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Schmidt VF, Kapp FG, Goldann C, Huthmann L, Cucuruz B, Brill R, Vielsmeier V, Seebauer CT, Michel AJ, Seidensticker M, Uller W, Weiß JBW, Sint A, Häberle B, Haehl J, Wagner A, Cordes J, Holm A, Schanze D, Ricke J, Kimm MA, Wohlgemuth WA, Zenker M, Wildgruber M. Extracranial Vascular Anomalies Driven by RAS/MAPK Variants: Spectrum and Genotype-Phenotype Correlations. J Am Heart Assoc 2024; 13:e033287. [PMID: 38563363 DOI: 10.1161/jaha.123.033287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND We aimed to correlate alterations in the rat sarcoma virus (RAS)/mitogen-activated protein kinase pathway in vascular anomalies to the clinical phenotype for improved patient and treatment stratification. METHODS AND RESULTS This retrospective multicenter cohort study included 29 patients with extracranial vascular anomalies containing mosaic pathogenic variants (PVs) in genes of the RAS/mitogen-activated protein kinase pathway. Tissue samples were collected during invasive treatment or clinically indicated biopsies. PVs were detected by the targeted sequencing of panels of genes known to be associated with vascular anomalies, performed using DNA from affected tissue. Subgroup analyses were performed according to the affected genes with regard to phenotypic characteristics in a descriptive manner. Twenty-five vascular malformations, 3 vascular tumors, and 1 patient with both a vascular malformation and vascular tumor presented the following distribution of PVs in genes: Kirsten rat sarcoma viral oncogene (n=10), neuroblastoma ras viral oncogene homolog (n=1), Harvey rat sarcoma viral oncogene homolog (n=5), V-Raf murine sarcoma viral oncogene homolog B (n=8), and mitogen-activated protein kinase kinase 1 (n=5). Patients with RAS PVs had advanced disease stages according to the Schobinger classification (stage 3-4: RAS, 9/13 versus non-RAS, 3/11) and more frequent progression after treatment (RAS, 10/13 versus non-RAS, 2/11). Lesions with Kirsten rat sarcoma viral oncogene PVs infiltrated more tissue layers compared with the other PVs including other RAS PVs (multiple tissue layers: Kirsten rat sarcoma viral oncogene, 8/10 versus other PVs, 6/19). CONCLUSIONS This comparison of patients with various PVs in genes of the RAS/MAPK pathway provides potential associations with certain morphological and clinical phenotypes. RAS variants were associated with more aggressive phenotypes, generating preliminary data and hypothesis for future larger studies.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Friedrich G Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Linda Huthmann
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Caroline T Seebauer
- Department of Otorhinolaryngology Regensburg University Medical Center Regensburg Germany
| | - Armin-Johannes Michel
- Department of Pediatric and Adolescent Surgery Paracelsus Medical University Hospital Salzburg Austria
| | - Max Seidensticker
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Jakob B W Weiß
- Department of Plastic and Hand Surgery University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg Freiburg Germany
| | - Alena Sint
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Julia Haehl
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Alexandra Wagner
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital LMU University Hospital, LMU Munich München Germany
| | - Johanna Cordes
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Annegret Holm
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine University Medical Center Freiburg, University of Freiburg Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Jens Ricke
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Melanie A Kimm
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology Martin-Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg Magdeburg Germany
| | - Moritz Wildgruber
- Department of Radiology LMU University Hospital, LMU Munich München Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA) LMU University Hospital, LMU Munich München Germany
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Claire Hou YC, Evenson MJ, Corliss MM, Mahapatra L, Aldawood A, Carpentieri DF, Chamlin SL, Kulungowski AM, Madan-Khetarpal S, Sebastian J, Pet MA, Coughlin CC, Willing MC, Pearson GD, Setty BA, El-Haffaf Z, Cottrell CE, Parikh BA, Krysiak K, Schroeder MC, Heusel JW, Neidich JA, Cao Y. A comparative analysis of RAS variants in patients with disorders of somatic mosaicism. Genet Med 2023; 25:100348. [PMID: 36571464 DOI: 10.1016/j.gim.