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      Prevalence of the TP53 p.R337H Mutation in Breast Cancer Patients in Brazil

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          Abstract

          Germline TP53 mutations predispose individuals to multiple cancers and are associated with Li-Fraumeni/Li-Fraumeni-Like Syndromes (LFS/LFL). The founder mutation TP53 p.R337H is detected in 0.3% of the general population in southern Brazil. This mutation is associated with an increased risk of childhood adrenal cortical carcinoma (ACC) but is also common in Brazilian LFS/LFL families. Breast Cancer (BC) is one of the most common cancers diagnosed in TP53 mutation carriers. We have assessed the prevalence of p.R337H in two groups: (1) 59 BC affected women with a familial history (FH) suggestive of hereditary cancer syndrome but no LFS/LFL features; (2) 815 BC affected women unselected for cancer FH, diagnosed with BC at or before age 45 or at age 55 or older. Among group 1 and group 2 patients, 2/59 (3.4%, CI95%: 0.4%–11.7%) and 70/815 (8.6%, CI95%: 6.8%–10.7%), respectively, were p.R337H carriers in the germline. The prevalence of p.R337H was higher in women diagnosed with BC at or before age 45 (12.1%, CI95%: 9.1%–15.8%) than at age 55 or older (5.1%, CI95%: 3.2%–7.7%), p<0.001). The Brazilian founder p.R337H haplotype was detected in all carriers analysed. These results suggest that inheritance of p.R337H may significantly contribute to the high incidence of BC in Brazil, in addition to its recently demonstrated impact on the risk of childhood ACC.

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          Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms.

          Familial cancer syndromes have helped to define the role of tumor suppressor genes in the development of cancer. The dominantly inherited Li-Fraumeni syndrome (LFS) is of particular interest because of the diversity of childhood and adult tumors that occur in affected individuals. The rarity and high mortality of LFS precluded formal linkage analysis. The alternative approach was to select the most plausible candidate gene. The tumor suppressor gene, p53, was studied because of previous indications that this gene is inactivated in the sporadic (nonfamilial) forms of most cancers that are associated with LFS. Germ line p53 mutations have been detected in all five LFS families analyzed. These mutations do not produce amounts of mutant p53 protein expected to exert a trans-dominant loss of function effect on wild-type p53 protein. The frequency of germ line p53 mutations can now be examined in additional families with LFS, and in other cancer patients and families with clinical features that might be attributed to the mutation.
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            An inherited p53 mutation that contributes in a tissue-specific manner to pediatric adrenal cortical carcinoma.

            The incidence of pediatric adrenal cortical carcinoma (ACC) in southern Brazil is 10-15 times higher than that of pediatric ACC worldwide. Because childhood ACC is associated with Li-Fraumeni syndrome, we examined the cancer history and p53 status of 36 Brazilian patients and their families. Remarkably, 35 of 36 patients had an identical germ-line point mutation of p53 encoding an R337H amino acid substitution. Differences within intragenic polymorphic markers demonstrated that at least some mutant alleles arose independently, thus eliminating a founder effect. In tumor cells, the wild-type allele was deleted, and mutant p53 protein accumulated within the nuclei. Although these features are consistent with Li-Fraumeni syndrome-associated adrenal tumors, there was no history of increased cancer incidence among family members. Therefore, this inherited R337H p53 mutation represents a low-penetrance p53 allele that contributes in a tissue-specific manner to the development of pediatric ACC.
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              Li-Fraumeni and related syndromes: correlation between tumor type, family structure, and TP53 genotype.

              A database has been created to collect information on families carrying a germ-line mutation in the TP53 gene and on families affected with Li-Fraumeni syndromes [Li-Fraumeni syndrome (LFS) and Li-Fraumeni-like syndrome (LFL)]. Data from the published literature have been included. The database is available online at http://www.iarc.fr/p53, as part of the IARC TP53 Database. The analysis of the 265 families/individuals that have been included thus far has revealed several new findings. In classical LFS families with a germ-line TP53 mutation (83 families), the mean age of onset of breast cancer was significantly lower than in LFS families (16 families) without a TP53 mutation (34.6 versus 42.5 years; P = 0.0035). In individuals with a TP53 mutation, a correlation between the genotype and phenotype was found. Brain tumors were associated with missense TP53 mutations located in the DNA-binding loop that contact the minor groove of DNA (P = 0.01), whereas adrenal gland carcinomas were associated with missense mutations located in the loops opposing the protein-DNA contact surface (P = 0.003). Finally, mutations likely to result in a null phenotype (absence of the protein or loss of function) were associated with earlier onset brain tumors (P = 0.004). These observations have clinical implications for genetic testing and tumor surveillance in LFS/LFL families.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                17 June 2014
                : 9
                : 6
                : e99893
                Affiliations
                [1 ]Genomic Medicine Laboratory, Experimental Research Centre, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
                [2 ]Post-Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
                [3 ]Pathology Service, HCPA, Porto Alegre, Rio Grande do Sul, Brazil and Instituto de Patologia, Porto Alegre, Rio Grande do Sul, Brazil
                [4 ]Pathology Service, Hospital do Câncer AC Camargo (HCACC), São Paulo, São Paulo, Brazil
                [5 ]Protein and Molecular Analysis Laboratory, Experimental Research Centre, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
                [6 ]Molecular Oncology Research Centre, Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
                [7 ]National Institute of Populational Medical Genetics (INAGEMP), UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
                [8 ]Oncogenetics Department, HCACC, São Paulo, São Paulo, Brazil
                [9 ]International Agency for Research on Cancer (IARC), Lyon, Rhone, France
                [10 ]Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
                [11 ]Bioethics Research Laboratory, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
                [12 ]International Prevention Research Institute, Lyon, Rhone, France
                [13 ]Department of Statistics, Institute of Mathematics, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
                [14 ]Post-Graduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
                Cancer Research Centre of Lyon, France
                Author notes

                Competing Interests: An academic grant from GlaxoSmithKline Oncology (Ethnic Research Initiative Grant Award 2009) provided partial funding for this study. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: JG MSG CABTO PKS EIP JRG PH SAC PAP. Performed the experiments: JG. Analyzed the data: JG MSG CABTO PKS EIP MZO RADM CSN GCF MIWSA GMP FAS MC JRG PH SAC PAP. Contributed reagents/materials/analysis tools: JG MSG CABTO EIP FAS PH PAP. Wrote the paper: JG MSG CABTO PKS EIP MZO RADM CSN GCF MIWSA GMP FAS MC JRG PH SAC PAP.

                Article
                PONE-D-13-54278
                10.1371/journal.pone.0099893
                4061038
                24936644
                ba8d2b4e-2b20-49f8-acc4-d009e78eef10
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 December 2013
                : 20 May 2014
                Page count
                Pages: 7
                Funding
                The study was supported in part by grants from GlaxoSmithKline Oncology (Ethnic Research Initiative Grant Award 2009), U.K.; CNPq to PA-P (grant 307779 2009-2), Brazil; FAPERGS-PPSUS (grant # 09/0103-0), FAPERGS PRONEX (grant #10/0051-9) and Fundo de Incentivo a Pesquisa e Eventos, Hospital de Clínicas de Porto Alegre (GPPG # 08080), Brazil. The work of JG was supported by fellowships from CAPES and CNPQ (Brazil). The authors certify that none of the funders had a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Computational Biology
                Evolutionary Biology
                Population Genetics
                Genetics
                Genomics
                Genomic Medicine
                Genetic Counseling
                Cancer Genetics
                Mutation
                Population Biology
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Breast Tumors
                Breast Cancer
                Women's Health
                Obstetrics and Gynecology

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