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Mosbah H, Vatier C, Andriss B, Belalem I, Delemer B, Janmaat S, Jéru I, Le Collen L, Maiter D, Nobécourt E, Vantyghem MC, Vigouroux C, Dumas A. Patients' perspective on the medical pathway from first symptoms to diagnosis in genetic lipodystrophy. Eur J Endocrinol 2024; 190:23-33. [PMID: 38128113 DOI: 10.1093/ejendo/lvad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Underdiagnosis is an important issue in genetic lipodystrophies, which are rare diseases with metabolic, cardiovascular, gynecological, and psychological complications. We aimed to characterize the diagnostic pathway in these diseases from the patients' perspective. DESIGN Cross-sectional study conducted through a self-reported patient questionnaire. METHODS Patients with genetic lipodystrophy were recruited throughout the French national reference network for rare diseases of insulin secretion and insulin sensitivity. Patients completed a self-reported questionnaire on disease symptoms, steps leading to the diagnosis, and healthcare professionals involved. Descriptive analyses were conducted. RESULTS Out of 175 eligible patients, 109 patients (84% women) were included; 93 had partial familial lipodystrophy and 16 congenital generalized lipodystrophy. Metabolic comorbidities (diabetes 68%, hypertriglyceridemia 66%, hepatic steatosis 57%), cardiovascular (hypertension 54%), and gynecologic complications (irregular menstruation 60%) were frequently reported. Median age at diagnosis was 30 years (interquartile range [IQR] 23-47). The overall diagnostic process was perceived as "very difficult" for many patients. It extended over 12 years (IQR 5-25) with more than five different physicians consulted by 36% of respondents, before diagnosis, for lipodystrophy-related symptoms. The endocrinologist made the diagnosis for 77% of the patients. Changes in morphotype were reported as the first symptoms by the majority of respondents. CONCLUSIONS Diagnostic pathway in patients with genetic lipodystrophy is rendered difficult by the multisystemic features of the disease and the lack of knowledge of non-specialized physicians. Training physicians to systematically include adipose tissue examination in routine clinical evaluation should improve diagnosis and management of lipodystrophy and lipodystrophy-associated comorbidities.
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Affiliation(s)
- Héléna Mosbah
- ECEVE UMR 1123, INSERM, Université Paris Cité, 75014 Paris, France
- Service Endocrinologie, Diabétologie, Nutrition, CHU La Milétrie, 86000 Poitiers, France
- Hôpital Saint-Antoine, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France
| | - Camille Vatier
- Hôpital Saint-Antoine, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France
- Inserm U938, Centre de Recherche Saint-Antoine et Institut de Cardio-Métabolisme et Nutrition (ICAN), Sorbonne Université, 75012 Paris, France
| | - Béatrice Andriss
- Unité d'Epidémiologie Clinique, APHP, Hôpital Universitaire Robert Debré, 75019 Paris, France
| | - Inès Belalem
- Hôpital Saint-Antoine, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France
| | - Brigitte Delemer
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, 51100 Reims, France
| | - Sonja Janmaat
- Hôpital Saint-Antoine, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France
- Inserm U938, Centre de Recherche Saint-Antoine et Institut de Cardio-Métabolisme et Nutrition (ICAN), Sorbonne Université, 75012 Paris, France
| | - Isabelle Jéru
- Inserm U938, Centre de Recherche Saint-Antoine et Institut de Cardio-Métabolisme et Nutrition (ICAN), Sorbonne Université, 75012 Paris, France
- Département de Génétique Médicale, DMU BioGeM, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Lauriane Le Collen
