Modélisation de la susceptibilité génétique non observée d’un individu à partir de son histoire familiale de cancer : application aux études d'identification pangénomiques et à l'estimation du risque de cancer dans le syndrome de Lynch

Lynch syndrome is responsible of about 5% of cases of colorectal cancer (CRC). It corresponds to the transmission of a mutation, which is arare genetic variant, that confers a high risk of CRC. Such a mutation isidentified, however, in only one family of two. In families without identifiedmutation, called negative, the risk of CRC is largely unknown in particularthere is a lack of individualized risk estimates. This thesis has two main objectives.Obj. 1 - to explore strategies that could reduce the required samplesizes of identification studies, and Obj. 2 - to define a theoretical frameworkfor estimating individualized risk of CRC in negative families, using personaland family history of CRC of the individuals. Our work is based on thetheory of Mendelian models and the simulation of family data, from whichit is possible to study the power of identification studies as well as to assessand compare in silico the predictive ability of risk estimation methods. Theresults provide new knowledge for designing future studies, and the methodologicalframework we propose allows a more precise estimate of risk, thatmight lead to a more individualized cancer follow-up.Le syndrome de Lynch est responsable d’environ 5% des cas de cancer colorectaux (CCR). Il correspond à la transmission d’une mutation,variation génétique rare, qui confère un haut risque de CCR. Une telle mutationn’est cependant identifiée que dans une famille sur deux. Dans lesfamilles sans mutation identifiée, dites négatives, le risque de CCR est malconnu en particulier les estimations individuelles du risque. Cette thèse comportedeux objectifs principaux. Obj. 1- étudier les stratégies capables de réduireles tailles d’échantillon dans les études visant à identifier de nouveauxgènes de susceptibilité ; et Obj. 2- définir un cadre théorique permettantd’estimer des risques individualisés de CCR dans les familles négatives, enutilisant l’histoire familiale et personnelle de CCR de l’individu. Notre travails’appuie sur la théorie des modèles mendéliens et la simulation de donnéesfamiliales, à partir desquelles il est possible d’étudier la puissance d’étudesd’identification, et d’évaluer in silico les qualités prédictives de méthodesd’estimation du risque. Les résultats obtenus apportent des connaissancesnouvelles pour la planification d’études futures. D’autre part, la cadre méthodologiqueque nous proposons permet une estimation plus précise durisque individuel, permettant d’envisager une surveillance plus individualisée

Modélisation de la susceptibilité génétique non observée d’un individu à partir de son histoire familiale de cancer : application aux études d'identification pangénomiques et à l'estimation du risque de cancer dans le syndrome de Lynch

Lynch syndrome is responsible of about 5% of cases of colorectal cancer (CRC). It corresponds to the transmission of a mutation, which is arare genetic variant, that confers a high risk of CRC. Such a mutation isidentified, however, in only one family of two. In families without identifiedmutation, called negative, the risk of CRC is largely unknown in particularthere is a lack of individualized risk estimates. This thesis has two main objectives.Obj. 1 - to explore strategies that could reduce the required samplesizes of identification studies, and Obj. 2 - to define a theoretical frameworkfor estimating individualized risk of CRC in negative families, using personaland family history of CRC of the individuals. Our work is based on thetheory of Mendelian models and the simulation of family data, from whichit is possible to study the power of identification studies as well as to assessand compare in silico the predictive ability of risk estimation methods. Theresults provide new knowledge for designing future studies, and the methodologicalframework we propose allows a more precise estimate of risk, thatmight lead to a more individualized cancer follow-up.Le syndrome de Lynch est responsable d’environ 5% des cas de cancer colorectaux (CCR). Il correspond à la transmission d’une mutation,variation génétique rare, qui confère un haut risque de CCR. Une telle mutationn’est cependant identifiée que dans une famille sur deux. Dans lesfamilles sans mutation identifiée, dites négatives, le risque de CCR est malconnu en particulier les estimations individuelles du risque. Cette thèse comportedeux objectifs principaux. Obj. 1- étudier les stratégies capables de réduireles tailles d’échantillon dans les études visant à identifier de nouveauxgènes de susceptibilité ; et Obj. 2- définir un cadre théorique permettantd’estimer des risques individualisés de CCR dans les familles négatives, enutilisant l’histoire familiale et personnelle de CCR de l’individu. Notre travails’appuie sur la théorie des modèles mendéliens et la simulation de donnéesfamiliales, à partir desquelles il est possible d’étudier la puissance d’étudesd’identification, et d’évaluer in silico les qualités prédictives de méthodesd’estimation du risque. Les résultats obtenus apportent des connaissancesnouvelles pour la planification d’études futures. D’autre part, la cadre méthodologiqueque nous proposons permet une estimation plus précise durisque individuel, permettant d’envisager une surveillance plus individualisée

