An Asymptomatic, Ectopic Mass as a Presentation of Adrenocortical Carcinoma Due to a Novel Germline TP53 p.Phe338Leu Tetramerisation Domain Variant

Adrenocortical carcinoma (ACC) is a rare cancer in childhood. ACC is frequently associated with germline TP53 variants, with founder effects especially due to the p.Arg337His mutation. ACC leads to the secretion of adrenocortical hormones, resulting in endocrine syndromes, which is the usual trigger for establishing the diagnosis. We present a surprising ACC pathology in a non-secreting, ectopic retroperitoneal tumour in a 4-year-old boy, successfully controlled with chemotherapy and mitotane after microscopically incomplete tumour resection with spillage. Genomic analysis (gene panel sequencing and copy-number microarray) demonstrated a novel p.Phe338Leu tetramerisation domain (TD) TP53 variant in the proband and his cancer-free mother and a monoallelic deletion encompassing the TP53 locus in cancer tissue, consistent with cancer-predisposition syndrome. While the recurrent p.Arg337His variant translates into high ACC risk, residue 338 and, in general, TD domain variants drive heterogeneous clinical scenarios, despite generally being considered less disruptive than TP53 DNA-binding domain mutations.

Four Decades of Carrier Detection and Prenatal Diagnosis in Hemophilia A: Historical Overview, State of the Art and Future Directions

Hemophilia A (HA), a rare recessive X-linked bleeding disorder, is caused by either deficiency or dysfunction of coagulation factor VIII (FVIII) resulting from deleterious mutations in the F8 gene encoding FVIII. Over the last 4 decades, the methods aimed at determining the HA carrier status in female relatives of HA patients have evolved from phenotypic studies based on coagulation tests providing merely probabilistic results, via genetic linkage studies based on polymorphic markers providing more accurate results, to next generation sequencing studies enabling highly precise identification of the causative F8 mutation. In parallel, the options for prenatal diagnosis of HA have progressed from examination of FVIII levels in fetal blood samples at weeks 20-22 of pregnancy to genetic analysis of fetal DNA extracted from chorionic villus tissue at weeks 11-14 of pregnancy. In some countries, in vitro fertilization (IVF) combined with preimplantation genetic diagnosis (PGD) has gradually become the procedure of choice for HA carriers who wish to prevent further transmission of HA without the need to undergo termination of pregnancies diagnosed with affected fetuses. In rare cases, genetic analysis of a HA carrier might be complicated by skewed X chromosome inactivation (XCI) of her non-hemophilic X chromosome, thus leading to the phenotypic manifestation of moderate to severe HA. Such skewed XCI may be associated with deleterious mutations in X-linked genes located on the non-hemophilic X chromosome, which should be considered in the process of genetic counseling and PGD planning for the symptomatic HA carrier. Therefore, whole exome sequencing, combined with X-chromosome targeted bioinformatic analysis, is highly recommended for symptomatic HA carriers diagnosed with skewed XCI in order to identify additional deleterious mutations potentially involved in XCI skewing. Identification of such mutations, which may profoundly impact the reproductive choices of HA carriers with skewed XCI, is extremely important.

A high prevalence of neutrophil-specific antibodies in ELANE-mutated severe congenital neutropenia

An assay for neutrophil-specific antibodies is frequently used in the workup of chronic severe neutropenia and is suggestive of autoimmune, or sporadically alloimmune neutropenia, rather than severe congenital neutropenia (SCN). We analyzed a neutropenia consortium database for the outcomes of antibody testing initiated before receiving genetic diagnosis in Polish SCN cohort. Test results, performed in a single reference laboratory, were available for 14 patients with ELANE-mutated SCN or cyclic neutropenia, and were frequently positive (36%). We note that the trigger for genetic studies in severe neutropenia should not be affected by antibody-positivity and should be clinically driven.

Challenges in the interpretation of a germline TERT variant in a patient with juvenile myelomonocytic leukemia

Dyskeratosis congenita (DC) is a bone marrow failure syndrome with extrahematopoietic abnormalities. DC is a paradigmatic telomere biology disorder (TBD) caused by germline mutations in genes responsible for telomere maintenance including TERT. Cryptic TBD is a bone marrow failure syndrome due to premature telomere shortening but without additional symptoms, frequently clinically indistinguishable from severe aplastic anemia (SAA) or hypoplastic myelodysplastic syndrome. We present the complex diagnostic pathway in a boy with a rare germline p.Thr726Met TERT variant with previous reports of SAA association and compromised enzymatic function who presented with juvenile myelomonocytic leukemia, which is a rare myelodysplastic/myeloproliferative neoplasm of childhood.

