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Taylor H, Yerlioglu D, Phen C, Ballauff A, Nedelkopoulou N, Spier I, Loverdos I, Busoni VB, Heise J, Dale P, de Meij T, Sweet K, Cohen MC, Fox VL, Mas E, Aretz S, Eng C, Buderus S, Thomson M, Rojas I, Uhlig HH. mTOR inhibitors reduce enteropathy, intestinal bleeding and colectomy rate in patients with juvenile polyposis of infancy with PTEN-BMPR1A deletion. Hum Mol Genet 2021; 30:1273-1282. [PMID: 33822054 PMCID: PMC8804886 DOI: 10.1093/hmg/ddab094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022] Open
Abstract
Ultra-rare genetic disorders can provide proof of concept for efficacy of targeted therapeutics and reveal pathogenic mechanisms relevant to more common conditions. Juvenile polyposis of infancy (JPI) is caused by microdeletions in chromosome 10 that result in haploinsufficiency of two tumor suppressor genes: phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and bone morphogenetic protein receptor type IA (BMPR1A). Loss of PTEN and BMPR1A results in a much more severe phenotype than deletion of either gene alone, with infantile onset pan-enteric polyposis and a high mortality rate. No effective pharmacological therapy exists. A multi-center cohort analysis was performed to characterize phenotype and investigate the therapeutic effect of mammalian target of rapamycin (mTOR) inhibition (adverse events, disease progression, time to colectomy and mortality) in patients with JPI. Among 25 JPI patients identified (mean age of onset 13 months), seven received mTOR inhibitors (everolimus, n = 2; or sirolimus, n = 5). Treatment with an mTOR inhibitor reduced the risk of colectomy (hazard ratio = 0.27, 95% confidence interval = 0.07-0.954, P = 0.042) and resulted in significant improvements in the serum albumin level (mean increase = 16.3 g/l, P = 0.0003) and hemoglobin (mean increase = 2.68 g/dl, P = 0.0077). Long-term mTOR inhibitor treatment was well tolerated over an accumulated follow-up time of 29.8 patient years. No serious adverse events were reported. Early therapy with mTOR inhibitors offers effective, pathway-specific and personalized treatment for patients with JPI. Inhibition of the phosphoinositol-3-kinase-AKT-mTOR pathway mitigates the detrimental synergistic effects of combined PTEN-BMPR1A deletion. This is the first effective pharmacological treatment identified for a hamartomatous polyposis syndrome.
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Affiliation(s)
- Henry Taylor
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
| | - Dilay Yerlioglu
- Faculty of Medicine, Istanbul University, Istanbul, Fatih 34093, Turkey
| | - Claudia Phen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Antje Ballauff
- Zentrum für Kinder- und Jugendmedizin Gastroenterology, HELIOS Klinikum Krefeld, Krefeld, Nordrhein-Westfalen 47805, Germany
| | - Natalia Nedelkopoulou
- Pediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Yorkshire S10 2TH, UK
| | - Isabel Spier
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Nordrhein-Westfalen 53012, Germany.,National Centre for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Nordrhein-Westfalen 53126, Germany
| | - Inés Loverdos
- Pediatric Gastroenterology Hepatology and Nutrition Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia comunidad 08208, Spain
| | - Veronica B Busoni
- Pediatric Gastroenterology, Hepatology and Liver-Intestine Transplantation Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jürgen Heise
- Zentrum für Kinder- und Jugendmedizin Gastroenterology, HELIOS Klinikum Krefeld, Krefeld, Nordrhein-Westfalen 47805, Germany
| | - Peter Dale
- Royal Gwent Hospital, Newport NP20 2UB, UK
| | - Tim de Meij
- VU University Medical Center, Amsterdam 1081, The Netherlands
| | - Kevin Sweet
- Division of Human Genetics, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Yorkshire S10 2TH, UK
| | - Victor L Fox
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA
| | - Emmanuel Mas
- Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, and IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, Occitanie 31300, France
| | - Stefan Aretz
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Nordrhein-Westfalen 53012, Germany.,National Centre for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Nordrhein-Westfalen 53126, Germany
