Oncology Section and.
Molecular Biology Laboratory, Hospital of Gastroenterology "Dr. C.B. Udaondo," Buenos Aires, Argentina.
JCI Insight. 2020 Sep 17;5(18):140698. doi: 10.1172/jci.insight.140698.
Lynch syndrome is the most common cause of hereditary colorectal cancer (CRC), and it is characterized by DNA mismatch repair (MMR) deficiency. The term Lynch-like syndrome (LLS) is used for patients with MMR-deficient tumors and neither germline mutation in MLH1, MSH2, MSH6, PMS2, or EPCAM nor MLH1 somatic methylation. Biallelic somatic inactivation or cryptic germline MMR variants undetected during genetic testing have been proposed to be involved. Sixteen patients with early-onset LLS CRC were selected for germline and tumor whole-exome sequencing. Two potentially pathogenic germline MCM8 variants were detected in a male patient with LLS with fertility problems. A knockout cellular model for MCM8 was generated by CRISPR/Cas9 and detected genetic variants were produced by mutagenesis. DNA damage, microsatellite instability, and mutational signatures were monitored. DNA damage was evident for MCM8KO cells and the analyzed genetic variants. Microsatellite instability and mutational signatures in MCM8KO cells were compatible with the involvement of MCM8 in MMR. Replication in an independent familial cancer cohort detected additional carriers. Unexplained MMR-deficient CRC cases, even showing somatic biallelic MMR inactivation, may be caused by underlying germline defects in genes different than MMR genes. We suggest MCM8 as a gene involved in CRC germline predisposition with a recessive pattern of inheritance.
林奇综合征是遗传性结直肠癌(CRC)最常见的原因,其特征是 DNA 错配修复(MMR)缺陷。术语林奇样综合征(LLS)用于 MMR 缺陷型肿瘤患者,这些患者既没有 MLH1、MSH2、MSH6、PMS2 或 EPCAM 种系突变,也没有 MLH1 体细胞甲基化。据推测,双等位基因体细胞失活或遗传检测中未检测到隐匿性 MMR 变体与此有关。选择了 16 例早发性 LLS CRC 患者进行种系和肿瘤全外显子组测序。在一名患有 LLS 和生育问题的男性患者中,检测到了两种潜在致病性的 MCM8 种系变体。通过 CRISPR/Cas9 生成了 MCM8 的敲除细胞模型,并检测到了诱变产生的遗传变异。监测了 DNA 损伤、微卫星不稳定性和突变特征。MCM8KO 细胞的 DNA 损伤明显,分析的遗传变异也是如此。MCM8KO 细胞中的微卫星不稳定性和突变特征与 MCM8 参与 MMR 一致。在独立的家族性癌症队列中检测到了其他携带者。即使显示体细胞双等位基因 MMR 失活,也可能是由于 MMR 基因以外的种系缺陷导致无法解释的 MMR 缺陷型 CRC 病例。我们建议 MCM8 作为一种与隐性遗传模式相关的参与 CRC 种系易感性的基因。
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