Novel FANCA mutation in the first fully-diagnosed patient with Fanconi anemia in Polish population - case report

BACKGROUND

Fanconi anemia is a rare genetic disorder caused by mutations in genes which protein products are involved in replication, cell cycle control and DNA repair. It is characterized by congenital malformations, bone marrow failure, and high risk of cancer. The diagnosis is based on morphological and hematological abnormalities such as pancytopenia, macrocytic anaemia and progressive bone marrow failure. Genetic examination, often very complex, includes chromosomal breakage testing and mutational analysis.

CASE PRESENTATION

We present a child with clinical diagnosis of Fanconi anemia. Although morphological abnormalities of skin and bones were present from birth, diagnosis was only suspected at the age of 8. Chromosome breakage test in patient's lymphocytes showed increased level of aberrations (gaps, chromatid breaks, chromosome breaks, radial figures and rearrangements) compared to control. Next generation sequencing revealed presence of two pathogenic variants in FANCA gene, one of which was not previously reported.

CONCLUSIONS

The article provides additional supportive evidence that compound biallelic mutations of FANCA are associated with Fanconi anemia. It also illustrates the utility of combination of cytogenetic and molecular tests, together with detailed clinical evaluation in providing accurate diagnosis of Fanconi anemia. This report, to the best of our knowledge, describes the first fully diagnosed FA patient in Polish population.

The Clinical and Genetic Spectrum of 82 Patients With RAG Deficiency Including a c.256_257delAA Founder Variant in Slavic Countries

Background: Variants in recombination-activating genes (RAG) are common genetic causes of autosomal recessive forms of combined immunodeficiencies (CID) ranging from severe combined immunodeficiency (SCID), Omenn syndrome (OS), leaky SCID, and CID with granulomas and/or autoimmunity (CID-G/AI), and even milder presentation with antibody deficiency. Objective: We aim to estimate the incidence, clinical presentation, genetic variability, and treatment outcome with geographic distribution of patients with the RAG defects in populations inhabiting South, West, and East Slavic countries. Methods: Demographic, clinical, and laboratory data were collected from RAG-deficient patients of Slavic origin via chart review, retrospectively. Recombinase activity was determined in vitro by flow cytometry-based assay. Results: Based on the clinical and immunologic phenotype, our cohort of 82 patients from 68 families represented a wide spectrum of RAG deficiencies, including SCID (n = 20), OS (n = 37), and LS/CID (n = 25) phenotypes. Sixty-seven (81.7%) patients carried RAG1 and 15 patients (18.3%) carried RAG2 biallelic variants. We estimate that the minimal annual incidence of RAG deficiency in Slavic countries varies between 1 in 180,000 and 1 in 300,000 live births, and it may vary secondary to health care disparities in these regions. In our cohort, 70% (n = 47) of patients with RAG1 variants carried p.K86Vfs^*33 (c.256_257delAA) allele, either in homozygous (n = 18, 27%) or in compound heterozygous (n = 29, 43%) form. The majority (77%) of patients with homozygous RAG1 p.K86Vfs^*33 variant originated from Vistula watershed area in Central and Eastern Poland, and compound heterozygote cases were distributed among all Slavic countries except Bulgaria. Clinical and immunological presentation of homozygous RAG1 p.K86Vfs^*33 cases was highly diverse (SCID, OS, and AS/CID) suggestive of strong influence of additional genetic and/or epigenetic factors in shaping the final phenotype. Conclusion: We propose that RAG1 p.K86Vfs^*33 is a founder variant originating from the Vistula watershed region in Poland, which may explain a high proportion of homozygous cases from Central and Eastern Poland and the presence of the variant in all Slavs. Our studies in this cohort of RAG1 founder variants confirm that clinical and immunological phenotypes only partially depend on the underlying genetic defect. As access to HSCT is improving among RAG-deficient patients in Eastern Europe, we anticipate improvements in survival.

Six molecular patterns leading to hemophilia A phenotype in 18 females from Poland

INTRODUCTION

Female hemophilia is an intriguing rare disorder and few larger reports on its genetic etiology are available. While historically the diagnosis was satisfactorily reached by factor VIII activity assays, the clinical and potentially therapeutic heterogeneity of female hemophilia calls for comprehensive molecular diagnosis in each case. Currently, the genetic investigations are not a part of routine, state-funded, diagnostics in Poland, and thus molecular epidemiological data are missing.

AIM

We set out to perform a comprehensive genetic analysis of Polish females with hemophilia A.

