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      Management of suspected monogenic lung fibrosis in a specialised centre

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          Abstract

          At least 10% of patients with interstitial lung disease present monogenic lung fibrosis suspected on familial aggregation of pulmonary fibrosis, specific syndromes or early age of diagnosis. Approximately 25% of families have an identified mutation in genes mostly involved in telomere homeostasis, and more rarely in surfactant homeostasis.

          Beyond pathophysiological knowledge, detection of these mutations has practical consequence for patients. For instance, mutations involved in telomere homeostasis are associated with haematological complications after lung transplantation and may require adapted immunosuppression. Moreover, relatives may benefit from a clinical and genetic evaluation that should be specifically managed.

          The field of genetics of pulmonary fibrosis has made great progress in the last 10 years, raising specific problems that should be addressed by a specialised team.

          Abstract

          Monogenic pulmonary fibrosis raises specific problems that should be addressed by a specialised team http://ow.ly/YJUM30aoREG

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          Most cited references123

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          Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology

          The American College of Medical Genetics and Genomics (ACMG) previously developed guidance for the interpretation of sequence variants. 1 In the past decade, sequencing technology has evolved rapidly with the advent of high-throughput next generation sequencing. By adopting and leveraging next generation sequencing, clinical laboratories are now performing an ever increasing catalogue of genetic testing spanning genotyping, single genes, gene panels, exomes, genomes, transcriptomes and epigenetic assays for genetic disorders. By virtue of increased complexity, this paradigm shift in genetic testing has been accompanied by new challenges in sequence interpretation. In this context, the ACMG convened a workgroup in 2013 comprised of representatives from the ACMG, the Association for Molecular Pathology (AMP) and the College of American Pathologists (CAP) to revisit and revise the standards and guidelines for the interpretation of sequence variants. The group consisted of clinical laboratory directors and clinicians. This report represents expert opinion of the workgroup with input from ACMG, AMP and CAP stakeholders. These recommendations primarily apply to the breadth of genetic tests used in clinical laboratories including genotyping, single genes, panels, exomes and genomes. This report recommends the use of specific standard terminology: ‘pathogenic’, ‘likely pathogenic’, ‘uncertain significance’, ‘likely benign’, and ‘benign’ to describe variants identified in Mendelian disorders. Moreover, this recommendation describes a process for classification of variants into these five categories based on criteria using typical types of variant evidence (e.g. population data, computational data, functional data, segregation data, etc.). Because of the increased complexity of analysis and interpretation of clinical genetic testing described in this report, the ACMG strongly recommends that clinical molecular genetic testing should be performed in a CLIA-approved laboratory with results interpreted by a board-certified clinical molecular geneticist or molecular genetic pathologist or equivalent.
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            An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management

            American Journal of Respiratory and Critical Care Medicine, 183(6), 788-824
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              Genome-wide association studies for complex traits: consensus, uncertainty and challenges.

              The past year has witnessed substantial advances in understanding the genetic basis of many common phenotypes of biomedical importance. These advances have been the result of systematic, well-powered, genome-wide surveys exploring the relationships between common sequence variation and disease predisposition. This approach has revealed over 50 disease-susceptibility loci and has provided insights into the allelic architecture of multifactorial traits. At the same time, much has been learned about the successful prosecution of association studies on such a scale. This Review highlights the knowledge gained, defines areas of emerging consensus, and describes the challenges that remain as researchers seek to obtain more complete descriptions of the susceptibility architecture of biomedical traits of interest and to translate the information gathered into improvements in clinical management.
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                Author and article information

                Journal
                Eur Respir Rev
                Eur Respir Rev
                ERR
                errev
                European Respiratory Review
                European Respiratory Society
                0905-9180
                1600-0617
                30 June 2017
                26 April 2017
                : 26
                : 144
                : 160122
                Affiliations
                [1 ]Service de Pneumologie A, Centre de Compétence des Maladies Pulmonaires Rares, Paris, France
                [2 ]DHU FIRE, Hôpital Bichat, APHP, Paris, France
                [3 ]INSERM, Unité 1152, Paris, France
                [4 ]Université Paris Diderot, Paris, France
                [5 ]Laboratoire de Génétique, APHP, Hôpital Bichat, Paris, France
                [6 ]Service d'Hématologie Greffe de Moelle, CMRM Aplasies médullaires, Hôpital Saint Louis, APHP, Paris, France
                [7 ]Centre Français des Porphyries, Hôpital Louis Mourier, AP-HP, Colombes, France
                [8 ]Laboratory of Excellence, GR-Ex, Paris, France
                [9 ]INSERM UMR1149, Paris, France
                [10 ]Service de Pneumologie Pédiatrique, Centre National de Référence des Maladies Respiratoires Rares, Hôpital Armand-Trousseau, APHP, Paris, France
                [11 ]INSERM Unité Mixte de Recherche S933, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
                Author notes
                Raphael Borie, Service de pneumologie A, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. E-mail: raphael.borie@ 123456aphp.fr
                Article
                ERR-0122-2016
                10.1183/16000617.0122-2016
                9489110
                28446600
                4b24c33c-b02c-4bfb-a2a6-24b04e17752e
                Copyright ©ERS 2017.

                ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 23 December 2016
                : 21 February 2017
                Funding
                Funded by: Chancellerie des Universités de Paris
                Funded by: Université Sorbonne Paris Cité
                Award ID: FPI-SPC
                Funded by: Fondation de souffle
                Funded by: Roche, doi 10.13039/100004337;
                Categories
                Frontiers in Clinical Practice
                13
                16
                18

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