- Inserm/CNRS UMR 1283/8199, Institut Pasteur, EGID, Université Lille, 59000 Lille, France
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, 51100 Reims, France
- Service de Génétique clinique, Centre hospitalier de Reims, 51100 Reims, France
| | - Dominique Maiter
- Service d'Endocrinologie et Nutrition, Institut de Recherche Expérimentale et Clinique IREC, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, B-1348 Brussels, Belgique
| | - Estelle Nobécourt
- Service d'endocrinologie Diabétologie, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France
| | - Marie-Christine Vantyghem
- Endocrinologie, diabétologie et métabolisme, CHU Lille, 59000 Lille, France
- Inserm U1190, Université Lille, Institut Pasteur, 59000 Lille, France
| | - Corinne Vigouroux
- Hôpital Saint-Antoine, Centre de Référence des Maladies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Service d'Endocrinologie, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France
- Inserm U938, Centre de Recherche Saint-Antoine et Institut de Cardio-Métabolisme et Nutrition (ICAN), Sorbonne Université, 75012 Paris, France
| | - Agnes Dumas
- ECEVE UMR 1123, INSERM, Université Paris Cité, 75014 Paris, France
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Kouidrat Y, Le Collen L, Vaxillaire M, Dechaume A, Toussaint B, Vaillant E, Amanzougarene S, Derhourhi M, Delemer B, Azahaf M, Froguel P, Bonnefond A. Dominant PDX1 deficiency causes highly penetrant diabetes at different ages, associated with obesity and exocrine pancreatic deficiency: Lessons for precision medicine. Diabetes Metab 2024; 50:101507. [PMID: 38141807 DOI: 10.1016/j.diabet.2023.101507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Heterozygous pathogenic or likely pathogenic (P/LP) PDX1 variants cause monogenic diabetes. We comprehensively examined the phenotypes of carriers of P/LP PDX1 variants, and delineated potential treatments that could be efficient in an objective of precision medicine. METHODS The study primarily involved a family harboring a novel P/LP PDX1 variant. We then conducted an analysis of documented carriers of P/LP PDX1 variants, from the Human Gene Mutation Database (HGMD), RaDiO study, and Type 2 Diabetes Knowledge Portal (T2DKP) including 87 K participants. RESULTS Within the family, we identified a P/LP PDX1 variant encoding p.G232S in four relatives. All of them exhibited diabetes, albeit with very different ages of onset (10-40 years), along with caudal pancreatic agenesis and childhood-onset obesity. In the HGMD, 79 % of carriers of a P/LP PDX1 variant displayed diabetes (with differing ages of onset from eight days of life to 67 years), 63 % exhibited pancreatic insufficiency and surprisingly 40 % had obesity. The impact of P/LP PDX1 variants on increased risk of type 2 diabetes mellitus was confirmed in the T2DKP. Dipeptidyl peptidase 4 inhibitor (DPP4i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), enabled good glucose control without hypoglycemia and weight management. CONCLUSIONS This study reveals diverse clinical presentations among the carriers of a P/LP PDX1 variant, highlighting strong variations in diabetes onset, and unexpectedly high prevalence of obesity and pancreatic development abnormalities. Clinical data suggest that DPP4i and GLP1-RA may be the best effective treatments to manage both glucose and weight controls, opening new avenue in precision diabetic medicine.
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Affiliation(s)
- Youssef Kouidrat
- Department of Rehabilitation, Nutrition and Obesity, Berck Maritime Hospital, Greater Paris University Hospitals, AP-HP, Berck, France
| | - Lauriane Le Collen
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France; Department of Clinical Genetic, University Hospital Center of Reims, Reims, France.
