug resistance in bladder cancer.
Despite the progressive improvement provided by RNA-Seq technologies in
understanding the molecular basis for UCC pathogenesis, there is still a
lot to be done to prevent a recurrence, prevent further metastasis of
the malignant cells and reduce cancer-related death due to UCC. A good
number of dysregulated genes and biomarkers have been implicated in
bladder cancer, and the uses of these genes clinically have provided
controversial results. Hence, there has not been a single prognostic and
diagnostic biomarker that are successfully translated into clinical
application. This opens up an avenue for a potential research space to
fully understand bladder cancer. To address the current limitations,
there is a need to have a standard pipeline and integrated multiple
experiments analyses as a reference point for all studies due to the
high recurrence nature of UCC. The existence of molecular subsets of
cellular signatures and microenvironment promotes measures which could
avoid therapeutic failures exposed by RNA-Seq study. Although, the
acceptability of RNA-Seq regarding gene expression in UCC led to
existence of incompatibility due to RNA-Seq techniques and variability
in platform application.
In summary, RNA-Seq is regarded as the golden standard for large scale
high-throughput genome-wide and gene expression studies. It has provided
us an unknown insight into the transcriptional changes in bladder cancer
diagnosis and management. As the cost of sequencing is gradually
decreasing and more precision is being obtained in most of the
computational tools, RNA-Seq technology will continue to be applied in
studying bladder cancer transcriptomics and disease state. Consequently,
an in-depth exploration of the complex and stochastic genetic nature of
bladder cancer could possibly result in a novel biomarker discovery and
identifying new therapeutic strategies. Moreover, single cell sequencing
(scRNA-Seq) may offer a better option for comprehensive understanding of
UCC development and recurrence and could effectively help in improving
bladder cancer management.