Context:
The term pseudohypoparathyroidism (PHP) was coined to describe the clinical condition resulting from end-organ resistance to parathormone (rPTH), caused by genetic and/or epigenetic ...alterations within or upstream of GNAS. Although knowledge about PHP is growing, there are few data on the prevalence of underlying molecular defects.
Objective:
The purpose of our study was to ascertain the relative prevalence of PHP-associated molecular defects.
Design:
With a specially designed questionnaire, we collected data from all patients (n = 407) clinically and molecularly characterized to date by expert referral centers in France, Italy, and Spain.
Results:
Isolated rPTH (126/407, 31%) was caused only by epigenetic defects, 70% of patients showing loss of imprinting affecting all four GNAS differentially methylated regions and 30% loss of methylation restricted to the GNAS A/B:TSS-DMR. Multihormone resistance with no Albright's hereditary osteodystrophy (AHO) signs (61/407, 15%) was essentially due to epigenetic defects, although 10% of patients had point mutations. In patients with rPTH and AHO (40/407, 10%), the rate of point mutations was higher (28%) and methylation defects lower (about 70%). In patients with multihormone resistance and AHO (155/407, 38%), all types of molecular defects appeared with different frequencies. Finally, isolated AHO (18/407, 4%) and progressive osseous heteroplasia (7/407, 2%) were exclusively caused by point mutations.
Conclusion:
With European data, we have established the prevalence of various genetic and epigenetic lesions in PHP-affected patients. Using these findings, we will develop objective criteria to guide cost-effective strategies for genetic testing and explore the implications for management and prognosis.
Pseudohypoparathyroidism is caused by molecular alterations within or upstream of GNAS. We have established the prevalence of various genetic and epigenetic lesions in European PHP-affected patients.
Background:
Except after neck surgery, hypoparathyroidism is a rare disease caused by defects in genes involved in parathyroid gland development (TBX1/22q11.2 del, GCMB, GATA3, TBCE) or function ...calcium sensing receptor (CASR), GNA11, PTH, or the autoimmune polyglandular syndrome type 1 (AIRE). Approximately 90% of sporadic cases and 30% of familial cases of isolated hypoparathyroidism remain unexplained. Recurrent missense mutations in AP2S1, a calcium-sensing receptor regulator, have been recently identified in familial hyperparathyroidism.
Aim:
The aim of the study was to investigate AP2S1 as a putative hypoparathyroidism-causing gene.
Methods:
Sequencing analysis and quantitative genomic PCR of the AP2S1 gene in a large cohort of 10 index cases (from nine families) and 50 sporadic cases affected with isolated hypoparathyroidism were investigated.
Results and Conclusions:
None of the 60 patients presented with nucleotidic changes or copy number variation in the AP2S1 gene, thereby excluding AP2S1 defects as a frequent cause of isolated hypoparathyroidism.
Data from the literature indicate that genomic imprint marks are disturbed in human pluripotent stem cells (PSCs). GNAS is an imprinted locus that produces one biallelic (Gsα) and four monoallelic ...(NESP55, GNAS-AS1, XLsα, and A/B) transcripts due to differential methylation of their promoters (DMR). To document imprinting at the GNAS locus in PSCs, we studied GNAS locus DMR methylation and transcript (NESP55, XLsα, and A/B) expression in human embryonic stem cells (hESCs) and human induced pluripotent stem cells (hiPSCs) derived from two human fibroblasts and their progenies. Results showed that (1) methylation at the GNAS locus DMRs is DMR and cell line specific, (2) changes in allelic transcript expression can be independent of a change in allele-specific DNA methylation, and (3) interestingly, methylation at A/B DMR is correlated with A/B transcript expression. These results indicate that these models are valuable to study the mechanisms controlling GNAS methylation, factors involved in transcript expression, and possibly mechanisms involved in the pathophysiology of pseudohypoparathyroidism type 1B.
•GNAS locus methylation is DMR and cell line specific in human pluripotent stem cells•Allelic transcript expression can be independent of allele-specific DNA methylation•A/B transcript expression, a key for PHP1B, is correlated with A/B DMR methylation
GNAS, a complex imprinted locus, produces biallelic (Gsα) and monoallelic (NESP55, GNAS-AS1, XLsα, and A/B) transcripts. In this article, Silve and colleagues show that hESCs and hiPSCs are valuable models to study mechanisms controlling GNAS methylation, regulation of transcript expression, and possibly mechanisms involved in the pathophysiology of PHP1B, a constellation of rare diseases caused by GNAS methylation defects.
