Deletion and Reduced Expression of the Fanconi Anemia FANCA Gene in Sporadic Acute Myeloid Leukemia
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Leukemia (2004) 18, 420–425 & 2004 Nature Publishing Group All rights reserved 0887-6924/04 $25.00 www.nature.com/leu Deletion and reduced expression of the Fanconi anemia FANCA gene in sporadic acute myeloid leukemia MD Tischkowitz1, NV Morgan1, D Grimwade1,2, C Eddy1, S Ball3, I Vorechovsky4, S Langabeer2, R Sto¨ger1, SV Hodgson1 and CG Mathew1 1Department of Medical and Molecular Genetics, Division of Genetics and Development Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, Guy’s Hospital, London, UK; 2Department of Haematology, University College London, London, UK; 3Department of Haematology, St George’s Hospital, London, UK; and 4Human Genetics Division, School of Medicine, Southampton University Hospital, Tremona Road, Southampton, UK Fanconi anemia (FA) is an autosomal recessive chromosomal Since the incidence of AML is highly elevated in FA patients, instability disorder caused by mutations in one of seven known it is possible that inherited or acquired mutations in the FA genes genes (FANCA,C,D2,E,F,G and BRCA2). Mutations in the FANCA gene are the most prevalent, accounting for two-thirds contribute to the etiology of sporadic AML. Epidemiological of FA cases. Affected individuals have greatly increased risks studies assessing incidence of malignancies (including AML) in of acute myeloid leukemia (AML). This raises the question as to FA families have failed to demonstrate an increased incidence in whether inherited or acquired mutations in FA genes might be heterozygous individuals.14,15 However, it is conceivable that involved in the development of sporadic AML. Quantitative genomic instability may result from a second somatic mutation fluorescent PCR was used to screen archival DNA from in an FA carrier or from one or two somatic mutations in a sporadic AML cases for FANCA deletions, which account for 16 40% of FANCA mutations in FA homozygotes. Four hetero- progenitor cell resulting in malignancy. Another chromosome zygous deletions were found in 101 samples screened, which is instability syndrome, ataxia telangiectasia (AT) has been 35-fold higher than the expected population frequency for implicated in sporadic leukemias; the AT gene, ATM,is germline FANCA deletions (Po0.0001). Sequencing FANCA in frequently deleted or mutated in T-cell prolymphocytic leuke- the AML samples with FANCA deletions did not detect mia,17–19 and ATM mutations have also been detected in mutations in the second allele and there was no evidence of sporadic non-Hodgkin’s lymphomas18 and B-cell chronic epigenetic silencing by hypermethylation. However, real-time 20 quantitative PCR analysis in these samples showed reduced lymphocytic leukemia. Moreover, heterozygous carriers of expression of FANCA compared to nondeleted AML samples AT mutations have a phenotype at the gene expression level that 21 and to controls. These findings suggest that gene deletions and differs from control individuals. Thus, heterozygosity for an reduced expression of FANCA may be involved in the promo- ATM mutation may predispose to these malignancies. tion of genetic instability in a subset of cases of sporadic AML. Current evidence regarding the role of FA mutations in Leukemia (2004) 18, 420–425. doi:10.1038/sj.leu.2403280 sporadic hematological malignancies including AML is limited; Published online 29 January 2004 Keywords: Fanconi anemia; acute myeloid leukemia; DNA repair; an analysis of 79 cases of adult AML for FANCA point mutations gene deletions found 13 exonic nucleotide changes, none of which led to truncation of FANCA.22 Five changes were novel missense mutations leading to nonconservative amino-acid substitutions Introduction in four cases, none of which was present in 79 normal controls. One additional missense mutation A3982G (causing the amino- acid change T1328A) had previously been reported to be Fanconi anemia (FA) is an autosomal recessive DNA disorder 23 characterized by hypersensitivity to DNA crosslinking agents.1 pathogenic, and the other seven nucleotide changes were Affected individuals have characteristic congenital abnormal- polymorphisms. A recent analysis of FANCC in 97 cases of ities, develop bone marrow failure at an early age, and have a sporadic pediatric AML found no evidence of known pathogenic greatly increased risk of developing myelodysplasia (MDS), mutations, although one polymorphic variant was present at 2–4 four-fold greater frequency in the AML cases compared to acute myeloid leukemia (AML) and solid malignancies. A 24 25 report on 754 FA patients diagnosed over a 20-year period controls. Xie et al analyzed cellular lysates from 10 sporadic showed that the risks of developing bone marrow failure and AML cell lines for FANCA, C, F and G protein expression using MDS or AML by age 40 years were 90 and 33% respectively.3 A Western blotting. Aberrant FA protein