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Samborska M, Galli D, Achkar R, Thambyrajah S, Derwich K. Constitutional Mismatch Repair Deficiency Syndrome as a Cause of Numerous Malignancies in a Teenage Patient-A Case Report. J Pediatr Hematol Oncol 2023; 45:e917-e920. [PMID: 37526375 DOI: 10.1097/mph.0000000000002727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/15/2023] [Indexed: 08/02/2023]
Abstract
Constitutional mismatch repair deficiency syndrome is a genetic disorder resulting from a biallelic mutation in one of the following genes: MLH1, MSH2, MSH6, or PMS2. Individuals with constitutional mismatch repair deficiency are highly predisposed to develop both hematological and solid cancers in childhood, particularly lymphoma, brain tumors, and gastrointestinal neoplasms. We report a case of a boy diagnosed with B-cell acute lymphoblastic leukemia at the age of 3. In 2013, at the age of 6, head magnetic resonance imaging revealed hamartoma and astrocytoma lesions in the central nervous system. Two years after treatment completion, a diagnosis of precursor T-cell lymphoblastic lymphoma, accompanied by the vena cava syndrome, was established and treated accordingly. During treatment, a genetic test using Sanger sequencing was performed-a biallelic mutation in the MSH6 gene was detected. The study revealed that the mutation 17-bp c.2277-2293del. was inherited from the patient's mother. The second mutation, 5-bp c.1135_1139delAGAGA, developed inpatient de novo. At the age of 14, the diagnosis of isolated bone marrow relapse of acute lymphoblastic leukemia B-cell type was established. Due to the almost exceeded total dose of anthracyclines, the patient's treatment included blinatumomab, and subsequently, he was qualified for allogeneic hematopoietic cell transplantation. The patient remains in complete remission for 11 months after allogeneic hematopoietic stem cell transplantation under the care of the transplant center.
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Affiliation(s)
- Magdalena Samborska
- Department of Pediatric Oncology, Hematology and Transplantology, Institute of Pediatrics, Poznan University of Medical Sciencces, Poznan, Poland
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Voskarides K. An evolutionary explanation for antibiotics’ association with increased colon cancer risk. Evol Med Public Health 2022; 10:214-220. [PMID: 35539898 PMCID: PMC9081870 DOI: 10.1093/emph/eoac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
More than 10 studies have confirmed the association of antibiotic overuse with colorectal cancer. The exact cause is unknown, but most authors hypothesize that disturbance of colon microbiota is the main culprit. In this commentary, an evolutionary explanation is proposed. It is well known that antibiotics can induce antibiotic resistance in bacteria through selection of mutators—DNA mismatch repair deficient (dMMR) strains. Mutators have an increased survival potential due to their high mutagenesis rate. Antibiotics can also cause stress in human cells. Selection of dMMR colon cells may be advantageous under this stress, mimicking selection of bacterial mutators. Concomitantly, mismatch repair deficiency is a common cause of cancer, this may explain the increased cancer risk after multiple cycles of oral antibiotics. This proposed rationale is described in detail, along with supporting evidence from the peer-reviewed literature and suggestions for testing hypothesis validity. Treatment schemes could be re-evaluated, considering toxicity and somatic selection mechanisms. Lay Summary The association of antibiotics with colon cancer is well established but of unknown cause. Under an evolutionary framework, antibiotics may select for stress-resistant cancerous cells that lack mechanisms for DNA mismatch repair (MMR). This mimics the selection of antibiotic resistant ‘mutators’—MMR-deficient micro-organisms—highly adaptive due to their increased mutagenesis rate.
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Affiliation(s)
- Konstantinos Voskarides
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
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Tanimura K, Yamasaki K, Matsubara K, Noguchi M, Kikuchi N, Nitani C, Okada K, Fujisaki H, Okuno T, Inoue T, Nebiki H, Akagi K, Tomita N, Hara J. Could the immune checkpoint inhibitor against colorectal cancer in constitutional mismatch repair deficiency syndrome prevent new cancer formation? Pediatr Blood Cancer 2022; 69:e29312. [PMID: 34453473 DOI: 10.1002/pbc.29312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Kazuki Tanimura
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kai Yamasaki
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kohei Matsubara
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Mayuko Noguchi
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Natsumi Kikuchi
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Chika Nitani
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Keiko Okada
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroyuki Fujisaki
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Takahiro Okuno
- Department of Diagnostic Pathology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Diagnostic Pathology, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Kiwamu Akagi
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Saitama, Japan
| | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Osaka, Japan
| | - Junichi Hara
- Department of Pediatric Hematology and Oncology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
