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      A Six-attribute Classification of Genetic Mosaicism

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          Abstract

          Mosaicism denotes an individual who has at least two populations of cells with distinct genotypes that are derived from a single fertilized egg. Genetic variation among the cell lines can involve whole chromosomes, structural or copy number variants, small or single nucleotide variants, or epigenetic variants. The mutational events that underlie mosaic variants occur during mitotic cell divisions after fertilization and zygote formation. The initiating mutational event can occur in any types of cell at any time in development, leading to enormous variation in the distribution and phenotypic effect of mosaicism. A number of classification proposals have been put forward to classify genetic mosaicism into categories based on the location, pattern, and mechanisms of the disease. We here propose a new classification of genetic mosaicism that considers the affected tissue, the pattern and distribution of the mosaicism, the pathogenicity of the variant, the direction of the change (benign to pathogenic vs. pathogenic to benign), and the postzygotic mutational mechanism. The accurate and comprehensive categorization and subtyping of mosaicisms is important and has potential clinical utility to define the natural history of these disorders, tailor follow-up frequency and interventions, estimate recurrence risks, and guide therapeutic decisions.

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          Age-related clonal hematopoiesis associated with adverse outcomes.

          The incidence of hematologic cancers increases with age. These cancers are associated with recurrent somatic mutations in specific genes. We hypothesized that such mutations would be detectable in the blood of some persons who are not known to have hematologic disorders. We analyzed whole-exome sequencing data from DNA in the peripheral-blood cells of 17,182 persons who were unselected for hematologic phenotypes. We looked for somatic mutations by identifying previously characterized single-nucleotide variants and small insertions or deletions in 160 genes that are recurrently mutated in hematologic cancers. The presence of mutations was analyzed for an association with hematologic phenotypes, survival, and cardiovascular events. Detectable somatic mutations were rare in persons younger than 40 years of age but rose appreciably in frequency with age. Among persons 70 to 79 years of age, 80 to 89 years of age, and 90 to 108 years of age, these clonal mutations were observed in 9.5% (219 of 2300 persons), 11.7% (37 of 317), and 18.4% (19 of 103), respectively. The majority of the variants occurred in three genes: DNMT3A, TET2, and ASXL1. The presence of a somatic mutation was associated with an increase in the risk of hematologic cancer (hazard ratio, 11.1; 95% confidence interval [CI], 3.9 to 32.6), an increase in all-cause mortality (hazard ratio, 1.4; 95% CI, 1.1 to 1.8), and increases in the risks of incident coronary heart disease (hazard ratio, 2.0; 95% CI, 1.2 to 3.4) and ischemic stroke (hazard ratio, 2.6; 95% CI, 1.4 to 4.8). Age-related clonal hematopoiesis is a common condition that is associated with increases in the risk of hematologic cancer and in all-cause mortality, with the latter possibly due to an increased risk of cardiovascular disease. (Funded by the National Institutes of Health and others.).
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            Clonal hematopoiesis and blood-cancer risk inferred from blood DNA sequence.

            Cancers arise from multiple acquired mutations, which presumably occur over many years. Early stages in cancer development might be present years before cancers become clinically apparent. We analyzed data from whole-exome sequencing of DNA in peripheral-blood cells from 12,380 persons, unselected for cancer or hematologic phenotypes. We identified somatic mutations on the basis of unusual allelic fractions. We used data from Swedish national patient registers to follow health outcomes for 2 to 7 years after DNA sampling. Clonal hematopoiesis with somatic mutations was observed in 10% of persons older than 65 years of age but in only 1% of those younger than 50 years of age. Detectable clonal expansions most frequently involved somatic mutations in three genes (DNMT3A, ASXL1, and TET2) that have previously been implicated in hematologic cancers. Clonal hematopoiesis was a strong risk factor for subsequent hematologic cancer (hazard ratio, 12.9; 95% confidence interval, 5.8 to 28.7). Approximately 42% of hematologic cancers in this cohort arose in persons who had clonality at the time of DNA sampling, more than 6 months before a first diagnosis of cancer. Analysis of bone marrow-biopsy specimens obtained from two patients at the time of diagnosis of acute myeloid leukemia revealed that their cancers arose from the earlier clones. Clonal hematopoiesis with somatic mutations is readily detected by means of DNA sequencing, is increasingly common as people age, and is associated with increased risks of hematologic cancer and death. A subset of the genes that are mutated in patients with myeloid cancers is frequently mutated in apparently healthy persons; these mutations may represent characteristic early events in the development of hematologic cancers. (Funded by the National Human Genome Research Institute and others.).
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              The COSMIC (Catalogue of Somatic Mutations in Cancer) database and website

