Les femmes porteuses d’une mutation du gène BRCA1 ou BRCA2 ont un risque de cancer du sein (CS) très élevé dont les estimations varient beaucoup d’une étude à l’autre. L’objectif principal de cette étude est de mieux estimer le risque de CS associé aux gènes BRCA1/2 en tenant compte de la variabilité des mutations et des facteurs « environnementaux/style de vie » et de leur éventuelle interaction. Nous avons analysé les données de la cohorte GENEPSO composée de femmes porteuses d’une mutation du gène BRCA1 ou BRCA2 à l’aide d’un modèle de Cox pondéré. L’analyse des facteurs de risque gynéco-obstétrique et de « style de vie » a permis de mettre en évidence une association entre le risque de CS et les radiations ionisantes, la consommation de tabac, l’indice de masse corporelle, l’âge aux premières règles, la parité, les interruptions de grossesse, la contraception orale, la ménopause et les traitements hormonaux substitutifs. Cette étude confirme l’existence d’une zone centrale à moindre risque de CS dans les gènes BRCA1/2 et de décrire une nouvelle région à haut risque située dans la région 3’ du gène BRCA2. Cette étude montre également une interaction entre la localisation des mutations et la parité ainsi que la ménopause. Cette étude montre l’importance de la prise en compte simultanée des facteurs de risque « non génétiques » et de la localisation des mutations dans les gènes BRCA1/2 dans l’estimation des risques de CS. Si nos résultats sont confirmés sur de plus larges données, cette étude pourrait aider ces femmes dans le choix du type de stratégie de surveillance ou de prévention le mieux adapté à leur situation. / Breast cancer is the most frequent and mortal cancer among French women. Mutations in BRCA1 and BRCA2 confer a high risk of breast cancer. The diversity of BRCA1 and BRCA2 mutations and of gyneco-obstetrical and life style risk factors may modify the magnitude of this risk. The objective of this study is to assess breast cancer risk taking into account gyneco-obstetrical and life style factors, location of mutation in BRCA1 and BRCA2 genes and there potential interaction.The data from 1337 women BRCA1 and BRCA2 mutation carriers of the French study GENEPSO have been analysed by using a weighted Cox regression model to take into account the bias of recruitment. Our results show an association between breast cancer risk and X-ray exposures, tobacco, body mass index, age at menarche, parity, interrupted pregnancies, oral contraceptives, menopausal status and hormone replacement therapy. We confirm the existence of a central low breast cancer risk region in BRCA1 (LR1 region between codons 374 and 1161) and in BRCA2 (LR2 region between codons 957 and 1827). In addition, a new high breast cancer risk region is found in the 3’ region of BRCA2 (HR2 region between codons 2546 and 2968). Moreover, our results suggest a variation in breast cancer risk associated with parity and menopausal status according to the location of the mutation in BRCA1 and BRCA2. Our findings show that, taking into account environmental and lifestyle modifiers, mutation position might be important for the clinical management of BRCA1 and BRCA2 mutation carriers and could also be helpful in understanding how BRCA1 and BRCA2 genes are involved in breast cancer.

