Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2.

Le syndrome de Lynch est une affection héréditaire autosomique dominante due à des mutations constitutionnelles des gènes du système de réparation de l'ADN (MLH1, MSH2 et MSH6). Depuis 20 ans le réseau français des laboratoires impliqués dans le syndrome de Lynch a identifié un total de 6687 variants. Sept cent sept d'entre eux, essentiellement des variants faux sens, restent encore des variants de signification inconnue (VSI), sans utilité pour le conseil génétique. Le but de notre étude était de développer un algorithme permettant de classer les variants de signification inconnue. Les critères utilisés étaient les données des analyses in silico, phénotypiques (ségrégation, critères d'Amsterdam), l'état de la fonction MMR (MisMatch Repair) dans les cellules tumorales, les tests fonctionnels et d'épissage, ainsi que les données publiées. Cet algorithme a été appliqué à l'ensemble des VSI de la base de données française et nous a permis de caractériser 370 variants . Les données ont été intégrées dans la base de données française UMD des gènes MMR afin d'être disponibles pour la communauté scientifique. Grace aux données collectées par le réseau, nous avons également pu caractériser le phénotype du syndrome de Lynch. Nous avons ainsi confirmé que le cancer du sein ne fait pas partie du spectre du syndrome de Lynch et que les formes de ce syndrome associées à une mutation du gène EPCAM n'entrainent qu'un risque très faible de cancers de l'endomètre, permettant ainsi d'adapter les recommandations de suivi dans cette situation.de l'endomètre, permettant ainsi d'adapter les recommandations de suivi dans cette situation. / Lynch syndrome is a frequent cancer predisposition with an autosomal dominant mode of inheritance and caused by heterozygous germ line mutations in one of the major DNA mismatch repair (MMR) genes (MLH1, MSH2 and MSH6). For 20 years, the French laboratories network involved in Lynch syndrome identified a total of 6687 variations. Among them, 707, mainly missense variations, remained variants of uncertain significance (VUS), thus could not be used for reliable genetic counseling. The aim of our study was to develop an algorithm able to classify VUS, according to the international consensus (IARC). This algorithm was constructed based on criteria usually required for genetic characterization such as in silico analysis, phenotypical data (segregation, Amsterdam criteria's), MMR status in tumor cells, functional assays, splicing analyses and published data. Data were registered in the French database. As a result of this work, we were able to classify 370 variants of the 707 (52,3%). As part of this work, we also analyzed phenotypical data of patients with Lynch syndrome and showed that breast cancer can definitively be excluded from the spectrum of Lynch-related cancers, and that EPCAM mutations, which may lead to Lynch syndrome, are associated with a very low incidence of endometrial cancer and have probably to be considered as an allelic disease with specific clinical recommendations.

Lynch syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC) is the most common hereditary syndrome predisposing to colorectal cancer, accounting for 1-3% of all colorectal cancer. This multi-organ cancer predisposition syndrome is caused by mutations in the mismatch repair (MMR) genes, especially MLH1 and MSH2, and to lesser extents MSH6 and PMS2, which lead to widespread genetic instability and thus microsatellite instability (MSI). Hereditary cancer often manifests in two or more tumours in a single individual; 35-40% of Lynch syndrome patients have synchronous or metachronous tumours of the two major Lynch syndrome-related cancers: colorectal and endometrial. The main purposes of the work underlying this thesis were to identify persons at risk of Lynch syndrome or other types of hereditary colorectal cancer, to estimate the cancer risks associated with these predispositions and to identify the underlying genetic causes. A population-based cohort of 78 persons with double primary colorectal or colorectal and endometrial cancer was identified. Cancer risks in their 649 first-degree relatives were estimated in relation to tumour MSI status (positive or negative) and age at diagnosis (before or after 50 years of age) in the probands. The overall standardised incidence ratio was 1.69 (95% CI; 1.39-2.03). The highest risks for Lynch syndrome-associated cancers: (colorectal, endometrial, ovarian and gastric) were found in families with young MSI-positive probands, likely representing Lynch syndrome families. Importantly, no overall risk was found in families with old probands, irrespective of MSI status. Blood samples were available from 24 MSI-positive patients for mutation screening of MLH1, MSH2 and MSH6. Sequence variants or rearrangements predicted to affect protein function were found in 16 patients. Six novel variants were found: two large rearrangements, two truncating and two missense mutations. The missense mutations were found to segregate in the families. Studies of allele frequencies, MSI and loss of immunostaning in tumours from family members further supports the hypothesis that these missense changes play a role in Lynch syndrome, as do the non-conservative nature and evolutionary conservation of the amino acid exchanges. Five families had mutations in MLH1, five in MSH2, and six in MSH6. The unexpectedly large impact of MSH6 was in genealogical studies shown to be due to a founder effect. Cumulative risk studies showed that the MSH6 families, despite their late age of onset, have a high lifetime risk for all Lynch syndrome-related cancers, significantly higher in women (89% by age 80 years) than in men (69%). The gender differences are in part due to high endometrial (70%) and ovarian cancer risk (33%) in addition to the high colorectal cancer risk (60%). These findings are of great importance for counselling and surveillance of families with MSH6 mutations. Finally, in a large family with MSI-negative hereditary colorectal cancer for which the MMR genes and APC had been excluded as possible causes, a genome-wide linkage analysis was performed, resulting in a suggested linkage to chromosome 7. Conclusions: Relatives of probands with MSI-positive, double primary colorectal and endometrial cancer diagnosed before the age of 50 years have significantly increased risks of Lynch syndrome-related cancers. MSH6 mutations, which have unusually high impact in this study population due to a founder effect, confer high cumulative risks of cancer despite the generally late age of onset.