              Approximately one in three individuals in Europe and North America develops one of the approximately 200 different classes of cancer and it is the cause of death of one in five (Higginson, 1992). All cancers arise as a result of the acquisition of a series of fixed DNA sequence abnormalities, each of which ultimately confers growth advantage upon the clone of cells in which it has occurred (Vogelstein and Kinzler, 1998). These abnormalities include base substitutions, deletions, amplifications and rearrangements. The extent to which each of these mechanisms contributes to cancer varies markedly between different genes, and probably also between different cancer types. Identification of the genes that are mutated in cancer is a central aim of cancer research. Over the past 25 years, approximately 300 genes have been shown to be somatically mutated in cancer (Futreal et al, 2004). This work forms the foundation for understanding the biological abnormalities within neoplastic cells, provides information on the function of gene products and sheds light on more complex questions such as the relationships between genes and biochemical pathways. Current strategies for the development of new therapeutic and preventive agents in cancer are increasingly dependent upon modulation of these critical molecular targets. The scientific literature is a rich source of mutation data that, in general, is published in a piecemeal fashion. More comprehensive data sources do exist, such as Online Mendelian Inheritance in Man (OMIM, Wheeler et al, 2004), HGVbase (Fredman et al, 2002) and the Human Gene Mutation Database (HGMD, Stenson et al, 2003). These databases give overviews of the genetics and biology of many genes and associated diseases (OMIM), genome variants and associated genotype–phenotype relationships (HGVbase) or germline mutation data (HGMD). For somatic mutations in cancer, there are many locus-specific web resources, such as those for p53 (Olivier et al, 2002; Béroud and Soussi, 2003), that cover a single gene in depth. The value of these various databases should not be underestimated; however, none of them offer a comprehensive view of all previously reported somatic mutations in cancer. Looking to the future, the volume of somatic mutation data will continue to expand and the scientific community will be better served if this data is provided in a coherent fashion. A public, comprehensive, intuitive, accessible and integrated database is required to maximise the benefit from this rich data set. The Catalogue of Somatic Mutations in Cancer (COSMIC), (http://www.sanger.ac.uk/cosmic) is a database that holds somatic mutation data and associated information, and can be interrogated through a series of web pages to provide a graphical or tabular view of the data along with various export options. To date, the database has been populated with data from four genes: HRAS, KRAS2, NRAS and BRAF. DATA CURATION Gene selection The genes that have been selected for curation are taken from the list of cancer genes assembled in the Cancer Gene Census (Futreal et al, 2004). In the first instance, data was obtained for four genes that are known to be somatically mutated in cancer: HRAS (Reddy et al, 1982), KRAS2 (McCoy et al, 1983), NRAS (Hall et al, 1983) and BRAF (Davies et al, 2002). Data extraction from the literature PubMed (Wheeler et al, 2004) is broadly searched for references containing relevant somatic mutation data in cancer (example search: (ras OR genes, ras) AND human AND mutation). In the first instance, the abstract is read to identify, and select for inclusion in the database, papers that are likely to include somatic mutation information relating to cancer or precancerous conditions. Primary research papers are read and information about the samples, mutations and experimental methods (see Table 1 Table 1 Data entered in COSMIC Reference Sample Title Gene Authors Experimental information Journal Sample ID Year Mutation status Volume Normal tissue tested Page start and stop Site primary PubMed ID Site subtype 1 Experimental information Site subtype 2 Gene Histology   Histology subtype 1 Mutation Histology subtype 2 Mutation ID Stage Mutation type Grade DNA location Source tissue DNA change Loss of heterozygosity DNA evidence Gender Is somatic Age RNA label Other mutations RNA change Ethnicity RNA region Geographical location RNA location Parent tested RNA evidence Family ID Amino-acid label Remark Amino-acid location Reference Amino-acid change Environmental variables Amino-acid evidence   Gene Gene Sequence Name Remark Symbol   Other names Experimental information Chromosome Primary detection method Chromosome band Secondary detection method cDNA sequence accession Confirmation method cDNA sequence version Exons/codons screened Ensembl gene start and stop Whole gene screened Swissprot accession Remark OMIM accession Section heading for the data in COSMIC are in bold. ) is extracted and entered into the database. Reviews are also selected if thought to be specific to a gene of interest. In order to avoid duplication of data, this source is used to identify the relevant primary literature and not as the source of the mutation data. Any references containing incomplete data (e.g. mutations reported but not fully described) or data of insufficient quality (e.g. errors identified in the data) are not fully curated but are added to a list of additional references containing somatic mutation information. Simple mutations are fed through Mutation Checker (Stajich et al, 2002) before being imported to COSMIC, while more complex alterations are manually annotated. COSMIC DATABASE The COSMIC database is implemented in an Oracle relational database and has five sections each containing multiple tables. Gene information A static version of each gene is maintained in COSMIC. The genomic structure of each gene and chromosome location is derived from Ensembl (Birney et al, 2004) and cDNA sequence and protein sequence from the RefSeq project (Wheeler et al, 2004). Other information is held to provide links to web resources such as Ensembl (Birney et al, 2004), Pfam (Bateman et al, 2004), InterPro (Mulder et al, 2003) and OMIM (Wheeler et al, 2004). Paper information The details of the papers that have been curated are maintained in the paper section and include title, journal, author lists and links to PubMed. There are currently 1483 papers in COSMIC, 865 of these have been curated for mutations, while 618 either have no relevant data or incomplete data that could not accurately be extracted. By gene 30, 249, 718 and 303 papers report BRAF, HRAS, KRAS2 and NRAS mutations, respectively. Of the 865 papers reporting mutations, 615 report data on only one gene, while 72, 174 and four contain data on two, three or all four genes, respectively. Mutation information COSMIC can accommodate information on base substitutions, insertions and deletions, translocations and changes in copy number. For the four genes presently in COSMIC, there are 147 unique mutations (36 for BRAF, 27 for HRAS, 52 for KRAS2 and 32 for NRAS). In the tumours that have been analysed, there are a total of 10 647 mutations, 736 in BRAF, 477 in HRAS, 8302 in KRAS2 and 1132 in NRAS. Tumour classification system The tissue site and histology data is taken from the curated papers and entered into COSMIC (this forms the ‘paper definition’). Tumour classification is a continually evolving field and there is no standard nomenclature