profiles, including the recent survey of cancer incidence in 145 FA patients reported absence or reduced presence of protein, were observed in five nine cases of myeloid leukemia with a median age-of-onset of out of the 10 cell lines. In cell lysates from primary AML blasts, 11.3 years, and a ratio of observed to expected cases of 785.4 11 out of 15 cases also had aberrant profiles. Further evidence Complementation analysis by cell fusion and correction of that disruption of the FA pathway may be implicated in the etiology of some sporadic AML cases is provided by Lensch crosslinker hypersensitivity has delineated at least eight com- 26 plementation groups; FA-A, B, C, D1, D2, E, F, G,5 six genes et al, who reported a case of acquired cytogenetic instability have been cloned, FANCA, C, D2, E, F, G,6–12 and a recent in a 68-year-old man with AML and demonstrated FANCA report has shown biallelic inactivation of BRCA2 in FA-D1 cell dysfunction in tumor cells, while lymphoblastoid cells from the lines.13 same individual had normal FANCA function. The high incidence of AML in FA homozygotes and the evidence for deficiency of FA proteins and their complexes in Correspondence: Dr MD Tischkowitz, Clinical Genetics Unit, Institute sporadic AML,25,26 have led us to examine the role of of Child Health, 30, Guilford Street, London WC1N 1EH, UK; Fax: þ 44 20 78138141; E-mail: [email protected] inactivation of the FA pathway in the development of sporadic Received 17 July 2003; accepted 4 December 2003; Published online AML. We selected the FANCA gene for analysis since mutations 29 January 2004 in this gene account for 70% of all cases of FA. The mutation FANCA gene deletions in AML MD Tischkowitz et al 421 profile of FANCA is highly heterogeneous with over 100 the FANCA CpG island. Following sodium bisulfite conversion, different mutations described,23,27–29 and there is a 40% PCR reactions to amplify the FANCA CpG island sequence were incidence of large deletions, which remove 1–43 exons from performed on a Techne Genius thermocycler in oil-free 25 ml the gene.28,30 Screening for these mutations thus accounts for reactions. A measure of 12.5 ml of sodium bisulfite-converted nearly 30% of all FA mutations across all complementation DNA was added to 12.5 ml of the reaction mix containing 2 Â groups. Taq Polymerase buffer (67 mM Tris-HCl, pH 8.8, 16.6 mM (NH4)2SO4, 1.5 mM MgCl2, 170 mg BSA/ml), 400 mM each dNTP (Pharmacia) and 0.4 mM of each primer (1F, 50 TAGGT- Materials and methods TAGTTTGGAATTTTTGGG 30;1R50 AGAGAAAAAATG- GAAAAAAAA 30). After an initial denaturation of 5 min at Samples 941C, a touch-down protocol was used: five cycles of 941C for 20 s, 601C for 30 s (reducing by 11C/cycle) and 721C annealing Samples were obtained from tissue banks at the Departments of for 40 s, followed by a further 30 cycles of 941C for 20 s, 551C Hematology of University College Hospital, London, St for 30 s, 721C annealing for 40 s (increasing by 2 s with each George’s Hospital, London and the Karolinska Institute, Sweden. cycle), and a final extension step of 5 min at 721C. For the A total of 101 samples were analyzed. A total of 22 samples second (seminested) PCR, 0.5 ml of the first PCR end-product (22%) were selected for monosomy 7, since this is one of the was transferred to a new 24.5 ml PCR mixture with the same final commonest recurring cytogenetic findings in AML arising on a concentration of reagents as above, but using a different reverse background of FA,2 and the rest were randomly selected. The primer (2R, 50 GGAAATGAATGGGGTTGGTAATG 30). The median age was 58 years (range 16–90 years). FAB group was: conditions for this PCR were the same as above, but without the M1 ¼ 3, M2 ¼ 19, M3 ¼ 15, M4 ¼ 23, M5 ¼ 10, M6 ¼ 3, M7 ¼ 1, initial 5-cycle touch-down step. unknown ¼ 27. Risk classification based on cytogenetic analy- The PCR product was purified and sequenced using a sis31 was: adverse ¼ 25, intermediate ¼ 32, favorable ¼ 16, commercial sequencing kit (Applied Biosystems, Warrington, unknown ¼ 28. The study had ethical approval (MREC 99/7/45). UK) according to the manufacturer’s instructions. The reverse primer was the same as that used for the second PCR, with a 0 T different forward primer (2F, 5 GTAGG( /C)GTATTTTTTAG- Quantitative fluorescent PCR analysis of FANCA gene GATTAATATG 30). The resulting amplicon had an expected dosage length of 221 bp and was predicted to contain 24 CpG dinucleotides. The product was cleaned and analyzed using The FANCA multiplex quantitative fluorescent PCR (QF-PCR) an ABI 310 Genetic Analyzer (Applied Biosystems, Warrington, gene dosage assay used has been previously described by UK). Sequence data were analyzed using Sequence Navigator Morgan et al.28 This multiplex amplifies five exons (5, 11, 17, software (Applied Biosystems, Warrington, UK), specifically 21, and 31) and uses exon 1 of the myelin protein zero (MPZ) assessing each CpG island to determine whether a thymine was gene as a non-FA gene control.