Vid cancerdiagnostisering av Lynch syndrom används immunohistokemisk färgning för undersökning av eventuell defekt hos mismatch repair-generna MLH1, MSH2, MSH6 och PMS2. Färgningen använder sig av antikroppar som undersöker om cellkärnor i vävnad har intakta eller förlorade proteinuttryck hos respektive gen. Syftet med studien var att utföra en antikroppsvalidering för att granska om de nuvarande Dako Link Ready-to-Use-antikropparna (Link RTU) och koncentrerade antikroppen Dako PMS2 1:40 kunde bytas ut till Dako Omnis Ready-to-Use-antikroppar (Omnis RTU). Omnis RTU-antikropparna är optimerade för det automatiserade analysinstrumentet Dako Omnis som används vid patologavdelning på Universitetssjukhuset Örebro. Tolv vävnader med colorektalcancer och två externa positiva kontroller färgades med samtliga antikroppar för respektive gen och en jämförelse mellan Link RTU samt Dako PMS2 1:40 gjordes mot Omnis RTU-antikropparna. De nya färgningarna med Omnis RTU bedömdes som sämre, likvärdig eller bättre infärgad. Om antikroppen färgade rätt målceller och med stark färgintensitet bedömdes den och motsvarande protokoll som godkänd. Resultatet visade att Omnis RTU för MLH1 gav en förbättrad färgning. Omnis RTU för MSH2 gav i majoritet en förbättrad färgning med något mer bakgrundsfärg än önskvärt. Omnis RTU för MSH6 gav en svagare infärgning i majoriteten av fallen och Omnis RTU för PMS2 gav i majoritet en förbättrad färgning, men med för mycket bakgrundsfärg. Slutsatsen var att Omnis RTU för MSH6 och PMS2 kräver vidare optimering av protokoll innan de används i laboratoriets rutinfärgning. Protokollet för Omnis RTU för MSH2 kan behöva en mindre justering för minskad bakgrundsfärg och Omnis RTU för MLH1 fungerar väl med det nuvarande protokollet. / Immunohistochemistry staining is used in diagnostics of Lynch Syndrome to investigate possible defects in the mismatch repair genes MLH1, MSH2, MSH6 and PMS2. Antibodies is used to examine whether cell nuclei in cancer tissue have intact or loss of protein expression in said genes. The aim of the study was to perform an antibody validation to examine if the current Dako Link Ready-to-Use antibodies (Link RTU) and the concentrated PMS2 antibody can be replaced with Dako Omnis Ready-to-Use antibodies (Omnis RTU) that are optimized for the analytical instrument Dako Omnis, which is used in Universitetssjukhuset Örebro. Twelve tissues with colorectal cancer and two external positive controls was stained with all antibodies for each gene. A comparison was done between the old antibodies and Omnis RTU, where Omnis RTU was judged to be worse, equivalent or better. The antibody and used protocol were approved of laboratory use if it stained the target cells with a strong intensity. The results showed that Omnis RTU MLH1 had an improved staining. Omnis RTU MSH2 had in majority an improved staining, but with slightly more background staining than preferred. Omnis RTU MSH6 had in majority a weak staining while Omnis RTU PMS2 had an improved staining but with too much background staining. The conclusion was that the protocols for Omnis RTU MSH6 and PMS2 needed further optimization before laboratory use. The protocol for Omnis RTU MSH2 may need a minor adjustment to reduce background staining, while Omnis RTU MLH1 works well with the current protocol.

Lynch syndrome (LS), Lynch-like syndrome (LLS) and familial colorectal cancer type X (FCCX) are different entities of familial cancer predisposition leading to an increased risk of colorectal cancer (CRC). The aim of this prospective study was to characterise and to compare the risks for adenoma and CRC in these three risk groups. Data was taken from the registry of the German Consortium for Familial Intestinal Cancer. Patients were prospectively followed up in an intensified colonoscopic surveillance programme that included annual examinations. Cumulative risks for adenoma and CRC were calculated separately for LS, LLS and FCCX, and then for males and females. Multivariate Cox regression was used to analyse the independent contributions of risk group, mismatch repair gene (within LS), sex and previous adenoma. The study population comprised 1448 individuals (103 FCCX, 481 LLS and 864 LS). The risks were similar for colorectal adenomas, but different for first and metachronous CRC between the three risk groups. CRC risk was highest in LS, followed by LLS and lowest in FCCX. Male sex and a prevalent adenoma in the index colonoscopy were associated with a higher risk for incident adenoma and CRC. In patients with LS, CRC risks were particularly higher in female MSH2 than MLH1 carriers. Our study may support the development of risk-adapted surveillance policies in LS, LLS and FCCX. What's new? While associations between colorectal cancer (CRC) risk and Lynch syndrome (LS) are well-described, less is known about CRC risks linked to the closely related Lynch-like syndrome (LLS) and familial colorectal cancer type X (FCCX). In this prospective follow-up study of patients with LS, LLS, and FCCX, risks were similar for colorectal adenomas but considerably different for first and metachronous CRCs. In addition, LS females who carried MSH2 mutations had notably higher CRC risks than female MLH1 mutation carriers. The identification of variations in carcinogenic pathways between LS, LLS, and FCCX could enable risk-adapted CRC surveillance for these syndromes.

No description available.