Rare Mutations in RINT1 Predispose Carriers to Breast and Lynch Syndrome–Spectrum Cancers
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Published OnlineFirst May 2, 2014; DOI: 10.1158/2159-8290.CD-14-0212 RESEARCH ARTICLE Rare Mutations in RINT1 Predispose Carriers to Breast and Lynch Syndrome–Spectrum Cancers Daniel J. Park 1 , K a y o k o Ta o 7 , Florence Le Calvez-Kelm 17 , Tu Nguyen-Dumont 1 , Nivonirina Robinot 17 , Fleur Hammet1 , Fabrice Odefrey 1 , Helen Tsimiklis 1 , Zhi L. Teo 1 , Louise B. Thingholm 1 , Erin L. Young 7 , Catherine Voegele 17 , Andrew Lonie 4 , Bernard J. Pope 2 , 4 , Terrell C. Roane 10 , Russell Bell 7 , Hao Hu 11 , Shankaracharya 11 , Chad D. Huff 11 , Jonathan Ellis 6 , Jun Li 6 , Igor V. Makunin 6 , Esther M. John 12 , 13 , Irene L. Andrulis 19 , Mary B. Terry 14 , Mary Daly 15 , Saundra S. Buys 9 , Carrie Snyder 16 , Henry T. Lynch 16 , Peter Devilee20 , Graham G. Giles 3 , 5 , John L. Hopper 3 , 21 , Bing-Jian Feng 8 , 9 , Fabienne Lesueur 17 , 18 , Sean V. Tavtigian 7 , Melissa C. Southey 1 , and David E. Goldgar 8 , 9 ABSTRACT Approximately half of the familial aggregation of breast cancer remains unex- plained. A multiple-case breast cancer family exome-sequencing study identifi ed three likely pathogenic mutations in RINT1 (NM_021930.4) not present in public sequencing data- bases: RINT1 c.343C>T (p.Q115X), c.1132_1134del (p.M378del), and c.1207G>T (p.D403Y). On the basis of this fi nding, a population-based case–control mutation-screening study was conducted that identifi ed 29 carriers of rare (minor allele frequency < 0.5%), likely pathogenic variants: 23 in 1,313 early-onset breast cancer cases and six in 1,123 frequency-matched controls [OR, 3.24; 95% confi - dence interval (CI), 1.29–8.17; P = 0.013]. RINT1 mutation screening of probands from 798 multiple- case breast cancer families identifi ed four additional carriers of rare genetic variants. Analysis of the incidence of fi rst primary cancers in families of women carrying RINT1 mutations estimated that car- riers were at increased risk of Lynch syndrome–spectrum cancers [standardized incidence ratio (SIR), 3.35; 95% CI, 1.7–6.0; P = 0.005], particularly for relatives diagnosed with cancer under the age of 60 years (SIR, 10.9; 95% CI, 4.7–21; P = 0.0003). SIGNIFICANCE: The work described in this study adds RINT1 to the growing list of genes in which rare sequence variants are associated with intermediate levels of breast cancer risk. Given that RINT1 is also associated with a spectrum of cancers with mismatch repair defects, these fi ndings have clinical applications and raise interesting biological questions. Cancer Discov; 4(7); 804–15. ©2014 AACR. See related commentary by Ngeow and Eng, p. 762. 804 | CANCER DISCOVERYJULY 2014 www.aacrjournals.org Downloaded from cancerdiscovery.aacrjournals.org on September 27, 2021. © 2014 American Association for Cancer Research. Published OnlineFirst May 2, 2014; DOI: 10.1158/2159-8290.CD-14-0212 INTRODUCTION Although there has been substantial progress in the last 20 years in identifying genetic causes of breast cancer, a Large population-based studies have established that considerable proportion of the familial risk remains unex- women with a family history of breast cancer are at approx- plained. The current estimate of the proportion of familial imately 2- to 3-fold increased risk of the disease ( 1–3 ). risk explained by rare mutations in the high-risk breast Authors’ Affi liations: 1 Genetic Epidemiology Laboratory, Department of ada; 20Department of Human Genetics, Leiden University Medical Center, Pathology; 2 Department of Computing and Information Systems; 3 Centre Leiden, the Netherlands; and 21 School of Public Health, Seoul National for Epidemiology and Biostatistics, Melbourne School of Population and University, Seoul, Korea 4 Global Health, The University of Melbourne, Melbourne; Victorian Life Note: Supplementary data for this article are available at Cancer Discovery 5 Sciences Computation Initiative; Centre for Cancer Epidemiology, The Online (http://cancerdiscovery.aacrjournals.org/). Cancer Council Victoria, Carlton, Victoria; 6 The QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; Departments of 7 Onco- D.J. Park, K. Tao, and F. Le Calvez-Kelm contributed equally to this work. F. Lesueur, logical Sciences and 8 Dermatology, Huntsman Cancer Institute, University S.V. Tavtigian, M.C. Southey, and D.E. Goldgar contributed equally to this work. of Utah School of Medicine; 9 Huntsman Cancer Institute, University of Esther M. John’s contribution to this article is, in part, on behalf of the Breast Utah Health Sciences Center, Salt Lake City, Utah; 10 University of Texas at Cancer Family Registry. Melissa C. Southey’s contribution to this article is, Austin, Austin; 11 Department of Epidemiology, The University of Texas MD in part, on behalf of the Kathleen Cuningham Foundation Consortium for Anderson Cancer Center, Houston, Texas; 12 Cancer Prevention Institute of Research into Familial Breast Cancer. 