| | - Martine Vaxillaire
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Aurélie Dechaume
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Bénédicte Toussaint
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Emmanuel Vaillant
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Souhila Amanzougarene
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Mehdi Derhourhi
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
| | - Mustapha Azahaf
- Department of Radiology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France
| | - Philippe Froguel
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France; Department of Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
| | - Amélie Bonnefond
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France; Department of Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
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3
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Le Collen L, Delemer B, Poitou C, Vaxillaire M, Toussaint B, Dechaume A, Badreddine A, Boissel M, Derhourhi M, Clément K, Petit JM, Mau-Them FT, Bruel AL, Thauvin-Robinet C, Saveanu A, Cherifi BG, Le Beyec-Le Bihan J, Froguel P, Bonnefond A. Heterozygous pathogenic variants in POMC are not responsible for monogenic obesity: implication for MC4R agonist use. Genet Med 2023:100857. [PMID: 37092539 DOI: 10.1016/j.gim.2023.100857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/09/2022] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE Recessive deficiency for proopiomelanocortin (POMC) causes childhood-onset severe obesity. Cases can now benefit from the MC4R agonist setmelanotide. Furthermore, a phase 3 clinical trialis evaluating setmelanotide in heterozygotes for POMC. We performed a large-scale genetic analysis assessing the effect of heterozygous, pathogenic POMC variants on obesity. METHODS A genetic analysis was performed in a family including two cousins with childhood-onset obesity. We analyzed the obesity status of heterozygotes for pathogenic POMC variants in the Human Gene Mutation Database (HGMD). The association between heterozygous, pathogenic POMC variants and obesity risk was assessed using 190,000 exome samples from UK Biobank. RESULTS The two cousins carried a compound heterozygous, pathogenic variant in POMC. Six siblings were heterozygotes; only one of them had obesity. In HGMD, we identified 60 heterozygotes for pathogenic POMC variants, of whom 14 had obesity. In UK Biobank, heterozygous, pathogenic POMC variants were not associated with obesity risk, but modestly increased body mass index levels. CONCLUSIONS Heterozygous, pathogenic POMC variants do not contribute to monogenic obesity, but slightly increase BMI. Setmelanotide use in patients with obesity which would only be based on the presence of a heterozygous POMC variant can be questioned.
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Affiliation(s)
- Lauriane Le Collen
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France;; Department of Clinical Genetic, University Hospital Center of Reims, Reims, France;; University of Lille, Lille, France;.
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
| | - Christine Poitou
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: systemic approaches Research Unit (NutriOmics), Paris, France
| | - Martine Vaxillaire
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Bénédicte Toussaint
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Aurélie Dechaume
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Alaa Badreddine
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Mathilde Boissel
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Mehdi Derhourhi
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France
| | - Karine Clément
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, INSERM, Nutrition and Obesities: systemic approaches Research Unit (NutriOmics), Paris, France
| | - Jean Michel Petit
- Department of Endocrinology Diabetology, University Hospital Central of F.Mitterrand Dijon-Bourgogne
| | - Frédéric Tran Mau-Them
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, Dijon, France;; INSERM UMR1231 GAD, F-21000, Dijon, France
| | - Ange-Line Bruel
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, Dijon, France;; INSERM UMR1231 GAD, F-21000, Dijon, France
| | - Christel Thauvin-Robinet
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, Dijon, France;; INSERM UMR1231 GAD, F-21000, Dijon, France;; Centre de Référence Maladies Rares "Anomalies du développement et syndromes malformatifs", Centre de Génétique, FHU TRANSLAD et Institut GIMI, CHU Dijon Bourgogne, Dijon, France
| | - Alexandru Saveanu
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France;; Assistance Publique-Hôpitaux de Marseille (AP-HM), Reference Center for Rare Pituitary Diseases HYPO, Marseille, France;; Assistance-Publique des Hôpitaux de Marseille (AP-HM), Laboratory of Molecular Biology, Conception Hospital, Marseille, France
| | - Blandine Gatta Cherifi
- CHU Bordeaux, Endocrinology, Diabetology & Nutrition, F-33000, Bordeaux, France;; University of Bordeaux, F-33000, Bordeaux, France;; INSERMU1215 Neurocentre Magendie, University of Bordeaux, Bordeaux, France
| | - Johanne Le Beyec-Le Bihan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Endocrine and Oncological Biochemistry Department, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France;; INSERMU1149, Centre de recherche sur l'inflammation, Paris, France
| | - Philippe Froguel
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France;; Department of Metabolism, Imperial College London, London, United Kingdom
| | - Amélie Bonnefond
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France;; University of Lille, Lille, France;; Department of Metabolism, Imperial College London, London, United Kingdom.