adhered to for the purposes of publication in the various journals. Identical tissues and histologies can have different labels depending on the origin and age of the study. To overcome difficulties caused by these alternate nomenclatures, a standardised system of definitions has been developed (the ‘COSMIC definitions’) through consultation with experts in the field. This groups data from the same tissue types and histologies and can be used to translate the ‘paper definitions’ to ‘COSMIC definitions’. Every sample has up to eight definitions; primary tissue, tissue subtype 1, 2 and 3, primary histology and histology subtypes 1, 2 and 3. If there is no data for any of these definitions, COSMIC records an entry of NS, not specified. A total of 513 tissue definitions have been noted in the papers in COSMIC and have been translated to 372 COSMIC tissue definitions. Likewise, a total of 1150 histology definitions were found in the papers in COSMIC that were translated to 425 COSMIC histology definitions. This unified classification system is presented through the web pages to present a normalised browsing tool. Individual/tumour/sample data The sample data is taken from the curated papers and linked to the appropriate gene, paper, classification and when present a mutation. This forms the core of the COSMIC database. An individual can have many tumours and each tumour can have many samples. However in the COSMIC scheme, each sample is unique and could be considered as a single experiment. There are 66 634 sample records in COSMIC (5158, 11 876, 35 716 and 13 884 for BRAF, HRAS, KRAS2 and NRAS, respectively). These samples are derived from 57 444 tumours of which 51 988 were analysed in one gene, 2353 in two genes, 2930 in three genes and 173 in all four genes. COSMIC WEBSITE A series of web pages provides query tools to interrogate COSMIC and produces graphical (Figure 1 Figure 1 The initial output from COSMIC is a graphical view of the mutations distributed along the linear amino-acid sequence of the gene. The scale bar incorporates a zoom function to generate a more detailed view of the protein to the point where individual amino acids are named (when there are fewer than 31 amino acids displayed). When a Pfam or Interpro domain is present, a link is provided to these resources (adjacent to the Domain label) while links to the papers that were curated are positioned beneath the mutations (in red) with an option of either viewing the papers that have data for a particular location in the protein or all of the papers for the selected gene. ) and tabular (Table 2 Table 2 Mutation Details from COSMIC   Details for BRAF Tissue Mutations (% of All Samples) All Samples Mutation Data NS 0 3 More Details adrenal gland 0 2 More Details autonomic ganglia 0 27 More Details bile duct 16 (23%) 70 More Details bladder 0 37 More Details bone 1 (3%) 31 More Details brain 4 (7%) 56 More Details breast 1 (1%) 78 More Details cervix 0 49 More Details endometrium 0 5 More Details eye 0 31 More Details haematopoietic and lymphoid tissue 4 (1%) 322 More Details head neck 6 (4%) 152 More Details kidney 0 12 More Details large intestine 148 (13%) 1135 More Details larynx 0 25 More Details liver 1 (3%) 32 More Details lung 15 (2%) 829 More Details mouth 0 13 More Details ovary 57 (20%) 282 More Details pancreas 5 (4%) 114 More Details pharynx 3 (6%) 51 More Details placenta 0 1 More Details pleura 0 3 More Details prostate 0 43 More Details skin 282 (61%) 460 More Details small intestine 0 1 More Details soft tissue 5 (2%) 211 More Details stomach 7 (2%) 407 More Details testis 0 7 More Details thyroid 181 (27%) 669 More Details The mutations from COSMIC are presented by tissue and where selected by histology with a figure for the number of samples analysed for each tissue (All Samples) and the number of mutations reported (Mutated). The ‘More Details’ column gives further navigation options to view data for the selected tissue, view data for the same tissue in other genes or provide more details on the mutations for the selected tissue. ) displays of the data. Currently the output is provided at the amino-acid level based on the protein structure of each gene. Browse by gene Immediate access to the data is provided through the Browse by Gene link. This gives an instant overview of the mutation data for one or more genes and gives links to display data for individual tissues. Browse by tissue More complex queries can be constructed using the Browse by Tissue link. The user has the option to select one or more tissues, then one or more histologies, and finally one or more genes. If only one tissue or histology is selected, it is possible to select one or more tissue or histology subtypes before making a gene selection. All of the tissues present in the COSMIC classification scheme are available from the first page; however, subsequent pages only show the relevant options and not the entire list of options, for example having selected eye, the tissue subtype options are retina and uveal tract. Data display After querying the database, the results are displayed as a figure (Figure 1) and as a series of tables (Table 2) for each gene that was selected. The figure shows the linear amino-acid sequence derived from the gene with the mutations positioned along its length. Further information and links are provided as appropriate to the protein sequence. The table gives a summary of the mutations stratified by tissue and histology. The depth of the stratification relates to the depth of the original query. If only tissue was selected, the data will be stratified by tissue; however, if tissue, subtissue, histology and subhistology are selected, the data will be broken down further. Links from this table reload the figure to display a subset of the data and provide more details of the specific mutations. Two other tables provide a summary of the statistics in COSMIC for the selected gene and a summary of the mutations shown in the figure. Exports and downloads Having displayed the results from a query, the data can be formatted in simple text, Excel or HTML that can be downloaded from the COSMIC site. The cDNA and protein sequences are available through the Additional Info. link on the COSMIC home page as is the Classification Scheme. FUTURE DIRECTIONS There is a continuing effort to enter additional somatic mutation data in to COSMIC. In order to keep the data in COSMIC up-to-date, we regularly monitor the literature for new reports of mutations in the genes that exist in COSMIC. In addition, further cancer genes will be taken from the Cancer Gene Census (Futreal et al, 2004) and curated. The COSMIC website will be developed further to make use of the underlying data. This will include a DNA view of the mutations and methods to display insertions and deletions. In addition, we will display other data that has already been captured such as the patient sex and age for the samples and the experimental methods used to screen for the mutations. There are however limitations to this data as we can only collect data that is described in the original work. Even with this caveat the data provides a direct summary of the somatic mutation literature. Considering the data set as a whole it will be possible to analyse, in greater detail, the wider aspects of the biology underlying the genetic changes that take place in cancer.
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                Author and article information

