- Short Report
- Open Access
Analysis of BRCA1 and BRCA2 large genomic rearrangements in Sri Lankan familial breast cancer patients and at risk individuals
BMC Research Notes volume 7, Article number: 344 (2014)
Majority of mutations found to date in the BRCA1/BRCA2 genes in breast and/or ovarian cancer families are point mutations or small insertions and deletions scattered over the coding sequence and splice junctions. Such mutations and sequence variants of BRCA1 and BRCA2 genes were previously identified in a group of Sri Lankan breast cancer patients. Large genomic rearrangements have been characterized in BRCA1 and BRCA2 genes in several populations but these have not been characterized in Sri Lankan breast cancer patients.
A cohort of familial breast cancer patients (N = 57), at risk individuals (N = 25) and healthy controls (N = 23) were analyzed using multiplex ligation-dependent probe amplification method to detect BRCA1 and BRCA2 large genomic rearrangements. One familial breast cancer patient showed an ambiguous deletion in exon 6 of BRCA1 gene. Full sequencing of the ambiguous region was used to confirm MLPA results. Ambiguous deletion detected by MLPA was found to be a false positive result confirming that BRCA1 large genomic rearrangements were absent in the subjects studied. No BRCA2 rearrangement was also identified in the cohort.
Thus this study demonstrates that BRCA1 and BRCA2 large genomic rearrangements are unlikely to make a significant contribution to aetiology of breast cancer in Sri Lanka.
Germ-line mutations in BRCA1 and BRCA2 tumor suppressor genes cause a hereditary predisposition to breast and ovarian cancer. Such mutations account for 15-20% of familial breast cancer. Although familial breast cancer contributes to 5-10% of all breast cancers, individuals carrying mutations in one of these genes have a 40-80% chance of developing breast cancer. At present, in Sri Lanka women are diagnosed with breast cancer at a median age of 50 years contributing to approximately 25% of all cancers. Majority of mutations found to date in the BRCA1 and BRCA2 genes in breast and/or ovarian cancer families are point mutations or small insertions and deletions scattered over the whole coding sequence and the splice junctions. Point mutations and sequence variants in BRCA1 and BRCA2 genes were previously identified in this cohort of Sri Lankan breast cancer patients. More recently, large genomic alterations have been described in BRCA1 and BRCA2 genes. Such large alterations lead to change in genomic copy number and cannot be detected by conventional methods. Rearrangements have occasionally been reported in patients who are negative for BRCA1/BRCA2 mutations.
There is a difference in the degree of BRCA1/BRCA2 rearrangements found in different ethnic groups and populations. The prevalence of BRCA1/BRCA2 genomic rearrangements in Asians is thought to be low. However studies done in these populations are limited. Several deletions and duplications have been reported from Singapore, Korea, Malaysia and China. There are no published reports on the analysis of BRCA1 and BRCA2 large genomic rearrangements in Sri Lankans and this study examined the possibility of such genomic rearrangements in a cohort in which point mutations and sequence variants in BRCA1 and BRCA2 were previously described[5, 6].
Results and discussion
MLPA analysis did not reveal any large genomic rearrangements in BRCA2 gene in any of the subjects studied. However, according to MLPA analysis, one breast cancer patient was detected with an average intra normalized ratio (probe signal of each amplification product/ all reference probe signals within each sample run) of 0.64 in exon 6 of BRCA1 gene which was predicted as an ambiguous deletion. An average ratio of 0.64 indicates a reduction in relative peak area of the amplification product by 36%. Figure 1 shows the MLPA results of the patient found to have an ambiguous exon 6 deletion for BRCA1. Figure 2 shows the MLPA results for the BRCA2 gene of one of the familial breast cancer patients. The average ratios were within the 0.7-1.3 range indicating absence of exon deletions or duplications of the BRCA2 gene in all samples analysed.