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Branzoli F, Salgues B, Marjańska M, Laloi-Michelin M, Herman P, Le Collen L, Delemer B, Riancho J, Kuhn E, Jublanc C, Burnichon N, Amar L, Favier J, Gimenez-Roqueplo AP, Buffet A, Lussey-Lepoutre C. SDHx mutation and pituitary adenoma: can in vivo 1H-MR spectroscopy unravel the link? Endocr Relat Cancer 2023; 30:ERC-22-0198. [PMID: 36449569 PMCID: PMC9885742 DOI: 10.1530/erc-22-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
Germline mutations in genes encoding succinate dehydrogenase (SDH) are frequently involved in pheochromocytoma/paraganglioma (PPGL) development and were implicated in patients with the '3PAs' syndrome (associating pituitary adenoma (PA) and PPGL) or isolated PA. However, the causality link between SDHx mutation and PA remains difficult to establish, and in vivo tools for detecting hallmarks of SDH deficiency are scarce. Proton magnetic resonance spectroscopy (1H-MRS) can detect succinate in vivo as a biomarker of SDHx mutations in PGL. The objective of this study was to demonstrate the causality link between PA and SDH deficiency in vivo using 1H-MRS as a novel noninvasive tool for succinate detection in PA. Three SDHx-mutated patients suffering from a PPGL and a macroprolactinoma and one patient with an apparently sporadic non-functioning pituitary macroadenoma underwent MRI examination at 3 T. An optimized 1H-MRS semi-LASER sequence (TR = 2500 ms, TE = 144 ms) was employed for the detection of succinate in vivo. Succinate and choline-containing compounds were identified in the MR spectra as single resonances at 2.44 and 3.2 ppm, respectively. Choline compounds were detected in all the tumors (three PGL and four PAs), while a succinate peak was only observed in the three macroprolactinomas and the three PGL of SDHx-mutated patients, demonstrating SDH deficiency in these tumors. In conclusion, the detection of succinate by 1H-MRS as a hallmark of SDH deficiency in vivo is feasible in PA, laying the groundwork for a better understanding of the biological link between SDHx mutations and the development of these tumors.
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Affiliation(s)
- Francesca Branzoli
- Paris Brain Institute - Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Betty Salgues
- Sorbonne University, nuclear medicine department, Pitié-Salpêtrière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
- Paris Cardiovascular Research Center (PARCC), Inserm, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marie Laloi-Michelin
- Endocrinology department, Lariboisière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
| | - Philippe Herman
- ENT unit, Lariboisière Hospital, Assistance -Publique Hôpitaux de Paris, Paris-Cité University, INSERM U1141, Paris, France
| | - Lauriane Le Collen
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, University of Lille, Lille, France
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
- Department of Genetic, University Hospital Center of Reims, Reims, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de La Housse, BP 1039, Reims, France
| | - Julien Riancho
- AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, and Reference centre for rare adrenal diseases, Paris, France
| | - Emmanuelle Kuhn
- Pituitary Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France
| | - Christel Jublanc
- Pituitary Unit, Pitié-Salpêtrière Hospital APHP, Sorbonne University, Paris, France
| | - Nelly Burnichon
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Laurence Amar
- AP-HP, Hôpital Européen Georges Pompidou, Hypertension Unit, and Reference centre for rare adrenal diseases, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | | | - Anne-Paule Gimenez-Roqueplo
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Alexandre Buffet
- Département de médecine génomique des tumeurs et des cancers, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, Inserm, PARCC, Paris, France
| | - Charlotte Lussey-Lepoutre
- Sorbonne University, nuclear medicine department, Pitié-Salpêtrière Hospital, Assistance -Publique Hôpitaux de Paris, Paris, France
- Paris Cardiovascular Research Center (PARCC), Inserm, Paris, France
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Lagarde A, Mougel G, Coppin L, Haissaguerre M, Le Collen L, Mohamed A, Klein M, Odou MF, Tabarin A, Brixi H, Cuny T, Delemer B, Barlier A, Romanet P. Systematic detection of mosaicism by using digital NGS reveals three new MEN1 mosaicisms. Endocr Connect 2022; 11:e220093. [PMID: 36112497 PMCID: PMC9578105 DOI: 10.1530/ec-22-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022]