Modeling the unobserved genetic susceptibility of an individual from his family history of cancer : applications to genome-wide identification studies and to the cancer risk estimation in Lynch syndrome

Le syndrome de Lynch est responsable d’environ 5% des cas de cancer colorectaux (CCR). Il correspond à la transmission d’une mutation,variation génétique rare, qui confère un haut risque de CCR. Une telle mutationn’est cependant identifiée que dans une famille sur deux. Dans lesfamilles sans mutation identifiée, dites négatives, le risque de CCR est malconnu en particulier les estimations individuelles du risque. Cette thèse comportedeux objectifs principaux. Obj. 1- étudier les stratégies capables de réduireles tailles d’échantillon dans les études visant à identifier de nouveauxgènes de susceptibilité ; et Obj. 2- définir un cadre théorique permettantd’estimer des risques individualisés de CCR dans les familles négatives, enutilisant l’histoire familiale et personnelle de CCR de l’individu. Notre travails’appuie sur la théorie des modèles mendéliens et la simulation de donnéesfamiliales, à partir desquelles il est possible d’étudier la puissance d’étudesd’identification, et d’évaluer in silico les qualités prédictives de méthodesd’estimation du risque. Les résultats obtenus apportent des connaissancesnouvelles pour la planification d’études futures. D’autre part, la cadre méthodologiqueque nous proposons permet une estimation plus précise durisque individuel, permettant d’envisager une surveillance plus individualisée.Lynch syndrome is responsible of about 5% of cases of colorectal cancer (CRC). It corresponds to the transmission of a mutation, which is arare genetic variant, that confers a high risk of CRC. Such a mutation isidentified, however, in only one family of two. In families without identifiedmutation, called negative, the risk of CRC is largely unknown in particularthere is a lack of individualized risk estimates. This thesis has two main objectives.Obj. 1 - to explore strategies that could reduce the required samplesizes of identification studies, and Obj. 2 - to define a theoretical frameworkfor estimating individualized risk of CRC in negative families, using personaland family history of CRC of the individuals. Our work is based on thetheory of Mendelian models and the simulation of family data, from whichit is possible to study the power of identification studies as well as to assessand compare in silico the predictive ability of risk estimation methods. Theresults provide new knowledge for designing future studies, and the methodologicalframework we propose allows a more precise estimate of risk, thatmight lead to a more individualized cancer follow-up

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Mutational characterization of individual breast tumors: TP53 and PI3K pathway genes are frequently and distinctively mutated in different subtypes.

