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Chiraphapphaiboon W, Thongnoppakhun W, Limjindaporn T, Sawasdichai S, Roothumnong E, Prangphan K, Pamornpol B, Limwongse C, Pithukpakorn M. STK11 Causative Variants and Copy Number Variations Identified in Thai Patients With Peutz-Jeghers Syndrome. Cureus 2023; 15:e34495. [PMID: 36874343 PMCID: PMC9983355 DOI: 10.7759/cureus.34495] [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] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disorder caused by germline mutations in the serine-threonine kinase 11 (STK11) tumor suppressor gene. This syndrome is characterized by hamartomatous gastrointestinal polyps, mucocutaneous melanin pigmentation, and a higher risk of developing various cancers. Methods We summarized the clinical and molecular characteristics of five unrelated Thai patients with PJS. Denaturing high-performance liquid chromatography (DHPLC) screening, coupled with direct DNA sequencing and multiplex ligation-dependent probe amplification (MLPA), were applied for the molecular analysis of STK11. Results A total of four STK11 pathogenic changeswere identified in the five PJS patients, including two frameshift variants (a novel c.199dup, p.Leu67ProfsTer96 and a known c.834_835del, p.Cys278TrpfsTer6) and two types of copy number variations (CNV), exon 1 deletion and exons 2-3 deletion. Among reported STK11 exonic deletions, exon 1 and exons 2-3 deletions were found to be the two most commonly deleted exons. Conclusion All identified STK11 mutations were null mutations that were associated with more severe PJS phenotypes and cancers. This study broadens the phenotypic and mutational spectrum of STK11 in PJS.
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Affiliation(s)
| | - Wanna Thongnoppakhun
- Siriraj Genomics, Office of the Dean, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | | | - Sunisa Sawasdichai
- Siriraj Genomics, Office of the Dean, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | - Ekkapong Roothumnong
- Division of Medical Genetics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | - Kanjana Prangphan
- Siriraj Genomics, Office of the Dean, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | - Benjaporn Pamornpol
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | - Chanin Limwongse
- Siriraj Genomics, Office of the Dean, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA.,Division of Medical Genetics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
| | - Manop Pithukpakorn
- Siriraj Genomics, Office of the Dean, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA.,Division of Medical Genetics, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
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Zhao ZY, Lei Y, Wang ZM, Han H, Xing JJ, Xu XD, Gao XH, Zhang W, Yu ED. Re-recognition of BMPR1A-related polyposis: beyond juvenile polyposis and hereditary mixed polyposis syndrome. Gastroenterol Rep (Oxf) 2023; 11:goac082. [PMID: 36632626 PMCID: PMC9825710 DOI: 10.1093/gastro/goac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background Bone morphogenetic protein receptor type 1A (BMPR1A) is responsible for two individual Mendelian diseases: juvenile polyposis syndrome and hereditary mixed polyposis syndrome 2, which have overlapping phenotypes. This study aimed to elucidate whether these two syndromes are just two subtypes of a single syndrome rather than two isolated syndromes. Methods We sequenced the BMPR1A gene in 186 patients with polyposis and colorectal cancer, and evaluated the clinicopathological features and phenotypes of the probands and their available relatives with BMPR1A mutations. Results BMPR1A germline mutations were found in six probands and their three available relatives. The numbers of frameshift, nonsense, splice-site, and missense mutations were one, one, two, and two, respectively; two of the six mutations were novel. Typical juvenile polyps were found in only three patients. Two patients had colorectal cancer rather than any polyps. Conclusions Diseases in BMPR1A germline mutation carriers vary from mixed polyposis to sole colorectal cancer, and typical juvenile polyps do not always occur in these carriers. The variety of phenotypes reflected the features of BMPR1A-mutation carriers, which should be recognized as a spectrum of one syndrome. Genetic testing may be a good approach to identifying BMPR1A-related syndromes.
