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Delamare M, Le Roy A, Pacault M, Schmitt L, Garrec C, Maaziz N, Myllykoski M, Rimbert A, Karaghiannis V, Aral B, Catherwood M, Airaud F, Mansour-Hendili L, Hoogewijs D, Peroni E, Idriss S, Lesieur V, Caillaud A, Si-Tayeb K, Chariau C, Gaignerie A, Rab M, Haferlach T, Meggendorfer M, Bézieau S, Benetti A, Casadevall N, Hirsch P, Rose C, Wemeau M, Galacteros F, Cassinat B, Bellosillo B, Bento C, Van Wijk R, Petrides PE, Randi ML, McMullin MF, Koivunen P, Girodon F, Gardie B. Characterization of genetic variants in the EGLN1/PHD2 gene identified in a European collection of patients with erythrocytosis. Haematologica 2023; 108:3068-3085. [PMID: 37317877 PMCID: PMC10620589 DOI: 10.3324/haematol.2023.282913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
Hereditary erythrocytosis is a rare hematologic disorder characterized by an excess of red blood cell production. Here we describe a European collaborative study involving a collection of 2,160 patients with erythrocytosis sequenced in ten different laboratories. We focused our study on the EGLN1 gene and identified 39 germline missense variants including one gene deletion in 47 probands. EGLN1 encodes the PHD2 prolyl 4-hydroxylase, a major inhibitor of hypoxia-inducible factor. We performed a comprehensive study to evaluate the causal role of the identified PHD2 variants: (i) in silico studies of localization, conservation, and deleterious effects; (ii) analysis of hematologic parameters of carriers identified in the UK Biobank; (iii) functional studies of the protein activity and stability; and (iv) a comprehensive study of PHD2 splicing. Altogether, these studies allowed the classification of 16 pathogenic or likely pathogenic mutants in a total of 48 patients and relatives. The in silico studies extended to the variants described in the literature showed that a minority of PHD2 variants can be classified as pathogenic (36/96), without any differences from the variants of unknown significance regarding the severity of the developed disease (hematologic parameters and complications). Here, we demonstrated the great value of federating laboratories working on such rare disorders in order to implement the criteria required for genetic classification, a strategy that should be extended to all hereditary hematologic diseases.
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Affiliation(s)
- Marine Delamare
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Amandine Le Roy
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Mathilde Pacault
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Loïc Schmitt
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Céline Garrec
- Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Nada Maaziz
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | - Matti Myllykoski
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, 90014 Oulu, Finland. 90014 Oulu
| | - Antoine Rimbert
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Valéna Karaghiannis
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Bernard Aral
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | | | | | - Lamisse Mansour-Hendili
- Département de Biochimie-Biologie Moléculaire, Pharmacologie, Génétique Médicale AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil, IMRB Equipe Pirenne, Laboratoire d'excellence LABEX GRex, Créteil
| | - David Hoogewijs
- Section of Medicine, Department of Endocrinology, Metabolism and Cardiovascular System, University of Fribourg, CH-1700 Fribourg, Switzerland; National Center of Competence in Research "Kidney.CH"
| | - Edoardo Peroni
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy; Medical Genetics Unit, Mater Domini University Hospital, 88100 Catanzaro
| | - Salam Idriss
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Valentine Lesieur
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Amandine Caillaud
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Karim Si-Tayeb
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Caroline Chariau
- Nantes Université, CHU Nantes, CNRS, Inserm, BioCore, FR-44000, Nantes
| | - Anne Gaignerie
- Nantes Université, CHU Nantes, CNRS, Inserm, BioCore, FR-44000, Nantes
| | - Minke Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht
| | | | | | - Stéphane Bézieau
- Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Andrea Benetti
- Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128, Padua
| | - Nicole Casadevall
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, 75012, Paris
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, SIRIC CURAMUS, Hôpital Saint-Antoine, Service d'Hématologie Biologique, 75012, Paris
| | - Christian Rose
- Service d'onco-hématologie, Saint-Vincent de Paul Hospital, Boulevard de Belfort, Université Catholique de Lille, Univ. Nord de France, F-59000 Lille
| | - Mathieu Wemeau
- Hematology Department, Claude Huriez Hospital, Lille Hospital, 59000 Lille
| | - Frédéric Galacteros
- Département de Biochimie-Biologie Moléculaire, Pharmacologie, Génétique Médicale AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Red Cell Disease Referral Center-UMGGR, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Bruno Cassinat
- Université Paris Cité, APHP, Hôpital Saint-Louis, Laboratoire de Biologie Cellulaire, Paris
| | | | - Celeste Bento
- Hematology Department, Centro Hospitalar e Universitário de Coimbra; CIAS, University of Coimbra
| | - Richard Van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Petro E Petrides
- Hematology Oncology Center and Ludwig-Maximilians-University Munich Medical School, Munich
| | - Maria Luigia Randi
- Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128, Padua
| | - Mary Frances McMullin
- Belfast Health and Social Care Trust, Belfast N.Ireland; Queen's University, Belfast, N. Ireland
| | - Peppi Koivunen
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, 90014 Oulu, Finland. 90014 Oulu
| | - François Girodon
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France; Inserm U1231, Université de Bourgogne, Dijon, France; Laboratoire d'Excellence GR-Ex
| | - Betty Gardie