                Journal
                9815831
                22061
                Genet Med
                Genet Med
                Genetics in medicine : official journal of the American College of Medical Genetics
                1098-3600
                1530-0366
                4 November 2021
                14 July 2020
                November 2020
                11 November 2021
                : 22
                : 11
                : 1743-1757
                Affiliations
                [1- ]CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
                [2- ]Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain
                [3- ]Department of Pediatric Dermatology, Hospital Universitario La Paz-UAM, Madrid, Spain
                [4- ]Genetics Unit, Universitat Pompeu Fabra and Hospital del Mar Research Institute (IMIM), Barcelona, Spain
                [5- ]Women’s and Children’s Hospital, South Australia Medical and Health Research Institute (SAHMRI) and University of Adelaide, Adelaide, South Australia, Australia
                [6- ]Instituto de Investigaciones Biomédicas de Madrid (CSIC-UAM), Madrid, Spain
                [7- ]Department of Pediatrics, Hospital Universitario Niño Jesús, Madrid, Spain
                [8- ]Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicines at The Children’s Hospital of Philadelphia, USA
                [9- ]Department of Dermatology, Medical Center – University of Freiburg, Germany
                [10- ]Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, Maryland, USA
                [11- ]ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability
                Author notes
                [#]

                These seven authors contributed equally and should be considered Senior authors of this work.

