Deleterious and ethnic-related BRCA1/2 mutations in tissue and blood of Egyptian colorectal cancer patients and its correlation with human papillomavirus

This study aimed to identify BRCA1/2 mutational patterns in the tissue and blood of Egyptian colorectal cancer (CRC) patients and to study the possible correlation of this mutational pattern with Human papillomavirus (HPV) infection. Eighty-two colonoscopic biopsies and forty-six blood samples were collected from Egyptian CRC patients, as well as blood samples of age and sex-matched healthy controls (n = 43) were enrolled. The libraries were performed using Qiaseq Human BRCA1 and BRCA2 targeted DNA panel and sequenced via Ion proton sequencer. Also, the CRC tissues were subjected to conventional PCR targeting the HPV Late 1 (L1) region. Our analysis revealed that the BRCA-DNA damage pathway had been altered in more than 65% of the CRC patients. Comparing tissue and blood samples from CRC patients, 25 somatic mutations were found exclusively in tissue, while 41 germline mutations were found exclusively in blood. Additionally, we identified 23 shared BRCA1/2 pathogenic (PVs) mutations in both blood and tissue samples, with a significantly higher frequency in blood samples compared to tissue samples. The most affected exon in BRCA1 was exon 10, while the most affected exons in BRCA2 were 11, 14, 18, 24, and 27 exons. Notably, we revealed an ethnic-related cluster of polymorphism variants in our population closely related to South Asian and African ethnicities. Novel PVs were identified and submitted to the ClinVar database. HPV was found in 23.8% of the CRC tissues, and 54% of HPV-positive cases had somatic BRCA1/2 PVs. The results of this research point to a possible connection between infection with HPV and BRCA1/2 mutations in the occurrence of colorectal cancer in the Egyptian population, which has a mixed ethnic background. Our data also indicate that liquid biopsy (blood samples) may be more representative than tissue samples for detecting BRCA1/2 mutations. These findings may have implications for cancer screening and the development of personalized, targeted therapies, such as PARP inhibitors, which can effectively target BRCA1/2 mutations.

Percutaneous endoscopic gastrostomy (PEG) in cancer patients; technique, indications and complications

Enteral feeding is the preferred method of nutritional support in malnourished patients with inadequate oral intake but with intact gastrointestinal tract. In cancer patients, adequate nutrition plays an important role in the success of the treatment and hence the overall prognosis. Percutaneous endoscopic gastrostomy proved to be an effective means for providing enteral nutrition with easy technique, less hospital stay and cost with less morbidity and mortality.

AIM OF WORK

It is a prospective study on 40 cancer patients with different indications for PEG which is done by pull technique under local anesthesia and sedation over a period of 12 months with a follow up period of 60 days.

RESULTS

The procedure was successful in 38 patients (95%), 22 patients (55%) with esophageal cancer, 16 cases (40%) with head and neck cancer, and 2 cases (5%) for gastric decompression due to prepyloric gastric cancer. Mortality rate was 2.5% (1 case) due to leakage and peritonitis, and morbidity occurred in 6 cases (15%) due to port infection and minor leakage managed by dressing and systemic antibiotics.

CONCLUSION

PEG is an easy procedure for providing enteral nutrition for cancer patients and associated with fewer rates of morbidity and mortality compared to gastrostomy procedures.