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Pilsworth JA, Todeschini AL, Neilson SJ, Cochrane DR, Lai D, Anttonen M, Heikinheimo M, Huntsman DG, Veitia RA. FOXL2 in adult-type granulosa cell tumour of the ovary: oncogene or tumour suppressor gene? J Pathol 2021; 255:225-231. [PMID: 34338304 DOI: 10.1002/path.5771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022]
Abstract
A recurrent mutation in FOXL2 (c.402C>G; p.C134W) is present in over 95% of adult-type granulosa cell tumours (AGCTs). In contrast, various loss-of-function mutations in FOXL2 lead to the development of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). BPES is characterised by an eyelid malformation often accompanied with primary ovarian insufficiency. Two recent studies suggest that FOXL2 C402G is a gain- or change-of-function mutation with altered DNA-binding specificity. Another study proposes that FOXL2 C402G is selectively targeted for degradation, inducing somatic haploinsufficiency, suggesting its role as a tumour suppressor. The latter study relies on data indicative of an FOXL2 allelic imbalance in AGCTs. Here we present RNA-seq data as genetic evidence that no real allelic imbalance is observed at the transcriptomic level in AGCTs. Additionally, there is no loss of protein expression in tumours harbouring the mutated allele. These data and other features of this mutation compared to other oncogenes and tumour suppressor genes argue strongly against FOXL2 being a tumour suppressor in this context. Given the likelihood that FOXL2 C402G is oncogenic, targeting the variant protein or its downstream consequences is the most viable path forward to identifying an effective treatment for this cancer. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jessica A Pilsworth
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Anne-Laure Todeschini
- Université de Paris, Paris, France.,Université de Paris, CNRS, Institut Jacques Monod, Paris, France
| | | | - Dawn R Cochrane
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Daniel Lai
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Mikko Anttonen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David G Huntsman
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Reiner A Veitia
- Université de Paris, Paris, France.,Université de Paris, CNRS, Institut Jacques Monod, Paris, France.,Université Paris-Saclay, Institut de Biologie F. Jacob, Commissariat à l'Energie Atomique, Fontenay aux Roses, France
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2
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Pilsworth JA, Cochrane DR, Neilson SJ, Moussavi BH, Lai D, Munzur AD, Senz J, Wang YK, Zareian S, Bashashati A, Wong A, Keul J, Staebler A, van Meurs HS, Horlings HM, Kommoss S, Kommoss F, Oliva E, Färkkilä AEM, Gilks B, Huntsman DG. Adult-type granulosa cell tumor of the ovary: a FOXL2-centric disease. J Pathol Clin Res 2021; 7:243-252. [PMID: 33428330 PMCID: PMC8072996 DOI: 10.1002/cjp2.198] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
Adult-type granulosa cell tumors (aGCTs) account for 90% of malignant ovarian sex cord-stromal tumors and 2-5% of all ovarian cancers. These tumors are usually diagnosed at an early stage and are treated with surgery. However, one-third of patients relapse between 4 and 8 years after initial diagnosis, and there are currently no effective treatments other than surgery for these relapsed patients. As the majority of aGCTs (>95%) harbor a somatic mutation in FOXL2 (c.C402G; p.C134W), the aim of this study was to identify genetic mutations besides FOXL2 C402G in aGCTs that could explain the clinical diversity of this disease. Whole-genome sequencing of 10 aGCTs and their matched normal blood was performed to identify somatic mutations. From this analysis, a custom amplicon-based panel was designed to sequence 39 genes of interest in a validation cohort of 83 aGCTs collected internationally. KMT2D inactivating mutations were present in 10 of 93 aGCTs (10.8%), and the frequency of these mutations was similar between primary and recurrent aGCTs. Inactivating mutations, including a splice site mutation in candidate tumor suppressor WNK2 and nonsense mutations in PIK3R1 and NLRC5, were identified at a low frequency in our cohort. Missense mutations were identified in cell cycle-related genes TP53, CDKN2D, and CDK1. From these data, we conclude that aGCTs are comparatively a homogeneous group of tumors that arise from a limited set of genetic events and are characterized by the FOXL2 C402G mutation. Secondary mutations occur in a subset of patients but do not explain the diverse clinical behavior of this disease. As the FOXL2 C402G mutation remains the main driver of this disease, progress in the development of therapeutics for aGCT would likely come from understanding the functional consequences of the FOXL2 C402G mutation.