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Affiliation(s)
| | | | | | - Huan Han
- Department of Pathology, Changhai Hospital, Shanghai, P. R. China
| | - Jun-Jie Xing
- Department of Colorectal Surgery and Hereditary Colorectal Cancer Registry, Changhai Hospital, Shanghai, P. R. China
| | - Xiao-Dong Xu
- Department of Colorectal Surgery and Hereditary Colorectal Cancer Registry, Changhai Hospital, Shanghai, P. R. China
| | - Xian-Hua Gao
- Department of Colorectal Surgery and Hereditary Colorectal Cancer Registry, Changhai Hospital, Shanghai, P. R. China
| | - Wei Zhang
- Department of Colorectal Surgery and Hereditary Colorectal Cancer Registry, Changhai Hospital, Shanghai, P. R. China
| | - En-Da Yu
- Corresponding author. Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd., Shanghai 200433, China. Tel: +86-13901688626;
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Delayed diagnosis of Peutz-Jeghers syndrome due to pathological information loss or mistake in family/personal history. Orphanet J Rare Dis 2021; 16:261. [PMID: 34103092 PMCID: PMC8186215 DOI: 10.1186/s13023-021-01900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To report Peutz-Jeghers syndrome (PJS) cases with non-definitive clues in the family or personal history and finally diagnosed through pathological examination and STK11 gene mutation test. CLINICAL PRESENTATION AND INTERVENTION PJS was suspected in 3 families with tortuous medical courses. Two of them had relatives departed due to polyposis or colon cancer without pathological results, and the other one had been diagnosed as hyperplastic polyposis before. Diagnosis of PJS was confirmed by endoscopy and repeated pathological examinations, and the STK11 mutation test finally confirmed the diagnosis at genetic level, during which 3 novel mutation were detected (536C > A, 373_374insA, 454_455insGGAGAAGCGTTTCCCAGTGTGCC). CONCLUSION Early diagnosis of PJS is important and may be based on a family history with selective features among family members, and the pathological information is the key. The novel mutations also expand the STK11 variant spectrum.
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Jiang YL, Zhao ZY, Li BR, Li J, Jin XW, Yu ED, Xu XD, Ning SB. Early screening the small bowel is key to protect Peutz-Jeghers syndrome patients from surgery: a novel mutation c.243delG in STK11 gene. BMC Gastroenterol 2019; 19:70. [PMID: 31072341 PMCID: PMC6507206 DOI: 10.1186/s12876-019-0987-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background Peutz-Jeghers syndrome (PJS) is a Mendelian disease, whose causative gene is STK11, mainly characterized by gastrointestinal polyposis and increased cancer risk. Clinical observation reveals intussusception in childhood are more frequent and severe than in adults, and it is difficult to prevent this knotty complication. Case presentation A boy without a positive family history grew oral MP after birth and developed abdominal pain and bloody stood at 7 years old. Endoscopy revealed multiple polyps within the colon and the ileum, and endoscopic polypectomy and regular surveillance protected him from severe complications and open surgeries. A heterozygous deletion in STK11, c.243delG, was detected in the proband but not in his parents. This mutation has not been documented in databases. Conclusions We suspect a child of PJS may need a more thorough endoscopic examination including enteroscopy or capsule endoscopy to take care of small bowel when PJS related symptoms comes up.
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Affiliation(s)
- Yu-Liang Jiang
- Department of Gastroenterology, Beijing Shijitan Hospital, 10 Tieyi Rd., Beijing, 100038, China.,Department of Gastroenterology, Airforce Medical Center of PLA, 30 Fucheng Rd., Beijing, 100142, China
| | - Zi-Ye Zhao
- Department of Colorectal Surgery, Shanghai Changhai Hospital, 168 Changhai Rd., Shanghai, 200433, China
| | - Bai-Rong Li
- Department of Gastroenterology, Airforce Medical Center of PLA, 30 Fucheng Rd., Beijing, 100142, China
| | - Jing Li
- Department of Gastroenterology, Airforce Medical Center of PLA, 30 Fucheng Rd., Beijing, 100142, China
| | - Xiao-Wei Jin
- Department of Gastroenterology, Airforce Medical Center of PLA, 30 Fucheng Rd., Beijing, 100142, China
| | - En-Da Yu
- Department of Colorectal Surgery, Shanghai Changhai Hospital, 168 Changhai Rd., Shanghai, 200433, China
| | - Xiao-Dong Xu
- Department of Colorectal Surgery, Shanghai Changhai Hospital, 168 Changhai Rd., Shanghai, 200433, China.
| | - Shou-Bin Ning
- Department of Gastroenterology, Airforce Medical Center of PLA, 30 Fucheng Rd., Beijing, 100142, China.
