From human genetics to radiobiology : in vitro radiosensitivity in individuals with a germline defect in DNA damage response genes

All currently known high to intermediate risk “breast cancer genes”, including BRCA1 and BRCA2, are involved in the DNA damage response pathway. Heterozygous germline mutations in these genes predispose to breast and ovarian cancer. In addition, such mutations may also result in enhanced radiosensitivity mediated by chromosomal instability after exposure to ionizing radiation, leading to a higher risk to develop radiation-induced breast cancer. However, results of currently available clinical studies evaluating carcinogenesis and in vitro studies comparing chromosomal radiosensitivity in mutation carriers and non-carriers are inconclusive. Nevertheless, insights into the radiosensitive phenotype of healthy tissues of mutation carriers is of the utmost importance for the safe use of ionizing radiation for diagnostic purposes or radiotherapy treatment. In this thesis, we evaluated in vitro radiosensitivity in carriers of a mutation in DNA damage response genes by means of two different assays. The first assay, the G2 micronucleus assay, is a cytogenetic assay in which MN are analyzed in cells irradiated in the G2 phase of the cell cycle. This assay was developed to evaluate radiosensitivity in cells with a heterozygous BRCA1 or BRCA2 mutation. BRCA1 and BRCA2 have a function in homologous recombination (HR), the main DNA double strand break repair pathway activated in late S and G2 phase of the cell cycle. Furthermore, BRCA1 is also involved in the G2/M cell cycle checkpoint. The G2 micronucleus assay allows evaluation of both functions by means of two distinct endpoints: (1) the radiation-induced micronucleus yield, which reflects DNA double strand break repair capacity and (2) the G2/M checkpoint efficiency ratio, which allows evaluation of the G2 arrest capacity. Before applying the G2 micronucleus assay on BRCA mutation carriers, the assay was validated in a patient with Ataxia Telangiectasia (AT). AT patients are characterized by a manifest increased radiosensitivity. AT patients show biallelic inactivation of ATM, involved in both DNA double strand break repair by means of HR and G2/M checkpoint activation. We demonstrated a severely increased radiosensitivity with both endpoints when applying the G2 micronucleus assay in lymphocytes of this AT patient. In lymphocytes of healthy relatives with a heterozygous ATM mutation the radiosensitivity observed with this assay was intermediate between the AT patient and the control cohort. When applying the G2 micronucleus assay on lymphocytes of healthy BRCA1/2 mutation carriers, we demonstrated significantly enhanced radiation-induced MN yields in both BRCA1 and BRCA2 germline mutation carriers, pointing to an impaired DNA double strand break repair capacity in both groups. Furthermore, an impaired G2 arrest capacity was observed in BRCA1 mutation carriers. In healthy relatives who did not inherit the familial mutation, no enhanced radiosensitivity was observed. Although a significantly enhanced radiosensitivity was demonstrated for the cohort of BRCA1 and BRCA2 mutation carriers compared to the control cohort, individual radiosensitivity evaluation was less straightforward due to overlap in micronucleus yields between both cohorts. Therefore, a scoring system to evaluate individual radiosensitivity was implemented. As both BRCA1 and BRCA2 are involved in HR, we evaluated if the accumulation of RAD51, a key protein involved in this pathway, at the double strand break site can be used to assess HR functionality and radiosensitivity. To this end, a radiation-induced RAD51 foci assay was optimized in a breast epithelial cell line (MCF10A) expressing ±50% reduced BRCA1 and BRCA2 protein levels, obtained by RNA interference. RAD51 foci were analyzed in cells synchronized in S phase by aphidicolin as HR is upregulated during this phase of the cell cycle. We demonstrated significantly reduced RAD51 foci formation, and thus impaired HR capacity, in response to the induction of radiation-induced double strand breaks in the BRCA knockdown cells compared to control cells. As no overlap in RAD51 foci distribution is observed between knockdown and control cells, we think that this assay could better differentiate between normal cells and cells with a heterozygous BRCA1 or BRCA2 mutation than the G2 micronucleus assay. This will be further explored in synchronized lymphocytes of heterozygous germline mutation carriers. In addition to the detection of unequivocal deleterious mutations in BRCA1 and BRCA2, variants of unknown clinical significance (VUS) are detected during diagnostic screening. The associated breast cancer risk is unknown, which creates a challenge for genetic counselling. mRNA analysis to assess variants that might impair proper RNA splicing, a highly regulated process, are widely used. We evaluated the outcome at cDNA level of 21 putative splicing variants in BRCA1 and BRCA2 and demonstrated aberrant splicing for 12 variants, suggesting that these are likely pathogenic. Furthermore, we demonstrated that in silico prediction tools might assist in the evaluation of these putative splicing variants. However, further optimization is warranted to allow reliable application outside the highly conserved consensus splice sites. The results obtained in this thesis may indicate that care should be taken when applying ionizing radiation for diagnostic or therapeutic purposes in individuals with a germline mutation in BRCA1 or BRCA2 as they may be at higher risk of developing radiation-induced breast cancer