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE RAS genes (HRAS, KRAS, and NRAS) are commonly found to be mutated in cancers, and activating RAS variants are also found in disorders of somatic mosaicism (DoSM). A survey of the mutational spectrum of RAS variants in DoSM has not been performed. METHODS A total of 938 individuals with suspected DoSM underwent high-sensitivity clinical next-generation sequencing-based testing. We investigated the mutational spectrum and genotype-phenotype associations of mosaic RAS variants. RESULTS In this article, we present a series of individuals with DoSM with RAS variants. Classic hotspots, including Gly12, Gly13, and Gln61 constituted the majority of RAS variants observed in DoSM. Furthermore, we present 12 individuals with HRAS and KRAS in-frame duplication/insertion (dup/ins) variants in the switch II domain. Among the 18.3% individuals with RAS in-frame dup/ins variants, clinical findings were mainly associated with vascular malformations. Hotspots were associated with a broad phenotypic spectrum, including vascular tumors, vascular malformations, nevoid proliferations, segmental overgrowth, digital anomalies, and combinations of these. The median age at testing was higher and the variant allelic fraction was lower in individuals with in-frame dup/ins variants than those in individuals with mosaic RAS hotspots. CONCLUSION Our work provides insight into the allelic and clinical heterogeneity of mosaic RAS variants in nonmalignant conditions.
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Affiliation(s)
- Ying-Chen Claire Hou
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael J Evenson
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Meagan M Corliss
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Lily Mahapatra
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ali Aldawood
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Sarah L Chamlin
- Departments of Pediatrics and Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
| | | | - Jessica Sebastian
- Division of Medical Genetics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Marcia C Willing
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Gregory D Pearson
- Department of Pediatric Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Bhuvana A Setty
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Zaki El-Haffaf
- Genetic Medicine Service, Montreal University Hospital (CHUM-CRCHUM), Montréal, Quebec, Canada
| | - Catherine E Cottrell
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pathology, The Ohio State University College of Medicine, Columbus, OH
| | - Bijal A Parikh
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kilannin Krysiak
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Molly C Schroeder
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jonathan W Heusel
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Julie A Neidich
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Yang Cao
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO.
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Schmidt VF, Masthoff M, Vielsmeier V, Seebauer CT, Cangir Ö, Meyer L, Mükke A, Lang W, Schmid A, Sporns PB, Brill R, Wohlgemuth WA, da Silva NPB, Seidensticker M, Schinner R, Küppers J, Häberle B, Haubner F, Ricke J, Zenker M, Kimm MA, Wildgruber M. Clinical Outcome and Quality of Life of Multimodal Treatment of Extracranial Arteriovenous Malformations: The APOLLON Study Protocol. Cardiovasc Intervent Radiol 2023; 46:142-151. [PMID: 36261507 PMCID: PMC9810564 DOI: 10.1007/s00270-022-03296-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Arteriovenous malformations (AVMs) as rare diseases are diagnostically and therapeutically challenging. Due to the limited evidence regarding treatment outcome, prospective data are needed on how different treatment regimens affect outcome. The aims of this prospective trial are to determine effectiveness, safety, and clinical outcome of multimodal treatment in patients with extracranial AVMs. MATERIALS AND METHODS After clinical and magnetic resonance imaging (MRI)-based diagnosis and informed consent, 146 patients (> 4 years and < 70 years) undergoing multimodal therapy in tertiary care vascular anomalies centers will be included in this prospective observational trial. Treatment options include conservative management, medical therapy, minimally invasive image-guided procedures (embolization, sclerotherapy) and surgery as well as combinations of the latter. The primary outcome is the patient-reported QoL 6 months after completion of treatment using the short form-36 health survey version 2 (SF-36v2) and the corresponding short form-10 health survey (SF-10) for children. In addition, clinical presentation (physician-reported signs), MRI imaging (radiological assessment of devascularization), recurrence rate, and therapeutic safety will be analyzed. Further follow-up will be performed after 12, 24, and 36 months. Moreover, liquid biopsies are being obtained from peripheral blood at multiple time points to investigate potential biomarkers for therapy response and disease progression. DISCUSSION The APOLLON trial is a prospective, multicenter, observational open-label trial with unequal study groups to generate prospective evidence for multimodal treatment of AVMs. A multicenter design with the potential to assess larger populations will provide an increased understanding of multimodal therapy outcome in this orphan disease. TRIAL REGISTRATION German Clinical Trials Register (identification number: DRKS00021019) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021019 .
