Reanalysis of BRCA1/2 negative high risk ovarian cancer patients reveals novel germline risk loci and insights into missing heritability

PLoS One. 2017 Jun 7;12(6):e0178450. doi: 10.1371/journal.pone.0178450. eCollection 2017.

Abstract

While up to 25% of ovarian cancer (OVCA) cases are thought to be due to inherited factors, the majority of genetic risk remains unexplained. To address this gap, we sought to identify previously undescribed OVCA risk variants through the whole exome sequencing (WES) and candidate gene analysis of 48 women with ovarian cancer and selected for high risk of genetic inheritance, yet negative for any known pathogenic variants in either BRCA1 or BRCA2. In silico SNP analysis was employed to identify suspect variants followed by validation using Sanger DNA sequencing. We identified five pathogenic variants in our sample, four of which are in two genes featured on current multi-gene panels; (RAD51D, ATM). In addition, we found a pathogenic FANCM variant (R1931*) which has been recently implicated in familial breast cancer risk. Numerous rare and predicted to be damaging variants of unknown significance were detected in genes on current commercial testing panels, most prominently in ATM (n = 6) and PALB2 (n = 5). The BRCA2 variant p.K3326*, resulting in a 93 amino acid truncation, was overrepresented in our sample (odds ratio = 4.95, p = 0.01) and coexisted in the germline of these women with other deleterious variants, suggesting a possible role as a modifier of genetic penetrance. Furthermore, we detected loss of function variants in non-panel genes involved in OVCA relevant pathways; DNA repair and cell cycle control, including CHEK1, TP53I3, REC8, HMMR, RAD52, RAD1, POLK, POLQ, and MCM4. In summary, our study implicates novel risk loci as well as highlights the clinical utility for retesting BRCA1/2 negative OVCA patients by genomic sequencing and analysis of genes in relevant pathways.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • BRCA1 Protein / genetics*
  • BRCA2 Protein / genetics*
  • Breast Neoplasms / genetics
  • Cell Cycle / genetics
  • DNA Repair / genetics
  • Female
  • Genetic Loci*
  • Genetic Predisposition to Disease
  • Germ Cells / metabolism*
  • Humans
  • Inheritance Patterns / genetics*
  • Male
  • Middle Aged
  • Mutation
  • Ovarian Neoplasms / genetics*
  • Pedigree
  • Penetrance
  • Risk Factors

Substances

  • BRCA1 Protein
  • BRCA1 protein, human
  • BRCA2 Protein
  • BRCA2 protein, human

Supplementary concepts

  • Breast Cancer, Familial

Grants and funding

This work was supported by Barbara and Fred Erb Endowed Chair in Cancer Genetics (MAT), the Karmanos Cancer Institute, Program in Molecular Therapeutic and the Applied Genomics Technology Center at Wayne State University and the Karmanos Cancer Institute, grant P30CA022453 (Whole Exome Sequencing of cohort) as well as the Interdisciplinary Biomedical Fellowship at Wayne State University (JS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.