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Mensa-Vilaró A, Bravo García-Morato M, de la Calle-Martin O, Franco-Jarava C, Martínez-Saavedra MT, González-Granado LI, González-Roca E, Fuster JL, Alsina L, Mutchinick OM, Balderrama-Rodríguez A, Ramos E, Modesto C, Mesa-Del-Castillo P, Ortego-Centeno N, Clemente D, Souto A, Palmou N, Remesal A, Leslie KS, Gómez de la Fuente E, Yadira Bravo Gallego L, Campistol JM, Dhouib NG, Bejaoui M, Dutra LA, Terreri MT, Mosquera C, González T, Cañellas J, García-Ruiz de Morales JM, Wouters CH, Bosque MT, Cham WT, Jiménez-Treviño S, de Inocencio J, Bloomfield M, Pérez de Diego R, Martínez-Pomar N, Rodríguez-Pena R, González-Santesteban C, Soler-Palacín P, Casals F, Yagüe J, Allende LM, Rodríguez-Gallego JC, Colobran R, Martínez-Martínez L, López-Granados E, Aróstegui JI. Unexpected relevant role of gene mosaicism in patients with primary immunodeficiency diseases. J Allergy Clin Immunol 2018; 143:359-368. [PMID: 30273710 DOI: 10.1016/j.jaci.2018.09.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/21/2018] [Accepted: 09/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postzygotic de novo mutations lead to the phenomenon of gene mosaicism. The 3 main types are called somatic, gonadal, and gonosomal mosaicism, which differ in terms of the body distribution of postzygotic mutations. Mosaicism has been reported occasionally in patients with primary immunodeficiency diseases (PIDs) since the early 1990s, but its real involvement has not been systematically addressed. OBJECTIVE We sought to investigate the incidence of gene mosaicism in patients with PIDs. METHODS The amplicon-based deep sequencing method was used in the 3 parts of the study that establish (1) the allele frequency of germline variants (n = 100), (2) the incidence of parental gonosomal mosaicism in families with PIDs with de novo mutations (n = 92), and (3) the incidence of mosaicism in families with PIDs with moderate-to-high suspicion of gene mosaicism (n = 36). Additional investigations evaluated body distribution of postzygotic mutations, their stability over time, and their characteristics. RESULTS The range of allele frequency (44.1% to 55.6%) was established for germline variants. Those with minor allele frequencies of less than 44.1% were assumed to be postzygotic. Mosaicism was detected in 30 (23.4%) of 128 families with PIDs, with a variable minor allele frequency (0.8% to 40.5%). Parental gonosomal mosaicism was detected in 6 (6.5%) of 92 families with de novo mutations, and a high incidence of mosaicism (63.9%) was detected among families with moderate-to-high suspicion of gene mosaicism. In most analyzed cases mosaicism was found to be both uniformly distributed and stable over time. CONCLUSION This study represents the largest performed to date to investigate mosaicism in patients with PIDs, revealing that it affects approximately 25% of enrolled families. Our results might have serious consequences regarding treatment and genetic counseling and reinforce the use of next-generation sequencing-based methods in the routine analyses of PIDs.
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Affiliation(s)
- Anna Mensa-Vilaró
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain.
