CHEK1 inhibitors are currently in clinical trials for their ability to abrogate chemotherapy-induced CHEK1 activation and S phase arrest resulting in cancer cell apoptosis. No studies have yet identified ovarian cancers that could benefit from CHEK1-targeting therapy. I hypothesised that knowledge of CHEK1 and CHEK2 signalling in the DNA damage response can assist in identifying potential biomarkers for platinum responsiveness and CHEK-targeting therapy in ovarian cancer. In vitro studies investigated the CHEK1/2 inhibitor AZD7762 (AZD) and cisplatin (CP) in same patient-derived platinum-sensitive/resistant high-grade serous ovarian cancer cell lines (PEO1/PEO4 and PEO14/PEO23). Cytotoxicity assays confirmed higher CP IC50’s for PEO4 and PEO23 relative to PEO1 and PEO14 cell lines, respectively. AZD was more toxic to PEO1 cells and an additive effect of AZD with CP relative to CP alone was seen. A nontoxic AZD treatment to PEO4 cells sensitised the cells to CP when applied in combination. PEO14 and PEO23 cells had similar cytotoxicity profiles for combination treatments. BRDU DNA synthesis assays and cell cycle analysis revealed increased BRDU incorporation and accumulation in S phase when all cell lines were treated with CP. AZD treatment had a similar effect in PEO14 and PEO23 cells and increased the sub-G1 population, a marker of apoptotic DNA fragmentation, relative to control. Drug combination had no major effect on cell cycle distributions of both PEO14 and PEO23 cells relative to single agents but resulted in BRDU incorporation levels below CP and control levels for PEO14 cells. In PEO1 and PEO4 cells, AZD did not affect the cell cycle or DNA synthesis levels relative to control. Drug combination did not alter the cell cycle relative to CP treatment for PEO1 cells but decreased S phase and increased G2/M and sub-G1 populations in PEO4 cells. This was coupled with a decrease of CP-induced BRDU levels in PEO4 control levels. Apoptotic PARP cleavage/total PARP occurred early in CP treated PEO1 and PEO14 cells. A surrogate CHEK1/2 activity marker, p-CDC2 (Y15), decreased in all lines treated with AZD relative to control. Within PEO1 and PEO4 cells, greatest PARP cleavage was observed with combination treatment and coincided with high p-H2AX (S139), a DNA damage marker. p-CHEK1 (S317) and p-CHEK2 (T68), both ATR and ATM phosphorylation sites during DNA damage, increased for lone drug treatment and, to a greater extent, the combination drug treatments. PARP cleavage occurs across all treatments in PEO1 cells while it only occurs in the combination treatment for PEO4 cells. The latter coincides with a decrease in p-CHEK1 (S296) a CHEK1 autophosphorylation site, p-TP53 (S15), and p-BRCA1 (S1524), a homologous recombination marker, relative to the CP treated sample. In PEO14 and PEO23 cells, lone AZD and combination treatments had similar cleaved PARP/total PARP levels compared to the PEO14 CP treated cells. This was coupled with increased p-H2AX (S139), decreased CHEK1, and decreased CHEK2 autophosphorylation p-CHEK2 (S516). A human ovarian cancer xenograft model identified increases in p-H2AX (S139), CHEK1, p-CHEK1 (S317), p-CHEK2 (T68), and p-BRCA1 (S1524) in the carboplatin responsive cancers. In the paired pre- and post-chemotherapy human ovarian cancer samples, p-CHEK1 (S317) was elevated in post-chemotherapy responsive samples. In the first cohort, high p-CHEK1 (S317) was an independent poor overall survival biomarker and correlated with high p-H2AX (S139), MYC, p-CHEK1 (S296), p-CHEK2 (T68), p-CHEK2 (S516), and p-TP53 (S15). p-CHEK1 (S317) was associated with poor overall survival in serous ovarian cancers within the second pre-treatment ovarian cancer cohort. In conclusion, AZD can induce apoptosis in CP resistant cancer cells by synergising with CP to abrogate the S phase checkpoint, increase DNA damage, and inhibit CHEK1, and BRCA1 function. As a single agent, AZD can induce apoptosis by decreasing CHEK1 levels and CHEK2 activity. p- CHEK1 (S317) is a platinum responsive / poor prognostic biomarker.