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Université de Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Laboratoire d'Excellence GR-Ex
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Karaghiannis V, Maric D, Garrec C, Maaziz N, Buffet A, Schmitt L, Antunes V, Airaud F, Aral B, Le Roy A, Corbineau S, Mansour-Hendili L, Lesieur V, Rimbert A, Laporte F, Delamare M, Rab M, Bézieau S, Cassinat B, Galacteros F, Gimenez-Roqueplo AP, Burnichon N, Cario H, Van Wijk R, Bento C, Girodon F, Hoogewijs D, Gardie B. Comprehensive in silico and functional studies for classification of EPAS1/HIF2A genetic variants identified in patients with erythrocytosis. Haematologica 2023. [PMID: 36700397 DOI: 10.3324/haematol.2022.281698] [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] [Received: 09/01/2022] [Indexed: 01/27/2023] Open
Abstract
Gain-of-function mutations in the EPAS1/HIF2A gene have been identified in patients with hereditary erythrocytosis that can be associated with the development of paraganglioma, pheochromocytoma and somatostatinoma. In the present study, we describe a unique european collection of 41 patients and 28 relatives diagnosed with an erythrocytosis associated with a germline genetic variant in EPAS1. In addition we identified 2 infants with severe erythrocytosis associated with a mosaic mutation present in less than 2% of the blood, one of whom later developed a paraganglioma. The aim of this study was to determine the causal role of these genetic variants, to establish pathogenicity, and to identify potential candidates eligible for the new HIF-222inhibitor treatment. Pathogenicity was predicted with in silico tools and the impact of 13 HIF-222variants has been studied by using canonical and real-time reporter luciferase assays. These functional assays consisted of a novel edited vector containing an expanded region of the erythropoietin (EPO) promoter combined with distal regulatory elements which substantially enhanced the HIF-22-dependent induction. Altogether, our studies allowed the classification of 11 mutations as pathogenic in 17 patients and 23 relatives. We described four new mutations (D525G, L526F, G527K, A530S) close to the key proline P531, which broadens the spectrum of mutations involved in erythrocytosis. Notably, we identified patients with only erythrocytosis associated with germline mutations A530S and Y532C previously identified at somatic state in tumors, thereby raising the complexity of the genotype/phenotype correlations. Altogether, this study allows accurate clinical follow-up of patients and opens the possibility of benefiting from HIF-222inhibitor treatment, so far the only targeted treatment in hypoxia-related erythrocytosis disease.
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Affiliation(s)
- Valéna Karaghiannis
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Darko Maric
- Section of Medicine, Department of Endocrinology, Metabolism and Cardiovascular System, University of Fribourg, CH-1700 Fribourg, Switzerland; National Center of Competence in Research "Kidney.CH"
| | - Céline Garrec
- Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Nada Maaziz
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | - Alexandre Buffet
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France; Département de Médecine Génomique des Tumeurs et des Cancers, AP-HP, Hôpital européen Georges Pompidou, F-75015 Paris
| | - Loïc Schmitt
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Vincent Antunes
- Section of Medicine, Department of Endocrinology, Metabolism and Cardiovascular System, University of Fribourg, CH-1700 Fribourg, Switzerland; National Center of Competence in Research "Kidney.CH"
| | | | - Bernard Aral
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon
| | - Amandine Le Roy
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | | | - Lamisse Mansour-Hendili
- Département de Biochimie-Biologie Moléculaire, Pharmacologie, Génétique Médicale, APHP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Université Paris-Est Créteil, IMRB Equipe Pirenne, Laboratoire d'excellence LABEX GRex, Créteil
| | - Valentine Lesieur
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Antoine Rimbert
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Fabien Laporte
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Marine Delamare
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes
| | - Minke Rab
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Stéphane Bézieau
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Service de Génétique Médicale, CHU de Nantes, Nantes
| | - Bruno Cassinat
- Université Paris Cité, APHP, Hôpital Saint-Louis, Laboratoire de Biologie Cellulaire, Paris
| | - Frédéric Galacteros
- Université Paris-Est Créteil, IMRB Equipe Pirenne, Laboratoire d'excellence LABEX GRex, Créteil, France; Red Cell Disease Referral Center-UMGGR, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Anne-Paule Gimenez-Roqueplo
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France; Département de Médecine Génomique des Tumeurs et des Cancers, AP-HP, Hôpital européen Georges Pompidou, F-75015 Paris
| | - Nelly Burnichon
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France; Département de Médecine Génomique des Tumeurs et des Cancers, AP-HP, Hôpital européen Georges Pompidou, F-75015 Paris
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Ulm
| | - Richard Van Wijk
- Central Diagnostic Laboratory - Research, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Celeste Bento
- Hematology Department, Centro Hospitalar e Universitário de Coimbra; CIAS, University of Coimbra
| | - François Girodon
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France; Inserm U1231, Université de Bourgogne, Dijon, France; Laboratoire d'Excellence GR-Ex
| | - David Hoogewijs
- Section of Medicine, Department of Endocrinology, Metabolism and Cardiovascular System, University of Fribourg, CH-1700 Fribourg, Switzerland; National Center of Competence in Research "Kidney.CH"
| | - Betty Gardie
- Ecole Pratique des Hautes Etudes, EPHE, Université PSL, France; Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Laboratoire d'Excellence GR-Ex
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