Abstract
Purpose Mosaicism is a feature of several inherited tumor syndromes. Only a few cases of mosaicism have been described in multiple endocrine neoplasia type 1 (MEN1). Next-generation sequencing (NGS) offers new possibilities for detecting mosaicism. Here, we report the first study to systematically look for MEN1 mosaicism, using blood DNA, in MEN1-suspected patients but without MEN1 pathogenic variants (PV) in a heterozygous state. Methods Digital targeted NGS, including unique molecular identifiers (UMIs), was performed in routine practice, and the analytic performance of this method was verified. Results Among a cohort of 119 patients harboring from 2 to 5 MEN1 lesions, we identified 3 patients with MEN1 mosaic PVs. The allele frequencies ranged from 2.3 to 9.5%. The detection rate of MEN1 mosaicism in patients bearing at least 3 MEN1 lesions was 17% (3/18). No cases were detected in patients with two lesions. Conclusion We report here three new cases with MEN1 mosaicism. This study examined the performance of UMI in the diagnosis of MEN1 mosaicism in routine practice, and our results underline that the frequency of mosaicism is probably underestimated in patients with suspected MEN1.
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Affiliation(s)
- Arnaud Lagarde
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
| | - Grégory Mougel
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
| | - Lucie Coppin
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 – CANTHER – Cancer – Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Magalie Haissaguerre
- Service d’Endocrinologie, Centre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, France
| | - Lauriane Le Collen
- Endocrinology, Diabetology and Nutrition Unit, University Hospital of Reims, Reims, France
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France
| | - Amira Mohamed
- Laboratory of Molecular Biology, Hospital La Conception, APHM, Marseille, France
| | - Marc Klein
- Service Endocrinologie, CHU de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Marie-Françoise Odou
- CHU Lille, Service de Biochimie et Biologie Moléculaire ‘Hormonologie, Métabolisme-Nutrition, Oncologie’, Lille, France
- Univ. Lille, Inserm, CHU Lille, U1286 – Infinite – Institute for Translational Research in Inflammation, Lille, France
| | - Antoine Tabarin
- Service d’Endocrinologie, Centre Hospitalier Universitaire, Hôpital du Haut Levêque, Pessac, France
| | - Hedia Brixi
- Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - Brigitte Delemer
- Endocrinology, Diabetology and Nutrition Unit, University Hospital of Reims, Reims, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France
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Lagarde A, Le Collen L, Boulagnon C, Brixi H, Durlach A, Mougel G, Cuny T, Delemer B, Barlier A, Romanet P. Early Detection of Relapse by ctDNA Sequencing in a Patient with Metastatic Thymic Tumor and MEN1 Mosaicism. J Clin Endocrinol Metab 2022; 107:e4154-e4158. [PMID: 35904487 DOI: 10.1210/clinem/dgac454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disease caused by inactivating mutations in the MEN1 gene. In the literature, few cases of MEN1 have been reported because of mosaic MEN1 mutations. OBJECTIVE We performed an extensive molecular characterization in several lesions and blood samples, including plasmatic circulating cell-free DNA (ccfDNA) in an exceptional case of a patient with MEN1 mosaicism causing primary hyperparathyroidism, multiple pancreatic neuroendocrine tumors (NETs), and a metastatic thymic NET. METHODS Blood, ccfDNA and multiple tissue analysis were performed by next-generation sequencing. RESULTS MEN1 mosaicism was confirmed by multiple tissue analysis. Somatic analysis of the largest pancreatic NET revealed the same MEN1 second-hit mutation as found in the thymic lesion, demonstrating its metastatic origin from the thymic lesion. Moreover, in ccfDNA we found the mosaic MEN1 mutation but also the somatic second-hit mutation found in the thymic primary tumor, revealing the presence of circulating tumor DNA (ctDNA). After surgical removal of the pancreatic metastasis, the mutated fraction of both mutations decreased, before increasing again several weeks before a new clinical relapse, suggesting that thymic ctDNA may be used as an early tumor biomarker. CONCLUSION This exceptional MEN1 case highlighted (1) the importance of looking for MEN1 mosaicism, (2) that MEN1 mosaicism can cause very aggressive disease, and (3) the interest in analyzing ccfDNA for confirming MEN1 mosaicism but also as a potential tumor biomarker for NET.
