Cell Types or Cell States? An Investigation of Adrenergic and Mesenchymal Cell Phenotypes in Neuroblastoma

Summary Neuroblastoma is a pediatric cancer that exhibits two cellular phenotypes: adrenergic (ADRN) and mesenchymal (MES). ADRN is differentiated and therapy-sensitive, while MES is less differentiated with elevated therapy resistance. To understand neuroblastoma and its treatment response, it is important to elucidate how these phenotypes impact the eco-evolutionary dynamics of cancer cell populations and whether they represent distinct cell types or dynamic cell states. Here, we show that neuroblastoma cells undergo an ADRN to a MES phenotypic switch under chemotherapy treatment. We use a strong inference approach to generate four hypotheses on how this switch may occur: cell types without resistance, cell types with resistance, cell states without resistance, and cell states with resistance. For each of these hypotheses, we create theoretical models to make qualitative predictions about their resulting eco-evolutionary dynamics. Our results provide a framework to further experimentally determine whether ADRN and MES phenotypes are distinct cell types or dynamic cell states.