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Bonilla-Velez J, Whitlock KB, Ganti S, Zenner K, Cheng CV, Jensen DM, Pham MHM, Mitchell RM, Dobyns W, Bly RA, Bennett JT, Dahl JP, Perkins JA. Acetylsalicylic acid suppression of the PI3K pathway as a novel medical therapy for head and neck lymphatic malformations. Int J Pediatr Otorhinolaryngol 2021; 151:110869. [PMID: 34537546 PMCID: PMC9632366 DOI: 10.1016/j.ijporl.2021.110869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Head and neck lymphatic malformations (HNLM) are caused by gain-of-function somatic mutations in PIK3CA. Acetylsalicylic acid (ASA/aspirin) is thought to limit growth in PIK3CA-mutated neoplasms through PI3K pathway suppression. We sought to determine if ASA could be beneficial for HNLM. METHODS Retrospective case series of patients (0-18 years) offered ASA (3-5 mg/kg/day) for HNLM treatment (2010-2018). Clinical and treatment characteristics, patient-reported symptom improvement, medication tolerance, compliance, and complications were recorded. Treatment response was determined by change in patient/caregiver-reported symptoms, or HNLM size [complete (resolved), partial (decreased), or stable]. RESULTS Fifty-three patients were offered ASA, 23 (43%) accepted (median age 10 years, IQR 6-14). Compared to patients who declined, patients receiving ASA were more likely to have extensive malformations: ex-utero intrapartum treatment procedure, bilateral malformations, oral cavity location, ≥2 invasive treatments, or tracheotomy (p < 0.05). All patients with tissue available had PIK3CA mutations (13/23). Treatment indications included oral pain/blebs (12, 52%), recurrent pain/swelling (6, 26%), or sudden/persistent swelling (5, 22%). Treatment plan was commonly one 81 mg tablet daily (19, 83%) for 3-12 months (8, 42%). Therapeutic adherence was reported by 18 patients (78%). Symptoms improved in 18 patients [78%; decreased pain (9, 39%) and swelling (8, 35%)]. Treatment resulted in partial (14, 61%) or complete response (4, 17%). Three patients developed oral bleb bleeding, which resolved with medication discontinuation. CONCLUSION ASA seems to be a well-tolerated, low-risk medication for HNLM treatment. This pilot study suggests that it often improves symptoms and reduces HNLM size. Further prospective, randomized studies are warranted to comprehensively assess indications, safety, and efficacy. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Juliana Bonilla-Velez
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA.
| | - Kathryn B. Whitlock
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Sheila Ganti
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Kaitlyn Zenner
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Chi Vicky Cheng
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Dana M. Jensen
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Minh-Hang M. Pham
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Ryan M. Mitchell
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Department of Otolaryngology–Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - William Dobyns
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Randall A. Bly
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - James T. Bennett
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, WA, USA,Division of Genetic Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
| | - John P. Dahl
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan A. Perkins
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA,Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA
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Hirsch S, Dikow N, Pfister SM, Pajtler KW. Cancer predisposition in pediatric neuro-oncology-practical approaches and ethical considerations. Neurooncol Pract 2021; 8:526-538. [PMID: 34594567 DOI: 10.1093/nop/npab031] [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] [Indexed: 12/11/2022] Open
Abstract
A genetic predisposition to tumor development can be identified in up to 10% of pediatric patients with central nervous system (CNS) tumors. For some entities, the rate of an underlying predisposition is even considerably higher. In recent years, population-based approaches have helped to further delineate the role of cancer predisposition in pediatric oncology. Investigations for cancer predisposition syndrome (CPS) can be guided by clinical signs and family history leading to directed testing of specific genes. The increasingly adopted molecular analysis of tumor and often parallel blood samples with multi-gene panel, whole-exome, or whole-genome sequencing identifies additional patients with or without clinical signs. Diagnosis of a genetic predisposition may put an additional burden on affected families. However, information on a given cancer predisposition may be critical for the patient as potentially influences treatment decisions and may offer the patient and healthy carriers the chance to take part in intensified surveillance programs aiming at early tumor detection. In this review, we discuss some of the practical and ethical challenges resulting from the widespread use of new diagnostic techniques and the most important CPS that may manifest with brain tumors in childhood.
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Affiliation(s)
- Steffen Hirsch
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp-Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Tan S, Wu X, Wang A, Ying L. Diagnostic challenges in a CMMRD patient with a novel mutation in the PMS2 gene: a case report. BMC Med Genomics 2021; 14:184. [PMID: 34247610 PMCID: PMC8274000 DOI: 10.1186/s12920-021-01031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive condition, which is caused by biallelic mutations in mismatch repair genes: MSH2, MLH1, MSH6, and PMS2. Case presentation We reported a unique case of an 11-year-old Chinese girl with colorectal polyposis and café-au-lait macules who had no obvious family history of Lynch syndrome-associated tumors, followed by brain gliomas and colorectal carcinoma five years later. The diagnosis of CMMRD was based on gene sequencing analysis showing a homozygous deletion NM_00535.5:c.1577delA (p.Asp526fs) in exon 11 of the PMS2 gene. Although the patient underwent surgery and radiation therapy, and close surveillances including radiological, endoscopic and hematological screening have been recommended, she died of the exacerbation of neurological symptoms at the age of 18. Conclusions We identified a novel homozygous deletion in the PMS2 gene in a CMMRD patient with complex clinical features. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-01031-9.
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Affiliation(s)
- Shiqing Tan
- Department of Gastroenterology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiaoting Wu
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, China.,The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Aoxue Wang
- Department of Dermatology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Li Ying
- Department of Gastroenterology, The Second Hospital of Dalian Medical University, Dalian, China.
