Dominantly Inherited Hereditary Nonpolyposis Colorectal Cancer Not Caused by MMR Genes
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Journal of Clinical Medicine Review Dominantly Inherited Hereditary Nonpolyposis Colorectal Cancer Not Caused by MMR Genes Mariona Terradas 1,2, Gabriel Capellá 1,2,3 and Laura Valle 1,2,3,* 1 Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; [email protected] (M.T.); [email protected] (G.C.) 2 Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain 3 Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-93-260-7145 Received: 29 May 2020; Accepted: 18 June 2020; Published: 23 June 2020 Abstract: In the past two decades, multiple studies have been undertaken to elucidate the genetic cause of the predisposition to mismatch repair (MMR)-proficient nonpolyposis colorectal cancer (CRC). Here, we present the proposed candidate genes according to their involvement in specific pathways considered relevant in hereditary CRC and/or colorectal carcinogenesis. To date, only pathogenic variants in RPS20 may be convincedly linked to hereditary CRC. Nevertheless, accumulated evidence supports the involvement in the CRC predisposition of other genes, including MRE11, BARD1, POT1, BUB1B, POLE2, BRF1, IL12RB1, PTPN12, or the epigenetic alteration of PTPRJ. The contribution of the identified candidate genes to familial/early onset MMR-proficient nonpolyposis CRC, if any, is extremely small, suggesting that other factors, such as the accumulation of low risk CRC alleles, shared environmental exposures, and/or gene–environmental interactions, may explain the missing heritability in CRC. Keywords: hereditary cancer; colorectal cancer; mismatch repair proficiency; familial colorectal cancer type X; gene identification; cancer predisposition; cancer susceptibility; cancer genetics; molecular pathways 1. Introduction While estimates indicate that approximately 14% of all colorectal cancer (CRC) patients have at least one first-degree relative affected with the same tumor type [1,2], 4–8% of all CRC patients carry germline pathogenic variants in one of the known high penetrance genes for this tumor [3–6], with a relevant proportion of the familial aggregation of CRC remaining unexplained. The identification of a germline pathogenic variant in a colorectal cancer-predisposing gene has important consequences for the patients and their relatives, as they can be counseled and managed based on gene-specific guidelines. This is the main reason why large efforts have been and are still being made to identify the genetic cause of the increased CRC risk observed in some families. Figure1 shows the known causal genes for nonpolyposis and polyposis CRC predisposition and the molecular pathways in which they are involved. J. Clin. Med. 2020, 9, 1954; doi:10.3390/jcm9061954 www.mdpi.com/journal/jcm J. Clin. Med. 2020, 9, 1954 2 of 19 J. Clin. Med. 2020, 9, x FOR PEER REVIEW 2 of 19 Figure 1. Schematic representation of colorectal cancer predisposing syndromes, causal genes, and Figure 1. Schematic representation of colorectal cancer predisposing syndromes, causal genes, and affected molecular pathways. Genes shaded in grey correspond to the most promising proposed affected molecular pathways. Genes shaded in grey correspond to the most promising proposed candidate genes. Abbreviations: BER, base excision repair; DSB, double strand breaks; meth, promoter candidate genes. Abbreviations: BER, base excision repair; DSB, double strand breaks; meth, promoter hypermethylation; MMR, DNA mismatch repair; SAC, spindle assembly checkpoint. hypermethylation; MMR, DNA mismatch repair; SAC, spindle assembly checkpoint. 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RPS20 Mutations as a Rare Cause of Hereditary Nonpolyposis Colorectal Cancer 2. RPS20 Mutations as a Rare Cause of Hereditary Nonpolyposis Colorectal Cancer So far, the only new candidate gene that has shown consistent association with hereditary nonpolyposisSo far, the CRC only is newRPS20 candidate, which gene encodes that ahas component shown consistent (S20) of theassociation small ribosome with hereditary subunit. nonpolyposisBy combining geneticCRC is linkageRPS20, analysiswhich encodes and exome a component sequencing, (S20) Nieminen of the etsmall al. (2014) ribosome identified subunit. a novel By combiningtruncating geneticRPS20 variant,linkage analysis c.147dupA and (p.Val50Serfs*23), exome sequencing, in Nieminen a Finnish four-generationet al. (2014) identified CRC-a aff novelected truncatingfamily. The RPS20 variant variant, was present c.147dupA in seven (p.Val50Serfs*23), CRC-affected members in a Finnish but neither four-generation in four cancer-free CRC-affected members family.nor in one The relative variant diagnosed was present with in breast seven cancer CRC-affected at age 55. members All studied but tumors neither were in four MMR cancer-free proficient membersand despite nor not in showingone relative loss diagnosed of the RPS20 withwildtype breast cancer allele, at patients age 55. All carrying studied the tumorsRPS20 werec.147dupA MMR proficientvariant showed and despite a marked not increaseshowing of loss 21S of pre-rRNAs, the RPS20 supporting wildtype allele, a late patients pre-rRNA carrying processing