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Tucker EJ, Sharp MF, Lokchine A, Bell KM, Palmer CS, Kline BL, Robevska G, van den Bergen J, Dulon J, Stojanovski D, Ayers KL, Touraine P, Crismani W, Jaillard S, Sinclair AH. Biallelic FANCA variants detected in sisters with isolated premature ovarian insufficiency. Clin Genet 2024; 106:321-335. [PMID: 38779778 DOI: 10.1111/cge.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
Premature ovarian insufficiency is a common form of female infertility affecting up to 4% of women and characterised by amenorrhea with elevated gonadotropin before the age of 40. Oocytes require controlled DNA breakage and repair for homologous recombination and the maintenance of oocyte integrity. Biallelic disruption of the DNA damage repair gene, Fanconi anemia complementation group A (FANCA), is a common cause of Fanconi anaemia, a syndrome characterised by bone marrow failure, cancer predisposition, physical anomalies and POI. There is ongoing dispute about the role of heterozygous FANCA variants in POI pathogenesis, with insufficient evidence supporting causation. Here, we have identified biallelic FANCA variants in French sisters presenting with POI, including a novel missense variant of uncertain significance and a likely pathogenic deletion that initially evaded detection. Functional studies indicated no discernible effect on DNA damage sensitivity in patient lymphoblasts. These novel FANCA variants add evidence that heterozygous loss of one allele is insufficient to cause DNA damage sensitivity and POI. We propose that intragenic deletions, that are relatively common in FANCA, may be missed without careful analysis, and could explain the presumed causation of heterozygous variants. Accurate variant curation is critical to optimise patient care and outcomes.
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Affiliation(s)
- Elena J Tucker
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael F Sharp
- DNA Repair and Recombination Laboratory, St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
- The Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - Anna Lokchine
- CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S1085, Univ Rennes, Rennes, France
- Service de Cytogénétique et Biologie Cellulaire, CHU Rennes, Rennes, France
| | - Katrina M Bell
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Bioinformatics, Murdoch Children's Research Institute, Victoria, Australia
| | - Catherine S Palmer
- Department of Biochemistry and Pharmacology and The Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brianna L Kline
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gorjana Robevska
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jocelyn van den Bergen
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jérôme Dulon
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University, Paris, France
| | - Diana Stojanovski
- Department of Biochemistry and Pharmacology and The Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katie L Ayers
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, AP-HP, Sorbonne University, Paris, France
| | - Wayne Crismani
- DNA Repair and Recombination Laboratory, St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
| | - Sylvie Jaillard
- CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S1085, Univ Rennes, Rennes, France
- Service de Cytogénétique et Biologie Cellulaire, CHU Rennes, Rennes, France
| | - Andrew H Sinclair
- Reproductive Development, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Balciuniene J, Ning Y, Lazarus HM, Aikawa V, Sherpa S, Zhang Y, Morrissette JJD. Cancer cytogenetics in a genomics world: Wedding the old with the new. Blood Rev 2024; 66:101209. [PMID: 38852016 DOI: 10.1016/j.blre.2024.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 06/10/2024]
Abstract
Since the discovery of the Philadelphia chromosome in 1960, cytogenetic studies have been instrumental in detecting chromosomal abnormalities that can inform cancer diagnosis, treatment, and risk assessment efforts. The initial expansion of cancer cytogenetics was with fluorescence in situ hybridization (FISH) to assess submicroscopic alterations in dividing or non-dividing cells and has grown into the incorporation of chromosomal microarrays (CMA), and next generation sequencing (NGS). These molecular technologies add additional dimensions to the genomic assessment of cancers by uncovering cytogenetically invisible molecular markers. Rapid technological and bioinformatic advances in NGS are so promising that the idea of performing whole genome sequencing as part of routine patient care may soon become economically and logistically feasible. However, for now cytogenetic studies continue to play a major role in the diagnostic testing and subsequent assessments in leukemia with other genomic studies serving as complementary testing options for detection of actionable genomic abnormalities. In this review, we discuss the role of conventional cytogenetics (karyotyping, chromosome analysis) and FISH studies in hematological malignancies, highlighting the continued clinical utility of these techniques, the subtleties and complexities that are relevant to treating physicians and the unique strengths of cytogenetics that cannot yet be paralleled by the current high-throughput molecular technologies. Additionally, we describe how CMA, optical genome mapping (OGM), and NGS detect abnormalities that were beyond the capacity of cytogenetic studies and how an integrated approach (broad molecular testing) can contribute to the detection of actionable targets and variants in malignancies. Finally, we discuss advances in the field of genomic testing that are bridging the advantages of individual (single) cell based cytogenetic testing and broad genomic testing.