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7
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Abidi A, Gorris MAJ, Brennan E, Jongmans MCJ, Weijers DD, Kuiper RP, de Voer RM, Hoogerbrugge N, Schreibelt G, de Vries IJM. Challenges of Neoantigen Targeting in Lynch Syndrome and Constitutional Mismatch Repair Deficiency Syndrome. Cancers (Basel) 2021; 13:2345. [PMID: 34067951 PMCID: PMC8152233 DOI: 10.3390/cancers13102345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022] Open
Abstract
Lynch syndrome (LS) and constitutional mismatch repair deficiency (CMMRD) are hereditary disorders characterised by a highly increased risk of cancer development. This is due to germline aberrations in the mismatch repair (MMR) genes, which results in a high mutational load in tumours of these patients, including insertions and deletions in genes bearing microsatellites. This generates microsatellite instability and cause reading frameshifts in coding regions that could lead to the generation of neoantigens and opens up avenues for neoantigen targeting immune therapies prophylactically and therapeutically. However, major obstacles need to be overcome, such as the heterogeneity in tumour formation within and between LS and CMMRD patients, which results in considerable variability in the genes targeted by mutations, hence challenging the choice of suitable neoantigens. The machine-learning methods such as NetMHC and MHCflurry that predict neoantigen- human leukocyte antigen (HLA) binding affinity provide little information on other aspects of neoantigen presentation. Immune escape mechanisms that allow MMR-deficient cells to evade surveillance combined with the resistance to immune checkpoint therapy make the neoantigen targeting regimen challenging. Studies to delineate shared neoantigen profiles across patient cohorts, precise HLA binding algorithms, additional therapies to counter immune evasion and evaluation of biomarkers that predict the response of these patients to immune checkpoint therapy are warranted.
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Affiliation(s)
- Asima Abidi
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.A.); (M.A.J.G.); (E.B.); (G.S.)
| | - Mark A. J. Gorris
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.A.); (M.A.J.G.); (E.B.); (G.S.)
| | - Evan Brennan
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.A.); (M.A.J.G.); (E.B.); (G.S.)
| | - Marjolijn C. J. Jongmans
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.C.J.J.); (D.D.W.); (R.P.K.)
- Department of Genetics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Dilys D. Weijers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.C.J.J.); (D.D.W.); (R.P.K.)
| | - Roland P. Kuiper
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.C.J.J.); (D.D.W.); (R.P.K.)
- Department of Genetics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Richarda M. de Voer
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (R.M.d.V.); (N.H.)
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (R.M.d.V.); (N.H.)
| | - Gerty Schreibelt
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.A.); (M.A.J.G.); (E.B.); (G.S.)
| | - I. Jolanda M. de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.A.); (M.A.J.G.); (E.B.); (G.S.)
- Department of Medical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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8
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Tadros S, Kondrashov A, Namagiri S, Chowdhury A, Banasavadi-Siddegowda YK, Ray-Chaudhury A. Pathological Features of Tumors of the Nervous System in Hereditary Cancer Predisposition Syndromes: A Review. Neurosurgery 2021; 89:343-363. [PMID: 33693933 DOI: 10.1093/neuros/nyab019] [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: 06/07/2020] [Accepted: 12/13/2020] [Indexed: 11/13/2022] Open
Abstract
Hereditary cancer predisposition syndromes (HCS) become more recognizable as the knowledge about them expands, and genetic testing becomes more affordable. In this review, we discussed the known HCS that predispose to central and peripheral nervous system tumors. Different genetic phenomena were highlighted, and the important cellular biological alterations were summarized. Genetic mosaicism and germline mutations are features of HCS, and recently, they were described in normal population and as modifiers for the genetic landscape of sporadic tumors. Description of the tumors arising in these conditions was augmented by representative cases explaining the main pathological findings. Clinical spectrum of the syndromes and diagnostic criteria were tabled to outline their role in defining these disorders. Interestingly, precision medicine has found its way to help these groups of patients by offering targeted preventive measures. Understanding the signaling pathway alteration of mammalian target of rapamycin (mTOR) in tuberous sclerosis helped introducing mTOR inhibitors as a prophylactic treatment in these patients. More research to define the germline genetic alterations and resulting cellular signaling perturbations is needed for effective risk-reducing interventions beyond prophylactic surgeries.
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Affiliation(s)
- Saber Tadros
- Laboratory of Pathology, National Cancer Institute , National Institutes of Health, Bethesda, Maryland, USA
| | - Aleksei Kondrashov
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Faculty of Medicine, Moscow State University, Moscow, Russia
| | - Sriya Namagiri
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashis Chowdhury
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Abhik Ray-Chaudhury
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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9
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Metachronous Wilms Tumor, Glioblastoma, and T-cell Leukemia in an Child With Constitutional Mismatch Repair Deficiency syndrome due to Novel Mutation in MSH6 (c.2590G>T). J Pediatr Hematol Oncol 2021; 43:e198-e202. [PMID: 31815888 DOI: 10.1097/mph.0000000000001687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
Constitutional mismatch repair deficiency (CMMRD) is an autosomal recessively inherited childhood cancer predisposition syndrome results from biallelic germline mutations affecting the key DNA mismatch repair gene: MLH1, MSH2, MSH6, or PMS2. CMMRD is associated with a high risk of developing early onset of central nervous system tumors, hematologic, and intestinal tract tumors. Clinical manifestations, genetic screening, and cancer prevention strategies are limited. In this report we present a patient with metachronous Wilms tumor, glioblastoma, and acute T-cell lymphoblastic leukemia. He had cutaneous features of neurofibromatosis type 1 (NF1). Molecular testing revealed a novel homozygous mutation in MSH6 (c.2590G>T; p.G864*) that has not been reported previously. CMMRD should be considered in patients with cutaneous features similar to NF1 if tumor is found other than expected tumors in NF, early onset cancer, and strong family history of cancer.