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Affiliation(s)
- Jessica A Pilsworth
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
- Department of Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
| | - Dawn R Cochrane
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Samantha J Neilson
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Bahar H Moussavi
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Daniel Lai
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Aslı D Munzur
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Janine Senz
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Yi Kan Wang
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Sina Zareian
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
| | - Ali Bashashati
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBCCanada
| | - Adele Wong
- Department of PathologyMassachusetts General HospitalBostonMAUSA
| | - Jacqueline Keul
- Department of Women's HealthTübingen University HospitalTübingenGermany
| | - Annette Staebler
- Institute of Pathology and NeuropathologyTübingen University HospitalTübingenGermany
| | - Hannah S van Meurs
- Department of GynecologyCenter for Gynecologic Oncology Amsterdam, Academic Medical CenterAmsterdamThe Netherlands
| | - Hugo M Horlings
- Department of PathologyThe Netherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
| | - Stefan Kommoss
- Department of Women's HealthTübingen University HospitalTübingenGermany
| | - Friedrich Kommoss
- Institute of Pathology, Medizin Campus BodenseeFriedrichshafenGermany
| | - Esther Oliva
- Department of PathologyMassachusetts General HospitalBostonMAUSA
| | - Anniina EM Färkkilä
- Research Program for Systems OncologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Blake Gilks
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
| | - David G Huntsman
- Department of Molecular OncologyBritish Columbia Cancer Research CentreVancouverBCCanada
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
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3
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Docking TR, Parker JDK, Jädersten M, Duns G, Chang L, Jiang J, Pilsworth JA, Swanson LA, Chan SK, Chiu R, Nip KM, Mar S, Mo A, Wang X, Martinez-Høyer S, Stubbins RJ, Mungall KL, Mungall AJ, Moore RA, Jones SJM, Birol İ, Marra MA, Hogge D, Karsan A. A clinical transcriptome approach to patient stratification and therapy selection in acute myeloid leukemia. Nat Commun 2021; 12:2474. [PMID: 33931648 PMCID: PMC8087683 DOI: 10.1038/s41467-021-22625-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
As more clinically-relevant genomic features of myeloid malignancies are revealed, it has become clear that targeted clinical genetic testing is inadequate for risk stratification. Here, we develop and validate a clinical transcriptome-based assay for stratification of acute myeloid leukemia (AML). Comparison of ribonucleic acid sequencing (RNA-Seq) to whole genome and exome sequencing reveals that a standalone RNA-Seq assay offers the greatest diagnostic return, enabling identification of expressed gene fusions, single nucleotide and short insertion/deletion variants, and whole-transcriptome expression information. Expression data from 154 AML patients are used to develop a novel AML prognostic score, which is strongly associated with patient outcomes across 620 patients from three independent cohorts, and 42 patients from a prospective cohort. When combined with molecular risk guidelines, the risk score allows for the re-stratification of 22.1 to 25.3% of AML patients from three independent cohorts into correct risk groups. Within the adverse-risk subgroup, we identify a subset of patients characterized by dysregulated integrin signaling and RUNX1 or TP53 mutation. We show that these patients may benefit from therapy with inhibitors of focal adhesion kinase, encoded by PTK2, demonstrating additional utility of transcriptome-based testing for therapy selection in myeloid malignancy.