Ovarian cancer is the deadliest gynecological malignancy affecting women. Diagnosis often occurs late due to non-specific symptoms, but if detected early, there is excellent chance for survival. One of the most important risk factors is family history. Up to 24% of cases are due to inherited loss-of-function mutations in genes involved in the DNA damage response. The theory underlying hereditary cancers is Knudson's two-hit theory of cancer causation, where two hits are necessary for cancer to occur in an individual: one in the germline and one in the tissue. The genes, CHEK1 and CHEK2, are modulators of the DNA damage response, and could be susceptible to a first hit. There is little to no evidence about whether loss-of-function mutations in either of these two genes can lead to ovarian cancer. Using a cohort of 587 ovarian cancer cases and 557 controls, this study sought to determine if CHEK1 and CHEK2 are associated with ovarian cancer. Applying Fisher's exact test to compare mutation rates and the t test to compare age at time of diagnosis, the alternative hypothesis about an association between disease and mutations in CHEK1 and CHEK2 was rejected, but an association between younger age at diagnosis in cases and mutations in either gene was confirmed. The association between age and mutations in either of these genes suggests that there is some influence of age on disease, but a clear association between development of disease and mutations cannot yet be established. This research has implications for social change: By recognizing the need to test earlier in women with mutations in CHEK1 and/or CHEK2, they will have a higher chance of survival and better health outcomes, not only for ovarian cancer but for related cancers as well.

Nous avons voulu évaluer si les gènes CHE2, ATM et TP53, associés à un risque intermédiaire de cancer du sein, étaient soumis à une différence d'expression allélique (DEA). Nous avons étudié des lignées cellulaires lymphoblastiques (LCLs) dérivées de patientes à haut risque, négatives pour des mutations dans CRCA1 et BRCA2. Nous avons développé une méthode basée sur la "fusion haute-résolution" (High-resolution melting curve analysis, HRM) et l'utilisation d'une sonde d'hybridation fluorescente pour détecter de la DEA chez des individus hétérozygotes pour un SNP marqueur exonique. Cette méthode permet de corréler le signal fluorescent à la quantité relative des transcrits alléliques. Nous avons développé un outil d'analyse adapté aux besoins spécifiques de l'étude de la DEA par HRM. Dans nos échantillons, une DEA statistiquement significative a été identifiée pour le gène CHEK2, chez les porteurs de la mutation tronquante 1100delC. En revanche, en combinant les données du criblage mutationnel des gènes candidats et de l'étude de DEA, nous n'avons pas identifié de variant régulateur localisé en cis qui induirait de la DEA significative dans les gènes étudiés, dans le contexte de régulation transcriptionnelle propre aux LCLs proliférant librement. Nos résultats montrent que le HRM est une méthode sensible et précise pour mesurer de la DAE et qui peut être appliquée à d'autres tissus, mammaires ou sanguins. Ces derniers présentent un grand intérêt pour les études de criblage mutationnel à haut-débit cherchant à identifier des variants dysfonctionnels dans les régions régulatrices de gènes candidats. / We aimed to assess whether the breast-cancer intermediate-risk genes CHEK2, ATM ant TP53 were subject to differential allelic expression (DAE) in lymphoblastoid cell lines (LCLs) from high-risk breast cancer patients for whom no mutation in BRCA1 or BRCA2 had been identified.We implemented an assay based on high-resolution melting curve analysis (HRM) of single labeled fluorescent probes to detect allelic expression imbalance. The method relies on the distinction of the two alleles of an exonic marker SNP in heterozygous individuals with a fluorescent signal correlated to the relative abundance of each transcript. We developed an analysis tool for HRM data processing, specifically dedicated to DAE assessment. In our series, we found evidence for DAE for CHEK2, in carriers of the truncating mutation 1100delC. When combining mutation-screening data and assessment of DAE, we did not identify functional regulatory variant located in cis of the studied genes that would lead to DAE, in the transcriptional regulatory milieu of freely proliferating LCLs. Our results support that HRM is a method with high sensitivity and accuracy that can be used for DAE assessment. This approach can be applied to study breast and blood tissue samples. The latter would be of great interest for high-throughput mutation screening projects aiming to identify dysfunctional regulatory variants in candidate genes.