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10
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Kratz CP, Jongmans MC, Cavé H, Wimmer K, Behjati S, Guerrini-Rousseau L, Milde T, Pajtler KW, Golmard L, Gauthier-Villars M, Jewell R, Duncan C, Maher ER, Brugieres L, Pritchard-Jones K, Bourdeaut F. Predisposition to cancer in children and adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:142-154. [PMID: 33484663 DOI: 10.1016/s2352-4642(20)30275-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022]
Abstract
Childhood malignancies are rarely related to known environmental exposures, and it has become increasingly evident that inherited genetic factors play a substantial causal role. Large-scale sequencing studies have shown that approximately 10% of children with cancer have an underlying cancer predisposition syndrome. The number of recognised cancer predisposition syndromes and cancer predisposition genes are constantly growing. Imaging and laboratory technologies are improving, and knowledge of the range of tumours and risk of malignancy associated with cancer predisposition syndromes is increasing over time. Consequently, surveillance measures need to be constantly adjusted to address these new findings. Management recommendations for individuals with pathogenic germline variants in cancer predisposition genes need to be established through international collaborative studies, addressing issues such as genetic counselling, cancer prevention, cancer surveillance, cancer therapy, psychological support, and social-ethical issues. This Review represents the work by a group of experts from the European Society for Paediatric Oncology (SIOPE) and aims to summarise the current knowledge and define future research needs in this evolving field.
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Affiliation(s)
- Christian P Kratz
- Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Marjolijn C Jongmans
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands; Department of Genetics, University Medical Center Utrecht, Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
| | - Hélène Cavé
- Department of Genetics, Assistance Publique Hôpitaux de Paris-Robert Debre University Hospital, Paris, France; Denis Diderot School of Medicine, University of Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1131, Institut de Recherche Saint Louis, Paris, France
| | - Katharina Wimmer
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sam Behjati
- Wellcome Sanger Institute, Cambridge, UK; Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Lea Guerrini-Rousseau
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Till Milde
- Clinical Cooperation Unit Paediatric Oncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; KiTZ Clinical Trial Unit, Department of Paediatric Haematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany; Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Kristian W Pajtler
- Clinical Cooperation Unit Paediatric Oncology, German Cancer Research Center and German Consortium for Translational Cancer Research, Heidelberg, Germany; KiTZ Clinical Trial Unit, Department of Paediatric Haematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany; Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Lisa Golmard
- Department of Genetics, Institut Curie, Paris, France; Paris Sciences Lettres Research University, Paris, France
| | - Marion Gauthier-Villars
- Department of Genetics, Institut Curie, Paris, France; Paris Sciences Lettres Research University, Paris, France
| | - Rosalyn Jewell
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge, UK; NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Centre, Cambridge Biomedical Campus, Cambridge, UK
| | - Laurence Brugieres
- Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Kathy Pritchard-Jones
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Franck Bourdeaut
- SIREDO Paediatric Cancer Center, Institut Curie, Paris, France; INSERM U830, Laboratory of Translational Research in Paediatric Oncology, Institut Curie, Paris, France; Paris Sciences Lettres Research University, Paris, France.
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11
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Kebudi R, Amayiri N, Abedalthagafi M, Rana AN, Kirmani S, Musthaq N, Lamki ZA, Houdzi JE, Yazici H, El-Naggar S, Edwards M, Bianchi VJ, Durno C, Tabori U, Bouffet E. Position paper: Challenges and specific strategies for constitutional mismatch repair deficiency syndrome in low-resource settings. Pediatr Blood Cancer 2020; 67:e28309. [PMID: 32472748 DOI: 10.1002/pbc.28309] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/25/2023]
Abstract
Germline biallelic mutations in one of the mismatch repair genes, mutS homolog 2, mutS homolog 6, mutL homolog 1, or postmeiotic segregation increased 2, result in one of the most aggressive cancer syndromes in humans termed as constitutional mismatch repair deficiency (CMMRD). Individuals with CMMRD are affected with multiple tumors arising from multiple organs during childhood, and these individuals rarely reach adulthood without specific interventions. The most common tumors observed are central nervous system, hematological, and gastrointestinal malignancies. The incidence of CMMRD is expected to be high in low-resource settings due to a high rate of consanguinity in these regions, and it is thought to be underrecognized and consequently underdiagnosed. This position paper is therefore important to provide a summary of the current situation, and to highlight the necessity of increasing awareness, diagnostic criteria, and surveillance to improve survival for patients and family members.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Nisreen Amayiri
- Department of Pediatrics, King Hussein Cancer Center, Hematology/Oncology, Amman, Jordan
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Asım Noor Rana
- Department of Pediatrics, Division of Hematology-Oncology, Dubai Hospital, Dubai, UAE
| | - Salman Kirmani
- Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Naureen Musthaq
- Department of Pharmaceutical Sciences, M.M. College of Pharmacy, M.M. University, Mullana, Ambala, Haryana, India
| | - Zakiya Al Lamki
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Jamila El Houdzi
- Hematology and Pediatric Oncology Unit, Centre d'Oncologie et d'Hematologie, Mohammed VI University Hospital, Marrakech, Morocco
| | - Hulya Yazici
- Division of Cancer Genetics, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Shahenda El-Naggar
- Tumor Biology Research Program, Department of Research, Basic Research Unit, Children's Cancer Hospital in Egypt 57357, Cairo, Egypt
| | - Melissa Edwards
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Vanessa J Bianchi