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STK11 gene analysis reveals a significant number of splice mutations in Chinese PJS patients. Cancer Genet 2018; 230:47-57. [PMID: 30528796 DOI: 10.1016/j.cancergen.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/02/2018] [Accepted: 11/27/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND The combination of direct sequencing and multiple ligation-dependent probe amplification (MLPA) has resulted in an 80% detection rate of serine/threonine kinase 11 (STK11) gene mutations in Peutz-Jeghers syndrome (PJS); however, this rate varies in different ethnicities. AIMS To test the efficacy of the combination in Chinese patients with PJS. METHODS PJS probands visiting our center during one year were enrolled. Sanger sequencing and MLPA were used to detect STK11 mutations. Associations between the occurrence of severe complications and risk factors were analyzed statistically. RESULTS We identified 47 PJS probands. Among them, 34 received an STK11 mutation test, revealing 23 point mutations and 2 exonic deletions. Nine of the mutations were splicing errors, reflecting a significantly higher proportion (p < 0.05). Laparotomy history existed for 33 of the probands, and seven families had a history of cancer. Statistical analysis revealed no associations between the occurrence of severe complications or cancers and risk factors. CONCLUSION The strategy achieved a high detection rate in Chinese people, validating its effectiveness. This cohort comprised a significantly higher proportion of splicing errors, reflecting the unique genetic characteristics Chinese people. No specific genotype-phenotype relationship was noted, while the wide usage of enteroscopy would benefit PJS surveillance.
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Jiang YL, Zhao ZY, Li BR, Yang F, Li J, Jin XW, Wang H, Yu ED, Sun SH, Ning SB. The altered activity of P53 signaling pathway by STK11 gene mutations and its cancer phenotype in Peutz-Jeghers syndrome. BMC MEDICAL GENETICS 2018; 19:141. [PMID: 30092773 PMCID: PMC6085611 DOI: 10.1186/s12881-018-0626-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/13/2018] [Indexed: 02/07/2023]
Abstract
Background Peutz-Jeghers syndrome (PJS) is caused by mutations in serine/threonine kinase 11 (STK11) gene. The increased cancer risk has been connected to P53 pathway. Methods PJS probands with STK11 mutation were included in the function analysis. P53 activity elevated by STK11 mutants was investigated using dual-luciferase reporter assay in vitro after constructing expression vectors of STK11 wild type and mutants generated by site-directed substitution. The association between the P53 activity and clinicopathological factors was analysis, especially the cancer history. Results Thirteen probands with STK11 mutations were involved, and within the mutations, c.G924A was novel. P53 activity elevation caused by 6 truncating mutations were significantly lower than that of STK11 wild type (P < 0.05). Family history of cancer was observed in 5 families. Within them, P53 activity was reduced and cancer occurred before 40 in 2 families, while it was not significantly changed and cancers happened after 45 in the other 3 families. Conclusions The affected P53 activity caused by STK11 mutations in PJS patients is significantly associated with protein truncation, while cancer risk in PJS can be elevated through pathways rather than P53 pathway. P53 activity test is probably a useful supporting method to predict cancer risk in PJS, which could be helpful in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12881-018-0626-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Liang Jiang
- Hebei North University, Zhangjiakou, 075061, Hebei Province, China.,Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, 100142, China
| | - Zi-Ye Zhao
- Department of Medical Genetics, Naval Medical University, Shanghai, 200433, China.,Department of Colorectal Surgery, Changhai Hospital, Shanghai, 200433, China
| | - Bai-Rong Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, 100142, China
| | - Fu Yang
- Department of Medical Genetics, Naval Medical University, Shanghai, 200433, China
| | - Jing Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, 100142, China
| | - Xiao-Wei Jin
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, 100142, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, 200433, China
| | - En-Da Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, 200433, China
| | - Shu-Han Sun
- Department of Medical Genetics, Naval Medical University, Shanghai, 200433, China.
| | - Shou-Bin Ning
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, 100142, China.