| | | | | | - Clara Franco-Jarava
- Department of Immunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain; Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | | | - Luis I González-Granado
- Primary Immunodeficiencies Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Eva González-Roca
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Luis Fuster
- Department of Hematology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Laia Alsina
- Department of Allergy and Clinical Immunology, Hospital Sant Joan de Deu, Esplugues, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues, Spain
| | - Osvaldo M Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Eduardo Ramos
- Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Consuelo Modesto
- Department of Pediatric Rheumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pablo Mesa-Del-Castillo
- Department of Pediatric Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Daniel Clemente
- Department of Pediatric Rheumatology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Alejandro Souto
- Department of Rheumatology, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Natalia Palmou
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Agustín Remesal
- Department of Pediatric Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | | | | | | | - Naouel Guirat Dhouib
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis, Tunisia
| | - Mohamed Bejaoui
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis, Tunisia
| | - Lívia Almeida Dutra
- Division of General Neurology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Maria Teresa Terreri
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Catalina Mosquera
- Department of Pediatric Rheumatology, Universidad El Bosque, Bogota, Colombia
| | - Tatiana González
- Department of Pediatric Rheumatology, Universidad de Cartagena, Cartagena, Colombia
| | - Jerónima Cañellas
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Carine H Wouters
- Departments of Pediatric Rheumatology, Microbiology and Immunology, University Hospitals Leuven, KU University of Leuven, Leuven, Belgium
| | - María Teresa Bosque
- Department of Rheumatology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Weng Tarng Cham
- Department of Pediatric Rheumatology, Sunway Medical Centre, Kuala Lumpur, Malaysia
| | | | - Jaime de Inocencio
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Markéta Bloomfield
- Department of Immunology, 2(nd) Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Rebeca Pérez de Diego
- Laboratory of Immunogenetics of Diseases, IdiPAZ Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain; Innate Immunity Group, IdiPAZ Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Pere Soler-Palacín
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain; Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Ferran Casals
- Department of Genomics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Yagüe
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Luis M Allende
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense, Madrid, Spain; Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Roger Colobran
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain; Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Juan I Aróstegui
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain.
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Ramos F, Robledo C, Izquierdo-García FM, Suárez-Vilela D, Benito R, Fuertes M, Insunza A, Barragán E, Del Rey M, García-Ruiz de Morales JM, Tormo M, Salido E, Zamora L, Pedro C, Sánchez-Del-Real J, Díez-Campelo M, Del Cañizo C, Sanz GF, Hernández-Rivas JM. Bone marrow fibrosis in myelodysplastic syndromes: a prospective evaluation including mutational analysis. Oncotarget 2017; 7:30492-503. [PMID: 27127180 PMCID: PMC5058695 DOI: 10.18632/oncotarget.9026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/17/2016] [Indexed: 02/07/2023] Open
Abstract
The biological and molecular events that underlie bone marrow fibrosis in patients with myelodysplastic syndromes are poorly understood, and its prognostic role in the era of the Revised International Prognostic Scoring System (IPSS-R) is not yet fully determined. We have evaluated the clinical and biological events that underlie bone marrow fibrotic changes, as well as its prognostic role, in a well-characterized prospective patient cohort (n=77) of primary MDS patients. The degree of marrow fibrosis was linked to parameters of erythropoietic failure, marrow cellularity, p53 protein accumulation, WT1 gene expression, and serum levels of CXCL9 and CXCL10, but not to other covariates including the IPSS-R score. The presence of bone marrow fibrosis grade 2 or higher was associated with the presence of mutations in cohesin complex genes (31.5% vs. 5.4%, p=0.006). By contrast, mutations in CALR, JAK2, PDGFRA, PDGFRB,and TP53 were very rare. Survival analysis showed that marrow fibrosis grade 2 or higher was a relevant significant predictor for of overall survival, and independent of age, performance status, and IPSS-R score in multivariate analysis.
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Affiliation(s)
- Fernando Ramos
- Department of Hematology, Hospital Universitario de León, León, Spain.,Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Cristina Robledo
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | | | | | - Rocío Benito
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | - Marta Fuertes
- Department of Hematology, Hospital Universitario de León, León, Spain
| | - Andrés Insunza
- Department of Hematology, Hospital Universitario U. Marqués de Valdecilla, Santander, Spain
| | - Eva Barragán
- Department of Molecular Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mónica Del Rey
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | | | - Mar Tormo
- Department of Hematology-Oncology, Hospital Clínico Universitario, Valencia, Spain
| | - Eduardo Salido
- Department of Hematology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Lurdes Zamora
- Unit of Molecular Genetics, ICO-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Spain
| | - Carmen Pedro
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Guillermo F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesús María Hernández-Rivas
- Unidad de Diagnóstico Molecular y Celular del Cáncer, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain.,Department of Hematology, Hospital Universitario de Salamanca, Spain
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