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Flores SK, Estrada-Zuniga CM, Thallapureddy K, Armaiz-Peña G, Dahia PLM. Insights into Mechanisms of Pheochromocytomas and Paragangliomas Driven by Known or New Genetic Drivers. Cancers (Basel) 2021; 13:cancers13184602. [PMID: 34572828 PMCID: PMC8467373 DOI: 10.3390/cancers13184602] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Pheochromocytomas and paragangliomas are rare neuroendocrine tumors that are often hereditary. Although research has advanced considerably, significant gaps still persist in understanding risk factors, predicting metastatic potential and treating aggressive tumors. The study of rare mutations can provide new insights into how pheochromocytomas and paragangliomas develop. In this review, we provide examples of such rare events and how they can inform our understanding of the spectrum of mutations that can lead to these tumors and improve our ability to provide a genetic diagnosis. Abstract Pheochromocytomas and paragangliomas are rare tumors of neural crest origin. Their remarkable genetic diversity and high heritability have enabled discoveries of bona fide cancer driver genes with an impact on diagnosis and clinical management and have consistently shed light on new paradigms in cancer. In this review, we explore unique mechanisms of pheochromocytoma and paraganglioma initiation and management by drawing from recent examples involving rare mutations of hypoxia-related genes VHL, EPAS1 and SDHB, and of a poorly known susceptibility gene, TMEM127. These models expand our ability to predict variant pathogenicity, inform new functional domains, recognize environmental-gene connections, and highlight persistent therapeutic challenges for tumors with aggressive behavior.
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Affiliation(s)
- Shahida K. Flores
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (S.K.F.); (C.M.E.-Z.); (K.T.); (G.A.-P.)
| | - Cynthia M. Estrada-Zuniga
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (S.K.F.); (C.M.E.-Z.); (K.T.); (G.A.-P.)
| | - Keerthi Thallapureddy
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (S.K.F.); (C.M.E.-Z.); (K.T.); (G.A.-P.)
| | - Gustavo Armaiz-Peña
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (S.K.F.); (C.M.E.-Z.); (K.T.); (G.A.-P.)
| | - Patricia L. M. Dahia
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (S.K.F.); (C.M.E.-Z.); (K.T.); (G.A.-P.)
- Mays Cancer Center, University of Texas Health San Antonio, San Antonio, TX 78229, USA
- Correspondence:
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Armaiz-Pena G, Flores SK, Cheng ZM, Zhang X, Esquivel E, Poullard N, Vaidyanathan A, Liu Q, Michalek J, Santillan-Gomez AA, Liss M, Ahmadi S, Katselnik D, Maldonado E, Salgado SA, Jimenez C, Fishbein L, Hamidi O, Else T, Lechan R, Tischler AS, Benn DE, Dwight T, Clifton-Bligh R, Sanso G, Barontini M, Vincent D, Aronin N, Biondi B, Koops M, Bowhay-Carnes E, Gimenez-Roqueplo AP, Alvarez-Eslava A, Bruder JM, Kitano M, Burnichon N, Ding Y, Dahia PLM. Genotype-Phenotype Features of Germline Variants of the TMEM127 Pheochromocytoma Susceptibility Gene: A 10-Year Update. J Clin Endocrinol Metab 2021; 106:e350-e364. [PMID: 33051659 PMCID: PMC7765648 DOI: 10.1210/clinem/dgaa741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/24/2020] [Accepted: 10/08/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This work aimed to evaluate genotype-phenotype associations in individuals carrying germline variants of transmembrane protein 127 gene (TMEM127), a poorly known gene that confers susceptibility to pheochromocytoma (PHEO) and paraganglioma (PGL). DESIGN Data were collected from a registry of probands with TMEM127 variants, published reports, and public databases. MAIN OUTCOME ANALYSIS Clinical, genetic, and functional associations were determined. RESULTS The cohort comprised 110 index patients (111 variants) with a mean age of 45 years (range, 21-84 years). Females were predominant (76 vs 34, P < .001). Most patients had PHEO (n = 94; 85.5%), although PGL (n = 10; 9%) and renal cell carcinoma (RCC, n = 6; 5.4%) were also detected, either alone or in combination with PHEO. One-third of the cases had multiple tumors, and known family history was reported in 15.4%. Metastatic PHEO/PGL was rare (2.8%). Epinephrine alone, or combined with norepinephrine, accounted for 82% of the catecholamine profiles of PHEO/PGLs. Most variants (n = 63) occurred only once and 13 were recurrent (2-12 times). Although nontruncating variants were less frequent than truncating changes overall, they were predominant in non-PHEO clinical presentations (36% PHEO-only vs 69% other, P < .001) and clustered disproportionately within transmembrane regions (P < .01), underscoring the relevance of these domains for TMEM127 function. Integration of clinical and previous experimental data supported classification of variants into 4 groups based on mutation type, localization, and predicted disruption. CONCLUSIONS Patients with TMEM127 variants often resemble sporadic nonmetastatic PHEOs. PGL and RCC may also co-occur, although their causal link requires further evaluation. We propose a new classification to predict variant pathogenicity and assist with carrier surveillance.