Introdução: Mutações nos genes BRCA1 e BRCA2 são responsáveis por cerca de 50% dos casos de câncer de mama e/ou ovário hereditários. Atualmente não conhecemos o perfil de mutações destes genes na população brasileira, com exceção de mutações fundadoras que ocorrem em grupos étnicos específicos. Objetivos: Detectar mutações e polimorfismos nos genes BRCA1 e BRCA2 em 73 pacientes com câncer de mama selecionadas para o teste genético. Casuística e métodos: Realizamos o sequenciamento direto e o teste de MLPA para os genes BRCA1 e BRCA2 em 73 indivíduos, sendo 63 pacientes com câncer de mama com risco maior ou igual a 10% de acordo com os critérios de Frank, Evans e BRCAPRO, dois pacientes com câncer de ovário e oito indivíduos saudáveis com forte histórico familiar de câncer ligado a mutações em BRCA1 e/ou BRCA2. Resultados: Encontramos 60 mutações no gene BRCA1: 13 alterações missense (incluindo a deletéria R71G), sete mutações sinônimas, uma mutação frameshift (a deletéria 5382insC), uma mutação nonsense (a deletéria R1751X), uma deleção in frame, uma alteração 3UTR e 36 variantes intrônicas. Em BRCA2 encontramos 57 mutações, entre as quais 26 mutações missense, uma alteração 5UTR, 11 mutações sinônimas, 14 variantes intrônicas, duas mutações nonsense (as deletérias R2318X e R3128X) e três mutações frameshift deletérias (5844del5, 6633del5 e 6610insTT). Nenhuma mutação foi detectada pelo teste de MLPA. Discussão e considerações finais: Nove de 73 indivíduos estudados são portadores de mutações deletérias, sendo que a mutação fundadora Ashkenazi 5382insC foi encontrada em duas pacientes não aparentadas e que outro grupo de pesquisa já reportou sua alta frequência numa população paulistana. As alterações de significado clínico desconhecido foram encontradas em toda a extensão dos genes BRCA1 e BRCA2 e são inúmeras. Algumas apareceram em somente uma paciente, o que nos leva a pensar que talvez uma ou algumas destas mutações tenham algum efeito patogênico, como a mutação 6610insTT, que gera uma proteína incompleta e foi encontrada em três gerações de uma família. A técnica de MLPA não detectou grandes rearranjos em ambos os genes, mostrando que este tipo de alteração genética não é freqüente em nossa coorte e que talvez esta seja uma característica mais prevalente em populações menos miscigenadas. Salientamos, portanto, a importância de ampliar este estudo e de estimular pesquisas futuras, visando um aconselhamento genético eficiente, com a diminuição do número de casos inconclusivos gerados pelas variantes de significado indeterminado e o acompanhamento clínico das famílias / Introduction: Mutation in BRCA1 and BRCA2 genes are responsible for more than 50% of hereditarian breast and ovarian cancer cases. Nowadays, we still dont know the Brazilian mutation profile for these genes, except when founder mutations occur in specific ethnic groups. Objetives: Detection of mutation and polymorphisms in BRCA1 and BRCA2 genes in 73 breast cancer patients selected for genetic testing. Casuistic and methods: we have realized direct sequencing of BRCA1 and BRCA2 in 73 patients, whose 63 have had breast cancer and showed at least 10% of risk according to Frank, Evans and BRCAPRO, two patients with ovarian cancer and eight healthy individuals of strong family history of cancer linked to mutations in BRCA1 and BRCA2. Results: We have found 60 mutations in BRCA1: 13 missense mutations (including the deleterious R71G), seven synonymous mutations, one frameshift mutation (the deleterious 5382insC), one nonsense mutation (the deleterious R1751X), one in-frame deletion, one 3UTR mutation and 36 intronic variants. In BRCA2 we have found 57 mutations: 26 missense mutations, one 5UTR mutation, 11 synonymous mutations, 14 intronic variants, two nonsense mutations (the deleterious R2318X and R3128X) and three frameshift mutations (5844del5, 6610insTT and 6633del5). No mutation was detected by MLPA technique. Discussion and final considerations: Nine of 73 studied individuals carry deleterious mutations. Among them, the