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Carol Durno
- The Zane Cohen Center, Mount Sinai Hospital, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Eric Bouffet
- Division of Hematology-Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
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12
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Guerrini-Rousseau L, Varlet P, Colas C, Andreiuolo F, Bourdeaut F, Dahan K, Devalck C, Faure-Conter C, Genuardi M, Goldberg Y, Kuhlen M, Moalla S, Opocher E, Perez-Alonso V, Sehested A, Slavc I, Unger S, Wimmer K, Grill J, Brugières L. Constitutional mismatch repair deficiency-associated brain tumors: report from the European C4CMMRD consortium. Neurooncol Adv 2019; 1:vdz033. [PMID: 32642664 PMCID: PMC7212899 DOI: 10.1093/noajnl/vdz033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Malignant brain tumors (BT) are among the cancers most frequently associated with constitutional mismatch repair deficiency (CMMRD), a rare childhood cancer predisposition syndrome resulting from biallelic germline mutations in mismatch repair genes. This study analyzed data from the European “Care for CMMRD” (C4CMMRD) database to describe their clinical characteristics, treatments, and outcome with the aim of improving its diagnosis/treatment. Methods Retrospective analysis of data on patients with CMMRD and malignant BT from the C4CMMRD database up to July 2017. Results Among the 87 registered patients, 49 developed 56 malignant BTs: 50 high-grade gliomas (HGG) (with giant multinucleated cells in 16/21 histologically reviewed tumors) and 6 embryonal tumors. The median age at first BT was 9.2 years [1.1–40.6], with nine patients older than 18. Twenty-seven patients developed multiple malignancies (including16 before the BT). Most patients received standard treatment, and eight patients immunotherapy for relapsed HGG. The 3- and 5-year overall survival (OS) rates were 30% (95% CI: 19–45) and 22% (95% CI: 12–37) after the first BT, with worse prognosis for HGG (3-year OS = 20.5%). Six patients were alive (median follow-up 2.5 years) and 43 dead (38 deaths, 88%, were BT-related). Other CMMRD-specific features were café-au-lait macules (40/41), multiple BTs (5/15), developmental brain anomalies (11/15), and consanguinity (20/38 families). Conclusions Several characteristics could help suspecting CMMRD in pediatric malignant BTs: giant cells on histology, previous malignancies, parental consanguinity, café-au-lait macules, multiple BTs, and developmental brain anomalies. The prognosis of CMMRD-associated BT treated with standard therapies is poor requiring new therapeutic up-front approaches.
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Affiliation(s)
- Léa Guerrini-Rousseau
- Department of Pediatric and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France.,Gustave Roussy Cancer Center, Unite Mixte de Recherche 8203, Centre National de la Recherche Scientifique, Paris-Saclay University, Villejuif, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte Anne Hospital, Rene Descartes University, Paris, France
| | | | - Felipe Andreiuolo
- Department of Neuropathology, Sainte Anne Hospital, Rene Descartes University, Paris, France
| | - Franck Bourdeaut
- Curie Institute, SIREDO Cancer Center (Care, innovation and research in pediatric, adolescents and young adults oncology), Paris, France
| | - Karin Dahan
- Hôpital Universitaire Reine Fabiola (HUDERF), Genetic department, Université Libre de Belgique (ULB), Brussels, Belgium
| | - Christine Devalck
- Department of Hemato-Oncology, Hôpital Universitaire Reine Fabiola (HUDERF), Université Libre de Belgique (ULB). Brussels - Belgium
| | - Cécile Faure-Conter
- Centre Leon Berard, Pediatric hemato-oncology institute (IHOPe), Lyon, France
| | - Maurizio Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy.,Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yael Goldberg
- Raphael Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Michaela Kuhlen
- Department of Pediatric Oncology, University Children´s Hospital, Hematology and Clinical Immunology Duesseldorf, Germany
| | - Salma Moalla
- Department of Radiology, Gustave Roussy Cancer Center, Université Paris-Saclay, Villejuif, France
| | - Enrico Opocher
- Azienda Ospedaliera di Padova, Pediatric Oncology & Hematology, Padova, Italy
| | - Vanessa Perez-Alonso
- Hospital Universitario Doce de Octubre, Unidad de Oncología Pediátrica, Madrid, Spain
| | - Astrid Sehested
- Copenhagen University Hospital, Department of pediatrics and adolescent medicin, Copenhagen, Denmark
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sheila Unger
- Centre Hospitalier Universitaire Vaudois, Division of Genetic Medicine, University of Lausanne, Lausanne Switzerland
| | - Katharina Wimmer
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - Jacques Grill
- Department of Pediatric and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France.,Gustave Roussy Cancer Center, Unite Mixte de Recherche 8203, Centre National de la Recherche Scientifique, Paris-Saclay University, Villejuif, France
| | - Laurence Brugières
- Department of Pediatric and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
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13
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Toledano H, Orenstein N, Sofrin E, Ruhrman-Shahar N, Amarilyo G, Basel-Salmon L, Shuldiner AR, Smirin-Yosef P, Aronson M, Al-Tarrah H, Bazak L, Gonzaga-Jauregui C, Tabori U, Wimmer K, Goldberg Y. Paediatric systemic lupus erythematosus as a manifestation of constitutional mismatch repair deficiency. J Med Genet 2019; 57:505-508. [PMID: 31501241 DOI: 10.1136/jmedgenet-2019-106303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/01/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022]
Abstract
Biallelic mutations in any of the four mismatch repair genes MSH2, MSH6, MLH1 and PMS2 result in one of the most aggressive childhood cancer predisposition syndromes, termed constitutional mismatch repair deficiency (CMMRD) syndrome. In addition to a very high tumour risk, the CMMRD phenotype is often characterised by the presence of signs reminiscent of neurofibromatosis type 1. Although paediatric systemic lupus erythematosus (pSLE) has been reported so far in three patients with CMMRD, it has not been considered a diagnostic feature of the syndrome. We report here two additional female patients with pSLE and CMMRD due to biallelic pathogenic variants in MSH6 Hence, there are a total of five out of approximately 200 (2.5%) currently reported patients with CMMRD that also have pSLE, suggesting pSLE should raise the suspicion of a diagnosis of CMMRD, especially if supported by additional indicative features.