International audienceUnderstanding how cancer genes are mutated in individual tumors is an important issue with potential clinical and therapeutic impact. This is especially relevant with recently developed targeted therapies since mutated genes can be targets and/or predictors. However, to date, gene mutation profiling in individual tumors is still underexplored. Breast cancer is composed of various subtypes. We presumed that this heterogeneity reflected the involvement of different molecular mechanisms including gene mutations that affect defined signaling pathways. Unlike the majority of published mutational studies, this study was aimed to draw a mutation profile in individual tumors by screening a panel of cancer genes in the same tumor. Thus, five genes frequently mutated in breast cancers: TP53, PIK3CA, PTEN, CDH1, and AKT1 were screened in each of 120 human primary breast tumors. Mutations in at least one of these genes were found in 62.5% of the tumors, of which the majority carried a single-gene mutation. Interestingly, a substantial proportion of tumors carried mutations either in TP53 or in genes of the PI3K pathway (PIK3CA or PTEN or AKT1). These two distinct mutation patterns were significantly associated to hormone receptor expression but independent of HER2 status

Integrated analysis highlights APC11 protein expression as a likely new independent predictive marker for colorectal cancer

International audienceAfter a diagnosis of colorectal cancer (CRC), approximately 50% of patients will present distant metastasis. Although significant progress has been made in treatments, most of them will die from the disease. We investigated the predictive and prognostic potential of APC11, the catalytic subunit of APC/C, which has never been examined in the context of CRC. The expression of APC11 was assessed in CRC cell lines, in tissue microarrays (TMAs) and in public datasets. Overexpression of APC11 mRNA was associated with chromosomal instability, lymphovascular invasion and residual tumor. Regression models accounting for the effects of well-known protein markers highlighted association of APC11 protein expression with residual tumor (odds ratio: OR = 6.51; 95% confidence intervals: CI = 1.54-27.59; P = 0.012) and metastasis at diagnosis (OR = 3.87; 95% CI = 1.20-2.45; P = 0.024). Overexpression of APC11 protein was also associated with worse distant relapse-free survival (hazard ratio: HR = 2.60; 95% CI = 1.26-5.37; P = 0.01) and worse overall survival (HR = 2.69; 95% CI = 1.31-5.51; P = 0.007). APC11 overexpression in primary CRC thus represents a potentially novel theranostic marker of metastatic CRC. Colorectal cancer (CRC) is the third most frequent cancer and the fourth cause of cancer-related mortality worldwide 1. Patient survival is highly dependent on the stage of CRC at the time of diagnosis but approximately 50% of the patients will be concerned by distant metastasis development, either present at diagnosis (20%) or occurring after the curative-intent surgery of the primary tumor. The most frequent sites affected by metastatic CRC (mCRC) are the liver and lung 1. The current first-line standard-of-care for mCRC relies on the combination of cytotoxic chemotherapy (5FU/FA, oxaliplatin, irinotecan) and biologic agents (anti VEGF(R) or anti-EGFR mon-oclonal antibodies) guided by the molecular profile of the tumor. Surgery or local tumor ablation may also play a role in the treatment of mCRC patients, especially those with oligometastatic disease. Several biomarkers, mostly predictive, are routinely used for mCRC 2,3. Activating RAS mutations (KRAS and NRAS), present in nearly 50% of mCRC cases, are negative predictive markers of anti-EGFR inhibitor efficacy (cetuximab, panitumumab) and RAS testing is now mandatory in all mCRC patients, from the first-line meta-static setting. V600E-BRAF mutation is a significant negative poor-prognostic marker for patients with mCRC and may be a negative predictive factor for anti-EGFR therapies

Nuclear <scp>PRMT5</scp> is a biomarker of sensitivity to tamoxifen in <scp>ERα</scp>⁺ breast cancer

International audienceEndocrine therapies targeting estrogen signaling, such as tamoxifen, have significantly improved management of estrogen receptor alpha (ERa)-positive breast cancers. However, their efficacy is limited by intrinsic and acquired resistance to treatment, and there is currently no predictive marker of response to these anti-estrogens to guide treatment decision. Here, using two independent cohorts of breast cancer patients, we identified nuclear PRMT5 expression as an independent predictive marker of sensitivity to tamoxifen. Mechanistically, we discovered that tamoxifen stimulates ERa methylation by PRMT5, a key event for its binding to corepressors such as SMRT and HDAC1, participating in the inhibition of the transcriptional activity of ERa. Although PRMT5 is mainly localized in the cytoplasm of tumor cells, our analyses show that tamoxifen triggers its nuclear translocation in tamoxifen-sensitive tumors but not in resistant ones. Hence, we unveil a biomarker of sensitivity to tamoxifen in ERa-positive breast tumors that could be used to enhance the response of breast cancer patients to endocrine therapy, by fostering its nuclear expression