Ashkenazi founder mutation 5382insC has been found in two unrelated patients and it was previously reported by another research group for its high prevalence on a population from São Paulo. Alterations of unknown clinical significance have been found all over BRCA1 and BRCA2 gene extension and are countless. Some of them are shown only in one patient, leading us to think that maybe one or a few might have a pathogenic effect, like 6610insTT, which leads to a BRCA2 incomplete protein and was shown in 3 generations of a family. MLPA technique have not detected large genomic rearrangements in both genes, showing that this kind of mutation is not frequent on our cohort and maybe this genetic alteration characterizes less miscigenated populations. So, we emphasize the importance of enlarge this study and stimulate future researches, aiming an efficient genetic counseling, decreasing inconclusive cases generated by unknown clinical significance variants, and follow up of affected families

Comme pour toute pathologie, la survenue d’un cancer du sein est conditionnée par l’association de facteurs génétiques héréditaires et de facteurs environnementaux acquis. Les facteurs génétiques connus comprennent à la fois des mutations pathogènes rares induisant un risque élevé de développer un cancer du sein et des variants génétiques fréquents (single nucleotides polymorphisms - SNP) responsables d’une faible augmentation du risque. L’ensemble des résultats de ce manuscrit plaide en faveur d’un impact majeur des facteurs génétiques constitutionnels à la fois en ce qui concerne le risque de développer un cancer du sein mais aussi en tant que déterminants du type de cancer du sein, voire du pronostic. La survenue d’un cancer du sein exprimant les récepteurs aux estrogènes et HER2-négatif est associée à 4 SNP introniques du gène FGFR2. Le pronostic des cancers du sein n’est pas associé aux variants impliquant un risque de développer un cancer. Quatre SNP indépendants sont associés à une évolution péjorative des cancers du sein triple-négatifs.La séquence d’événements qui mène du génome du patient à celui de la tumeur reste complexe, mal connue et probablement spécifique à chaque cancer comme l’illustrent les deux cas liés à des mutations germinales BRCA1/2 étudiés en deuxième partie de manuscrit. Le dernier travail permet de faire un lien vers la pratique clinique et rapporte une prévalence des mutations germinales BRCA1/2 d’environ 3% dans une cohorte prospective de patientes présentant un cancer du sein métastatique, non sélectionnées en fonction de leur âge, type de cancer ou antécédents familiaux. / As in any disease, the development of breast cancer depends on genetic hereditary factors and environmental acquired factors. Genetic factors of breast cancer involve rare pathogenic mutations with high risk of developing a breast cancer and frequent genetic variants (single nucleotides polymorphisms - SNP) responsible for a low increase in the risk of cancer. The works presented in this manuscript show that germline genetic factors strongly determine the risk of developing a breast cancer, but also the subtype of breast cancer and may impact the prognosis. Estrogen-positive, HER2-negative breast cancer development is associated with 4 intronic SNP in FGFR2 gene. Breast cancer prognosis is not associated with variants conferring a risk of developing a breast cancer. Four independent SNP are associated with bad outcomes in triple-negative breast cancers.The way that leads from patient genome to tumor genome is complex, mainly unknown and probably different for each case, as illustrated in the two case reports involving BRCA1/2 germline mutations described in the second part of the manuscript. Last work is a clinical research trial and shows a prevalence of BRCA1/2 mutations of around 3%, in a prospective cohort with metastatic breast cancer patients unselected on their age, cancer type or family history.