CHEK2 gene codes for serin/threonine kinase Chk2 (Checkpoint kinase 2). In response to genomic DNA damage, Chk2 phosphorylates its substrates (proteins Cdc25C, BRCA1 or p53), whose activation leads either to cell cycle arrest, DNA damage repair or induction of apoptosis. Germline mutations in CHEK2 gene increase risk of cancer development. Analysis of high risk breast cancer patients in Czech Republic reveals rare CHEK2 mutations (mainly missense) with yet unknown clinical significance. This work focuses on functional impact of these variants and analysis of kinase activity of variant isoforms of Chk2 kinase. For this purpose, recombinant constructs were expressed in bacterial cells of E. coli. Enzymatic activity of Chk2 kinase isoforms in crude cell lysates was measured by the phosphorylation of Chk2 arteficial substrate spectrophotometrically. Results of in vitro kinase assay were correlated to the results of in silico prediction software. The results show that from 15 analyzed mutations (together with one in frame deletion), kinase activity was abrogated in all variants affecting the kinase domain of Chk2, in concordance with in silico predictions. The same result has been found for a FHA domain variant p.R145Q. No significant changes in kinase activity were observed in case of two FHA domain variants...

We aimed to assess whether the breast-cancer intermediate-risk genes CHEK2, ATM ant TP53 were subject to differential allelic expression (DAE) in lymphoblastoid cell lines (LCLs) from high-risk breast cancer patients for whom no mutation in BRCA1 or BRCA2 had been identified.We implemented an assay based on high-resolution melting curve analysis (HRM) of single labeled fluorescent probes to detect allelic expression imbalance. The method relies on the distinction of the two alleles of an exonic marker SNP in heterozygous individuals with a fluorescent signal correlated to the relative abundance of each transcript. We developed an analysis tool for HRM data processing, specifically dedicated to DAE assessment. In our series, we found evidence for DAE for CHEK2, in carriers of the truncating mutation 1100delC. When combining mutation-screening data and assessment of DAE, we did not identify functional regulatory variant located in cis of the studied genes that would lead to DAE, in the transcriptional regulatory milieu of freely proliferating LCLs. Our results support that HRM is a method with high sensitivity and accuracy that can be used for DAE assessment. This approach can be applied to study breast and blood tissue samples. The latter would be of great interest for high-throughput mutation screening projects aiming to identify dysfunctional regulatory variants in candidate genes.

Despite national guidelines, women with a BRCA VUS or CHEK2 pathogenic variant are choosing to have risk-reducing surgeries such as bilateral mastectomies which are not aligned with their level of cancer risk based on genetic test results alone. Semi-structured telephone interviews were conducted with 6 women with a BRCA VUS and 12 with a CHEK2 pathogenic variant exploring the factors influencing their decision-making process when considering medical management options. Patients from a cancer registry agreed to a recorded telephone interview. Coding was performed using the main constructs from the Ottawa Patient Decision Guide including: knowledge, uncertainty, values, and support. Iterative analysis was used to identify emerging themes. Analysis of the interviews revealed overlapping of the four constructs in the decision-making process. The knowledge sought to make medical management decisions was driven by the uncertainty associated with the genetic test results. Participants often contextualized their risk by building on the risk associated with genetic test results with family history, variant re-interpretation, and the knowledge that the risks associated with other genes may be higher. Patients generally made the decision they thought was best for them, even though it was more difficult if that decision was not supported by healthcare providers, friends, or family. When faced with uncertain cancer risks and presented with options for medical management, values were weighed against the negatives of each option. Often mental health was prioritized over the negatives associated with ‘removing body parts’. These findings offer a look into the decisional needs of patients such as accurate knowledge, certainty, decisional support, and attention to personal values. Better understanding of the unmet needs of these patients and working to rectify them through provider education, outreach, counseling strategies to mitigate uncertainty, and research on how to best address and identify each patient’s specific decisional needs can contribute to the goal of risk-appropriate and values-based decision-making. With a better understanding of patients’ decisional needs, healthcare providers can better advocate for tailored counseling sessions which explore and address specific patient needs to help them make informed, risk-appropriate, and value-based medical management decisions.