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Affiliation(s)
- Gustavo Armaiz-Pena
- Division of Endocrinology, Department of Medicine, University of Texas Health San Antonio (UTHSA), San Antonio, Texas
| | - Shahida K Flores
- Division of Hematology and Medical Oncology, Department of Medicine, UTHSA, San Antonio, Texas
| | - Zi-Ming Cheng
- Division of Hematology and Medical Oncology, Department of Medicine, UTHSA, San Antonio, Texas
| | - Xhingyu Zhang
- Division of Hematology and Medical Oncology, Department of Medicine, UTHSA, San Antonio, Texas
| | - Emmanuel Esquivel
- Division of Hematology and Medical Oncology, Department of Medicine, UTHSA, San Antonio, Texas
| | | | | | - Qianqian Liu
- Department of Population Health Sciences, UTHSA, San Antonio, Texas
| | - Joel Michalek
- Department of Population Health Sciences, UTHSA, San Antonio, Texas
| | | | - Michael Liss
- Department of Urology, UTHSA, San Antonio, Texas
| | - Sara Ahmadi
- Division of Endocrinology, Department of Medicine, University of Texas Health San Antonio (UTHSA), San Antonio, Texas
| | | | - Enrique Maldonado
- Division of Endocrinology, Department of Medicine, University of Texas Health San Antonio (UTHSA), San Antonio, Texas
| | - Sarimar Agosto Salgado
- Department Endocrine Neoplasia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilo Jimenez
- Department Endocrine Neoplasia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lauren Fishbein
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Oksana Hamidi
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, Texas
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ron Lechan
- Tufts Medical Center, Boston, Massachusetts
| | | | - Diana E Benn
- Cancer Genetics, Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
| | - Trisha Dwight
- Cancer Genetics, Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
| | - Rory Clifton-Bligh
- Cancer Genetics, Kolling Institute, Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia
| | - Gabriela Sanso
- Center for Endocrinological Investigations (CEDIE), Hospital de Niños R. Gutiérrez, Buenos Aires, C1425EFD Argentina
| | - Marta Barontini
- Center for Endocrinological Investigations (CEDIE), Hospital de Niños R. Gutiérrez, Buenos Aires, C1425EFD Argentina
| | - Deepa Vincent
- Division of Endocrinology, University of Massachusetts, Worcester, Massachusetts
| | - Neil Aronin
- Division of Endocrinology, University of Massachusetts, Worcester, Massachusetts
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maureen Koops
- Division of Endocrinology, Department of Medicine, University of Texas Health San Antonio (UTHSA), San Antonio, Texas
| | | | - Anne-Paule Gimenez-Roqueplo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Genetics Department, Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
| | | | - Jan M Bruder
- Division of Endocrinology, Department of Medicine, University of Texas Health San Antonio (UTHSA), San Antonio, Texas
| | - Mio Kitano
- Mays Cancer Center, UTHSA, San Antonio, Texas
- Division of Surgical Oncology, Department of Surgery, UTHSA, San Antonio, Texas
| | - Nelly Burnichon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Genetics Department, Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
| | - Yanli Ding
- Department of Pathology, UTHSA, San Antonio, Texas
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, UTHSA, San Antonio, Texas
- Mays Cancer Center, UTHSA, San Antonio, Texas
- Correspondence and Reprint Requests: Patricia L.M. Dahia, MD, PhD, Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, MC7880, San Antonio, TX 78229, USA. E-mail:
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Flores SK, Deng Y, Cheng Z, Zhang X, Tao S, Saliba A, Chu I, Burnichon N, Gimenez-Roqueplo AP, Wang E, Aguiar RCT, Dahia PLM. Functional Characterization of TMEM127 Variants Reveals Novel Insights into Its Membrane Topology and Trafficking. J Clin Endocrinol Metab 2020; 105:dgaa396. [PMID: 32575117 PMCID: PMC7414969 DOI: 10.1210/clinem/dgaa396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT TMEM127 is a poorly known tumor suppressor gene associated with pheochromocytomas, paragangliomas, and renal carcinomas. Our incomplete understanding of TMEM127 function has limited our ability to predict variant pathogenicity. PURPOSE To better understand the