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-19T10:42:04Z No. of bitstreams: 2 Dissertação - Rebeca Mota Goveia - 2018.pdf: 2457051 bytes, checksum: 721dc25f2c29d54fc3bd4f0f13c5fc83 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-19T11:18:57Z (GMT) No. of bitstreams: 2 Dissertação - Rebeca Mota Goveia - 2018.pdf: 2457051 bytes, checksum: 721dc25f2c29d54fc3bd4f0f13c5fc83 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-19T11:18:57Z (GMT). No. of bitstreams: 2 Dissertação - Rebeca Mota Goveia - 2018.pdf: 2457051 bytes, checksum: 721dc25f2c29d54fc3bd4f0f13c5fc83 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Breast cancer is the second most common cancer in the world, and the most common among women, only 5% to 10% are hereditary and half of them are caused by hereditary breast and ovarian cancer (HBOC) , caused by variations in the BRCA1 and BRCA2 genes. Objectives: The present study aimed to identify the prevalence of deletions and duplications in BRCA1 and BRCA2 genes in breast cancer patients in Goiás, Brazil. Materials and methods: We evaluated 46 breast cancer patients who met National Comprehensive Cancer Network (NCCN) criteria for HBOC syndrome screening. A 4 ml blood sample was collected for DNA extraction using commercial kit and the MLPA (Multiplex Ligation Dependent Probe Amplification) technique was performed using the SALSA MLPA P002 BRCA1 and SALSA MLPA P045 BRCA2 / CHECK2 kits. Results and discussion: The majority of the patients were female (97.83%) and the mean age of the patients was 37.52 years. In this group, 43.47% of the patients were younger than 35 years at the time of diagnosis and 35% of them were diagnosed with triple negative tumors. The most common molecular subtype was luminal A (46.2%) followed by triple negative tumors (28.20%). No patient was found with rearrangements in BRCA1. In the BRCA2 gene, one patient (2.12%) presented a false positive result for the heterozygous deletion of exon 27, which may have been caused by the presence of a small change in the probe binding region. Conclusion: This was the first study performed to analyze large deletions and duplications in patients from the central-western region of Brazil. We can conclude that the frequency of large deletions and duplications in the BRCA1 and BRCA2 genes in the Goian population is low. / Introdução: O câncer de mama é o segundo tipo de câncer mais freqüente no mundo, e o mais comum entre as mulheres, apenas 5% a 10% são hereditários e metade deles são causados ​​pela síndrome do câncer de mama e ovário hereditário (HBOC), causada por variações nos genes BRCA1 e BRCA2. Objetivos: O presente estudo teve como objetivo identificar a prevalência de deleções e duplicações nos genes BRCA1 e BRCA2 em pacientes com câncer de mama no estado de Goiás, Brasil. Materiais e métodos: Avaliamos 46 pacientes com câncer de mama que atenderam aos critérios do National Comprehensive Cancer Network (NCCN) para pesquisa da síndrome HBOC. Foi coletada uma amostra de sangue de 4 ml para extração de DNA usando kit comercial e a técnica MLPA (Multiplex Ligation Dependent Probe Amplification) foi realizada usando os kits SALSA MLPA P002 BRCA1 e SALSA MLPA P045 BRCA2 / CHECK2. Resultados e discussão: A maioria dos pacientes era do sexo feminino (97.83%) e a idade média dos pacientes era de 37,52 anos. Neste grupo 43.47% dos pacientes possuíam idade inferior a 35 anos no momento do diagnóstico sendo que 35% destes foram diagnosticados com tumores triplo negativo. O subtipo molecular mais comum foi o luminal A (46.2%) seguido de tumores triplo negativos (28.20%). Nenhum paciente foi encontrado com rearranjos no gene BRCA1. No gene BRCA2, um paciente (2,12%) apresentou um resultado falso positivo para a deleção em heterozigoze do éxon 27, fato que pode ter sido ocasionado pela presença de uma pequena alteração na região de ligação da sonda. Conclusão: Este foi o primeiro estudo realizado para análise de grandes deleções e duplicações em pacientes da região centro-oeste do Brasil. Podemos concluir que a frequência de grandes deleções e duplicações nos genes BRCA1 e BRCA2 na população goiana é baixa.