Objective Disorders caused by impairments in the parathyroid hormone (PTH) signalling pathway are historically classified under the term pseudohypoparathyroidism (PHP), which encompasses rare, ...related and highly heterogeneous diseases with demonstrated (epi)genetic causes. The actual classification is based on the presence or absence of specific clinical and biochemical signs together with an in vivo response to exogenous PTH and the results of an in vitro assay to measure Gsa protein activity. However, this classification disregards other related diseases such as acrodysostosis (ACRDYS) or progressive osseous heteroplasia (POH), as well as recent findings of clinical and genetic/epigenetic background of the different subtypes. Therefore, the EuroPHP network decided to develop a new classification that encompasses all disorders with impairments in PTH and/or PTHrP cAMP-mediated pathway. Design and methods Extensive review of the literature was performed. Several meetings were organised to discuss about a new, more effective and accurate way to describe disorders caused by abnormalities of the PTH/PTHrP signalling pathway. Results and conclusions After determining the major and minor criteria to be considered for the diagnosis of these disorders, we proposed to group them under the term ‘inactivating PTH/PTHrP signalling disorder’ (iPPSD). This terminology: (i) defines the common mechanism responsible for all diseases; (ii) does not require a confirmed genetic defect; (iii) avoids ambiguous terms like ‘pseudo’ and (iv) eliminates the clinical or molecular overlap between diseases. We believe that the use of this nomenclature and classification will facilitate the development of rationale and comprehensive international guidelines for the diagnosis and treatment of iPPSDs.
GNAS-activating mutations are reported in intraductal papillary mucinous neoplasms (IPMNs) and in McCune-Albright syndrome, characterized by fibrous dysplasia, precocious puberty, and café au lait ...spots. Recently, IPMNs have been described as a McCune-Albright syndrome–associated tumor, present in about 15% of patients. The aim of the present work was to assess the prevalence of polyostotic fibrous dysplasia and McCune-Albright syndrome among patients operated on for presumptive sporadic IPMNs. All patients operated on for IPMNs between January 1, 2007, and December 31, 2012, with available imaging were retrospectively screened for polyostotic fibrous dysplasia based on their preoperative abdominal or thoracoabdominal spiral computed tomography images. Systematic screening of 272 patients operated on for IPMNs revealed 1 patient with axial and peripheral polyostotic fibrous dysplasia and café au lait spots on clinical examination suggestive of McCune-Albright syndrome. This patient had been operated on for an unusually large invasive colloid adenocarcinoma (pT3N0M0 R0) derived from an intestinal subtype GNAS-mutated IPMN. The patient underwent adjuvant chemotherapy with gemcitabine for 6 months and was alive without recurrence 6 years later. Besides providing additional evidence of a syndromic IPMN as a feature of McCune-Albright syndrome, this observation is further evidence of the functional oncogenic consequences of GNAS mutations in the pancreas.
Context:
GNAS is one of few genetic loci that undergo allelic-specific methylation resulting in the parent-specific expression of at least four different transcripts. Due to monoallelic expression, ...heterozygous GNAS mutations affecting either paternally or maternally derived transcripts cause different forms of pseudohypoparathyroidism (PHP), including autosomal-dominant PHP type Ib (AD-PHP1B) associated with loss of methylation (LOM) at exon A/B alone or sporadic PHP1B (sporPHP1B) associated with broad GNAS methylation changes. Similar to effects other imprinted genes have on early development, we recently observed severe intrauterine growth retardation in newborns, later diagnosed with pseudopseudohypoparathyroidism (PPHP) because of paternal GNAS loss-of-function mutations.
Objectives:
This study aimed to determine whether GNAS methylation abnormalities affect intrauterine growth.
Patients and Methods:
Birth parameters were collected of patients who later developed sporPHP1B or AD-PHP1B, and of their healthy siblings. Comparisons were made to newborns affected by PPHP or PHP1A.
Results:
As newborns, AD-PHP1B patients were bigger than their healthy siblings and well above the reference average; increased sizes were particularly evident if the mothers were unaffected carriers of STX16 deletions. SporPHP1B newborns were slightly above average for weight and length, but their overgrowth was less pronounced than that of AD-PHP1B newborns from unaffected mothers.
Conclusion:
LOM at GNAS exon A/B due to maternal STX16 deletions and the resulting biallelic A/B expression are associated with enhanced fetal growth. These findings are distinctly different from those of PPHP patients with paternal GNAS exons 2–13 mutations, whose birth parameters are almost 4.5 z-scores below those of AD-PHP1B patients born to healthy mothers.
LRP1 (low-density lipoprotein receptor-related protein 1), a multifunctional endocytic receptor, has recently been identified as a hub within a biomarker network for multi-cancer clinical outcome ...prediction. As its role in colon cancer has not yet been characterized, we here investigate the relationship between LRP1 and outcome.
mRNA expression was determined in colon adenocarcinoma and paired colon mucosa samples, as well as in stromal and tumor cells obtained after laser capture microdissection. Clinical potential was further investigated by immunohistochemistry in a population-based colon cancer series (
= 307).
methylation, mutation and miR-205 expression were evaluated and compared with LRP1 expression levels.
mRNA levels were significantly lower in colon adenocarcinoma cells compared with colon mucosa and stromal cells obtained after laser capture microdissection. Low LRP1 immunohistochemical expression in adenocarcinomas was associated with higher age, right-sided tumor, loss of CDX2 expression, Annexin A10 expression, CIMP-H, MSI-H and
V600E mutation. Low LRP1 expression correlated with poor clinical outcome, especially in stage IV patients. While LRP1 expression was downregulated by
mutation,
promoter was never methylated.