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Affiliation(s)
- Jorune Balciuniene
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yi Ning
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States of America
| | - Vania Aikawa
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sarina Sherpa
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yanming Zhang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer J D Morrissette
- Division of Precision and Computational Diagnostics, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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3
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Joshi G, Arthur NBJ, Geetha TS, Datari PVR, Modak K, Roy D, Chaudhury AD, Sundaraganesan P, Priyanka S, Na F, Ramprasad V, Abraham A, Srivastava VM, Srivastava A, Kulkarni UP, George B, Velayudhan SR. Comprehensive laboratory diagnosis of Fanconi anaemia: comparison of cellular and molecular analysis. J Med Genet 2023; 60:801-809. [PMID: 36894310 PMCID: PMC10423531 DOI: 10.1136/jmg-2022-108714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/03/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Fanconi anaemia (FA) is a rare inherited bone marrow failure disease caused by germline pathogenic variants in any of the 22 genes involved in the FA-DNA interstrand crosslink (ICL) repair pathway. Accurate laboratory investigations are required for FA diagnosis for the clinical management of the patients. We performed chromosome breakage analysis (CBA), FANCD2 ubiquitination (FANCD2-Ub) analysis and exome sequencing of 142 Indian patients with FA and evaluated the efficiencies of these methods in FA diagnosis. METHODS We performed CBA and FANCD2-Ub analysis in the blood cells and fibroblasts of patients with FA. Exome sequencing with improved bioinformatics to detect the single number variants and CNV was carried out for all the patients. Functional validation of the variants with unknown significance was done by lentiviral complementation assay. RESULTS Our study showed that FANCD2-Ub analysis and CBA on peripheral blood cells could diagnose 97% and 91.5% of FA cases, respectively. Exome sequencing identified the FA genotypes consisting of 45 novel variants in 95.7% of the patients with FA. FANCA (60.2%), FANCL (19.8%) and FANCG (11.7%) were the most frequently mutated genes in the Indian population. A FANCL founder mutation c.1092G>A; p.K364=was identified at a very high frequency (~19%) in our patients. CONCLUSION We performed a comprehensive analysis of the cellular and molecular tests for the accurate diagnosis of FA. A new algorithm for rapid and cost-effective molecular diagnosis for~90% of FA cases has been established.
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Affiliation(s)
- Gaurav Joshi
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | | | | | - Kirti Modak
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Debanjan Roy
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anurag Dutta Chaudhury
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Sweety Priyanka
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Fouzia Na
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Aby Abraham
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Vivi M Srivastava
- Department of Cytogenetics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Alok Srivastava
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- Center for Stem Cell Research, Vellore, Tamil Nadu, India
| | - Uday Prakash Kulkarni
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Biju George
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Shaji R Velayudhan
- Department of Haematology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- Center for Stem Cell Research, Vellore, Tamil Nadu, India
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4
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Modern management of Fanconi anemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:649-657. [PMID: 36485157 PMCID: PMC9821189 DOI: 10.1182/hematology.2022000393] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this review, we present a clinical case report and discussion to outline the importance of long-term specific Fanconi anemia (FA) monitoring, and we discuss the main aspects of the general management of patients with FA and clinical complications. While several nontransplant treatments are currently under evaluation, hematopoietic stem cell transplantation (HSCT) remains the only therapeutic option for bone marrow failure (BMF). Although HSCT outcomes in patients with FA have remarkably improved over the past 20 years, in addition to the mortality intrinsic to the procedure, HSCT increases the risk and accelerates the appearance of late malignancies. HSCT offers the best outcome when performed in optimal conditions (moderate cytopenia shifting to severe, prior to transfusion dependence and before clonal evolution or myelodysplasia/acute myeloid leukemia); hence, an accurate surveillance program is vital. Haploidentical HSCT offers very good outcomes, although long-term effects on malignancies have not been fully explored. A monitoring plan is also important to identify cancers, particularly head and neck carcinomas, in very early phases. Gene therapy is still experimental and offers the most encouraging results when performed in early phases of BMF by infusing high numbers of corrected cells without genotoxic effects. Patients with FA need comprehensive monitoring and care plans, coordinated by centers with expertise in FA management, that start at diagnosis and continue throughout life. Such long-term follow-up is essential to detect complications related to the disease or treatment in this setting.
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5
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Errazquin R, Page A, Suñol A, Segrelles C, Carrasco E, Peral J, Garrido-Aranda A, Del Marro S, Ortiz J, Lorz C, Minguillon J, Surralles J, Belendez C, Alvarez M, Balmaña J, Bravo A, Ramirez A, Garcia-Escudero R. Development of a mouse model for spontaneous oral squamous cell carcinoma in Fanconi anemia. Oral Oncol 2022; 134:106184. [PMID: 36191479 DOI: 10.1016/j.oraloncology.2022.106184] [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: 06/22/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
Fanconi anemia (FA) patients frequently develop oral squamous cell carcinoma (OSCC). This cancer in FA patients is diagnosed within the first 3-4 decades of life, very often preceded by lesions that suffer a malignant transformation. In addition, they respond poorly to current treatments due to toxicity or multiple recurrences. Translational research on new chemopreventive agents and therapeutic strategies has been unsuccessful partly due to scarcity of disease models or failure to fully reproduce the disease. Here we report that Fanca gene knockout mice (Fanca-/-) frequently display pre-malignant lesions in the oral cavity. Moreover, when these animals were crossed with animals having conditional deletion of Trp53 gene in oral mucosa (K14cre;Trp53F2-10/F2-10), they spontaneously developed OSCC with high penetrance and a median latency of less than ten months. Tumors were well differentiated and expressed markers of squamous differentiation, such as keratins K5 and K10. In conclusion, Fanca and Trp53 genes cooperate to suppress oral cancer in mice, and Fanca-/-;K14cre;Trp53F2-10/F2-10 mice constitute the first animal model of spontaneous OSCC in FA.