function of the transmembrane protein TMEM127 we undertook cellular and molecular evaluation of patient-derived germline variants. DESIGN Subcellular localization and steady-state levels of tumor-associated, transiently expressed TMEM127 variants were compared to the wild-type protein using immunofluorescence and immunoblot analysis, respectively, in cells genetically modified to lack endogenous TMEM127. Membrane topology and endocytic mechanisms were also assessed. RESULTS We identified 3 subgroups of mutations and determined that 71% of the variants studied are pathogenic or likely pathogenic through loss of membrane-binding ability, stability, and/or internalization capability. Investigation into an N-terminal cluster of missense variants uncovered a previously unrecognized transmembrane domain, indicating that TMEM127 is a 4- transmembrane, not a 3-transmembrane domain-containing protein. Additionally, a C-terminal variant with predominant plasma membrane localization revealed an atypical, extended acidic, dileucine-based motif required for TMEM127 internalization through clathrin-mediated endocytosis. CONCLUSION We characterized the functional deficits of several germline TMEM127 variants and identified novel structure-function features of TMEM127. These findings will assist in determining pathogenicity of TMEM127 variants and will help guide future studies investigating the cellular role of TMEM127.
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Affiliation(s)
- Shahida K Flores
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
| | - Yilun Deng
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
| | - Ziming Cheng
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
| | - Xingyu Zhang
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
- Central South University Xiangya School of Medicine, Changsha, Hunan, China
| | - Sifan Tao
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
- Central South University Xiangya School of Medicine, Changsha, Hunan, China
| | - Afaf Saliba
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
| | - Irene Chu
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
| | - Nelly Burnichon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Genetics Department, Paris, France
- Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Genetics Department, Paris, France
- Université de Paris, PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
| | - Exing Wang
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, Texas
| | - Ricardo C T Aguiar
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
- Mays Cancer Center, UT Health San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, Audie Murphy VA Hospital, San Antonio, Texas
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio
- Mays Cancer Center, UT Health San Antonio, San Antonio, Texas
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Flores SK, Cheng Z, Jasper AM, Natori K, Okamoto T, Tanabe A, Gotoh K, Shibata H, Sakurai A, Nakai T, Wang X, Zethoven M, Balachander S, Aita Y, Young W, Zheng S, Takekoshi K, Nakamura E, Tothill RW, Aguiar RCT, Dahia PLM. A synonymous VHL variant in exon 2 confers susceptibility to familial pheochromocytoma and von Hippel-Lindau disease. J Clin Endocrinol Metab 2019; 104:3826-3834. [PMID: 30946460 PMCID: PMC6660912 DOI: 10.1210/jc.2019-00235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT von Hippel-Lindau disease, comprising renal cancer, hemangioblastoma and/or pheochromocytoma (PHEO) is caused by missense or truncating variants of the VHL tumor suppressor gene, which is involved in degradation of hypoxia inducible factors (HIFs). However, the role of synonymous VHL variants in the disease is unclear. OBJECTIVE We evaluated a synonymous VHL variant in patients with familial PHEO or VHL disease without a detectable pathogenic VHL mutation. DESIGN We performed genetic and transcriptional analyses of leukocytes and/or tumors from affected and unaffected individuals and evaluated VHL splicing in existing cancer databases. RESULTS We identified a synonymous VHL variant(c.414A>G, p.Pro138Pro) as the driver event in five independent individuals/families with PHEOs or VHL syndrome. This variant promotes exon 2 skipping and, hence, abolishes expression of the full-length VHL transcript. Exon 2 spans the HIF binding domain, required for HIF