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Affiliation(s)
- T Roderick Docking
- Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Jeremy D K Parker
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Martin Jädersten
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Gerben Duns
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Linda Chang
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Jihong Jiang
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Jessica A Pilsworth
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Lucas A Swanson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Simon K Chan
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Readman Chiu
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Ka Ming Nip
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Samantha Mar
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Angela Mo
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Xuan Wang
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | | | - Ryan J Stubbins
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - İnanç Birol
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Donna Hogge
- Leukemia Bone Marrow Transplant Program of BC, Vancouver General Hospital, Vancouver, BC, Canada
| | - Aly Karsan
- Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada. .,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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4
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Pilsworth JA, Cochrane DR, Neilson S, Färkkilä AE, Horlings HM, Yanagida S, Senz J, Wang YK, Moussavi B, Lai D, Bashashati A, Keul J, Wong A, Meurs HV, Brucker SY, Taran FA, Krämer B, Staebler A, Oliva E, Shah SP, Kommoss S, Kommoss F, Gilks CB, Huntsman DG. Abstract GMM-047: GENOMIC CHARACTERIZATION OF ADULT-TYPE GRANULOSA CELL TUMORS: IMPLICATIONS FOR PATHOGENESIS AND TREATMENT OF RECURRENT DISEASE. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-gmm-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Adult granulosa cell tumors (AGCT) represent 3-5% of all ovarian cancers. These tumors are characterized by their slow growth and usually occur in postmenopausal women with a median age of diagnosis of 50 to 54 years. The majority of patients are diagnosed as stage I and are treated with surgery to remove their ovaries and uterus. Although these treatments are effective at first, one third of patients relapse leading to mortality in 50-80% of relapsed patients. The best course of treatment for patients with recurrent advanced stage disease is optimal debulking surgery. Currently, there are no effective treatments available for patients where surgery is not an option. Our research team previously discovered a somatic missense mutation (c.402C>G; pC134W) in the transcription factor Forkhead box L2 (FOXL2) in 97% of AGCTs. We also discovered frequent activating telomerase reverse transcriptase (TERT) promoter mutations in AGCT. As the FOXL2 C134W mutation is present in essentially all AGCTs and telomerase reactivation is required for tumorigenesis, it is likely that additional mutations are responsible for the variability in clinical behaviour. This study aims to describe the mutational landscape of AGCT to further refine our understanding of the frequent recurrence of this disease.
METHODS: Using whole genome sequencing (WGS), we characterized the genomes of ten AGCTs and their matched normal blood. We observed that AGCTs have a low mutation burden and the majority of mutations are single nucleotides variants. We have collected 516 formalin-fixed paraffin-embedded AGCT specimens including primary, recurrent and metastatic tumors from seven international centres for validation of our WGS results. Allelic discrimination assays were used for hotspots mutations, in addition to targeted sequencing of 39 genes of interest using a custom amplicon-based panel in our extension cohort.
RESULTS: Of the 39 genes analyzed, the third most commonly mutated gene (FOXL2 and TERT being the first and second most common) in our preliminary analysis of 88 cases was lysine (K)-specific methyltransferase 2D (KMT2D or MLL2). We identified various missense and nonsense mutations in this gene in 16 of 88 AGCTs (18%) analyzed thus far. KMT2D is a histone methyltransferase that targets histone H3 lysine 4 (H3K4), a methylation activation mark, and has an essential role in transcriptional regulation. Using an allelic discrimination assay, we identified a known hotspot mutation (c.49G>A;p.E17K) in v-akt murine thymoma viral oncogene 1 (AKT1) in 2 of 67 (3%) AGCT patients, one of which the mutation was present in all three recurrent specimens from the same patient. AKT1 E17K mutation has been reported in multiple cancers such as breast, colorectal and high grade serous ovarian cancer at a low prevalence. A recent clinical trial of AKT inhibition in solid tumors with AKT1 mutations included one recurrent AGCT patient and showed significant tumor regression in one metastatic site.
CONCLUSION: AKT1 E17K mutations are present in AGCT at a low prevalence and could represent a therapeutic target for patients with recurrent advanced stage disease harbouring this mutation.
Citation Format: Jessica A. Pilsworth, Dawn R. Cochrane, Samantha Neilson, Anniina E.M. Färkkilä, Hugo M. Horlings, Satoshi Yanagida, Janine Senz, Yi Kan Wang, Bahar Moussavi, Daniel Lai, Ali Bashashati, Jacqueline Keul, Adele Wong, Hannah van Meurs, Sara Y. Brucker, Florin-Andrei Taran, Bernhard Krämer, Annette Staebler, Esther Oliva, Sohrab P. Shah, Stefan Kommoss, Friedrich Kommoss, C. Blake Gilks and David G. Huntsman. GENOMIC CHARACTERIZATION OF ADULT-TYPE GRANULOSA CELL TUMORS: IMPLICATIONS FOR PATHOGENESIS AND TREATMENT OF RECURRENT DISEASE [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr GMM-047.