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Affiliation(s)
- Ricardo Errazquin
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain
| | - Angustias Page
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Anna Suñol
- Hereditary Cancer Genetics Group and Medical Oncology Department, VHIO, Barcelona, Spain
| | - Carmen Segrelles
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group and Medical Oncology Department, VHIO, Barcelona, Spain
| | - Jorge Peral
- Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | | | - Sonia Del Marro
- Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Jessica Ortiz
- Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Corina Lorz
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Jordi Minguillon
- Join Research Unit on Genomic Medicine UAB-Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; Centro de Investigación Biomédica en Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Jordi Surralles
- Join Research Unit on Genomic Medicine UAB-Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; Centro de Investigación Biomédica en Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Cristina Belendez
- Centro de Investigación Biomédica en Enfermedades Raras (CIBERER), 28029 Madrid, Spain; Pediatric Hematology and Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Martina Alvarez
- Centro de Investigaciones Médico-Sanitarias (CIMES), Malaga, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group and Medical Oncology Department, VHIO, Barcelona, Spain
| | - Ana Bravo
- Department of Anatomy, Animal Production and Veterinary Clinical Sciences, Laboratory of Pathology Phenotyping of Genetically Engineered Mice, Faculty of Veterinary Medicine, University of Santiago de Compostela, 27002 Lugo, Spain
| | - Angel Ramirez
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain
| | - Ramon Garcia-Escudero
- Research Institute Hospital 12 de Octubre (imas12), University Hospital "12 de Octubre", Av Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain; Biomedical Oncology Unit, CIEMAT (Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas), Avenida Complutense 40, 28040 Madrid, Spain.
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Repczynska A, Julga K, Skalska-Sadowska J, Kacprzak MM, Bartoszewska-Kubiak A, Lazarczyk E, Loska D, Drozniewska M, Czerska K, Wachowiak J, Haus O. Next-generation sequencing reveals novel variants and large deletion in FANCA gene in Polish family with Fanconi anemia. Orphanet J Rare Dis 2022; 17:282. [PMID: 35854323 PMCID: PMC9295492 DOI: 10.1186/s13023-022-02424-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fanconi anemia (FA) is the most common inherited bone marrow failure syndrome. However, establishing its molecular diagnosis remains challenging. Chromosomal breakage analysis is the gold standard diagnostic test for this disease. Nevertheless, molecular analysis is always required for the identification of pathogenic alterations in the FA genes. RESULTS We report here on a family with FA diagnosis in two siblings. Mitomycin C (MMC) test revealed high level of chromosome breaks and radial figures. In both children, array-Comparative Genomic Hybridization (aCGH) showed maternally inherited 16q24.3 deletion, including FANCA gene, and next generation sequencing (NGS) disclosed paternally inherited novel variants in the FANCA gene-Asn1113Tyr and Ser890Asn. A third sibling was shown to be a carrier of FANCA deletion only. CONCLUSIONS Although genetic testing in FA patients often requires a multi-method approach including chromosome breakage test, aCGH, and NGS, every effort should be made to make it available for whole FA families. This is not only to confirm the clinical diagnosis of FA in affected individuals, but also to enable identification of carriers of FA gene(s) alterations, as it has implications for diagnostic and genetic counselling process.
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Affiliation(s)
- Anna Repczynska
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
| | - Katarzyna Julga
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | | | - Alicja Bartoszewska-Kubiak
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Ewelina Lazarczyk
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | | | - Malgorzata Drozniewska
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Olga Haus
- Department of Clinical Genetics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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7
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Encarnación JA, Cerezuela P, Español I, García MR, Manso C, De la Fuente I, Garrigós N, Viney A, Minguillon J, Surrallés J. Fanconi-like anemia related to a FANCM mutation. Eur J Med Genet 2021; 65:104399. [PMID: 34793962 DOI: 10.1016/j.ejmg.2021.104399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/21/2021] [Accepted: 11/13/2021] [Indexed: 11/03/2022]
Abstract
Fanconi anemia is primarily inherited as an autosomal recessive genetic disorder with common delays in diagnosis and challenging treatments. Fanconi anemia patients have a high risk of developing solid tumors, particularly in the head and neck or anogenital regions. The diagnosis of Fanconi anemia is primarily based on the chromosomal breakage but FA gene sequencing is recommended in all patients with a positive chromosome fragility test. Here, we present a 32-year-old man with advanced tonsil squamous cell carcinoma and fatal toxicity after the first cycle of chemotherapy. No anemia was present. A recent variant mutation if the FANCM gene was detected (c1511_1515delGAGTA (pArg504AsnfsTer29)). Homozygous or double heterozygous pathogenic variants have been reported in FANCM and linked to azoospermia and primary ovarian failure without anemia. Alterations in this gene have also been associated with a genetic predisposition for solid tumors (breast and ovarian cancer) and hematological malignancies (B-cell acute lymphoblastic leukemia). Due to the hypersensitivity of these patients to DNA-damaging agents such as chemotherapy and radiotherapy, surgery is the best treatment option for malignant solid tumors. Dose reductions or alternative regimens of chemotherapy and/or radiotherapy are recommended in FA patients who develop a malignant tumor.