Analysis of chromosomal radiosensitivity of healthy BRCA2 mutation carriers and non-carriers in BRCA families with the G2 micronucleus assay

Breast cancer risk drastically increases in individuals with a heterozygous germline BRCA1 or BRCA2 mutation, while it is estimated to equal the population risk for relatives without the familial mutation (non-carriers). The aim of the present study was to use a G2 phase-specific micronucleus assay to investigate whether lymphocytes of healthy BRCA2 mutation carriers are characterized by increased radiosensitivity compared to controls without a family history of breast/ovarian cancer and how this relates to healthy non-carrier relatives. BRCA2 is active in homologous recombination, a DNA damage repair pathway, specifically active in the late S/G2 phase of the cell cycle. We found a significantly increased radiosensitivity in a cohort of healthy BRCA2 mutation carriers compared to individuals without a familial history of breast cancer (P=0.046; Mann-Whitney U test). At the individual level, 50% of healthy BRCA2 mutation carriers showed a radiosensitive phenotype (radiosensitivity score of 1 or 2), whereas 83% of the controls showed no radiosensitivity (P=0.038; one-tailed Fisher's exact test). An odds ratio of 5 (95% CI, 1.07-23.47) indicated an association between the BRCA2 mutation and radiosensitivity in healthy mutation carriers. These results indicate the need for the gentle use of ionizing radiation for either diagnostic or therapeutic use in BRCA2 mutation carriers. We detected no increased radiosensitivity in the non-carrier relatives

Evaluation of relative quantification of alternatively spliced transcripts using droplet digital PCR

Introduction: For the relative quantification of isoform expression, RT-qPCR has been the gold standard for over a decade. More recently, digital PCR is becoming widely implemented, as it is promised to be more accurate, sensitive and less affected by inhibitors, without the need for standard curves. In this study we evaluated RT-qPCR versus RT-droplet digital PCR (ddPCR) for the relative quantification of isoforms in controls and carriers of the splice site mutation BRCA1 c.212+3A>G, associated with increased expression of several isoforms. Materials and methods: RNA was extracted from EBV cell lines of controls and heterozygous BRCA1 c.212+3A>G carriers. Transcript-specific plasmids were available to determine the efficiency, precision, reproducibility and accuracy of each method. Results: Both ddPCR and RT-qPCR were able to accurately quantify all targets and showed the same LOB, LOD and LOQ; also precision and reproducibility were similar. Both techniques have the same dynamic range and linearity at biologically relevant template concentrations. However, a significantly higher cost and workload was required for ddPCR experiments. Conclusions: Our study recognizes the potential and validity of digital PCR but shows the value of a highly optimized qPCR for the relative quantification of isoforms. Cost efficiency and simplicity turned out to be better for RT-qPCR. Keywords: Reverse transcriptase polymerase chain reaction, Alternative splicing, Droplet digital PC

RENEB accident simulation exercise

Purpose: The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event. Materials and methods: Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners. Results: The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes). Conclusions: Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested.VII Programa Marco de Investigación y Desarrollo (VIIPM) de la Unión Europea. nº 29551

Hidden genetic variation in LCA9-associated congenital blindness explained by 5′UTR mutations and copy-number variations of NMNAT1

Leber congenital amaurosis (LCA) is a severe autosomal-recessive retinal dystrophy leading to congenital blindness. A recently identified LCA gene is NMNAT1, located in the LCA9 locus. Although most mutations in blindness genes are coding variations, there is accumulating evidence for hidden noncoding defects or structural variations (SVs). The starting point of this study was an LCA9-associated consanguineous family in which no coding mutations were found in the LCA9 region. Exploring the untranslated regions of NMNAT1 revealed a novel homozygous 5'UTR variant, c.-70A>T. Moreover, an adjacent 5'UTR variant, c.-69C>T, was identified in a second consanguineous family displaying a similar phenotype. Both 5'UTR variants resulted in decreased NMNAT1 mRNA abundance in patients' lymphocytes, and caused decreased luciferase activity in human retinal pigment epithelial RPE-1 cells. Second, we unraveled pseudohomozygosity of a coding NMNAT1 mutation in two unrelated LCA patients by the identification of two distinct heterozygous partial NMNAT1 deletions. Molecular characterization of the breakpoint junctions revealed a complex Alu-rich genomic architecture. Our study uncovered hidden genetic variation in NMNAT1-associated LCA and emphasized a shift from coding to noncoding regulatory mutations and repeat-mediated SVs in the molecular pathogenesis of heterogeneous recessive disorders such as hereditary blindness

Thorough in silico and in vitro cDNA analysis of 21 putative BRCA1 and BRCA2 splice variants and a complex tandem duplication in BRCA2 allowing the identification of activated cryptic splice donor sites in BRCA2 exon 11