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Affiliation(s)
- Vanessa F. Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Caroline T. Seebauer
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Özlem Cangir
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lutz Meyer
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Antje Mükke
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Axel Schmid
- Department for Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Richard Brill
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Küppers
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Zenker
- Institute for Human Genetics, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Melanie A. Kimm
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Hallermayr A, Neuhann TM, Steinke-Lange V, Scharf F, Laner A, Ewald R, Liesfeld B, Holinski-Feder E, Pickl JMA. Highly sensitive liquid biopsy Duplex sequencing complements tissue biopsy to enhance detection of clinically relevant genetic variants. Front Oncol 2022; 12:1014592. [PMID: 36636551 PMCID: PMC9831673 DOI: 10.3389/fonc.2022.1014592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background Liquid biopsy (LB) is a promising complement to tissue biopsy for detection of clinically relevant genetic variants in cancer and mosaic diseases. A combined workflow to enable parallel tissue and LB analysis is required to maximize diagnostic yield for patients. Methods We developed and validated a cost-efficient combined next-generation sequencing (NGS) workflow for both tissue and LB samples, and applied Duplex sequencing technology for highly accurate detection of low frequency variants in plasma. Clinically relevant cutoffs for variant reporting and quantification were established. Results We investigated assay performance characteristics for very low amounts of clinically relevant variants. In plasma, the assay achieved 100% sensitivity and 92.3% positive predictive value (PPV) for single nucleotide variants (SNVs) and 91.7% sensitivity and 100% PPV for insertions and deletions (InDel) in clinically relevant hotspots with 0.5-5% variant allele frequencies (VAFs). We further established a cutoff for reporting variants (i.e. Limit of Blank, LOB) at 0.25% VAF and a cutoff for quantification (i.e. Limit of Quantification, LOQ) at 5% VAF in plasma for accurate clinical interpretation of analysis results. With our LB approach, we were able to identify the molecular cause of a clinically confirmed asymmetric overgrowth syndrome in a 10-year old child that would have remained undetected with tissue analysis as well as other molecular diagnostic approaches. Conclusion Our flexible and cost-efficient workflow allows analysis of both tissue and LB samples and provides clinically relevant cutoffs for variant reporting and precise quantification. Complementing tissue analysis by LB is likely to increase diagnostic yield for patients with molecular diseases.