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Affiliation(s)
- Arnaud Lagarde
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Lauriane Le Collen
- Department of Endocrinology Diabetology, University of Reims , Reims, France
- Inserm/CNRS UMR 1283/8199, Institut Pasteur de Lille , EGID, Lille, France
- Department of Clinical Genetics, University of Reims , Reims, France
| | - Camille Boulagnon
- Biopathology Laboratory, Pôle de Biologie Territorial, CHU de Reims, 51092 Reims, France
- Université de Reims Champagne Ardenne (URCA), CNRS, UMR 7369 MEDyC, Reims, France
| | - Hedia Brixi
- Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Anne Durlach
- Biopathology Laboratory, Pôle de Biologie Territorial, CHU de Reims, 51092 Reims, France
- Inserm UMR-S 1250, 51092 Reims, France
| | - Grégory Mougel
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Department of endocrinology, Marseille, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University of Reims , Reims, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, MMG, Hospital La Conception Laboratory of Molecular Biology, Marseille, France
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Le Collen L, Delemer B, Spodenkiewicz M, Cornillet Lefebvre P, Durand E, Vaillant E, Badreddine A, Derhourhi M, Mouhoub TA, Jouret G, Juttet P, Souchon PF, Vaxillaire M, Froguel P, Bonnefond A, Doco Fenzy M. Compound genetic etiology in a patient with a syndrome including diabetes, intellectual deficiency and distichiasis. Orphanet J Rare Dis 2022; 17:86. [PMID: 35227307 PMCID: PMC8887189 DOI: 10.1186/s13023-022-02248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied a young woman with atypical diabetes associated with mild intellectual disability, lymphedema distichiasis syndrome (LDS) and polymalformative syndrome including distichiasis. We used different genetic tools to identify causative pathogenic mutations and/or copy number variations. RESULTS Although proband's, diabetes mellitus occurred during childhood, type 1 diabetes was unlikely due to the absence of detectable autoimmunity. DNA microarray analysis first identified a de novo, heterozygous deletion at the chr16q24.2 locus. Previously, thirty-three pathogenic or likely pathogenic deletions encompassing this locus have been reported in patients presenting with intellectual deficiency, obesity and/or lymphedema but not with diabetes. Of note, the deletion encompassed two topological association domains, whose one included FOXC2 that is known to be linked with LDS. Via whole-exome sequencing, we found a heterozygous, likely pathogenic variant in WFS1 (encoding wolframin endoplasmic reticulum [ER] transmembrane glycoprotein) which was inherited from her father who also had diabetes. WFS1 is known to be involved in monogenic diabetes. We also found a likely pathogenic variant in USP9X (encoding ubiquitin specific peptidase 9 X-linked) that is involved in X-linked intellectual disability, which was inherited from her mother who had dyscalculia and dyspraxia. CONCLUSIONS Our comprehensive genetic analysis suggested that the peculiar phenotypes of our patient were possibly due to the combination of multiple genetic causes including chr16q24.2 deletion, and two likely pathogenic variants in WFS1 and USP9X.
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Affiliation(s)
- Lauriane Le Collen
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France. .,Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France. .,University of Lille, Lille, France. .,Department of Genetic, University Hospital Center of Reims, Reims, France.