degradation by VHL. Accordingly, PHEOs carrying this variant display HIF hyperactivation typical of VHL loss. Moreover, other exon 2 VHL variants from the TCGA pan-cancer datasets are biased toward expression of a VHL transcript that excludes this exon, supporting a broader impact of this spliced variant. CONCLUSION A recurrent synonymous VHL variant (c.414A>G, p.Pro138Pro) confers susceptibility to PHEO and VHL disease through splice disruption, leading to VHL dysfunction. This finding indicates that certain synonymous VHL variants may be clinically relevant and should be considered in genetic testing and surveillance settings. The observation that other coding VHL variants can exclude exon 2 suggests that dysregulated splicing may be an underappreciated mechanism in VHL-mediated tumorigenesis.
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Affiliation(s)
- Shahida K Flores
- Division of Hematology and Medical Oncology, Department of Medicine, Mays Cancer Center, University of Texas San Antonio, San Antonio, Texas
| | - Ziming Cheng
- Division of Hematology and Medical Oncology, Department of Medicine, Mays Cancer Center, University of Texas San Antonio, San Antonio, Texas
| | - Angela M Jasper
- Division of Hematology and Medical Oncology, Department of Medicine, Mays Cancer Center, University of Texas San Antonio, San Antonio, Texas
| | - Keiko Natori
- Department of Breast and Endocrine Surgery, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
| | - Koro Gotoh
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Akihiro Sakurai
- Department of Medical Genetics and Genomics, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Xiaojing Wang
- Greehey Children’s Cancer Research Institute, University of Texas San Antonio, San Antonio, Texas
| | - Magnus Zethoven
- Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shiva Balachander
- Department of Clinical Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuichi Aita
- Division of Sports Medicine and Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - William Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Siyuan Zheng
- Greehey Children’s Cancer Research Institute, University of Texas San Antonio, San Antonio, Texas
| | - Kazuhiro Takekoshi
- Division of Sports Medicine and Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eijiro Nakamura
- DSK Project, Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Richard W Tothill
- Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Clinical Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ricardo C T Aguiar
- Division of Hematology and Medical Oncology, Department of Medicine, Mays Cancer Center, University of Texas San Antonio, San Antonio, Texas
- Greehey Children’s Cancer Research Institute, University of Texas San Antonio, San Antonio, Texas
- Audie Murphy VA Hospital, San Antonio, South Texas Veterans Health Care System, San Antonio, Texas
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, Mays Cancer Center, University of Texas San Antonio, San Antonio, Texas
- Greehey Children’s Cancer Research Institute, University of Texas San Antonio, San Antonio, Texas
- Correspondence and Reprint Requests: Patricia L. M. Dahia, MD, PhD, Department of Medicine, University of Texas Health San Antonio, Mail Code 7880, 7703 Floyd Curl Drive, San Antonio, Texas 78229-3900. E-mail:
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Deng Y, Flores SK, Cheng Z, Qin Y, Schwartz RC, Malchoff C, Dahia PLM. Molecular and phenotypic evaluation of a novel germline TMEM127 mutation with an uncommon clinical presentation. Endocr Relat Cancer 2018; 25:X3. [PMID: 30030286 PMCID: PMC7220814 DOI: 10.1530/erc-17-0359e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yilun Deng
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Shahida K Flores
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - ZiMing Cheng
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Yuejuan Qin
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Robin C Schwartz
- Department of Genetics and Genome SciencesUCONN Health, Farmington, Connecticut, USA
- University of Connecticut Carole and Ray Neag Comprehensive Cancer CenterFarmington, Connecticut, USA
| | - Carl Malchoff
- University of Connecticut Carole and Ray Neag Comprehensive Cancer CenterFarmington, Connecticut, USA
| | - Patricia L M Dahia