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Affiliation(s)
- Ariane Hallermayr
- MGZ – Medizinisch Genetisches Zentrum, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany,Institute for Medical Information Processing, Biometry, and Epidemiology –IBE, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | | | - Verena Steinke-Lange
- MGZ – Medizinisch Genetisches Zentrum, Munich, Germany,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | | | - Andreas Laner
- MGZ – Medizinisch Genetisches Zentrum, Munich, Germany
| | - Roland Ewald
- Limbus Medical Technologies GmbH, Rostock, Germany
| | - Ben Liesfeld
- Limbus Medical Technologies GmbH, Rostock, Germany
| | - Elke Holinski-Feder
- MGZ – Medizinisch Genetisches Zentrum, Munich, Germany,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Julia M. A. Pickl
- MGZ – Medizinisch Genetisches Zentrum, Munich, Germany,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany,*Correspondence: Julia M. A. Pickl,
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Shen Y, Wang Z, Yang X, Zheng L, Wen M, Han Y, Li X, Zhang L, Wang J, You J, Jiang C, Su L, Fan X, Wang D. Novel classification for simple peripheral arteriovenous malformations based on anatomic localization: Prevalence data from the tertiary referral center in China. Front Cardiovasc Med 2022; 9:935313. [PMID: 35942181 PMCID: PMC9356220 DOI: 10.3389/fcvm.2022.935313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background In absence of the large-sample study of simple peripheral arteriovenous malfomations (pAVM), we aimed to perform the epidemiological analysis of over 1,000 simple pAVM patients from our center in the past 5 years, and establish a novel classification based on the anatomical localization of the primary lesion. Results Between March 27, 2016, and March 31, 2021, Chinese patients who were diagnosed with simple pAVM were taken into account. Those who suffered from simple arteriovenous malformations of the central nervous system (cnsAVM), combined types of AVM, and syndromes, such as CLOVES syndrome, etc. were all excluded from this study. A total of 1,070 simple pAVM patients were screened out. All of the simple pAVM patients were diagnosed by clinical manifestations and imaging examinations. Demographic data were obtained from the National Bureau of Statistics of China. The 5-year prevalence of simple pAVM was about (2.15–6.60) /1,000,000 population. The male-female ratio was approximately 1.22:1. The pAVM inpatients that were included in the age group of 21~30 years old had the highest constituent ratio (P = 0.01). The classification included four groups: Type I (primarily occurring in soft tissue); Type II (primarily occurring in bone); Type III (primarily occurring in the viscus) and Type IV (simple pAVM coexisting with CNS lesions). There were two subtypes of Type I: the A subtype (involving one major anatomical region) and the B subtype (involving two or more major anatomical regions); two subtypes of Type II: the A subtype (the cortex was intact) and the B subtype (the lesion had broken through the cortex). Generally, 657 patients were classified as Type IA (61.4%), 232 patients were Type IB (21.7%), 82 patients were Type IIA (7.7%) and 79 were categorized as Type IIB (7.4%); the number of patients who had Type III and Type IV pAVM were 9 (0.8%) and 11 (1.0%), respectively. The clinical manifestations and diagnostic standards for each type were also systematically summarized. Conclusions Prevalence data for simple pAVM were analyzed, and a novel classification was proposed based on the anatomy of the lesions. The present work was expected to facilitate the diagnosis of simple pAVM in clinical works.
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Diociaiuti A, Rotunno R, Pisaneschi E, Cesario C, Carnevale C, Condorelli AG, Rollo M, Di Cecca S, Quintarelli C, Novelli A, Zambruno G, El Hachem M. Clinical and Molecular Spectrum of Sporadic Vascular Malformations: A Single-Center Study. Biomedicines 2022; 10:biomedicines10061460. [PMID: 35740480 PMCID: PMC9220263 DOI: 10.3390/biomedicines10061460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/22/2022] [Accepted: 06/16/2022] [Indexed: 01/04/2023] Open
Abstract
Sporadic vascular malformations (VMs) are a large group of disorders of the blood and lymphatic vessels caused by somatic mutations in several genes—mainly regulating the RAS/MAPK/ERK and PI3K/AKT/mTOR pathways. We performed a cross-sectional study of 43 patients affected with sporadic VMs, who had received molecular diagnosis by high-depth targeted next-generation sequencing in our center. Clinical and imaging features were correlated with the sequence variants identified in lesional tissues. Six of nine patients with capillary malformation and overgrowth (CMO) carried the recurrent GNAQ somatic mutation p.Arg183Gln, while two had PIK3CA mutations. Unexpectedly, 8 of 11 cases of diffuse CM with overgrowth (DCMO) carried known PIK3CA mutations, and the remaining 3 had pathogenic GNA11 variants. Recurrent PIK3CA mutations were identified in the patients with megalencephaly–CM–polymicrogyria (MCAP), CLOVES, and Klippel–Trenaunay syndrome. Interestingly, PIK3CA somatic mutations were associated with hand/foot anomalies not only in MCAP and CLOVES, but also in CMO and DCMO. Two patients with blue rubber bleb nevus syndrome carried double somatic TEK mutations, two of which were previously undescribed. In addition, a novel sporadic case of Parkes Weber syndrome (PWS) due to an RASA1 mosaic pathogenic variant was described. Finally, a girl with a mild PWS and another diagnosed with CMO carried pathogenic KRAS somatic variants, showing the variability of phenotypic features associated with KRAS mutations. Overall, our findings expand the clinical and molecular spectrum of sporadic VMs, and show the relevance of genetic testing for accurate diagnosis and emerging targeted therapies.