For 21 putative BRCA1 and BRCA2 splice site variants, the concordance between mRNA analysis and predictions by in silico programs was evaluated. Aberrant splicing was confirmed for 12 alterations. In silico prediction tools were helpful to determine for which variants cDNA analysis is warranted, however, predictions for variants in the Cartegni consensus region but outside the canonical sites, were less reliable. Learning algorithms like Adaboost and Random Forest outperformed the classical tools. Further validations are warranted prior to implementation of these novel tools in clinical settings. Additionally, we report here for the first time activated cryptic donor sites in the large exon 11 of BRCA2 by evaluating the effect at the cDNA level of a novel tandem duplication (5 breakpoint in intron 4; 3 breakpoint in exon 11) and of a variant disrupting the splice donor site of exon 11 (c.6841+1G>C). Additional sites were predicted, but not activated. These sites warrant further research to increase our knowledge on cis and trans acting factors involved in the conservation of correct transcription of this large exon. This may contribute to adequate design of ASOs (antisense oligonucleotides), an emerging therapy to render cancer cells sensitive to PARP inhibitor and platinum therapies

Increased chromosomal radiosensitivity in asymptomatic carriers of a heterozygous BRCA1 mutation

Background: Breast cancer risk increases drastically in individuals carrying a germline BRCA1 mutation. The exposure to ionizing radiation for diagnostic or therapeutic purposes of BRCA1 mutation carriers is counterintuitive, since BRCA1 is active in the DNA damage response pathway. The aim of this study was to investigate whether healthy BRCA1 mutations carriers demonstrate an increased radiosensitivity compared with healthy individuals. Methods: We defined a novel radiosensitivity indicator (RIND) based on two endpoints measured by the G2 micronucleus assay, reflecting defects in DNA repair and G2 arrest capacity after exposure to doses of 2 or 4 Gy. We investigated if a correlation between the RIND score and nonsense-mediated decay (NMD) could be established. Results: We found significantly increased radiosensitivity in the cohort of healthy BRCA1 mutation carriers compared with healthy controls. In addition, our analysis showed a significantly different distribution over the RIND scores (p = 0.034, Fisher’s exact test) for healthy BRCA1 mutation carriers compared with non-carriers: 72 % of mutation carriers showed a radiosensitive phenotype (RIND score 1–4), whereas 72 % of the healthy volunteers showed no radiosensitivity (RIND score 0). Furthermore, 28 % of BRCA1 mutation carriers had a RIND score of 3 or 4 (not observed in control subjects). The radiosensitive phenotype was similar for relatives within several families, but not for unrelated individuals carrying the same mutation. The median RIND score was higher in patients with a mutation leading to a premature termination codon (PTC) located in the central part of the gene than in patients with a germline mutation in the 5′ end of the gene. Conclusions: We show that BRCA1 mutations are associated with a radiosensitive phenotype related to a compromised DNA repair and G2 arrest capacity after exposure to either 2 or 4 Gy. Our study confirms that haploinsufficiency is the mechanism involved in radiosensitivity in patients with a PTC allele, but it suggests that further research is needed to evaluate alternative mechanisms for mutations not subjected to NMD

RENEB accident simulation exercise

Purpose: The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event. Materials and methods: Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners. Results: The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes). Conclusions: Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested

Relative biological effectiveness of mammography X-rays at the level of DNA and chromosomes in lymphocytes

Purpose: In many countries, breast cancer screening programs based on periodic mammography exist, giving a large group of women regularly a small dose of ionizing radiation. In order to assess the benefit/risk ratio of those programs the relative biological effectiveness (RBE) of mammography X-rays needs to be determined. Materials and methods: Blood of five healthy donors was irradiated in vitro with 30 kV X-rays and Co-60 gamma-rays with doses between 5 and 2000 mGy. The phosphorylated histone subtype H2A isoform X-foci (gamma H2AX-foci) technique was used to quantify the number of DNA double-strand breaks (DSB) after irradiation. Chromosomal damage resulting from non-or misrepaired DNA DSB was quantified with the micronucleus (MN)-assay and the sensitivity was improved by counting only centromere negative micronuclei (MNCM.). Results: The threshold detection dose obtained with the gamma H2AX-foci test was 10 mGy for mammography X-rays compared to 50 mGy for gamma-rays. With the MN-assay respectively MN-centromere-assay threshold detection doses of 100, respectively, 50 mGy were obtained for mammography X-rays compared to 200 respectively 100 mGy for gamma-rays. An RBE of 1.4 was obtained with the gamma H2AX-foci assay. With the MN-assays low-dose RBE values between 3 and 4 were determined. Conclusion: Our results indicate that exposure to mammography X-rays resulted in a modest increase in the induction of DSB compared to gamma-rays. However, due to the higher linear energy transfer (LET) of mammography X-rays more clustered DNA damage is produced that is more difficult to repair and results in a more pronounced increase in micronucleus formation