Evaluating Common De-Identification Heuristics for Personal Health Information

BACKGROUND: With the growing adoption of electronic medical records, there are increasing demands for the use of this electronic clinical data in observational research. A frequent ethics board requirement for such secondary use of personal health information in observational research is that the data be de-identified. De-identification heuristics are provided in the Health Insurance Portability and Accountability Act Privacy Rule, funding agency and professional association privacy guidelines, and common practice. OBJECTIVE: The aim of the study was to evaluate whether the re-identification risks due to record linkage are sufficiently low when following common de-identification heuristics and whether the risk is stable across sample sizes and data sets. METHODS: Two methods were followed to construct identification data sets. Re-identification attacks were simulated on these. For each data set we varied the sample size down to 30 individuals, and for each sample size evaluated the risk of re-identification for all combinations of quasi-identifiers. The combinations of quasi-identifiers that were low risk more than 50% of the time were considered stable. RESULTS: The identification data sets we were able to construct were the list of all physicians and the list of all lawyers registered in Ontario, using 1% sampling fractions. The quasi-identifiers of region, gender, and year of birth were found to be low risk more than 50% of the time across both data sets. The combination of gender and region was also found to be low risk more than 50% of the time. We were not able to create an identification data set for the whole population. CONCLUSIONS: Existing Canadian federal and provincial privacy laws help explain why it is difficult to create an identification data set for the whole population. That such examples of high re-identification risk exist for mainstream professions makes a strong case for not disclosing the high-risk variables and their combinations identified here. For professional subpopulations with published membership lists, many variables often needed by researchers would have to be excluded or generalized to ensure consistently low re-identification risk. Data custodians and researchers need to consider other statistical disclosure techniques for protecting privacy

Variants in the netrin-1 receptor UNC5C prevent apoptosis and increase risk of familial colorectal cancer.

International audienceBACKGROUND & AIMS: Expression of the netrin-1 dependence receptor UNC5C is reduced in many colorectal tumors; mice with the UNC5C mutations have increased progression of intestinal tumors. We investigated whether specific variants in UNC5C increase risk of colorectal cancer (CRC). METHODS: We analyzed the sequence of UNC5C in blood samples from 1801 patients with CRC and 4152 controls from 3 cohorts (France, United States, and Finland). Almost all cases from France and the United States had familial CRC; of the Finnish cases, 92 of 984 were familial. We analyzed whether CRC segregates with the UNC5C variant A628K in 3 families with histories of CRC. We also performed haplotype analysis to determine the origin of this variant. RESULTS: Of 817 patients with familial CRC, 14 had 1 of 4 different, unreported missense variants in UNC5C. The variants p.Asp353Asn (encodes D353N), p.Arg603Cys (encodes R603C), and p.Gln630Glu (encodes Q630E) did not occur significantly more often in cases than controls. The variant p.Ala628Lys (A628K) was detected in 3 families in the French cohort (odds ratio, 8.8; Wald's 95% confidence interval, 1.47-52.93; P = .03) and in 2 families in the US cohort (odds ratio, 1.9; P = .6) but was not detected in the Finnish cohort; UNC5C A628K segregated with CRC in families. Three families with A628K had a 109-kilobase identical haplotype that spanned most of UNC5C, indicating recent origin of this variant in white subjects (14 generations; 95% confidence interval, 6-36 generations). Transfection of HEK293T cells with UNC5C-A628K significantly reduced apoptosis compared with wild-type UNC5C, measured in an assay of active caspase-3. CONCLUSIONS: Inherited mutations in UNC5C prevent apoptosis and increase risk of CRC