                [& ]Corresponding authors, Address for Correspondence: Pablo Lapunzina M.D., Ph.D. INGEMM-Instituto de Genética Médica y Molecular. IdiPAZ- Instituto de Investigación Sanitaria del Hospital Universitario La Paz-Universidad Autónoma de Madrid- CIBERER- Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid- Paseo de la Castellana 261-28046-Madrid-Spain. Phone: 3491 727 72 17. Fax: 34 91 207 10 40. pablo.lapunzina@ 123456salud.madrid.org ; plapunzina@ 123456ciberer.es ; Víctor Martínez-Glez M.D., Ph.D. INGEMM-Instituto de Genética Médica y Molecular. IdiPAZ- Instituto de Investigación Sanitaria del Hospital Universitario La Paz-Universidad Autónoma de Madrid- CIBERER- Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid- Paseo de la Castellana 261-28046-Madrid-Spain. Phone: 3491 727 72 17. Fax: 34 91 207 10 40, vmartinezglez@ 123456salud.madrid.org
                Article
                NIHMS1615429
                10.1038/s41436-020-0877-3
                8581815
                32661356
                1fb4c30c-23c8-47f4-988e-1c84939174df

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                Article

                Genetics
                mosaicism,postzygotic,new classification,mutational event
                Genetics
                mosaicism, postzygotic, new classification, mutational event

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