PATIENTS/METHODS

Eighteen females with hemophilia A (including 2 with severe and 5 with moderate hemophilia phenotype) consented for genetic diagnostics. To establish F8 mutations, we used next-generation sequencing of a panel of genes associated with hematological disorders, standard assays for recurrent intragenic F8 inversions and MLPA when deletions were suspected. When appropriate we also used karyotyping, genomic microarrays and X chromosome inactivation assays.

RESULTS

While abnormally skewed X-chromosome inactivation combined with a F8 variant on the active allele was, as expected, the most common genetic etiology, a number of other genetic scenarios were unraveled. This included: misdiagnosis (molecular diagnosis of vWd), Turner syndrome, compound heterozygosity and androgen insensitivity syndrome (a phenotypical 46,XY female with a novel androgen receptor gene mutation). We report 3 novel F8 mutations.

CONCLUSION

Every case of female hemophilia warrants full genomic diagnostics, as this may change the diagnosis or reveal broader morbidity than a coagulation disorder (Turner syndrome, androgen insensitivity, or cardiovascular morbidity that we described previously in a SHAM syndrome carrier).

[Genetic analysis of human remains exhumed during archaeological excavations on former military training ground Brus in Lodz]

The aim of this study was the genetic identification of Nazi repression victims. Human remains were found in 2011 in the area of former military training ground BRUS in Lodz. Genetic tests were performed upon the request of the Departmental Commission for the Prosecution of Crimes against the Polish Nation of the Institute of National Remembrance in Lodz. The research material was provided by the Institute of Archaeology (University of Lodz). It consisted of bones and teeth which were exhumed from mass Grave No 7. As a reference material we used a buccal swab collected from the putative son of one of the victims. Genomic DNA was extracted from the skeletal samples using the PrepFiler BTA Forensic DNA Extraction Kit. DNA was amplified using the AmpFlSTR Identifiler Plus PCR Amplification Kit and analyzed using an AB 3500 genetic analyzer. The obtained results showed 12 male genetic profiles. The analysis excluded paternity of 10 investigated victims. The genetic data of the remaining samples did not allow for paternity settlement.

[Y-STR Poland--a database for evaluation of evidence value in forensic genetics]

The "Y-STR Poland" is a multicenter project, the aim of which is the construction of a widely available database of Y chromosome haplotypes determined in the Polish population in a range of sixteen loci in AmpFISTR Y-filer system. The database will be regularly updated and it will be used in assessment of evidence value in forensic genetics. The starting base "Y-STR Poland" contains 1600 Y-STR haplotypes and encompasses data collected in Lodz (two independent centers), Warsaw and Szczecin regions. The present report contains as an attachment the data in an Excel-type file, which serves as a tool in frequency determination of a given Y haplotype in the Polish population. The file will be updated on a regular basis along with updating the database, and will be freely available from www.genetyka-sadowa.pl.

[The usefulness of SNP markers for analyses of highly degraded biological materials]

The most common cause of problems associated with analyzing DNA extracted from forensic samples is their high level of degradation. Such difficulties are caused by the fact that STR markers have too large amplicon sizes to be amplified in degraded DNA samples. Thus, it is necessary to employ more efficient markers for analyzing evidential samples. SNPs are ideal tools for such purposes, for the SNP genotyping method does not require large amplicon size, and thus increases the possibility of amplifying degraded DNA samples. Although single SNP is not polymorphic enough, we can obtain sufficient results by examining several SNPs. The aim of this study was to examine the usefulness of the SNP-pentaplex (rs2294067, rs2282160, rs2070764, rs2277216, rs1063739) for forensic applications by analysing several forensic cases, which were impossible to solve in a range of STR markers because of highly degraded DNA. DNA fragments were amplified in one multiplex PCR reaction, which contained 5 primer pairs. SNPs were subsequently identified in a minisequencing reaction and gel electrophoresis in an ABI Prism 377 Sequencer. The research confirmed the usefulness of SNP-pentaplex for forensic applications. Despite employing mainly degraded and low copy number DNA, full genetic profiles were obtained in almost every sample. Although the discrimination power of SNP-pentaplex is not sufficient for obtaining adequate evidential value, it seems to be an ideal screening method for forensic applications.

SNP-minisequencing as an excellent tool for analysing degraded DNA recovered from archival tissues

SNP-minisequencing has become common in forensic genetics, especially for analysing degraded or low copy number DNA (LCN DNA). The aim of this study was to examine the usefulness of five SNP (single nucleotide polymorphism) markers for analyzing degraded and LCN DNA recovered from archival samples. DNA extractions of eight formalin-fixed paraffin-embedded (FFPE) tissues were performed and DNA fragments were amplified in one multiplex PCR (polymerase chain reaction). SNPs were identified in a minisequencing reaction and a gel electrophoresis in ABI Prism 377 Sequencer. The research confirmed the usefulness of SNP-minisequencing for analysing FFPE tissues.

