Recurrent Germline DLST Mutations in Individuals with Multiple Pheochromocytomas and Paragangliomas

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Laura Remacha - , Instituto de Salud Carlos III (Author)
  • David Pirman - , Agios Pharmaceuticals (Author)
  • Christopher E. Mahoney - , Agios Pharmaceuticals (Author)
  • Javier Coloma - , Instituto de Salud Carlos III (Author)
  • Bruna Calsina - , Instituto de Salud Carlos III (Author)
  • Maria Currás-Freixes - , Instituto de Salud Carlos III (Author)
  • Rocío Letón - , Instituto de Salud Carlos III (Author)
  • Rafael Torres-Pérez - , Instituto de Salud Carlos III (Author)
  • Susan Richter - , Institute of Clinical Chemistry and Laboratory Medicine (Author)
  • Guillermo Pita - , Instituto de Salud Carlos III (Author)
  • Belén Herráez - , Instituto de Salud Carlos III (Author)
  • Giovanni Cianchetta - , Agios Pharmaceuticals (Author)
  • Emiliano Honrado - , Hospital of León (Author)
  • Lorena Maestre - , Instituto de Salud Carlos III (Author)
  • Miguel Urioste - , Instituto de Salud Carlos III (Author)
  • Javier Aller - , Universidad Autónoma de Madrid (Author)
  • Óscar García-Uriarte - , Hospital Universitario Araba (Author)
  • María Ángeles Gálvez - , Hospital Universitario Reina Sofía, Maimónides Institute of Biomedical Research of Cordoba (Author)
  • Raúl M. Luque - , Maimónides Institute of Biomedical Research of Cordoba (Author)
  • Marcos Lahera - , Hospital Universitario de la Princesa (Author)
  • Cristina Moreno-Rengel - , Hospital de Basurto (Author)
  • Graeme Eisenhofer - , Department of internal Medicine 3 (Author)
  • Cristina Montero-Conde - , Instituto de Salud Carlos III (Author)
  • Cristina Rodríguez-Antona - , Instituto de Salud Carlos III, CIBER - Center for Biomedical Research Network (Author)
  • Óscar Llorca - , Instituto de Salud Carlos III (Author)
  • Gromoslaw A. Smolen - , Agios Pharmaceuticals (Author)
  • Mercedes Robledo - , Instituto de Salud Carlos III, CIBER - Center for Biomedical Research Network (Author)
  • Alberto Cascón - , Instituto de Salud Carlos III, CIBER - Center for Biomedical Research Network (Author)

Abstract

Pheochromocytomas and paragangliomas (PPGLs) provide some of the clearest genetic evidence for the critical role of metabolism in the tumorigenesis process. Approximately 40% of PPGLs are caused by driver germline mutations in 16 known susceptibility genes, and approximately half of these genes encode members of the tricarboxylic acid (TCA) cycle. Taking as a starting point the involvement of the TCA cycle in PPGL development, we aimed to identify unreported mutations that occurred in genes involved in this key metabolic pathway and that could explain the phenotypes of additional individuals who lack mutations in known susceptibility genes. To accomplish this, we applied a targeted sequencing of 37 TCA-cycle-related genes to DNA from 104 PPGL-affected individuals with no mutations in the major known predisposing genes. We also performed omics-based analyses, TCA-related metabolite determination, and 13C5-glutamate labeling assays. We identified five germline variants affecting DLST in eight unrelated individuals (∼7%); all except one were diagnosed with multiple PPGLs. A recurrent variant, c.1121G>A (p.Gly374Glu), found in four of the eight individuals triggered accumulation of 2-hydroxyglutarate, both in tumors and in a heterologous cell-based assay designed to functionally evaluate DLST variants. p.Gly374Glu-DLST tumors exhibited loss of heterozygosity, and their methylation and expression profiles are similar to those of EPAS1-mutated PPGLs; this similarity suggests a link between DLST disruption and pseudohypoxia. Moreover, we found positive DLST immunostaining exclusively in tumors carrying TCA-cycle or EPAS1 mutations. In summary, this study reveals DLST as a PPGL-susceptibility gene and further strengthens the relevance of the TCA cycle in PPGL development.

Details

Original languageEnglish
Pages (from-to)651-664
Number of pages14
JournalAmerican journal of human genetics
Volume104
Issue number4
Publication statusPublished - 4 Apr 2019
Peer-reviewedYes

External IDs

PubMed 30929736
ORCID /0000-0002-3549-2477/work/142244898

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • cancer susceptibility gene, DLST, paraganglioma, pheochromocytoma, TCA cycle