Cerca de 10% dos casos de câncer de mama e/ou ovário são caracterizados como hereditários, onde a presença de mutações germinativas no gene de suscetibilidade BRCA1 aumenta o risco de desenvolver esses cânceres durante a vida da mulher. O BRCA1 é um gene supressor tumoral envolvido na resposta de danos ao DNA, controle do ciclo celular, na remodelação da cromatina, ubiquitinação e regulação da transcrição. O presente estudo tem como objetivo central caracterizar as mutações do gene BRCA1 associadas a Síndrome Hereditária do Câncer de Mama e/ou Ovário (HBOC) em pacientes atendidos no Serviço de Aconselhamento Genético do Câncer do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP). Os vinte e dois éxons codificantes do BRCA1 foram analisados utilizando o método de High Resolution Melting (HRM) para triagem de mutações pontuais, seguido pelo sequenciamento de DNA dos casos selecionados para validação. A técnica de MLPA (Multiplex Ligation-dependent Probe Amplification) também foi usada para detectar grandes deleções e duplicações. Uma vez confirmada a mutação, membros da família considerados de alto risco, serão investigados para a mutação específica, a fim de proporcionar-lhes um aconselhamento genético apropriado para a detecção precoce do câncer. No presente estudo, foram investigados 41 pacientes que preencheram os critérios para o teste genético de acordo com NCCN Clinical Practice Guidelines in Oncology v.1.2010. Um total de 21 mutações foram identificadas, duas das quais são patogênicas: a deleção dos éxons 17-18 e a deleção dos éxon 19. Ambas estão localizadas no domínio BRCT do gene BRCA1, essencial para a ligação de fosfoproteínas críticas para a ativação do complexo de reparo do DNA. Outra mutação, a S616del, foi tratada como patogênica, mas apresenta informações controversas em diferentes estudos. O trabalho também identificou uma nova mutação, Val1117Ile. Um estudo de haplótipos das mutações identificadas nos pacientes foi realizado e revelou que um dos haplótipos, denominado de 6, contendo quatro resíduos mutados (871Leu, 1038Gly, 1183Arg e 1613Gly) estava presente em 50% das pacientes. O estudo de associação com 82 indivíduos saudáveis, mostrou diferença significativa (p=0,026) nos pacientes, sugerindo assim um risco aumentado de HBOC. Adicionalmente, foi analisada a mutação germinativa R337H no gene p53 para os casos suspeitos de Síndrome de Li-Fraumeni. Em síntese, o presente estudo contribui com a identificação de uma nova mutação não-sinônina no gene BRCA1 e sugere que o haplótipo 871Leu-1038Gly-1183Arg-1613Gly possa conferir risco aumentado do câncer de mama e/ou ovário em pacientes diagnosticados com HBOC. / About 10% of cases of breast and/or ovary cancer are characterized as hereditary, where the presence of germline mutations in susceptibility BRCA1 gene increases the risk of developing these cancers during womans lifetime. BRCA1 is a tumor suppressor gene involved in DNA damage response, cell cycle control, chromatin remodeling, ubiquitination and transcriptional regulation. The present study aims to characterize BRCA1 gene mutations associated with Hereditary Breast/Ovary Cancer Syndrome (HBOC) in patients from the Cancer Genetic Counseling Service of the General Hospital of the Medical School of Ribeirão Preto, University of São Paulo (HCFMRP-USP). The twenty two coding exons of BRCA1 were analyzed using High Resolution Melting (HRM) method for the screening of point mutations, followed by DNA sequencing of the cases selected to validation. MLPA (Multiplex Ligation-dependent Probe Amplification) technique was also used to detect gross deletions and duplications. Once confirmed the mutation, family members most at risk will be analyzed for the specific mutation in order to provide them with an appropriate genetic counseling for early detection of cancer. In the present study, we investigated 41 patients that fulfilled the criteria for genetic testing according to NCCN Clinical Practice Guidelines in Oncology v.1.2010. A total of 21 mutations were identified, two of them are pathogenic: a deletion of exons 17-18 and a deletion of exon 19. Both of them are located in the BRCT domain of BRCA1 gene, impairing the binding of essential phosphoproteins critical to the activation of DNA repair complex. Another mutation, S616del, shows controversial information about its pathogenesis in different studies.The present study also describes a new mutation, Val1117Ile. A study of haplotypes of the mutations identified in patients was performed and revealed that one of the haplotypes, called 6, containing four mutated residues (871Leu, 1038Gly, and 1183Arg 1613Gly) was present in 50% of patients. The association study with 82 healthy subjects showed a significant difference (p = 0.026) in patients, thus suggesting an increased risk for HBOC. Additionally, the germline mutation R337H on p53 gene was also analyzed in the present study for suspected cases of Li-Fraumeni Syndrome. In summary, this study contributes to the identification of a new missense mutation in the BRCA1 gene and suggests that the haplotype-871Leu-1038Gly 1183Arg-1613Gly may confer increased risk of breast cancer and / or ovarian cancer in patients diagnosed with HBOC.