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of Genetics and Genome Sciences, and CASE Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Stephan Buderus
- GFO-Kliniken Bonn, St. Marien-Hospital, Bonn, Nordrhein-Westfalen 53115, Germany
| | - Mike Thomson
- Pediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Yorkshire S10 2TH, UK
| | - Isabel Rojas
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Holm H Uhlig
- Translational Gastroenterology Unit, University of Oxford, Oxford, Oxfordshire OX3 9DU, UK.,Department of Pediatrics, University of Oxford, Oxford, Oxfordshire OX3 9DU, UK.,Biomedical Research Centre, University of Oxford, Oxford, Oxfordshire OX4 2PG, UK
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Macken WL, Tischkowitz M, Lachlan KL. PTEN Hamartoma tumor syndrome in childhood: A review of the clinical literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:591-610. [PMID: 31609537 DOI: 10.1002/ajmg.c.31743] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Abstract
PTEN hamartoma tumor syndrome (PHTS) is a highly variable autosomal dominant condition associated with intellectual disability, overgrowth, and tumor predisposition phenotypes, which often overlap. PHTS incorporates a number of historical clinical presentations including Bannayan-Riley-Ruvalcaba syndrome, Cowden syndrome, and a macrocephaly-autism/developmental delay syndrome. Many reviews in the literature focus on PHTS as an adult hamartoma and malignancy predisposition condition. Here, we review the current literature with a focus on pediatric presentations. The review starts with a summary of the main conditions encompassed within PHTS. We then discuss PHTS diagnostic criteria, and clinical features. We briefly address rarer PTEN associations, and the possible role of mTOR inhibitors in treatment. We acknowledge the limited understanding of the natural history of childhood-onset PHTS as a cancer predisposition syndrome and present a summary of important management considerations.
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Affiliation(s)
- William L Macken
- Wessex Clinical Genetics Service, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Marc Tischkowitz
- Department of Clinical Genetics, East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medical Genetics, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Katherine L Lachlan
- Wessex Clinical Genetics Service, University Hospitals Southampton NHS Trust, Southampton, United Kingdom.,Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Hsiao YH, Wei CH, Chang SW, Chang L, Fu YW, Lee HC, Liu HL, Yeung CY. Juvenile polyposis syndrome: An unusual case report of anemia and gastrointestinal bleeding in young infant. Medicine (Baltimore) 2016; 95:e4550. [PMID: 27631205 PMCID: PMC5402548 DOI: 10.1097/md.0000000000004550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
BACKGROUND Juvenile polyposis syndrome, a rare disorder in children, is characterized with multiple hamartomatous polyps in alimentary tract. A variety of manifestations include bleeding, intussusception, or polyp prolapse. In this study, we present an 8-month-old male infant of juvenile polyposis syndrome initially presenting with chronic anemia. To the best of our knowledge, this is the youngest case reported in the literature. METHODS We report a rare case of an 8-month-old male infant who presented with chronic anemia and gastrointestinal bleeding initially. Panendoscopy and abdominal computed tomography showed multiple polyposis throughout the entire alimentary tract leading to intussusception. Technetium-99m-labeled red blood cell (RBC) bleeding scan revealed the possibility of gastrointestinal tract bleeding in the jejunum. Histopathological examination on biopsy samples showed Peutz-Jeghers syndrome was excluded, whereas the diagnosis of juvenile polyposis syndrome was established. RESULTS Enteroscopic polypectomy is the mainstay of the treatment. However, polyps recurred and occupied the majority of the gastrointestinal tract in 6 months. Supportive management was given. The patient expired for severe sepsis at the age of 18 months. CONCLUSION Juvenile polyposis syndrome is an inherited disease, so it is not possible to prevent it. Concerning of its poor outcome and high mortality rate, it is important that we should increase awareness and education of the parents at its earliest stages.