Apie 5–10 proc. visų krūties navikų atvejų sudaro paveldimas vėžys. BRCA1 ir BRCA2 genai yra patys svarbiausi polinkį susirgti krūties vėžiu sąlygojantys genai. Kiti reikšmingai su padidėjusia krūties navikų išsivystymo rizika susiję – CHEK2 ir NBS1 genai. Šiame darbe ištirtos paveldimos dažniausiai Europos regione nustatomos šių genų mutacijos. Nustatytas BRCA1 ir CHEK2 genų mutacijų dažnis tarp jaunų krūties vėžiu susirgusių moterų, ištyrinėtos jų sąsajos su pacientės amžiumi, naviko klinikinėmis ir morfologinėmis savybėmis. Išanalizuota šeiminės anamnezės prognozinė vertė nustatant paveldimus BRCA1 ir CHEK2 genų pokyčius. Pirmą kartą Lietuvoje įsisavintas CHEK2 bei NBS1 genų tyrimas, nustatyta, kokios CHEK2 geno mutacijos dažniausios. Nors NBS1 geno mutacijų nerasta, bet įsisavinta metodika, kuri bus panaudota ateities tyrimams. Sukurtas kompleksinis BRCA1 bei CHEK2 genų mutacijų radimo prognozavimo modelis. Šiandien klinikinėje praktikoje panašūs modeliai naudojami įvertinti BRCA1/2 genų mutacijų tikimybę. Jų pritaikomumas ir specifiškumas skirtingose etninėse grupėse gali skirtis. Naudojant tirtų pacienčių charakteristikas, įtraukiant ne tik šeiminę anamnezę, pacientės ypatybes, bet ir klinikinius bei molekulinius navikų požymius, sukurti mūsų regionui pritaikyti modeliai bei nustatyti kriterijai, kurie padės atrinkti pacientes genetiniam konsultavimui dėl BRCA1 bei CHEK2 genų mutacijų. Šis naujas požiūris turi didžiulę praktinę naudą. / Approximately 5–10% of all breast cancer cases are considered to be hereditary. BRCA1 and BRCA2 genes are the most important breast cancer predisposing genes. Other genes significantly linked with an increased risk of breast tumors are CHEK2 and NBS1 gene. In this scientific work were studied the most prevalent in European region mutations of these genes. The rate of BRCA1 and CHEK2 gene mutations in young women with breast cancer was evaluated and the relationships between these mutations and patient's age, clinical and morphological tumor features are examined. The prognostic value of family history was analyzed when forecasting hereditary BRCA1 and CHEK2 gene mutations. For the first time in Lithuania the CHEK2, NBS1 genes tests were applied and the evaluation of which CHEK2 gene mutations are most prevalent was obtained. Although NBS1 gene mutations were not found, but applied test technique will be used in future research. There was created a prognostic model for determination of BRCA1 and CHEK2 gene mutations. In today's clinical practice similar models are used to assess the likelihood of the BRCA1/2 mutation. Their applicability and specificity in different ethnic groups may vary. Applying the studied data there was created a model adapted to our region. Testing patients, there were considered not only family medical history and personal characteristics, but also the clinical and molecular features of tumors. The criteria have been found which will help in selecting... [to full text]

On average, 5-10% of all cancers occur in patients with hereditary tumors, who may have mutations in tens to hundreds of tumor predisposition genes. The phenotypes in mutation carriers overlap, and parallel analyses with sequencing panels is the method of choice in diagnostics. In our laboratory, we designed a universal panel and a targeted panel for a specific cancer, which allowed us to identify genetic alterations in patients with ovarian cancer, breast cancer, melanoma, and other cancers in the Czech Republic. The results of next generation sequencing (NGS) analyses show that the most frequent genetic alteration in ovarian cancers patients in the Czech Republic are hereditary mutations in BRCA1 (in 24% of unselected patients) and in malignant melanoma patients CDKN2A (in 2% of high risk patients). The presence of hereditary alterations is a clinically significant phenomenon affecting the prognosis and treatment of the disease. However, the interpretation of NGS findings is complicated by the presence of variants of unknown significance (VUS). We participate in the interpretation of VUS in the main predisposing genes BRCA1 and BRCA2 within the international consortium ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles). Our and international results of the most...