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Affiliation(s)
- Jessica A. Pilsworth
- 1University of British Columbia, Vancouver, BC, Canada,
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
| | | | | | - Anniina E.M. Färkkilä
- 3University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
- 4Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA,
| | | | | | - Janine Senz
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
| | - Yi Kan Wang
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
| | | | - Daniel Lai
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
| | | | | | - Adele Wong
- 7Massachusetts General Hospital, Boston, MA,
| | - Hannah van Meurs
- 8Center for Gynecologic Oncology Amsterdam, Academic Medical Center, Amsterdam, The Netherlands,
| | | | | | | | | | | | - Sohrab P. Shah
- 1University of British Columbia, Vancouver, BC, Canada,
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
| | | | | | | | - David G. Huntsman
- 1University of British Columbia, Vancouver, BC, Canada,
- 2British Columbia Cancer Agency, Vancouver, BC, Canada,
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5
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Bast RC, Matulonis UA, Sood AK, Ahmed AA, Amobi AE, Balkwill FR, Wielgos-Bonvallet M, Bowtell DDL, Brenton JD, Brugge JS, Coleman RL, Draetta GF, Doberstein K, Drapkin RI, Eckert MA, Edwards RP, Elias KM, Ennis D, Futreal A, Gershenson DM, Greenberg RA, Huntsman DG, Ji JXY, Kohn EC, Iavarone C, Lengyel ER, Levine DA, Lord CJ, Lu Z, Mills GB, Modugno F, Nelson BH, Odunsi K, Pilsworth JA, Rottapel RK, Powell DJ, Shen L, Shih LM, Spriggs DR, Walton J, Zhang K, Zhang R, Zou L. Critical questions in ovarian cancer research and treatment: Report of an American Association for Cancer Research Special Conference. Cancer 2019; 125:1963-1972. [PMID: 30835824 PMCID: PMC6557260 DOI: 10.1002/cncr.32004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
Abstract
Substantial progress has been made in understanding ovarian cancer at the molecular and cellular level. Significant improvement in 5-year survival has been achieved through cytoreductive surgery, combination platinum-based chemotherapy, and more effective treatment of recurrent cancer, and there are now more than 280,000 ovarian cancer survivors in the United States. Despite these advances, long-term survival in late-stage disease has improved little over the last 4 decades. Poor outcomes relate, in part, to late stage at initial diagnosis, intrinsic drug resistance, and the persistence of dormant drug-resistant cancer cells after primary surgery and chemotherapy. Our ability to accelerate progress in the clinic will depend on the ability to answer several critical questions regarding this disease. To assess current answers, an American Association for Cancer Research Special Conference on "Critical Questions in Ovarian Cancer Research and Treatment" was held in Pittsburgh, Pennsylvania, on October 1-3, 2017. Although clinical, translational, and basic investigators conducted much of the discussion, advocates participated in the meeting, and many presentations were directly relevant to patient care, including treatment with poly adenosine diphosphate ribose polymerase (PARP) inhibitors, attempts to improve immunotherapy by overcoming the immune suppressive effects of the microenvironment, and a better understanding of the heterogeneity of the disease.