13 California, Fremont; Department of Health Research and Policy, Stanford Corresponding Authors: Melissa C. Southey, Department of Pathology, 14 Cancer Institute, Stanford, California; Department of Epidemiology, Mail- The University of Melbourne, Melbourne, VIC 3010, Australia. Phone: man School of Public Health, Columbia University, New York, New York; 61-3-8344-4895; Fax: 61-3-8344-4004; E-mail: [email protected]. 15 16 Fox Chase Cancer Center, Philadelphia, Pennsylvania; Department of au ; and David E. Goldgar, Department of Dermatology, Huntsman Cancer 17 Preventive Medicine, Creighton University, Omaha, Nebraska; Genetic Institute, University of Utah School of Medicine, 30 N. Medical Drive, Salt Cancer Susceptibility Group, International Agency for Research on Can- Lake City, UT 84112. Phone: 801-585-0337; Fax: 801-585-0990; E-mail: 18 cer, Lyon; Genetic Epidemiology of Cancer Team, Institut National de la [email protected] Santé et de la Recherche Medicale (INSERM), U900, Institut Curie, Mines doi: 10.1158/2159-8290.CD-14-0212 ParisTech, Paris, France; 19 Department of Molecular Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Can- © 2014 American Association for Cancer Research. JULY 2014CANCER DISCOVERY | 805 Downloaded from cancerdiscovery.aacrjournals.org on September 27, 2021. © 2014 American Association for Cancer Research. Published OnlineFirst May 2, 2014; DOI: 10.1158/2159-8290.CD-14-0212 RESEARCH ARTICLE Park et al. cancer susceptibility genes BRCA1 [Mendelian Inheritance in the public sequencing databases. The nonsense substitu- in Man (MIM) 113705], BRCA2 (MIM 600185), and PALB2 tion was carried by both women included in the WES from (MIM 610355) is 20%, and another 28% is explained by asso- the family in which it was observed. The in-frame deletion ciations with common genetic variants ( 4 ), although these (c.1132_1134del) and missense substitution (c.1207G>T; proportions are highly dependent on age at diagnosis. A fur- p.D403Y) were observed in one WES subject each, but both ther approximately 5% is likely to be explained by mutations fall at protein positions that are highly evolutionarily con- in genes in the homologous recombination repair detection served and are thus likely to be damaging to protein function and signaling pathways, including MRE11A (MIM 600814), (Figs. 1 and 2 ). RAD50 (MIM 604040), NBN (MIM 602667), ATM (MIM 607585), and CHEK2 (MIM 604373), and the RAD51 para- Additional Genotyping in WES Pedigrees logs RAD51C (MIM 602774), RAD51D (MIM 602954), and In the family in which RINT1 c.343C>T (p.Q115X) was XRCC2 (MIM 600375), which are all currently under inves- identifi ed, the mutation was carried by both women for tigation. The potential for intrafamily exome-sequencing whom WES was conducted (II-2 and I-4; Fig. 1A ), and approaches to identify additional breast cancer susceptibility subsequent testing revealed that the two other female rela- genes has been demonstrated recently ( 5–7 ). Although large- tives diagnosed with breast cancer in the family (II-1 and scale validation of fi ndings from these studies has provided II-4) and a male relative (I-2) affected by bladder and lung further insight into the possible roles and clinical signifi - cancers were also carriers ( Fig. 1A ). The RINT1 c.1207G>T cance of these susceptibility genes in cancer predisposition, (p.D403Y) variant was identifi ed in 1 of the 2 affected these studies have also illustrated the challenges posed in women selected for WES (III-8 but not III-1; Fig. 1B ). This the context of breast cancer, a disease that has variable phe- family had an extensive family history of cancer, including notypes and is likely to involve a great number of intermedi- 9 diagnoses of breast cancer in 7 female members [2 women ate- to high-risk rare variants in multiple susceptibility genes were found to be carriers (III-8 and II-10), 2 were found to be (5, 6 , 8–11 ). noncarriers (III-1 and II-12), and 3 could not be genotyped In many, if not most, cases, mutations in specifi c cancer (II-1, II-7, and I-4) for c.1207G>T]. The family also had 4 susceptibility genes are associated with high risks of cancer individuals (II-4, II-9, II-10, and III-10) who had malignant at one or two primary sites, but are also associated with more melanoma at early ages (39, 39, 36, and 33 years, respec- modest increases in risk for a number of other cancer types. tively). Of these cases, 3 were carriers of c.1207G>T (II-4, For instance, BRCA2 mutations confer high risk of breast and II-9, and II-10) and 1 could not be genotyped. The RINT1 ovarian cancers but are also associated with increased risk of c.1132_1134del (p.378del) variant was carried by 1 of the 2 prostate cancer with an estimated relative risk of 2.5 ( 12 ) and women selected for WES (II-1 but not III-1), whereas the car- pancreatic cancer with an increased risk of 6-fold reported rier’s mother (I-4), affected by breast cancer at the age of 42 in two large independent studies ( 12, 13 ).