In the patient who showed an ambiguous deletion for BRCA1 exon 6, the average ratio for exon 6 was outside the 95% confidence limits and outside the arbitrary range of 0.7 to 1.3. Although for exon 7, the average ratio exceeded the arbitrary range this was still within the 95% confidence limits. Thus we attempted to confirm the BRCA1/ exon 6 deletion by direct sequencing. The sample was sequenced (both forward and reverse strands) along with a healthy control sample for comparison. Sequence data were analysed using Mutation Surveyor DNA Variant Analysis Software – Softgenetics against reference sequence of BRCA1 in the basic local alignment search tool (BLAST) published by National Centre for Biotechnology Information (NCBI), USA (accession no. L78833). Sequence data showed no change in the DNA sequence of exon 5, 6 and 7of the patient compared to reference sequence. Data also indicated that the MLPA probe hybridization site was intact.
Familial breast cancer patients and at risk individuals were previously investigated for BRCA1 and BRCA2 mutations and some were positive for BRCA1/2 mutations. From this cohort, three at risk individuals and two familial breast cancer patients were positive for clearly pathogenic BRCA1 mutations and only six familial breast cancer patients were positive for clearly pathogenic BRCA2 mutations. The same cohort was used for the detection of BRCA1 and BRCA2 genomic rearrangements in the present study.
Detection of BRCA rearrangements is very important in a population since in some populations the occurrence of large deletions and duplications in either BRCA1 or BRCA2 is substantial. A prevalence of 2.1% for BRCA1 large genomic rearrangements has been detected in Spanish hereditary breast/ovarian cancer families testing negative for point variations and small insertions/deletions in BRCA1 and BRCA2. BRCA1/2 large genomic rearrangements have shown noticeable founder effect in certain European and American populations. One large genomic rearrangement, BRCA1 exon 9–12 deletion, is considered as a mutation in Mexican population. In Northern Finland, a large deletion of exons 1A-13 in BRCA1 gene is currently identified to represent 14.3% (1/7) of the Finnish population.
Arthrobacter luteus (Alu) short stretches of repetitive DNA appear to be the main source of large genomic rearrangements by providing hotspots for unequal homologous recombination[15, 16]. Several large genomic rearrangements reported in BRCA1 have been frequently recognized within intragenic Alu repeats and BRCA1 pseudogene (ΨBRCA1) 30 kb upstream[17, 18]. To date, at least 81 different large genomic rearrangements have been found in BRCA1 gene and account for 8%–27% of all BRCA1 mutations. Alternatively Alu sequences are less common in BRCA2 gene, where only few large genomic rearrangements are reported, accounting for 0%–11% of all BRCA2 mutations[19–21].
The aim of this study was to assess the contribution of BRCA1 and BRCA2 rearrangements for predisposing to breast cancer in familial breast cancer patients and at risk individuals in Sri Lanka. We did not observe any conclusive large genomic rearrangements of BRCA1 and BRCA2 among the subjects studied. However in other Asian countries like Singapore three novel BRCA rearrangements have been found. These were exon 13 duplication and exon 13–15 deletion of BRCA1, and exon 4–11 duplication in BRCA2. BRCA1 genomic rearrangement found in Korean population involved exons 13–15. This exon 13–15 deletion has also been identified in three families with America/French-German, Danish, and Singaporean/Indian ethnicities[12, 22, 23]. In a Malaysian population, two genomic rearrangements in BRCA1 (exon 13–15 deletion and exon 1–14 deletion) and one in BRCA2 (exon 14–16 deletion) were detected.
According to the findings of the present study BRCA1 and BRCA2 large genomic rearrangements are unlikely to significantly contribute to breast cancer in Sri Lanka. This is the first report on the analysis of BRCA1 large genomic rearrangements in Sri Lanka.
The importance of recognizing the large rearrangements with respect to BRCA1/2 is explained by BRCA rearrangements showing apparent founder effect in some populations which can be used as diagnostic tools. BRAC Analysis Large Rearrangement Test (BART) is already established in the country like US and also has been introduced as new updates to HBOC (Hereditary Breast and Ovarian Cancer) guidelines by National Comprehensive Cancer Network (NCCN). So BART is especially recommended for the individuals with strong personal and family history of breast and ovarian cancer along with routine BRCA analysis. Under such circumstances, it is so important to undergo large genomic rearrangements analysis by the familial breast cancer patients and their at risk individuals in a particular population as a diagnosis tool for breast cancer.
Although we failed to find any conclusive BRCA1 large genomic rearrangement and did not find any BRCA2 large genomic rearrangement in familial breast cancer patients and at risk individuals in the current study, a large study sample especially including Eurasians and other ethnic groups may reveal novel or reported genomic rearrangements among Sri Lankans.