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Affiliation(s)
- Robert C. Bast
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anil K. Sood
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | - Zhen Lu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Brad H. Nelson
- University of British Columbia, Canada
- BC Cancer Agency, Canada
| | | | | | | | | | - Li Shen
- Roswell Park Cancer Institute, Buffalo, NY
| | - le-Ming Shih
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Lee Zou
- Massachusetts General Hospital, Boston, MD
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6
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Pilsworth JA, Cochrane DR, Xia Z, Aubert G, Färkkilä AEM, Horlings HM, Yanagida S, Yang W, Lim JLP, Wang Y, Bashashati A, Keul J, Wong A, Oliva E, Shah SP, Kommoss S, Kommoss F, Lansdorp PM, Baird DM, Huntsman DG. Abstract PR13: TERT is frequently mutated in adult-type granulosa cell tumors of the ovary compared to other malignant sex cord-stromal tumors. Clin Cancer Res 2018. [DOI: 10.1158/1557-3265.ovca17-pr13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The telomerase reverse transcriptase (TERT) gene is highly expressed in stem cells and silenced upon differentiation. Cancer cells can attain immortality by activating TERT to maintain telomere length and telomerase activity, a crucial step of tumorigenesis. Two somatic mutations in the TERT promoter (C228T; C250T) have been identified in multiple cancers, such as melanoma and glioblastoma, as gain-of-function mutations that promote transcriptional activation of TERT. A recent study investigating TERT promoter mutations in ovarian carcinomas found mutations in 15% of clear cell carcinomas. However, it is unknown whether these mutations are prevalent in adult-type granulosa cell tumors (AGCTs) of the ovary, Sertoli-Leydig cell tumors (SLCTs), and other malignant sex cord-stromal tumors.
We performed whole-genome sequencing on ten AGCT cases with matched normal and identified the TERT C228T promoter mutation in 50% of cases. We found that AGCT cases with mutated TERT promoter have increased expression of TERT mRNA compared to those with wild-type TERT promoter. All five TERT promoter mutated cases had high levels of TERT mRNA expression, whereas three of the five wild-type TERT cases had no measurable TERT mRNA expression. There was a tendency towards longer telomere lengths in AGCT cases with the TERT promoter mutation relative to those without, although it was not statistically significant. These results suggest that telomerase may be activated by a different method in the cases with no TERT promoter mutations but have TERT mRNA expression. The remaining cases with neither TERT promoter mutations nor TERT mRNA expression likely maintain their telomeres using a telomerase-independent method, such as the alternative lengthening of telomeres pathway. TERT C228T allelic discrimination analysis of 331 AGCTs, 5 SLCTs, and 18 other malignant sex cord-stromal tumors detected the mutation in 56/247 (23%) of primary AGCTs, 22/84 (26%) of recurrent AGCTs, 1/5 (20%) of SLCTs and (0/18) 0% of other malignant sex cord-stromal tumors. The single SLCT case with the TERT promoter mutation was poorly differentiated and harbored the pathognomonic FOXL2 mutation of AGCT, suggesting this SLCT case may actually be an AGCT. In 204 AGCT cases with available survival data, there was a trend towards worse disease-specific survival in patients with the TERT promoter mutation compared to those without; however, statistical significance was not reached (p = 0.128, log-ranked test). In 5 AGCT cases with primary and recurrent tissues, we found that the TERT promoter mutation was absent in the primary tumors but present in the recurrent tumors, suggesting that TERT C228T mutation may play an active role in progression of AGCTs.
Overall, we found that TERT C228T promoter mutation was most common in AGCTs among the different malignant sex cord-stromal tumors. Our data confirm the activation of telomerase in AGCTs via TERT C228T promoter mutation, although alternative telomerase activation methods in AGCTs may exist. Our results suggest that TERT activation may play a role in AGCT recurrence. As such, telomere biology may be important for the progression of AGCTs.
This abstract is also being presented as Poster B54.