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Affiliation(s)
- J A Encarnación
- Servicio de Oncología Radioterápica Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - P Cerezuela
- Servicio de Oncología Médica Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - I Español
- Servicio de Hematología y Hemoterapia Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M R García
- Servicio de Oncología Médica Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - C Manso
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - I De la Fuente
- Servicio de Oncología Radioterápica Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - N Garrigós
- Centro Inmunológico de Alicante, Spain; Servicio de Biología Molecular de Cialab Ribera Salud, Spain
| | - A Viney
- Servicio de Farmacia, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - J Minguillon
- Genome Instability and DNA Repair Syndromes Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Join Unit UAB-IR Sant Pau on Genomic Medicine, 08041, Barcelona, Spain; Genetics Department, Hospital de la Santa Creu I Sant Pau, 08041, Barcelona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER), Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041, Barcelona, Spain
| | - J Surrallés
- Genome Instability and DNA Repair Syndromes Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Join Unit UAB-IR Sant Pau on Genomic Medicine, 08041, Barcelona, Spain; Genetics Department, Hospital de la Santa Creu I Sant Pau, 08041, Barcelona, Spain; Genetics and Microbiology Department, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER), Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041, Barcelona, Spain
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8
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George M, Solanki A, Chavan N, Rajendran A, Raj R, Mohan S, Nemani S, Kanvinde S, Munirathnam D, Rao S, Radhakrishnan N, Lashkari HP, Ghildhiyal RG, Manglani M, Shanmukhaiah C, Bhat S, Ramesh S, Cherian A, Junagade P, Vundinti BR. A comprehensive molecular study identified 12 complementation groups with 56 novel FANC gene variants in Indian Fanconi anemia subjects. Hum Mutat 2021; 42:1648-1665. [PMID: 34585473 DOI: 10.1002/humu.24286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/09/2021] [Accepted: 09/25/2021] [Indexed: 12/18/2022]
Abstract
Fanconi anemia (FA) is a rare autosomal or X-linked genetic disorder characterized by chromosomal breakages, congenital abnormalities, bone marrow failure (BMF), and cancer. There has been a discovery of 22 FANC genes known to be involved in the FA pathway. This wide number of pathway components makes molecular diagnosis challenging for FA. We present here the most comprehensive molecular diagnosis of FA subjects from India. We observed a high frequency (4.42 ± 1.5 breaks/metaphase) of chromosomal breakages in 181 FA subjects. The major clinical abnormalities observed were skin pigmentation (70.2%), short stature (46.4%), and skeletal abnormalities (43.1%), along with a few minor clinical abnormalities. The combination of Sanger sequencing and Next Generation Sequencing could molecularly characterize 164 (90.6%) FA patients and identified 12 different complementation groups [FANCA (56.10%), FANCG (16.46%), FANCL (12.80%), FANCD2 (4.88%), FANCJ (2.44%), FANCE (1.22%), FANCF (1.22%), FANCI (1.22%), FANCN (1.22%), FANCC (1.22%), FANCD1 (0.61%) and FANCB (0.61%)]. A total of 56 novel variants were identified in our cohort, including a hotspot variant: a deletion of exon 27 in the FANCA gene and a nonsense variant at c.787 C>T in the FANCG gene. Our comprehensive molecular findings can aid in the stratification of molecular investigation in the diagnosis and management of FA patients.
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Affiliation(s)
- Merin George
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K.E.M. Hospital Campus, Mumbai, Maharashtra, India
| | - Avani Solanki
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K.E.M. Hospital Campus, Mumbai, Maharashtra, India
| | - Niranjan Chavan
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K.E.M. Hospital Campus, Mumbai, Maharashtra, India
| | - Aruna Rajendran
- Department of Pediatric Hematology, Institute of Child Health and Hospital for Children, Chennai, Tamilnadu, India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Apollo Speciality Hospital, Chennai, Tamilnadu, India
| | - Sheila Mohan
- Department of Pediatric Hematology, Oncology, Apollo Speciality Hospital, Chennai, Tamilnadu, India
| | - Sandeep Nemani
- Department of Hematology, Usha Hematology Center, Sangli, Maharashtra, India
| | - Shailesh Kanvinde
- Department of Paediatric Hematology Oncology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Deendayalan Munirathnam
- Department of Pediatric Oncology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
| | - Sudha Rao
- Department of Paediatric Haemato-Oncology and Immunology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Nita Radhakrishnan
- Department of Paediatric Haematology Oncology, Super Specialty Pediatric Hospital & Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Harsha Prasada Lashkari
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Mangalore, India
| | - Radha Gulati Ghildhiyal
- Department of Pediatrics, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Mamta Manglani