SNP-minisequencing as an excellent tool for analysing degraded DNA recovered from archival tissues

SNP-minisequencing has become common in forensic genetics, especially for analysing degraded or low copy number DNA (LCN DNA). The aim of this study was to examine the usefulness of five SNP (single nucleotide polymorphism) markers for analyzing degraded and LCN DNA recovered from archival samples. DNA extractions of eight formalin-fixed paraffin-embedded (FFPE) tissues were performed and DNA fragments were amplified in one multiplex PCR (polymerase chain reaction). SNPs were identified in a minisequencing reaction and a gel electrophoresis in ABI Prism 377 Sequencer. The research confirmed the usefulness of SNP-minisequencing for analysing FFPE tissues.

[The central Poland population database of 500 SNP alleles]

SNP analysis is one of the most contemporary methods for personal identification in forensic genetics. It is increasingly more frequently used in forensic practice, especially for analyses of highly degraded DNA samples from crime scenes and thus it requires suitable population data. The aim of this study was to develop a central Poland population database consisting of 500 alleles in a range of 5 SNP biallelic loci (rs2294067, rs2282160, rs2070764, rs2277216, rs1063739). DNA fragments were amplified in one multiplex PCR reaction and SNPs were identified in a minisequencing reaction. The combined PD of the pentaplex was 0.9907147657. This makes the pentaplex a good screening method for forensic applications.

[The utility of the 16 Y-STRS markers in the central Poland population]

Haplotype and allele frequencies for the panel of 16 Y-chromosome STR loci, namely DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393, DYS437, DYS438, DYS439, DYS448, DYS456, DYS458, DYS635 and Y GATA-H4 were determined in a population sample of 250 unrelated males from the central region of Poland. The 238 different haplotypes were identified, of which 227 haplotypes were unique, 10 were duplicated and one haplotype was shared between three unrelated men. The average gene diversity was 0.5995, combined gene diversity was 0.9998 and probability that two randomly chosen haplotypes are different in the population was 0.9996. Interpopulation comparisons revealed that Polish population is homogeneous within the three compared samples, while it differs statistically significantly from other population samples apart from Spanish population. This seems to be the first report showing the analysis of the molecular genetic distance between the population of Poland and other European and world populations for the panel of 16 Y-chromosome STR loci. The analyzed set of Y-STR markers is very useful in forensic casework to identify males and trace paternal lineages.

[SNP pentaplex--the allele frequency database of central Poland population]

SNP analysis is among the most contemporary method for personal identification in forensic genetics, especially in analyses of untypical cases and in studies of degraded DNA samples from crime scenes. This paper shows the results of Central Poland population studies carried out using minisequencing and SNP-pentaplex, which contains 5 biallelic loci rs2294067, rs2282160, rs2070764, rs2277216 and rs1063739. DNA fragments were amplified in one multiplex PCR reaction and SNPs were identified by the minisequencing method. The combined PD was 0.9895253125, which makes the pentaplex useful for forensic applications.

[Estimating the efficiency of DNA isolation methods in semen, blood and saliva stains using the QuantiBlot system]

The aim of this study was to compare and select the optimal method of DNA isolation from blood, semen and saliva stains, as well as to determine appropriate conditions for employing amplification kits for identification of individual persons [brak w polskim tekście]. The materials analyzed in this study consisted of stains of blood, semen and saliva samples stored for a year, and stains of blood stored for a month. Seven various methods of isolation were compared: the Fast DNA kit (Qbiogene), phenol/chloroform extraction, Sherlock (DNA II Gdansk), Dneasy (Qiagen), Wizard Genomic Purification Kit (Promega), Chelex 100 (Biorad) and salting out proteins method. After the isolation, the quantity of DNA was measured with QuantiBlot [brak w polskim tekście]. The highest DNA concentration in bloodstains stored for one year and one month was observed employing the salting out proteins method. The phenol-chloroform extraction method was also found to produce reasonably good results. Isolation from blood and semen with salting-out method appeared to be the most effective. The phenol/chloroform method was dependent on the age and origin of the materials [brak w polskim tekście]. The Sherlock kit was proven to be effective in blood samples stored for one year. DNA concentration values obtained in semen and saliva samples were very low and characterized by a low repeatability.