Loss of LRP1 expression is associated with worse colon cancer outcomes. Mechanistically,
mutation modulates LRP1 expression.
Pseudohypoparathyroidism is a rare endocrine disorder that can be caused by genetic (mainly maternally inherited inactivating point mutations, although intragenic and gross deletions have rarely been ...reported) or epigenetic alterations at GNAS locus. Clinical and molecular characterization of this disease is not that easy because of phenotypic, biochemical and molecular overlapping features between both subtypes of the disease. The European Consortium for the study of PHP (EuroPHP) designed the present work with the intention of generating the standards of diagnostic clinical molecular (epi)genetic testing in PHP patients. With this aim, DNA samples of eight independent PHP patients carrying GNAS genetic and/or epigenetic defects (three patients with GNAS deletions, two with 20q uniparental disomy and three with a methylation defect of unknown origin) without GNAS point mutations were anonymized and sent to the five participant laboratories for their routine genetic analysis (methylation-specific (MS)-MLPA, pyrosequencing and EpiTYPER) and interpretations. All laboratories were able to detect methylation defects and, after the data analysis, the Consortium compared the results to define technical advantages and disadvantages of different techniques. To conclude, we propose as first-level investigation in PHP patients copy number and methylation analysis by MS-MLPA. Then, in patients with partial methylation defect, the result should be confirmed by single CpG bisulphite-based methods (ie pyrosequencing), whereas in case of a complete methylation defect without detectable deletion, microsatellites or SNP genotyping should be performed to exclude uniparental disomy 20.
GNAS est un locus complexe soumis à l'empreinte parentale. Il code pour cinq transcrits alternatifs dont l’expression est régulée de manière parentale, tissulaire et développementale : la sous-Unité ...alpha stimulatrice de la protéine G hétérotrimérique (Gαs), XLαs, NESP55, et deux ARNnc, A/B et GNAS-AS1. Gαs est une protéine clé dans la transduction hormonale partageant avec XLαs la capacité de produire l'AMPc intracellulaire après stimulation des récepteurs couplés à Gαs.Dans la première partie de ma thèse, je me suis concentrée sur l'étude du rôle des transcrits de GNAS, en particulier XLαs, dans la croissance fœtale et post-Natale. J’ai profité du modèle unique des pseudohypoparathyroïdies (PHPs), pathologies humaines rare de l’empreinte, causées par des anomalies génétiques ou épigénétiques du locus GNAS altérant le dosage génique des transcrits de GNAS. La croissance anormale est une caractéristique majeure des PHPs.Dans la deuxième partie de ma thèse, j’ai étudié le profil épigénétique du locus GNAS (méthylation de l'ADN et expression des transcrits) dans les cellules souches humaines embryonnaires -HESCs-, dans les cellules pluripotentes induites dérivées à partir de fibroblastes de sujets sains -IPSCs- et dans les cellules redifférenciées en cellules souches neurales et mésenchymateuses. La caractérisation précise du locus humain GNAS en physiologie (cellules souches) et pathologie (PHP) est essentielle pour une meilleure compréhension des processus développementaux importants comme la croissance. L'exploration du phénotype "croissance" de différents types de PHPs a permis de mieux comprendre le rôle des transcrits du locus GNAS dans la physiologie et la physiopathologie. L'analyse de cellules des PHPs a permis de mieux caractériser l’impact des anomalies moléculaires du locus GNAS en pathologie humaine. Les hiPSCs peuvent être un outil utile pour étudier les modifications épigénétiques au niveau du locus GNAS.
GNAS is a complex locus subjected to parental imprinting encoding five parental-, tissue- and developmental-Manner regulated transcripts : the alpha stimulatory subunit of the G protein (Gαs), XLαs, NESP55, and two ncRNAs, A/B and the antisens GNAS-AS1. Gαs is a key protein in hormonal signaling sharing with XLαs the ability to produce intracellular cAMP upon stimulation of Gαs-Coupled receptors. In the first part of my thesis, I focused on studying the role of the GNAS transcripts, particularly XLαs, in fetal and postnatal growth. I took advantage of the unique model of pseudohypoparathyroidism (PHP), a rare human disease, caused by genetic or epigenetic abnormalities at the GNAS locus leading to various combinations of GNAS transcripts alterations. Abnormal growth appears to be a major feature of PHP. In the second part of my thesis, I studied the epigenetic pattern of GNAS (DNA methylation and transcripts expression) in human embryonic stem cells -HESCs-, in induced pluripotent stem cells -IPSCs- derived from fibroblasts from healthy individuals, and in cells re-Differentiated from these stem cells in neuronal and mesenchymal cells. The precise characterization of the human GNAS locus in physiology (stem cells) and pathology (PHP) is critical for a better understanding of major processes like growth. Through exploration of the "growth" phenotype of different groups of PHPs we have participated to the better understanding of the role of the GNAS transcripts in the physiology and pathophysiology. Human iPSCs may be an useful tool to study epigenetic modifications at the GNAS locus.
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