Introdução: Mutações nos genes BRCA1 e BRCA2 são responsáveis por cerca de 50% dos casos de câncer de mama e/ou ovário hereditários. Atualmente não conhecemos o perfil de mutações destes genes na população brasileira, com exceção de mutações fundadoras que ocorrem em grupos étnicos específicos. Objetivos: Detectar mutações e polimorfismos nos genes BRCA1 e BRCA2 em 73 pacientes com câncer de mama selecionadas para o teste genético. Casuística e métodos: Realizamos o sequenciamento direto e o teste de MLPA para os genes BRCA1 e BRCA2 em 73 indivíduos, sendo 63 pacientes com câncer de mama com risco maior ou igual a 10% de acordo com os critérios de Frank, Evans e BRCAPRO, dois pacientes com câncer de ovário e oito indivíduos saudáveis com forte histórico familiar de câncer ligado a mutações em BRCA1 e/ou BRCA2. Resultados: Encontramos 60 mutações no gene BRCA1: 13 alterações missense (incluindo a deletéria R71G), sete mutações sinônimas, uma mutação frameshift (a deletéria 5382insC), uma mutação nonsense (a deletéria R1751X), uma deleção in frame, uma alteração 3UTR e 36 variantes intrônicas. Em BRCA2 encontramos 57 mutações, entre as quais 26 mutações missense, uma alteração 5UTR, 11 mutações sinônimas, 14 variantes intrônicas, duas mutações nonsense (as deletérias R2318X e R3128X) e três mutações frameshift deletérias (5844del5, 6633del5 e 6610insTT). Nenhuma mutação foi detectada pelo teste de MLPA. Discussão e considerações finais: Nove de 73 indivíduos estudados são portadores de mutações deletérias, sendo que a mutação fundadora Ashkenazi 5382insC foi encontrada em duas pacientes não aparentadas e que outro grupo de pesquisa já reportou sua alta frequência numa população paulistana. As alterações de significado clínico desconhecido foram encontradas em toda a extensão dos genes BRCA1 e BRCA2 e são inúmeras. Algumas apareceram em somente uma paciente, o que nos leva a pensar que talvez uma ou algumas destas mutações tenham algum efeito patogênico, como a mutação 6610insTT, que gera uma proteína incompleta e foi encontrada em três gerações de uma família. A técnica de MLPA não detectou grandes rearranjos em ambos os genes, mostrando que este tipo de alteração genética não é freqüente em nossa coorte e que talvez esta seja uma característica mais prevalente em populações menos miscigenadas. Salientamos, portanto, a importância de ampliar este estudo e de estimular pesquisas futuras, visando um aconselhamento genético eficiente, com a diminuição do número de casos inconclusivos gerados pelas variantes de significado indeterminado e o acompanhamento clínico das famílias / Introduction: Mutation in BRCA1 and BRCA2 genes are responsible for more than 50% of hereditarian breast and ovarian cancer cases. Nowadays, we still dont know the Brazilian mutation profile for these genes, except when founder mutations occur in specific ethnic groups. Objetives: Detection of mutation and polymorphisms in BRCA1 and BRCA2 genes in 73 breast cancer patients selected for genetic testing. Casuistic and methods: we have realized direct sequencing of BRCA1 and BRCA2 in 73 patients, whose 63 have had breast cancer and showed at least 10% of risk according to Frank, Evans and BRCAPRO, two patients with ovarian cancer and eight healthy individuals of strong family history of cancer linked to mutations in BRCA1 and BRCA2. Results: We have found 60 mutations in BRCA1: 13 missense mutations (including the deleterious R71G), seven synonymous mutations, one frameshift mutation (the deleterious 5382insC), one nonsense mutation (the deleterious R1751X), one in-frame deletion, one 3UTR mutation and 36 intronic variants. In BRCA2 we have found 57 mutations: 26 missense mutations, one 5UTR mutation, 11 synonymous mutations, 14 intronic variants, two nonsense mutations (the deleterious R2318X and R3128X) and three frameshift mutations (5844del5, 6610insTT and 6633del5). No mutation was detected by MLPA technique. Discussion and final considerations: Nine of 73 studied individuals