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
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Ong RKS, Flores SK, Reddick RL, Dahia PLM, Shawa H. A Unique Case of Metastatic, Functional, Hereditary Paraganglioma Associated With an SDHC Germline Mutation. J Clin Endocrinol Metab 2018; 103:2802-2806. [PMID: 29878124 PMCID: PMC7263789 DOI: 10.1210/jc.2017-01302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/01/2018] [Indexed: 12/24/2022]
Abstract
CONTEXT Mutations in genes encoding for the succinate dehydrogenase (SDH) complex are linked to hereditary paraganglioma syndromes. Paraganglioma syndrome 3 is associated with mutations in SDHC and typically manifests as benign, nonfunctional head and neck paragangliomas. DESIGN We describe a case of a 51-year-old woman who initially presented with diarrhea and hypertension and was found to have a retroperitoneal mass, which was resected with a pathology consistent with paraganglioma. Five years later, her symptoms recurred, and she was found to have new retroperitoneal lymphadenopathy and lytic lesions in the first lumbar vertebral body and the right iliac crest, which were visualized on CT scan and octreoscan but not on iodine-123-meta-iodobenzylguanidine (123I-MIBG) and bone scans. She had significantly elevated 24-hour urine norepinephrine and dopamine. The patient received external beam radiation and a series of different antineoplastic agents. Her disease progressed, and she eventually expired within 2 years. Genetic testing revealed a heterozygous SDHC c.43C>T, p.Arg15X mutation, which was also detected in her daughter and her grandson, both of whom have no biochemical or imaging evidence of paraganglioma syndrome yet. CONCLUSION We report a unique case of functional, metastatic abdominal paraganglioma associated with SDHC germline mutation. Our case exemplifies that SDHC germline mutation has variable penetrance, which may manifest with an aggressive biology that could be missed by a 123I-MIBG scan.
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Affiliation(s)
- Raquel Kristin S Ong
- Division of Endocrinology and Metabolism, Albany Medical College, Albany, New York
| | - Shahida K Flores
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert L Reddick
- Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Mays Cancer Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hassan Shawa
- Division of Endocrinology and Metabolism, Albany Medical College, Albany, New York
- Correspondence and Reprint Requests: Hassan Shawa, MD, Division of Endocrinology and Metabolism, Albany Medical College, 25 Hackett Blvd., MC141, Albany, New York 12208. E-mail:
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Deng Y, Qin Y, Srikantan S, Luo A, Cheng ZM, Flores SK, Vogel KS, Wang E, Dahia PLM. The TMEM127 human tumor suppressor is a component of the mTORC1 lysosomal nutrient-sensing complex. Hum Mol Genet 2018; 27:1794-1808. [PMID: 29547888 PMCID: PMC5932569 DOI: 10.1093/hmg/ddy095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/10/2018] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 12/22/2022] Open
Abstract
The TMEM127 tumor suppressor gene encodes a transmembrane protein of unknown function mutated in pheochromocytomas and, rarely, in renal cancers. Tumors with inactivating TMEM127 mutations have increased mTORC1 signaling by undefined mechanisms. Here we report that TMEM127 interacts with the lysosome-anchored complex comprised of Rag GTPases, the LAMTOR pentamer (or 'ragulator') and vATPase, which controls amino acid-mediated mTORC1 activation. We found that under nutrient-rich conditions TMEM127 expression reduces mTORC1 recruitment to Rags. In addition, TMEM127 interacts with LAMTOR in an amino acid-dependent manner and decreases the LAMTOR1-vATPase association, while TMEM127-vATPase binding requires intact lysosomal acidification but is amino acid independent. Conversely, both murine and human cells lacking TMEM127 accumulate LAMTOR proteins in the lysosome. Consistent with these findings, pheochromocytomas with TMEM127 mutations have increased levels of LAMTOR proteins. These results suggest that TMEM127 interactions with ragulator and vATPase at the lysosome contribute to restrain mTORC1 signaling in response to amino acids, thus explaining the increased mTORC1 activation seen in TMEM127-deficient tumors.