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Affiliation(s)
- Helen Toledano
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Orenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Genetic Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Efrat Sofrin
- Pediatric Genetic Clinic, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - Lina Basel-Salmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Recanati Genetics Institute, Rabin Medical Center, Petah Tikva, Israel
| | | | - Pola Smirin-Yosef
- Department of Molecular Biology, Genomic Bioinformatics Laboratory, Ariel University, Ariel, Israel
| | - Melyssa Aronson
- Zane Cohen Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Haematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hibs Al-Tarrah
- Zane Cohen Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lili Bazak
- Recanati Genetics Institute, Rabin Medical Center, Petah Tikva, Israel
| | | | - Uri Tabori
- Zane Cohen Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,The Arthur and Sonia Labbatt Brain Tumour Research Centre, The Hospital for Sick Children, Institute of Medical Sciences, The University of Toronto, Toronto, Ontario, Canada
| | - Katharina Wimmer
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - Yael Goldberg
- Recanati Genetics Institute, Rabin Medical Center, Petah Tikva, Israel
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14
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Abstract
Cutaneous findings that appear in childhood may be the first sign of a hereditary tumor syndrome. Early detection of genodermatoses allows the patient and at-risk family members to be screened for associated malignancies. This article provides a brief description of the pathogenesis and clinical manifestations of various inherited disorders with skin involvement, along with treatment updates. Advances in molecular-based therapy have spurred development of novel treatment methods for various genodermatoses such as xeroderma pigmentosum (XP) and Gorlin-Goltz syndrome. Further studies are needed to better assess the efficacy of many of these new treatment options.
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Affiliation(s)
- Ramiz N Hamid
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
| | - Zeynep M Akkurt
- Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
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15
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Mihajluk K, Simms C, Reay M, Madureira PA, Howarth A, Murray P, Nasser S, Duckworth CA, Pritchard DM, Pilkington GJ, Hill R. RETRACTED: IP1867B suppresses the insulin-like growth factor 1 receptor (IGF1R) ablating epidermal growth factor receptor inhibitor resistance in adult high grade gliomas. Cancer Lett 2019; 458:29-38. [PMID: 31129148 DOI: 10.1016/j.canlet.2019.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/07/2019] [Accepted: 05/21/2019] [Indexed: 12/23/2022]
Abstract
This article has been retracted at the request of the Editor-in-Chief due to concerns regarding the legitimacy of images and data presented in the paper. Though a corrigendum (Can. Lett. Vol. 469, 2020, pages 524-535) was previously published to address some of these concerns, this corrigendum has also been found to contain errors and therefore cannot stand. Specific concerns are listed below.
The Editor and Publisher received a letter from the University of Portsmouth alerting us to an investigation into alleged research misconduct. The University concluded their investigation with external experts and determined that misconduct did take place in relation to the research involved in this paper.
Upon our separate investigation, it has been determined that the paper headline relies on showing that there was considerable reduction of IGF1R, IL6R and EGFR post treatment in all cell lines. During review, it was determined that this cannot be concluded from the presented data. For example, in SEBTA-003 the EGFR levels go up and there is no difference in IGFR1. It is apparent from Fig 4d that in the SEBTA-003 cell line the EGFR level does not go down, which is stated in the Results section on page 32, it is rather going up. The data for IGFR1 are inconclusive and there are concerns regarding the blot. The general implications would be that the effects of the drug IP1867B does not seem to be the same for all tested cell lines, and this should have been discussed in detail by the authors. Additionally, in subsequent experiments (Fig. 4g and h) the SEBTA-003 cell line (no reduction of EGFR, rather increased expression) and the other 3 cell lines (reduction of EGFR) show similar responses. This is particularly evident in Fig. 4g: Two cell lines are compared, SEBTA-003 (increased EGFR expression) and UP-029 (decreased EGFR expression), both behave similarly after exposure to drugs.
The corrigendum (https://doi.org/10.1016/j.canlet.2019.10.002) issue is with respect to the Supplemental Figure 6i EGFR, particularly panel IP1867B. The Corrigendum states that the left part is a cut out of the very right part. If so, the bands for IP1867B should show the same staining pattern - but they do not. Also, in the Corrigendum, there are incorrect mentions between day 14 in the Figure and day 19 in the Figure legend.
All authors were informed of the retraction in advance. Drs. Pritchard and Duckworth agreed to the retraction. The corresponding author, Dr Hill, did not agree to the retraction. No response had been received from Drs. Mihajluk, Simms, Reay, Madureira, Howarth, Murray, Nasser and Pilkinton at the time of the retraction being published.