- Department of Hematology, Comprehensive Thalassemia Care Center and Bone Marrow Transplantation Center, Mumbai, Maharashtra, India
| | | | - Sunil Bhat
- Department of Paediatric Haematology, Oncology and Blood & Bone Marrow Transplantation, Narayana Health Network Hospitals, Bangalore, India
| | - Sowmyashree Ramesh
- Department of Pediatrics, Vanivilas Hospital, Bangalore, Karnataka, India
| | - Anchu Cherian
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pritesh Junagade
- Department of stem cell transplantation, Lotus Hospital, Pune, Maharashtra, India
| | - Babu Rao Vundinti
- Department of Cytogenetics, ICMR-National Institute of Immunohematology, K.E.M. Hospital Campus, Mumbai, Maharashtra, India
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9
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Schneider KW, Suttman A, McKinney C, Giller R, Dollerschell K, Nakano TA. Incorporating genetic counseling into the evaluation of pediatric bone marrow failure. J Genet Couns 2021; 31:433-446. [PMID: 34570941 DOI: 10.1002/jgc4.1510] [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: 01/23/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022]
Abstract
The timely identification of germline genetic causes of pediatric bone marrow failure (BMF) impacts medical screening practices, family counseling, therapeutic decision-making, and risk of progression to myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). At diagnosis, treatment decisions need to be made quickly to mitigate risks associated with profound cytopenias. As genetic testing options are rapidly evolving, an efficient multi-disciplinary approach and algorithm, including early involvement of a genetics team, is needed to expedite diagnosis and therapeutic decision-making. This process aids in the identification of appropriate candidates for molecular genetic testing. We present our single center experience reviewing the implementation of genetic counseling and a diagnostic and therapeutic algorithm used to guide genetic evaluation of pediatric BMF. Disease-specific next-generation sequencing (NGS) panels were most often pursued in patients who presented with a clinical phenotype consistent with a known inherited BMF syndrome and when trying to reduce incidental or uninformative results. Broader BMF NGS panels were most often utilized when unable to narrow the suspected etiology to a single disorder. Whole exome sequencing helped with optimizing treatment decision-making in higher risk children with BMF who required expedited hematopoietic stem cell transplantation. The experience has led to improvements to our process for evaluating patients with BMF.
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Affiliation(s)
- Kami Wolfe Schneider
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
| | - Alexandra Suttman
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
| | - Christopher McKinney
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
| | - Roger Giller
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
| | - Kaylee Dollerschell
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
| | - Taizo A Nakano
- Department of Pediatrics, Section of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Aurora, CO, USA
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10
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Sevilla J, Navarro S, Rio P, Sánchez-Domínguez R, Zubicaray J, Gálvez E, Merino E, Sebastián E, Azqueta C, Casado JA, Segovia JC, Alberquilla O, Bogliolo M, Román-Rodríguez FJ, Giménez Y, Larcher L, Salgado R, Pujol RM, Hladun R, Castillo A, Soulier J, Querol S, Fernández J, Schwartz J, García de Andoín N, López R, Catalá A, Surralles J, Díaz-de-Heredia C, Bueren JA. Improved collection of hematopoietic stem cells and progenitors from Fanconi anemia patients for gene therapy purposes. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2021; 22:66-75. [PMID: 34485595 PMCID: PMC8390450 DOI: 10.1016/j.omtm.2021.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
Difficulties in the collection of hematopoietic stem and progenitor cells (HSPCs) from Fanconi anemia (FA) patients have limited the gene therapy in this disease. We have investigated (ClinicalTrials.gov, NCT02931071) the safety and efficacy of filgrastim and plerixafor for mobilization of HSPCs and collection by leukapheresis in FA patients. Nine of eleven enrolled patients mobilized beyond the threshold level of 5 CD34+ cells/μL required to initiate apheresis. A median of 21.8 CD34+ cells/μL was reached at the peak of mobilization. Significantly, the oldest patients (15 and 16 years old) were the only ones who did not reach that threshold. A median of 4.27 million CD34+ cells/kg was collected in 2 or 3 aphereses. These numbers were markedly decreased to 1.1 million CD34+ cells/kg after immunoselection, probably because of weak expression of the CD34 antigen. However, these numbers were sufficient to facilitate the engraftment of corrected HSPCs in non-conditioned patients. No procedure-associated serious adverse events were observed. Mobilization of CD34+ cells correlated with younger age, higher leukocyte counts and hemoglobin values, lower mean corpuscular volume, and higher proportion of CD34+ cells in bone marrow (BM). All these values offer crucial information for the enrollment of FA patients for gene therapy protocols.