carry deleterious mutations. Among them, the Ashkenazi founder mutation 5382insC has been found in two unrelated patients and it was previously reported by another research group for its high prevalence on a population from São Paulo. Alterations of unknown clinical significance have been found all over BRCA1 and BRCA2 gene extension and are countless. Some of them are shown only in one patient, leading us to think that maybe one or a few might have a pathogenic effect, like 6610insTT, which leads to a BRCA2 incomplete protein and was shown in 3 generations of a family. MLPA technique have not detected large genomic rearrangements in both genes, showing that this kind of mutation is not frequent on our cohort and maybe this genetic alteration characterizes less miscigenated populations. So, we emphasize the importance of enlarge this study and stimulate future researches, aiming an efficient genetic counseling, decreasing inconclusive cases generated by unknown clinical significance variants, and follow up of affected families

Mutations in the breast cancer susceptibility 1 (BRCA1) gene are linked to breast as well as ovarian cancers. However, most cancer-causing mutations within the BRCA1 gene have been found in the N’ and C’ terminal regions of the BRCA1 protein, both believed to be important for DNA double-strand break (DSB) repair. The BRCA1 C’ terminal (BRCT) repeats have been implicated in phospho-serine protein binding whereas the N’ terminal RING domain interacts with the BARD1 protein to form a hetero-dimeric complex with E3 ubiquitin ligase activity. The BRCA1 BRCT domain binds CtIP, BACH1, and RAP80, all of which have been directly implicated in homologous recombination repair (HRR). Lysine 1702 (K1702) of BRCA1 resides within the phospho-serine binding pocket of the first BRCT repeat of BRCA1. To determine the effect of manipulating the ability of BRCA1 to bind CtIP and other phospho-proteins binding to the BRCA1 BRCT domain on DSB repair, and specifically HRR, we introduced a K1702M mutation into BRCA1 known to impair BRCT binding to a pSer-X-X-Phe peptide representing BACH1. Surprisingly, instead of impairing HRR, we found that BRCA1 K1702M resulted in hyper-recombination with > 3-fold higher levels of HRR compared to wild-type BRCA1 using an HRR assay based on GFP expression in BRCA1-defective HCC1937 cells. This hyper-recombinogenic phenotype coincided with cell-cycle arrest in S/G2 suggesting that the potential lack of binding of critical proteins to the BRCA1 BRCT domain results in abnormal HRR by priming cells to undergo more HRR which is enhanced during the S and G2 phases of the cell-cycle. In line with the increased HRR seen with the HRR/GFP assay, HCC1937 cells expressing BRCA1 K1702M showed increased levels of RAD51 foci and nuclear staining suggesting that HRR was highly elevated. Interestingly, the hyper-recombinogenic phenotype of BRCA1 K1702M could be reduced to normal levels with a second mutation (I26A) in BRCA1 that affects BRCA1 and CtIP ubiquitination. These results reveal a hierarchal regulation of HRR with ubiquitination having a dominate role in DSB repair by BRCA1 and suggests that targeted disruption of BRCT-CtIP binding increases HRR that is in turn controlled by ubiquitination. In addition, we provide evidence that BRCA1 serine 1387 phosphorylation within the SQ cluster region of BRCA1 is involved in the cell survival and DNA damage response to IR. The BRCA1 S1387A mutant only partially increased the radiosurvival of HCC1937 cells compared to cells expressing wild-type BRCA1 and immunocytochemical analysis revealed wild-type BRCA1 was located in the nucleus whereas the S1387A mutant was cytoplasmic in response to IR. We also show that BRCA1 SQ cluster serine phosphorylation in addition to serine 1387 is involved in HRR. Altogether, these findings reveal the importance of various regions of BRCA1 in DSB repair and may lead to multiple strategies of modulating BRCA1 function in response to DNA damage.