Citation Format: Jessica A. Pilsworth, Dawn R. Cochrane, Zhouchunyang Xia, Geraldine Aubert, Anniina E. M. Färkkilä, Hugo M. Horlings, Satoshi Yanagida, Winnie Yang, Jamie L. P. Lim, Yikan Wang, Ali Bashashati, Jacqueline Keul, Adele Wong, Esther Oliva, Sohrab P. Shah, Stefan Kommoss, Friedrich Kommoss, Peter M. Lansdorp, Duncan M. Baird, David G. Huntsman. TERT is frequently mutated in adult-type granulosa cell tumors of the ovary compared to other malignant sex cord-stromal tumors. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr PR13.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yikan Wang
- 2BC Cancer Agency, Vancouver, BC, Canada,
| | | | | | - Adele Wong
- 5Massachusetts General Hospital, Boston, MA,
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7
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Pilsworth JA, Cochrane DR, Xia Z, Aubert G, Färkkilä AEM, Horlings HM, Yanagida S, Yang W, Lim JLP, Wang YK, Bashashati A, Keul J, Wong A, Norris K, Brucker SY, Taran FA, Krämer B, Staebler A, van Meurs H, Oliva E, Shah SP, Kommoss S, Kommoss F, Gilks CB, Baird DM, Huntsman DG. TERT promoter mutation in adult granulosa cell tumor of the ovary. Mod Pathol 2018; 31:1107-1115. [PMID: 29449679 DOI: 10.1038/s41379-018-0007-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/28/2017] [Accepted: 12/03/2017] [Indexed: 12/29/2022]
Abstract
The telomerase reverse transcriptase (TERT) gene is highly expressed in stem cells and silenced upon differentiation. Cancer cells can attain immortality by activating TERT to maintain telomere length and telomerase activity, which is a crucial step of tumorigenesis. Two somatic mutations in the TERT promoter (C228T; C250T) have been identified as gain-of-function mutations that promote transcriptional activation of TERT in multiple cancers, such as melanoma and glioblastoma. A recent study investigating TERT promoter mutations in ovarian carcinomas found C228T and C250T mutations in 15.9% of clear cell carcinomas. However, it is unknown whether these mutations are frequent in other ovarian cancer subtypes, in particular, sex cord-stromal tumors including adult granulosa cell tumors. We performed whole-genome sequencing on ten adult granulosa cell tumors with matched normal blood and identified a TERT C228T promoter mutation in 50% of tumors. We found that adult granulosa cell tumors with mutated TERT promoter have increased expression of TERT mRNA and exhibited significantly longer telomeres compared to those with wild-type TERT promoter. Extension cohort analysis using allelic discrimination revealed the TERT C228T mutation in 51 of 229 primary adult granulosa cell tumors (22%), 24 of 58 recurrent adult granulosa cell tumors (41%), and 1 of 22 other sex cord-stromal tumors (5%). There was a significant difference in overall survival between patients with TERT C228T promoter mutation in the primary tumors and those without it (p = 0.00253, log-rank test). In seven adult granulosa cell tumors, we found the TERT C228T mutation present in recurrent tumors and absent in the corresponding primary tumor. Our data suggest that TERT C228T promoter mutations may have an important role in progression of adult granulosa cell tumors.
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Affiliation(s)
- Jessica A Pilsworth
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Dawn R Cochrane
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Zhouchunyang Xia
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Geraldine Aubert
- Terry Fox Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Anniina E M Färkkilä
- Children's Hospital and Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Radiation Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hugo M Horlings
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Satoshi Yanagida
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Winnie Yang
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jamie L P Lim
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Yi Kan Wang
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ali Bashashati
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jacqueline Keul
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Adele Wong
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin Norris
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Sara Y Brucker
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Florin-Andrei Taran
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Bernhard Krämer
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | - Annette Staebler
- Tübingen University Hospital, Institute of Pathology, Tübingen, Germany
| | - Hannah van Meurs
- Department of Gynecology, Center for Gynecologic Oncology Amsterdam, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sohrab P Shah
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Kommoss
- Department of Women's Health, Tübingen University Hospital, Tübingen, Germany
| | | | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Duncan M Baird
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - David G Huntsman
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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8
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Pilsworth JA, Cochrane DR, Xia Z, Horlings HM, Yang W, McConechy MK, Yanagida S, Färkkilä AE, Wong AP, Trigo-Gonzalez G, Cheng SG, Wang Y, Bashashati A, Morin GB, Oliva E, Shah SP, Huntsman DG. Abstract 3381: TERT promoter mutation in granulosa cell tumours of the ovary: Prevalence and prognostic significance. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Granulosa cell tumours (GCTs) of the ovary account for 90% of sex cord-stromal tumours and have a high recurrence rate up to 50%. A missense mutation in the FOXL2 gene (c.402C>G; pC134W) is a defining feature of GCT and is used as a robust marker for diagnosis. However, other than the FOXL2 mutation the pathogenesis and the driving pathways remain unknown. Determining secondary genetic events in GCTs is essential to understanding and improving prognosis.