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France. .,Faculty of Medicine of Reims, CRESTIC EA 3804, University of Reims Champagne Ardenne, Moulin de La Housse, BP 1039, 51687, Reims Cedex 2, France.
| | | | | | - Emmanuelle Durand
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France.,University of Lille, Lille, France
| | - Emmanuel Vaillant
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France.,University of Lille, Lille, France
| | - Alaa Badreddine
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France.,University of Lille, Lille, France
| | - Mehdi Derhourhi
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France.,University of Lille, Lille, France
| | - Tarik Ait Mouhoub
- Department of Genetic, University Hospital Center of Reims, Reims, France
| | - Guillaume Jouret
- Department of Genetic, University Hospital Center of Reims, Reims, France.,Departement of Genetic, 1 rue Louis Rech Dudelange, 3555, Luxembourg, Luxembourg
| | | | | | - Martine Vaxillaire
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France.,University of Lille, Lille, France
| | - Philippe Froguel
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France. .,University of Lille, Lille, France.
| | - Amélie Bonnefond
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille, EGID, Lille, France. .,University of Lille, Lille, France.
| | - Martine Doco Fenzy
- Department of Genetic, University Hospital Center of Reims, Reims, France. .,Faculty of Medicine of Reims, EA 3801, URCA, Reims, France.
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Le Collen L, Barraud S, Braconnier A, Coppin L, Zachar D, Boulagnon C, Deguelte S, Souchon PF, Spodenkiewicz M, Poirsier C, Aubert S, Odou MF, Delemer B. A large extended family with hyperparathyroidism-jaw tumor syndrome due to deletion of the third exon of CDC73: clinical and molecular features. Endocrine 2021; 73:693-701. [PMID: 33999366 DOI: 10.1007/s12020-021-02756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We described the phenotype of a large 4-generation family with Hyperparathyrodism-Jaw Tumor syndrome (HPT-JT) associated with a rare deletion of exon 3 of the CDC73 gene. METHODS We collected medical, genetic data on 24 family members descended from a common ancestor carrying a heterozygous deletion of exon 3. RESULTS Thirteen carried the deletion, the penetrance was estimated at 50% at 40 years. Seven patients (39 ± 14.5 years) presented with HPT which could start at 13. Median plasmatic calcium and PTH levels were 3.13 ± 0.7 mmol/L and 115 ± 406 pg/ml, respectively. Kidney disease related to hypercalcemia were present in 57.1% of patients. All seven patients underwent surgery to remove a single parathyroid adenoma. One recurrence occurred 7 years post-surgery. No parathyroid carcinoma has been found to date. We found two atypical parathyroid adenomas. We described an additional somatic variant in exon 1 of gene CDC73 in two tumors. Jaw tumors were not necessarily associated with hyperparathyroidism, as shown in one case. Two kidney cysts were also reported. Variable phenotype expressivity was emphasized by clinical presentations in 2 monozygotic twins: acute hypercalcemia, kidney failure and ossifying fibroma in one twin, versus normocalcemic parathyroid adenoma in the other one. CONCLUSION We report a family carrier of a deletion of exon 3 of the CDC73 gene. This is characterized by a high level of hypercalcemia, deleterious kidney effects and atypical parathyroid adenomas without carcinomas. Onset and intensity of HPT remain unpredictable. The additional somatic mutation found in the parathyroid tumor could lead to these phenotypical variations.
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Affiliation(s)
- Lauriane Le Collen
- Department of Endocrinology Diabetology, University of Reims, Reims, France.
- Inserm/CNRS UMR 1283/8199, Institut Pasteur de Lille, EGID, Lille, France.
| | - Sara Barraud
- Department of Endocrinology Diabetology, University of Reims, Reims, France
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de La Housse, BP 1039, 51687, Reims Cedex 2, France
| | | | - Lucie Coppin
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer - Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | | | | | | | | | | | | | | | - Marie Françoise Odou
- Univ. Lille, Inserm, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University of Reims, Reims, France.
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de La Housse, BP 1039, 51687, Reims Cedex 2, France.
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