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Affiliation(s)
- Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (R.R.); (C.C.); (M.E.H.)
- Correspondence: ; Tel.: +39-0668592509
| | - Roberta Rotunno
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (R.R.); (C.C.); (M.E.H.)
| | - Elisa Pisaneschi
- Translational Cytogenomics Unit, Multimodal Medicine Research Area, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (E.P.); (C.C.); (A.N.)
| | - Claudia Cesario
- Translational Cytogenomics Unit, Multimodal Medicine Research Area, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (E.P.); (C.C.); (A.N.)
| | - Claudia Carnevale
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (R.R.); (C.C.); (M.E.H.)
| | - Angelo Giuseppe Condorelli
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (A.G.C.); (G.Z.)
| | - Massimo Rollo
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy;
| | - Stefano Di Cecca
- Department Onco-Haematology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (S.D.C.); (C.Q.)
| | - Concetta Quintarelli
- Department Onco-Haematology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (S.D.C.); (C.Q.)
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Antonio Novelli
- Translational Cytogenomics Unit, Multimodal Medicine Research Area, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (E.P.); (C.C.); (A.N.)
| | - Giovanna Zambruno
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (A.G.C.); (G.Z.)
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (R.R.); (C.C.); (M.E.H.)
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Johnson C, Burkhart DL, Haigis KM. Classification of KRAS-Activating Mutations and the Implications for Therapeutic Intervention. Cancer Discov 2022; 12:913-923. [PMID: 35373279 PMCID: PMC8988514 DOI: 10.1158/2159-8290.cd-22-0035] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
Members of the family of RAS proto-oncogenes, discovered just over 40 years ago, were among the first cancer-initiating genes to be discovered. Of the three RAS family members, KRAS is the most frequently mutated in human cancers. Despite intensive biological and biochemical study of RAS proteins over the past four decades, we are only now starting to devise therapeutic strategies to target their oncogenic properties. Here, we highlight the distinct biochemical properties of common and rare KRAS alleles, enabling their classification into functional subtypes. We also discuss the implications of this functional classification for potential therapeutic avenues targeting mutant subtypes. SIGNIFICANCE Efforts in the recent past to inhibit KRAS oncogenicity have focused on kinases that function in downstream signal transduction cascades, although preclinical successes have not translated to patients with KRAS-mutant cancer. Recently, clinically effective covalent inhibitors of KRASG12C have been developed, establishing two principles that form a foundation for future efforts. First, KRAS is druggable. Second, each mutant form of KRAS is likely to have properties that make it uniquely druggable.
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Affiliation(s)
- Christian Johnson
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah L Burkhart
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kevin M Haigis
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Schmidt VF, Olivieri M, Häberle B, Masthoff M, Deniz S, Sporns PB, Wohlgemuth WA, Wildgruber M. Interventional Treatment Options in Children with Extracranial Vascular Malformations. Hamostaseologie 2022; 42:131-141. [PMID: 35263769 DOI: 10.1055/a-1728-5686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Martin Olivieri
- Paediatric Thrombosis and Haemostasis Unit, Dr. von Hauner Children's Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Sinan Deniz
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
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Mussa A, Carli D, Cardaropoli S, Ferrero GB, Resta N. Lateralized and Segmental Overgrowth in Children. Cancers (Basel) 2021; 13:cancers13246166. [PMID: 34944785 PMCID: PMC8699773 DOI: 10.3390/cancers13246166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023] Open
Abstract
Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith-Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Clinical Genetics Unit, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-0113135372
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
| | | | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari “Aldo Moro”, 70121 Bari, Italy;
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