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Affiliation(s)
- K Mihajluk
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - C Simms
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - M Reay
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - P A Madureira
- Centre for Biomedical Research (CBMR), University of Algarve, Campus of Gambelas, Building 8, Room 3.4, 8005-139, Faro, Portugal
| | - A Howarth
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - P Murray
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - S Nasser
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - C A Duckworth
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, L69 3GE, UK
| | - D M Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, L69 3GE, UK
| | - G J Pilkington
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK
| | - R Hill
- Brain Tumour Research Centre, Institute of Biomedical and Biomolecular Sciences, IBBS, University of Portsmouth, PO1 2DT, UK.
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16
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Gallon R, Mühlegger B, Wenzel S, Sheth H, Hayes C, Aretz S, Dahan K, Foulkes W, Kratz CP, Ripperger T, Azizi AA, Baris Feldman H, Chong A, Demirsoy U, Florkin B, Imschweiler T, Januszkiewicz‐Lewandowska D, Lobitz S, Nathrath M, Pander H, Perez‐Alonso V, Perne C, Ragab I, Rosenbaum T, Rueda D, Seidel MG, Suerink M, Taeubner J, Zimmermann S, Zschocke J, Borthwick GM, Burn J, Jackson MS, Santibanez‐Koref M, Wimmer K. A sensitive and scalable microsatellite instability assay to diagnose constitutional mismatch repair deficiency by sequencing of peripheral blood leukocytes. Hum Mutat 2019; 40:649-655. [PMID: 30740824 PMCID: PMC6519362 DOI: 10.1002/humu.23721] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
Constitutional mismatch repair deficiency (CMMRD) is caused by germline pathogenic variants in both alleles of a mismatch repair gene. Patients have an exceptionally high risk of numerous pediatric malignancies and benefit from surveillance and adjusted treatment. The diversity of its manifestation, and ambiguous genotyping results, particularly from PMS2, can complicate diagnosis and preclude timely patient management. Assessment of low-level microsatellite instability in nonneoplastic tissues can detect CMMRD, but current techniques are laborious or of limited sensitivity. Here, we present a simple, scalable CMMRD diagnostic assay. It uses sequencing and molecular barcodes to detect low-frequency microsatellite variants in peripheral blood leukocytes and classifies samples using variant frequencies. We tested 30 samples from 26 genetically-confirmed CMMRD patients, and samples from 94 controls and 40 Lynch syndrome patients. All samples were correctly classified, except one from a CMMRD patient recovering from aplasia. However, additional samples from this same patient tested positive for CMMRD. The assay also confirmed CMMRD in six suspected patients. The assay is suitable for both rapid CMMRD diagnosis within clinical decision windows and scalable screening of at-risk populations. Its deployment will improve patient care, and better define the prevalence and phenotype of this likely underreported cancer syndrome.
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Affiliation(s)
- Richard Gallon
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Barbara Mühlegger
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | | | - Harsh Sheth
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Christine Hayes
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Stefan Aretz
- Institute of Human GeneticsBiomedical Centre, University Hospital BonnBonnGermany
| | - Karin Dahan
- Centre de génétique humaineInstitut de pathologie et génétique (IPG)GosseliesBelgium
| | - William Foulkes
- Program in Cancer Genetics, Departments of Oncology and Human GeneticsMcGill UniversityMontrealQuebecCanada
- Department of Human GeneticsMcGill UniversityMontrealQuebecCanada
- Department of Medical GeneticsMcGill University Health CentreMontrealQuebecCanada
- Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQuebecCanada
| | - Christian P. Kratz
- Department of Pediatric Hematology and OncologyHannover Medical SchoolHannoverGermany
| | - Tim Ripperger
- Department of Human GeneticsHannover Medical SchoolHannoverGermany
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Hagit Baris Feldman
- The Genetics Institute, Rambam Health Care Campus, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyHaifaIsrael
| | - Anne‐Laure Chong
- Department of Human GeneticsMcGill UniversityMontrealQuebecCanada
- Department of Medical GeneticsMcGill University Health CentreMontrealQuebecCanada
- Lady Davis Institute for Medical ResearchJewish General HospitalMontrealQuebecCanada
| | - Ugur Demirsoy
- Department of Pediatric OncologyKocaeli UniversityKocaeliTurkey
| | - Benoît Florkin
- Department of PediatricsCHR Citadelle Hospital, University of LiègeLiègeBelgium
| | | | | | - Stephan Lobitz
- Department of Pediatric Oncology/Pediatric HematologyKliniken der Stadt Köln gGmbH, Children's Hospital Amsterdamer StrasseKölnGermany
| | - Michaela Nathrath
- Pediatric Hematology and Oncology, Klinikum KasselKasselGermany
- Department of PediatricsPediatric Oncology Center , Technische Universität MünchenMunichGermany
| | | | - Vanesa Perez‐Alonso
- Pediatrics DepartmentUniversity Hospital Doce de Octubre, i+12 Research InstituteMadridSpain
| | - Claudia Perne
- Institute of Human GeneticsBiomedical Centre, University Hospital BonnBonnGermany
| | - Iman Ragab
- Pediatrics DepartmentHematology‐Oncology Unit, Faculty of Medicine, Ain Shams UniversityCairoEgypt
| | | | - Daniel Rueda
- Hereditary Cancer LaboratoryUniversity Hospital Doce de Octubre, i+12 Research InstituteMadridSpain
| | - Markus G. Seidel
- Research Unit Pediatric Hematology and Immunology, Division of Pediatric Hematology‐Oncology, Department of Pediatrics and Adolescent MedicineMedical University GrazGrazAustria
| | - Manon Suerink
- Department of Clinical GeneticsLeiden University Medical CenterLeidenNetherlands
| | - Julia Taeubner
- Department of Pediatric OncologyHematology and Clinical Immunology, University Children´s Hospital, Medical Faculty, Heinrich Heine UniversityDuesseldorfGermany
| | | | - Johannes Zschocke