The term "BRCAness" is used to describe breast-cancer patients who lack a germline mutation in BRCA1 or BRCA2, yet who are believed to express characteristics similar to patients who do have a germline mutation in BRCA1 or BRCA2. Although it is hypothesized that BRCAness is related to deficiency in the homologous recombination repair (HRR) pathways, relatively little is understood about what drives BRCAness or what criteria should be used to assign patients to this category. We hypothesized that patients whose tumor carries a genomic or epigenomic aberration in BRCA1 or BRCA2 should be classified under the BRCAness category and that these tumors would exhibit downstream effects (additional mutations or gene-expression changes) similar to patients with germline BRCA1/2 mutations. To better understand BRCAness, we examined similarities and differences in gene-expression profiles and somatic-mutation "signatures" among 1054 breast-cancer patients from The Cancer Genome Atlas. First, we categorized patients into three categories: those who carried a germline BRCA1/2 mutation, those whose tumor carried a genomic aberration or DNA hypermethylation in BRCA1/2 (the BRCAness group), and those who fell into neither of the first two groups. Upon evaluating the gene-expression data in context of the PAM50 subtypes, we did not observe significant similarity between the germline BRCA1/2 and BRCAness groups, but we did observe enrichment within the basal subtype, especially for BRCAness tumors with hypermethylation of BRCA1/2. However, the gene-expression profiles were fairly heterogeneous; for example, BRCA1 patients differed significantly from BRCA2 patients. In agreement with prior findings, certain mutational signatures—especially "Signature 3"—were enriched for patients with germline BRCA1/2 mutations as well as for BRCAness patients. Furthermore, we observed significant similarity between germline BRCA1/2 patients and patients with germline mutations in PALB2, RAD51B, and RAD51C, genes that are key parts of the HRR pathway and that interact with BRCA1/2. Our findings suggest that the BRCAness category does have biological and clinical relevance but that the criteria for including patients in this category should be carefully defined, potentially including BRCA1/2 hypermethylation and homozygous deletions as well as germline mutations in PALB2, RAD51B, and RAD51C.

This thesis describes a study on the impact of selected nutrients, growth hormones and in vivo genome stability on breast cancer risk in BRCA1 or BRCA2 germline mutation carriers. Peripheral blood lymphocyes of BRCA germline mutation carriers and healthy non-carrier controls were studied for the impact of folic acid deficiency on genome damage and the methionine-dependence phenotype (MDP; in combination with common polymorphisms in one-carbon metabolism) on breast cancer risk, respectively. Plasma IGF-1 and IGFBP-3 were determined and chromosome 17 aneuploidy and Her2 amplification were assessed in mononucleated lymphocytes to establish the association of these markers on breast cancer risk in BRCA germline mutation carriers, independently or in combination with plasma folate, vitamin B12, homocysteine, selenium and common gene variants in the one-carbon metabolism, DNA repair genes or glutathionine S-transferase.

Early events in BRCA1-associated tumorigenesis remain poorly understood. To understand the immediate consequences of BRCA1 loss of function, we modeled BRCA1 loss of function in vitro using normal primary human mammary epithelial cells (HMEC). We have found that in HMEC, loss of BRCA1 results in a novel type of senescence. Loss of BRCA1-induced senescence is not associated with DNA damage or p53 upregulation. We find that p53 protein levels are down regulated due to proteasome-mediated degradation. Although p53 levels are down regulated, we find that BRCA1 loss induced expression of a number of p53-dependent anti-oxidant genes. In particular we uncovered that SESN2, a p53 downstream target gene, inhibits loss of BRCA1 induced ROS and activates autophagy. In contrast to human fibroblasts, we found that loss of BRCA1 induced senescence is p53 independent, and can occur in the absence of ROS upregulation and autophagy induction.