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Affiliation(s)
- Julián Sevilla
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Susana Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Paula Rio
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Rebeca Sánchez-Domínguez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Josune Zubicaray
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Eva Gálvez
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Eva Merino
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Elena Sebastián
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Carmen Azqueta
- Banc de Sang i Teixits de Catalunya, 08005 Barcelona, Spain
| | - José A Casado
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - José C Segovia
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Omaira Alberquilla
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Massimo Bogliolo
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Francisco J Román-Rodríguez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Yari Giménez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Lise Larcher
- Université de Paris, Institut de Recherche Saint-Louis, 75010 Paris, France
| | - Rocío Salgado
- Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Roser M Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Raquel Hladun
- Servicio de Oncología y Hematología Pediátrica, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Ana Castillo
- Análisis Clínicos Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Jean Soulier
- Université de Paris, Institut de Recherche Saint-Louis, 75010 Paris, France
| | - Sergi Querol
- Banc de Sang i Teixits de Catalunya, 08005 Barcelona, Spain
| | | | | | | | | | - Albert Catalá
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Department of Hematology/Oncology, Hospital Sant Joan de Déu, 08950 Barcelona, Spain.,Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
| | - Jordi Surralles
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Cristina Díaz-de-Heredia
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Oncología y Hematología Pediátrica, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Juan A Bueren
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
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11
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Castells-Roca L, Gutiérrez-Enríquez S, Bonache S, Bogliolo M, Carrasco E, Aza-Carmona M, Montalban G, Muñoz-Subirana N, Pujol R, Cruz C, Llop-Guevara A, Ramírez MJ, Saura C, Lasa A, Serra V, Diez O, Balmaña J, Surrallés J. Clinical consequences of BRCA2 hypomorphism. NPJ Breast Cancer 2021; 7:117. [PMID: 34504103 PMCID: PMC8429460 DOI: 10.1038/s41523-021-00322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
The tumor suppressor FANCD1/BRCA2 is crucial for DNA homologous recombination repair (HRR). BRCA2 biallelic pathogenic variants result in a severe form of Fanconi anemia (FA) syndrome, whereas monoallelic pathogenic variants cause mainly hereditary breast and ovarian cancer predisposition. For decades, the co-occurrence in trans with a clearly pathogenic variant led to assume that the other allele was benign. However, here we show a patient with biallelic BRCA2 (c.1813dup and c.7796 A > G) diagnosed at age 33 with FA after a hypertoxic reaction to chemotherapy during breast cancer treatment. After DNA damage, patient cells displayed intermediate chromosome fragility, reduced survival, cell cycle defects, and significantly decreased RAD51 foci formation. With a newly developed cell-based flow cytometric assay, we measured single BRCA2 allele contributions to HRR, and found that expression of the missense allele in a BRCA2 KO cellular background partially recovered HRR activity. Our data suggest that a hypomorphic BRCA2 allele retaining 37–54% of normal HRR function can prevent FA clinical phenotype, but not the early onset of breast cancer and severe hypersensitivity to chemotherapy.
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Affiliation(s)
- Laia Castells-Roca
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sandra Bonache
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Massimo Bogliolo
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Miriam Aza-Carmona
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Montalban
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CHU de Québec - Université Laval Research Center, Oncology division, 9 Rue McMahon, Québec city, G1R 3S3, Québec, Canada
| | - Núria Muñoz-Subirana
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roser Pujol
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Cristina Cruz
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Llop-Guevara
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María J Ramírez
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain
| | - Cristina Saura
- Breast Cancer and Melanoma Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Adriana Lasa
- Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-705, Barcelona, Spain
| | - Violeta Serra
- Experimental Therapeutics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Orland Diez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Jordi Surrallés
- Genome Instability and DNA repair Syndromes Group and Join Unit UAB-IR Sant Pau on Genomic Medicine, Biomedical Research Institute IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Genetics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Center for Biomedical Network Research on Rare Diseases (CIBERER) U-745, Barcelona, Spain.
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12
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Moreno OM, Paredes AC, Suarez-Obando F, Rojas A. An update on Fanconi anemia: Clinical, cytogenetic and molecular approaches (Review). Biomed Rep 2021; 15:74. [PMID: 34405046 PMCID: PMC8329995 DOI: 10.3892/br.2021.1450] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Fanconi anemia is a genetic syndrome clinically characterized by congenital malformations that affect several human systems, leads to progressive bone marrow failure and predisposes an individual to cancer, particularly in the urogenital area as well as the head and neck. It is commonly caused by the biallelic compromise of one of 22 genes involved in the FA/BRCA repair pathway in most cases. The diagnosis is based on clinical suspicion and confirmation using genetic analysis, where the chromosomal breakage test is considered the gold standard. Other diagnostic methods used include western blotting, multiplex ligation-dependent probe amplification and next-generation sequencing. This genetic condition has variable expressiveness, which makes early diagnosis difficult in certain cases. Although early diagnosis does not currently allow for improved cure rates for this condition, it does enable healthcare professionals to perform a specific systematic follow-up and, if indicated, a bone marrow transplantation that improves the mobility and mortality of affected individuals. The present review article is a theoretical revision of the pathophysiology, clinical manifestations and diagnosis methods intended for different specialists and general practitioners to improve the diagnosis of this condition.