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Affiliation(s)
- Yi-Han Hsiao
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Chin-Hung Wei
- Department of Medicine, Mackay Medical College
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital
| | - Szu-Wen Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Lung Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Yu-Wei Fu
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital
| | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Hsuan-Liang Liu
- Institute of Biotechnology and Department of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
- Department of Medicine, Mackay Medical College
- Institute of Biotechnology and Department of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
- Correspondence: Chun-Yan Yeung, Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan (e-mail: )
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Ramalingam S, Ramamoorthy P, Subramaniam D, Anant S. Reduced Expression of RNA Binding Protein CELF2, a Putative Tumor Suppressor Gene in Colon Cancer. ACTA ACUST UNITED AC 2012; 1:27-33. [PMID: 23795348 DOI: 10.7178/ig.1.1.7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS Colon cancer is the third leading cause of cancer death in both men and women in the United States. Every year, 160000 cases of colorectal cancer are diagnosed, and 57000 patients die. CUGBP, Elav-like family member 2 (CELF2) is an RNA binding protein that modulates various posttranscriptional events including RNA splicing, shuttling, editing, stability and translation. Previous studies have demonstrated that CELF2 expression is low in colon cancer cells. Furthermore, ectopic overexpression of CELF2 induces cells to undergo death by mitotic catastrophe. Based on the above observations, we hypothesized that CELF2 expression might be reduced during neoplastic transformation of colon cells. METHODS Forty human colon cancer tissues along with 10 uninvolved normal colon tissues from cancer patients were utilized for immunohistochemical analysis of CELF2 expression. RESULTS We have observed that CELF2 levels are reduced in colon tumor tissues when compared to the normal intestinal tissues. The data set suggests that RNA binding protein CELF2 could be a potential tumor suppressor protein. CELF2 was predominantly nuclear in normal cells, while the cancer tissues had diffused cytoplasmic staining. CONCLUSION CELF2 expression is consistently reduced during neoplastic transformation suggesting that it might play a crucial role in tumor initiation and progression.
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Affiliation(s)
- Satish Ramalingam
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas, USA ; Kansas University Cancer Center, University of Kansas Medical Center, Kansas, USA
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Babovic N, Simmons PS, Moir C, Thorland EC, Scheithauer B, Gliem TJ, Babovic-Vuksanovic D. Mucinous cystadenoma of ovary in a patient with juvenile polyposis due to 10q23 microdeletion: expansion of phenotype. Am J Med Genet A 2010; 152A:2623-7. [PMID: 20815035 DOI: 10.1002/ajmg.a.33637] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Juvenile polyposis syndrome (JPS) is a hereditary condition characterized by development of gastrointestinal polyps, and caused by mutations in SMAD4 or BMPR1A genes. Juvenile polyps can also be found in a related group of syndromes with multisystemic involvement including Cowden disease, Lhermitte-Duclos disease, Bannayan-Riley-Ruvalcaba syndrome, and Proteus-like syndrome, all grouped as PTEN hamartoma tumor syndromes (PHTS). In all these conditions including JPS, polyps manifest in older childhood or early adulthood. Infantile juvenile polyposis (JPI) is a rare entity, presenting in the first year of life with severe gastrointestinal symptoms. Many of these patients have associated macrocephaly, hypotonia, and congenital anomalies. It was recently recognized that patients with infantile polyposis have a 10q23 microdeletion, involving both BMPR1A and PTEN genes. There is a major risk for gastrointestinal malignancies in these patients, but the risk for development of other tumors is not known. We describe a patient with a history of infantile polyposis, macrocephaly, developmental delay, hypotonia, and a 10q23 microdeletion. At age 14 she presented with bilateral mucinous cystadenoma of the ovary. This type of tumor was not previously reported in association with JPS, 10q23 microdeletion syndrome, or infantile polyposis. We believe that ovarian cystadenomas may be another neoplastic complication of infantile polyposis, and that our report widens the spectrum of the 10q23 microdeletion phenotype.
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Affiliation(s)
- Nikola Babovic
- Mayo Medical School, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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