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Affiliation(s)
- Yilun Deng
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Cell Systems & Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Yuejuan Qin
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Subramanya Srikantan
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Anqi Luo
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Zi-Ming Cheng
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Shahida K Flores
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Kris S Vogel
- Department of Cell Systems & Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Exing Wang
- Department of Cell Systems & Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Patricia L M Dahia
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Department of Cell Systems & Anatomy, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Vaidya A, Flores SK, Cheng ZM, Nicolas M, Deng Y, Opotowsky AR, Lourenço DM, Barletta JA, Rana HQ, Pereira MA, Toledo RA, Dahia PLM. EPAS1 Mutations and Paragangliomas in Cyanotic Congenital Heart Disease. N Engl J Med 2018; 378:1259-1261. [PMID: 29601261 PMCID: PMC5972530 DOI: 10.1056/nejmc1716652] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Shahida K Flores
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Zi-Ming Cheng
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Marlo Nicolas
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Yilun Deng
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | | | | | | | | | | | - Patricia L M Dahia
- University of Texas Health Science Center at San Antonio, San Antonio, TX
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Deng Y, Flores SK, Cheng Z, Qin Y, Schwartz RC, Malchoff C, Dahia PLM. Molecular and phenotypic evaluation of a novel germline TMEM127 mutation with an uncommon clinical presentation. Endocr Relat Cancer 2017; 24:L79-L82. [PMID: 28855235 PMCID: PMC5741081 DOI: 10.1530/erc-17-0359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Yilun Deng
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Shahida K Flores
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - ZiMing Cheng
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Yuejuan Qin
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| | - Robin C Schwartz
- Department of Genetics and Genome SciencesUCONN Health, Farmington, Connecticut, USA
- University of Connecticut Carole and Ray Neag Comprehensive Cancer CenterFarmington, Connecticut, USA
| | - Carl Malchoff
- University of Connecticut Carole and Ray Neag Comprehensive Cancer CenterFarmington, Connecticut, USA
| | - Patricia L M Dahia
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
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Fazel A, Kashef S, Aleyasin S, Harsini S, Karamizadeh Z, Zoghi S, Flores SK, Boztug K, Rezaei N. Novel AICDA mutation in a case of autosomal recessive hyper-IgM syndrome, growth hormone deficiency and autoimmunity. Allergol Immunopathol (Madr) 2017; 45:82-86. [PMID: 27789066 DOI: 10.1016/j.aller.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 08/01/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The Hyper-immunoglobulin M syndromes (HIGM) are a heterogeneous group of genetic disorders, which have been rarely reported to be associated with growth hormone deficiency (GHD). METHODS AND RESULTS A nine-year-old girl with recurrent urinary tract infections, diarrhoea, sinopulmonary infections, and failure to thrive since the age of six months had normal CD3+, CD4+, CD8+T lymphocytes, and CD19+B lymphocytes and natural killer (NK) cells, but extremely elevated IgM and significantly decreased IgG and IgA. In view of the patient's short stature, growth hormone evaluation was carried out and growth hormone deficiency established. The patient underwent Ig replacement therapy and received growth hormone therapy in addition to antibiotics and responded well. Furthermore, the patient developed benign cervical lymphadenopathy, as well as elevated erythrocyte sedimentation rate, positive autoantibodies to SSA-Ro, and severely dry eyes, which partially responded to both the punctate occlusion and systemic corticosteroids, at the age of seven years. Sequencing analysis of the exons from activation-induced cytidine deaminase (AICDA) gene revealed that the patient was homozygous for a single T to C transversion at position 455 in exon 4, which replaces a Valine with an Alanine. CONCLUSIONS To our knowledge, this is a new AICDA mutation, which has not been reported previously in HIGM. The mutation analysis could improve diagnosis of HIGM patients and also elaborating on the spectrum of AICDA mutations.