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Zhao ZY, Jiang YL, Li BR, Yu ED, Ning SB. A novel STK11 missense mutation (c.346G > T) causing Peutz-Jeghers syndrome in a Chinese male with a negative family history. Dig Liver Dis 2018; 50:864-866. [PMID: 29921539 DOI: 10.1016/j.dld.2018.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Zi-Ye Zhao
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Yu-Liang Jiang
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Bai-Rong Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - En-Da Yu
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China.
| | - Shou-Bin Ning
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China.
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Zhao ZY, Jiang YL, Li BR, Yu ED, Ning SB. A novel mutation (c.855delG) in STK11 gene is associated with Peutz-Jeghers syndrome in a Chinese family. Dig Liver Dis 2018; 50:312-314. [PMID: 29301733 DOI: 10.1016/j.dld.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/09/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Zi-Ye Zhao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Yu-Liang Jiang
- Hebei North University, Zhangjiakou, Hebei Province, China; Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Bai-Rong Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - En-Da Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.
| | - Shou-Bin Ning
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China.
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Zhao ZY, Jiang YL, Li BR, Yang F, Li J, Jin XW, Sun SH, Ning SB. A novel germline mutation (c.A527G) in STK11 gene causes Peutz-Jeghers syndrome in a Chinese girl: A case report. Medicine (Baltimore) 2017; 96:e8591. [PMID: 29245219 PMCID: PMC5728834 DOI: 10.1097/md.0000000000008591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Peutz-Jeghers syndrome (PJS) is a Mendelian autosomal dominant disease caused by mutations in the tumor suppressor gene, serine/threonine kinase 11 (STK11). The features of this syndrome include gastrointestinal (GI) hamartomas, melanin spots on the lips and the extremities, and an increased risk of developing cancer. Early onset of disease is often characterized by mucocutaneous pigmentation and intussusception due to GI polyps in childhood. PATIENT CONCERNS A girl with a positive family history grew oral pigmentation at 1 and got intussusception by small bowel hamartomas at 5. DIAGNOSES She was diagnosed with PJS based on oral pigmentation and a positive family history of PJS. INTERVENTIONS Enteroscopy was employed to treat the GI polyps. Sanger sequencing was used to investigate STK11 mutation in this family. OUTCOMES A large jejunal polyp together with other smaller ones was resected, and the girl recovered uneventfully. We discovered a heterozygous substitution in STK11, c.A527G in exon 4, in the girl and her father who was also a PJS patient, and the amine acid change was an aspartic acid-glycine substitution in codon 176. This mutation was not found in other healthy family members and 50 unrelated non-PJS controls, and it is not recorded in databases, which prove it a novel mutation. Evolutionary conservation analysis of amino acid residues showed this aspartic acid is a conserved one between species, and protein structure prediction by SWISS-MODEL indicated an obvious change in local structure. In addition, PolyPhen-2 score for this mutation is 1, which indicates it probably damaging. LESSONS PJS can cause severe complication like intussusception in young children, and early screening for small bowel may be beneficial for these patients. The mutation of STK11 found in this girl is a novel one, which enlarges the spectrum of STK11. Our analysis supported it a causative one in PJS.
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Affiliation(s)
- Zi-Ye Zhao
- Department of Medical Genetics, Naval Medical University, Shanghai 200433, China
| | - Yu-Liang Jiang
- Hebei North University, Zhangjiakou, Hebei Province, China
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Bai-Rong Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Fu Yang
- Department of Medical Genetics, Naval Medical University, Shanghai 200433, China
| | - Jing Li
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Xiao-Wei Jin
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
| | - Shu-Han Sun
- Department of Medical Genetics, Naval Medical University, Shanghai 200433, China
| | - Shou-Bin Ning
- Department of Gastroenterology, Airforce General Hospital of PLA, Beijing, China
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