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Affiliation(s)
- Olga María Moreno
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Angela Camila Paredes
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia.,Genetics Department, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
| | - Fernando Suarez-Obando
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia.,Genetics Department, Hospital Universitario San Ignacio, Bogotá 110231, Colombia
| | - Adriana Rojas
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
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13
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Ramírez MJ, Pujol R, Trujillo‐Quintero JP, Minguillón J, Bogliolo M, Río P, Navarro S, Casado JA, Badell I, Carrasco E, Balmaña J, Català A, Sevilla J, Beléndez C, Argilés B, López M, Díaz de Heredia C, Rao G, Nicoletti E, Schwartz JD, Bueren JA, Surrallés J. Natural gene therapy by reverse mosaicism leads to improved hematology in Fanconi anemia patients. Am J Hematol 2021; 96:989-999. [PMID: 33984160 DOI: 10.1002/ajh.26234] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/31/2022]
Abstract
Fanconi anemia (FA) is characterized by chromosome fragility, bone marrow failure (BMF) and predisposition to cancer. As reverse genetic mosaicism has been described as "natural gene therapy" in patients with FA, we sought to evaluate the clinical course of a cohort of FA mosaic patients followed at referral centers in Spain over a 30-year period. This cohort includes patients with a majority of T cells without chromosomal aberrations in the DEB-chromosomal breakage test. Relative to non-mosaic FA patients, we observed a higher proportion of adult patients in the cohort of mosaics, with a later age of hematologic onset and a milder evolution of (BMF). Consequently, the requirement for hematopoietic stem cell transplant (HSCT) was also lower. Additional studies allowed us to identify a sub-cohort of mosaic FA patients in whom the reversion was present in bone marrow (BM) progenitor cells leading to multilineage mosaicism. These multilineage mosaic patients are older, have a lower percentage of aberrant cells, have more stable hematology and none of them developed leukemia or myelodysplastic syndrome when compared to non-mosaics. In conclusion, our data indicate that reverse mosaicism is a good prognostic factor in FA and is associated with more favorable long-term clinical outcomes.
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Affiliation(s)
- María José Ramírez
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Roser Pujol
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Juan Pablo Trujillo‐Quintero
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Unitat de Genètica Clínica Pediàtrica Parc Taulí Hospital Universitari Barcelona Spain
| | - Jordi Minguillón
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Massimo Bogliolo
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Paula Río
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Susana Navarro
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - José A. Casado
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Isabel Badell
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Pediatrics Department Hospital de Sant Pau Barcelona Spain
| | | | - Judith Balmaña
- High Risk and Cancer Prevention Unit VHIO Barcelona Spain
- Medical Oncology Department Hospital Vall d'Hebron Barcelona Spain
| | - Albert Català
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Pediatric Hematology Department Institut de Recerca Hospital Sant Joan de Déu Barcelona Barcelona Spain
| | - Julián Sevilla
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Hematología y Hemoterapia Fundación para la Investigación Biomédica Hospital Niño Jesus Madrid Spain
| | | | - Bienvenida Argilés
- Pediatric Hematology Department Hospital Universitario la Fe Valencia Spain
| | - Mónica López
- Hematology Department University Hospital Marqués de Valdecilla (IDIVAL) Santander Spain
| | | | - Gayatri Rao
- Rocket Pharmaceuticals, Inc. Cranbury New Jersey USA
| | | | | | - Juan A. Bueren
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Jordi Surrallés
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Department of Genetics Sant Pau Hospital Barcelona Spain
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14
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Heddar A, Misrahi M. Should FANCL heterozygous pathogenic variants be considered as potentially causative of primary ovarian insufficiency? Hum Mutat 2021; 41:1697-1699. [PMID: 32851770 DOI: 10.1002/humu.24077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Abdelkader Heddar
- Unité de Génétique Moléculaire des Maladies Métaboliques et de la Reproduction, APHP Hôpitaux Universitaires Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,UMR-S 1193, INSERM, Université Paris Saclay, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Micheline Misrahi
- Unité de Génétique Moléculaire des Maladies Métaboliques et de la Reproduction, APHP Hôpitaux Universitaires Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,UMR-S 1193, INSERM, Université Paris Saclay, AP-HP, Hôpital Paul Brousse, Villejuif, France
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15
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Sharp MF, Bythell-Douglas R, Deans AJ, Crismani W. The Fanconi anemia ubiquitin E3 ligase complex as an anti-cancer target. Mol Cell 2021; 81:2278-2289. [PMID: 33984284 DOI: 10.1016/j.molcel.2021.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Agents that induce DNA damage can cure some cancers. However, the side effects of chemotherapy are severe because of the indiscriminate action of DNA-damaging agents on both healthy and cancerous cells. DNA repair pathway inhibition provides a less toxic and targeted alternative to chemotherapy. A compelling DNA repair target is the Fanconi anemia (FA) E3 ligase core complex due to its critical-and likely singular-role in the efficient removal of specific DNA lesions. FA pathway inactivation has been demonstrated to specifically kill some types of cancer cells without the addition of exogenous DNA damage, including cells that lack BRCA1, BRCA2, ATM, or functionally related genes. In this perspective, we discuss the genetic and biochemical evidence in support of the FA core complex as a compelling drug target for cancer therapy. In particular, we discuss the genetic, biochemical, and structural data that could rapidly advance our capacity to identify and implement the use of FA core complex inhibitors in the clinic.
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Affiliation(s)
- Michael F Sharp
- Genome Stability Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia
| | - Rohan Bythell-Douglas
- Genome Stability Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia
| | - Andrew J Deans
- Genome Stability Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia; Department of Medicine (St. Vincent's), University of Melbourne, Fitzroy, VIC, Australia
| | - Wayne Crismani
- Genome Stability Unit, St. Vincent's Institute of Medical Research, Fitzroy, VIC, Australia; Department of Medicine (St. Vincent's), University of Melbourne, Fitzroy, VIC, Australia.