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Affiliation(s)
- A Fazel
- Allergy Research Center, Division of Pediatric Immunology and Allergy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Kashef
- Allergy Research Center, Division of Pediatric Immunology and Allergy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - S Aleyasin
- Allergy Research Center, Division of Pediatric Immunology and Allergy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Harsini
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Z Karamizadeh
- Division of Pediatric Endocrinology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Zoghi
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S K Flores
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - K Boztug
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - N Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Sheffield, UK.
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11
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Rolnick SJ, Flores SK, Fowler SE, Derman R, Davidson B. Conducting randomized, controlled trials. Experience with the dysfunctional uterine bleeding intervention trial. J Reprod Med 2001; 46:1-5, discussion 5-6. [PMID: 11209624] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To conduct a randomized, controlled trial (RCT) to examine issues associated with therapeutic alternatives to standard hysterectomy for women with dysfunctional uterine bleeding. STUDY DESIGN Participants were to be randomly assigned to one of three treatment groups: hysterectomy, endometrial ablation and medical management. Recruitment was targeted at 375 women. RESULTS Despite multiple recruitment strategies, recruitment was weak, with only five women enrolled after six months. Providers and women screened for eligibility often expressed discomfort with randomization. The protocol was amended to an elective treatment cohort design with a randomization component. Recruitment improved, with 37 women enrolled after four months. CONCLUSION The success of RCTs may be affected by multiple factors. Acceptance of the protocol by patients and providers is essential. The RCT may present providers with a conflict between the goals of research and of providing optimal individualized care. Thus, RCTs may not always be appropriate for studies designed to examine best treatments in clinical practice, and nonrandomized designs may provide appropriate alternatives in some cases.
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Affiliation(s)
- S J Rolnick
- HealthPartners Research Foundation, 8100 34th Avenue South, P.O. Box 1524, Minneapolis, MN 55440-1524, USA.
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Rolnick SJ, Flores SK, O'Fallon AM, Vanderburg NR. The implementation of clinical guidelines in a managed care setting: implications for children with special health care needs. Manag Care Q 2000; 8:29-38. [PMID: 11010389] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OVERVIEW The project tracked the development and implementation of a pediatric asthma guideline to determine its usefulness as a quality assurance mechanism for children with special health care needs. METHODS Interviews were conducted with clinic staff to gather descriptive information about guideline implementation at owned clinics within a large HMO. RESULTS Providers developed multiple implementation strategies emphasizing patient/family education. Service coordination within the health plan was well established, while coordination of services beyond the health plan was less clearly related to guideline implementation. CONCLUSION Guideline implementation appeared to be a highly variable process. Clinical guidelines alone may not be sufficient tools of quality assurance for children with chronic or complex conditions.
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Affiliation(s)
- S J Rolnick
- HealthPartners Research Foundation, Minneapolis, Minnesota, USA
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Rolnick SJ, Flores SK, O'Fallon AM, Vanderburg NR. A successful collaboration between a private nonprofit health plan and a state health department. Manag Care Q 2000; 8:52-5. [PMID: 11146845] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
This article describes the experience of a private, nonprofit health plan in establishing a collaborative relationship with a state health department. Through a federal grant project, efforts toward assuring quality care for children with special health care needs in managed care settings provided unique opportunities to form partnerships between multiple health plans, community groups, and other stakeholders. Collaborative activities included (1) formation of a pediatric asthma task force and a performance measurement and quality assurance committee; (2) planning and execution of a statewide conference; (3) development of a teaching manual for incorporating asthma education into elementary classroom curricula; and (4) publication of a parent resource manual for health plan members. Key ingredients and influencing factors for successful public-private partnerships are discussed.
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Affiliation(s)
- S J Rolnick
- HealthPartners Research Foundation, Minneapolis, Minnesota, USA
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