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | - Gillian M. Borthwick
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - John Burn
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Michael S. Jackson
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | | | - Katharina Wimmer
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
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17
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Syndrome CMMRD (déficience constitutionnelle des gènes MMR) : bases génétiques et aspects cliniques. Bull Cancer 2019; 106:162-172. [DOI: 10.1016/j.bulcan.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 11/19/2022]
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18
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Suerink M, Ripperger T, Messiaen L, Menko FH, Bourdeaut F, Colas C, Jongmans M, Goldberg Y, Nielsen M, Muleris M, van Kouwen M, Slavc I, Kratz C, Vasen HF, Brugiѐres L, Legius E, Wimmer K. Constitutional mismatch repair deficiency as a differential diagnosis of neurofibromatosis type 1: consensus guidelines for testing a child without malignancy. J Med Genet 2018; 56:53-62. [PMID: 30415209 DOI: 10.1136/jmedgenet-2018-105664] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
Constitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome caused by biallelic germline mutations in one of four mismatch-repair genes. Besides very high tumour risks, CMMRD phenotypes are often characterised by the presence of signs reminiscent of neurofibromatosis type 1 (NF1). Because NF1 signs may be present prior to tumour onset, CMMRD is a legitimate differential diagnosis in an otherwise healthy child suspected to have NF1/Legius syndrome without a detectable underlying NF1/SPRED1 germline mutation. However, no guidelines indicate when to counsel and test for CMMRD in this setting. Assuming that CMMRD is rare in these patients and that expected benefits of identifying CMMRD prior to tumour onset should outweigh potential harms associated with CMMRD counselling and testing in this setting, we aimed at elaborating a strategy to preselect, among children suspected to have NF1/Legius syndrome without a causative NF1/SPRED1 mutation and no overt malignancy, those children who have a higher probability of having CMMRD. At an interdisciplinary workshop, we discussed estimations of the frequency of CMMRD as a differential diagnosis of NF1 and potential benefits and harms of CMMRD counselling and testing in a healthy child with no malignancy. Preselection criteria and strategies for counselling and testing were developed and reviewed in two rounds of critical revisions. Existing diagnostic CMMRD criteria were adapted to serve as a guideline as to when to consider CMMRD as differential diagnosis of NF1/Legius syndrome. In addition, counselling and testing strategies are suggested to minimise potential harms.
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Affiliation(s)
- Manon Suerink
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tim Ripperger
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Ludwine Messiaen
- Department of Genetics, University of Alabama, Birmingham, Alabama, USA
| | - Fred H Menko
- Family Cancer Clinic, Antoni van Leeuwenhoek Hospital and The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Franck Bourdeaut
- Département d'Oncologie Pédiatrique et d'Adolescents Jeunes Adultes, Institut Curie, Paris, France
| | - Chrystelle Colas
- Department of Genetics, Institut Curie, Paris Sciences Lettres Research University, Paris, France.,Centre de Recherche Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Marjolijn Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yael Goldberg
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Maartje Nielsen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine Muleris
- Centre de Recherche Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Paris, France
| | - Mariëtte van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene Slavc
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Christian Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Hans F Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurence Brugiѐres
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Institute, Villejuif, France
| | - Eric Legius
- Department of Human Genetics, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Katharina Wimmer
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
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Abedalthagafi M. Constitutional mismatch repair-deficiency: current problems and emerging therapeutic strategies. Oncotarget 2018; 9:35458-35469. [PMID: 30459937 PMCID: PMC6226037 DOI: 10.18632/oncotarget.26249] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022] Open
Abstract
Mismatch repair (MMR) proteins remove errors from newly synthesized DNA, improving the fidelity of DNA replication. A loss of MMR causes a mutated phenotype leading to a predisposition to cancer. In the last 20 years, an increasing number of patients have been described with biallelic MMR gene mutations in which MMR defects are inherited from both parents. This leads to a syndrome with recessive inheritance, referred to as constitutional mismatch repair-deficiency (CMMRD). CMMRD is a rare childhood cancer predisposition syndrome. The spectrum of CMMRD tumours is broad and CMMRD-patients possess a high risk of multiple cancers including hematological, brain and intestinal tumors. The severity of CMMRD is highlighted by the fact that patients do not survive until later life, emphasising the requirement for new therapeutic interventions. Many tumors in CMMRD-patients are hypermutated leading to the production of truncated protein products termed neoantigens. Neoantigens are recognized as foreign by the immune system and induce antitumor immune responses. There is growing evidence to support the clinical efficacy of neoantigen based vaccines and immune checkpoint inhibitors (collectively referred to as immunotherapy) for the treatment of CMMRD cancers. In this review, we discuss the current knowledge of CMMRD, the advances in its diagnosis, and the emerging therapeutic strategies for CMMRD-cancers.
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Affiliation(s)
- Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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