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16
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Heddar A, Misrahi M. Concerns regarding the potentially causal role of FANCA heterozygous variants in human primary ovarian insufficiency. Hum Genet 2020; 140:691-694. [PMID: 33151384 DOI: 10.1007/s00439-020-02232-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Abdelkader Heddar
- Faculté de Médecine; Unité de Génétique Moléculaire Des Maladies Métaboliques Et de La Reproduction, APHP Hôpitaux Universitaires Paris-Saclay, Université Paris Saclay, Hôpital Bicêtre, 94275, Le Kremlin-Bicêtre, France.,Université Paris Saclay, UMR-S 1193, INSERM, Hôpital Paul Brousse, Villejuif, France
| | - Micheline Misrahi
- Faculté de Médecine; Unité de Génétique Moléculaire Des Maladies Métaboliques Et de La Reproduction, APHP Hôpitaux Universitaires Paris-Saclay, Université Paris Saclay, Hôpital Bicêtre, 94275, Le Kremlin-Bicêtre, France. .,Université Paris Saclay, UMR-S 1193, INSERM, Hôpital Paul Brousse, Villejuif, France.
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17
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Thongthip S, Conti BA, Lach FP, Smogorzewska A. Suppression of non-homologous end joining does not rescue DNA repair defects in Fanconi anemia patient cells. Cell Cycle 2020; 19:2553-2561. [PMID: 32865112 DOI: 10.1080/15384101.2020.1810394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Severe cellular sensitivity and aberrant chromosomal rearrangements in response to DNA interstrand crosslink (ICL) inducing agents are hallmarks of Fanconi anemia (FA) deficient cells. These phenotypes have previously been ascribed to inappropriate activity of non-homologous end joining (NHEJ) rather than a direct consequence of DNA ICL repair defects. Here we used chemical inhibitors, RNAi, and Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)-Cas9 to inactivate various components of NHEJ in cells from FA patients. We show that suppression of DNA-PKcs, DNA Ligase IV, and 53BP1 is not capable of rescuing ICL-induced proliferation defects and only 53BP1 knockout partially suppresses the chromosomal abnormalities of FA patient cells.
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Affiliation(s)
- Supawat Thongthip
- Laboratory of Genome Maintenance, The Rockefeller University , New York, NY, USA
| | - Brooke A Conti
- Laboratory of Genome Maintenance, The Rockefeller University , New York, NY, USA
| | - Francis P Lach
- Laboratory of Genome Maintenance, The Rockefeller University , New York, NY, USA
| | - Agata Smogorzewska
- Laboratory of Genome Maintenance, The Rockefeller University , New York, NY, USA
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18
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Sharp MF, Murphy VJ, Twest SV, Tan W, Lui J, Simpson KJ, Deans AJ, Crismani W. Methodology for the identification of small molecule inhibitors of the Fanconi Anaemia ubiquitin E3 ligase complex. Sci Rep 2020; 10:7959. [PMID: 32409752 PMCID: PMC7224301 DOI: 10.1038/s41598-020-64868-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022] Open
Abstract
DNA inter-strand crosslinks (ICLs) threaten genomic stability by creating a physical barrier to DNA replication and transcription. ICLs can be caused by endogenous reactive metabolites or from chemotherapeutics. ICL repair in humans depends heavily on the Fanconi Anaemia (FA) pathway. A key signalling step of the FA pathway is the mono-ubiquitination of Fanconi Anaemia Complementation Group D2 (FANCD2), which is achieved by the multi-subunit E3 ligase complex. FANCD2 mono-ubiquitination leads to the recruitment of DNA repair proteins to the site of the ICL. The loss of FANCD2 mono-ubiquitination is a common clinical feature of FA patient cells. Therefore, molecules that restore FANCD2 mono-ubiquitination could lead to a potential drug for the management of FA. On the other hand, in some cancers, FANCD2 mono-ubiquitination has been shown to be essential for cell survival. Therefore, inhibition of FANCD2 mono-ubiquitination represents a possible therapeutic strategy for cancer specific killing. We transferred an 11-protein FANCD2 mono-ubiquitination assay to a high-throughput format. We screened 9,067 compounds for both activation and inhibition of the E3 ligase complex. The use of orthogonal assays revealed that candidate compounds acted via non-specific mechanisms. However, our high-throughput biochemical assays demonstrate the feasibility of using sophisticated and robust biochemistry to screen for small molecules that modulate a key step in the FA pathway. The future identification of FA pathway modulators is anticipated to guide future medicinal chemistry projects with drug leads for human disease.
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Affiliation(s)
- Michael F Sharp
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia
| | - Vince J Murphy
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia
| | - Sylvie Van Twest
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia
| | - Winnie Tan
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia.,Department of Medicine (St. Vincent's Health), The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Jennii Lui
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Kaylene J Simpson
- Victorian Centre for Functional Genomics, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Andrew J Deans
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia.,Department of Medicine (St. Vincent's Health), The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Wayne Crismani
- St Vincent's Institute of Medical Research, Fitzroy, Victoria, 3065, Australia. .,Department of Medicine (St. Vincent's Health), The University of Melbourne, Melbourne, VIC, 3010, Australia.
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