In a pilot study, we completed an analysis of whole genome sequencing of ten GCTs and matched normal cases to generate a comprehensive catalogue of coding and non-coding events. We identified a TERT promoter mutation (c.228C>T) in 50% of these cases. TERT is normally inactivated in somatic tissues; however, this promoter mutation has been shown to re-activate transcription of TERT. We validated this TERT mutation in an international cohort of 300 GCTs and found it was present in approximately 25% of cases overall. These TERT promoter mutations have been used to revise the molecular classification of other cancer types such as gliomas. In GCT, we found that this TERT mutation was correlated with a significantly worse survival outcome in patients with primary GCT (p<0.005). Further, we found that this TERT mutation was present in a larger proportion of recurrent cases. Thus, this mutation may denote a novel subtype of GCT with a worse prognosis.
Previous research has shown that TERT activation is evident in over 90% of cancers and is a fundamental step in tumourigenesis that enables unlimited proliferation. This TERT promoter mutation in GCT provides an explanation of how granulosa cells escape atresia and attain immortality. Thus, we hypothesize a mechanism in which the FOXL2 mutation prevents apoptosis and the TERT mutation allows limitless proliferation for oncogenes to transform granulosa cells. However, the current cell models of GCT lack relevant functional pathways and do not recapitulate the biology of these tumours. Therefore, we are developing more suitable cell models to test our hypothesis. We believe that understanding the interaction between these TERT and FOXL2 mutations may lead to novel cancer cell-specific targeted therapies.
Citation Format: Jessica A. Pilsworth, Dawn R. Cochrane, Zhouchunyang Xia, Hugo M. Horlings, Winnie Yang, Melissa K. McConechy, Satoshi Yanagida, Anniina E. Färkkilä, Adele P. Wong, Genny Trigo-Gonzalez, S.W. Grace Cheng, Yikan Wang, Ali Bashashati, Gregg B. Morin, Esther Oliva, Sohrab P. Shah, David G. Huntsman. TERT promoter mutation in granulosa cell tumours of the ovary: Prevalence and prognostic significance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3381. doi:10.1158/1538-7445.AM2017-3381
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Affiliation(s)
| | | | - Zhouchunyang Xia
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Winnie Yang
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Yikan Wang
- 2BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Gregg B. Morin
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sohrab P. Shah
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | - David G. Huntsman
- 1University of British Columbia, Vancouver, British Columbia, Canada
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9
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Seid-Karbasi P, Ye XC, Zhang AW, Gladish N, Cheng SYS, Rothe K, Pilsworth JA, Kang MA, Doolittle N, Jiang X, Stirling PC, Wasserman WW. CuboCube: Student creation of a cancer genetics e-textbook using open-access software for social learning. PLoS Biol 2017; 15:e2001192. [PMID: 28267757 PMCID: PMC5340349 DOI: 10.1371/journal.pbio.2001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Student creation of educational materials has the capacity both to enhance learning and to decrease costs. Three successive honors-style classes of undergraduate students in a cancer genetics class worked with a new software system, CuboCube, to create an e-textbook. CuboCube is an open-source learning materials creation system designed to facilitate e-textbook development, with an ultimate goal of improving the social learning experience for students. Equipped with crowdsourcing capabilities, CuboCube provides intuitive tools for nontechnical and technical authors alike to create content together in a structured manner. The process of e-textbook development revealed both strengths and challenges of the approach, which can inform future efforts. Both the CuboCube platform and the Cancer Genetics E-textbook are freely available to the community.
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Affiliation(s)
| | - Xin C. Ye
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen W. Zhang
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Agency, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
- Graduate Program in Bioinformatics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Gladish
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne Y. S. Cheng
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
| | - Katharina Rothe
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Terry Fox Laboratory, BC Cancer Agency, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica A. Pilsworth
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Michael Smith’s Genome Science’s Centre, BC Cancer Agency, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
| | - Min A. Kang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Xiaoyan Jiang
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Terry Fox Laboratory, BC Cancer Agency, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter C. Stirling
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Terry Fox Laboratory, BC Cancer Agency, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
| | - Wyeth W. Wasserman
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Provincial Health Services Authority and University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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