A total of 105 participants (N = 57 with a family history of breast cancer, N = 25 at risk individuals and N = 23 healthy controls without a personal or family history of any cancer) were studied. Mean age at diagnosis was 47.76 ± 9.55 years for familial breast cancer patients.
Fourteen familial patients were diagnosed below 40 years of age. Mean age at the MLPA analysis was 36.88 ± 14.95 for at risk individuals. Among the familial cases 34, 17 and 4 patients had one, two and three affected family members respectively. Two patients had 4 affected family members. According to histopathlogical data of familial breast cancer patients, 48 had infiltrating (invasive) ductal carcinoma and data were not recorded for remaining 9 patients. None of the patients had metastasis.
The majority of the patients and controls and all at-risk individuals were ethnically Sinhalese. There were no descendents of Europeans. Ethical approval from the Research, Ethics and Higher Degree Committee, Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo and written informed consent from the study participants were obtained prior to the study.
Genomic DNA was extracted using the protocol described by Miller et al. from aliquots of peripheral blood samples that had been stored at -20˚C. MLPA was performed using the SALSA MLPA KIT P002-C1 BRCA1 probemix and SALSA MLPA KIT P090 BRCA2 probemix (MRC-Holland, Amsterdam, Netherlands) for BRCA1 and BRCA2 genes according to manufacturer’s protocol. The processed data obtained via MegaBACE Genetic Profiler software suite® v2.2 as well as via ABI GeneMapper® v4.1 were analyzed by using Coffalyser. Net 01 software.
Exon 5, 6 and 7 specific primers were designed in order to confirm the predicted ambiguous deletion detected from MLPA data. These primers were able to amplify whole regions of exon 5, 6 and 7 and MLPA probe hybridization site as well as several intronic regions. Resultant PCR products were subjected to direct sequencing using Applied Biosystems™ 3500 DX Genetic Analyzer in order to locate the deletion site of exon 6 as well as to confirm the data obtained from MLPA analysis.
Martin AM, Blackwood MA, Antin-Ozerkis D, Shih HA, Calzone K, Colligon TA, Seal S, Collins N, Stratton MR, Weber BL, Nathanson KL: Germline mutations in BRCA1 and BRCA2 in breast-ovarian families from a breast cancer risk evaluation clinic. J Clin Oncol. 2001, 19: 2247-2253.
Peto J: Cancer epidemiology in the last century and the next decade. Nature. 2001, 411: 390-395. 10.1038/35077256.
Fackenthal JD, Olopade OI: Breast cancer risk associated with BRCA1 and BRCA2 in diverse populations. Nat Rev Cancer. 2007, 7: 937-948. 10.1038/nrc2054.
Cancer Incidence Data Sri Lanka Year 2001–2005: Cancer Registry National Cancer Control Programme. 2009, Colombo 5
De Silva W, Karunanayake EH, Tennekoon KH, Allen M, Amarasinghe I, Angunawala P, Ziard MH: Novel sequence variants and a high frequency of recurrent polymorphisms in BRCA1 gene in Sri Lankan breast cancer patients and at risk individuals. BMC Cancer. 2008, 8: 214-10.1186/1471-2407-8-214.
De Silva S, Tennekoon KH, Karunanayake EH, De Silva W, Amarasinghe I, Angunawela P: Novel sequence variants and common recurrent polymorphisms of BRCA2 in Sri Lankan breast cancer patients and a family with BRCA1 mutations. Exp Ther Med. 2011, 2: 1163-1170.
Mazoyer S: Genomic rearrangements in the BRCA1 and BRCA2 genes. Hum Mutat. 2005, 25: 415-422. 10.1002/humu.20169.
Seong MW, Cho SI, Noh DY, Han W, Kim SW, Park CM, Park HW, Kim SY, Kim JY, Park SS: Low contribution of BRCA1/2 genomic rearrangement to high-risk breast cancer in the Korean population. Fam Cancer. 2009, 8: 505-508. 10.1007/s10689-009-9279-z.
Lim YK, Lau PT, Ali AB, Lee SC, Wong JE, Putti TC, Sng JH: Identification of novel BRCA large genomic rearrangements in Singapore Asian breast and ovarian patients with cancer. Clin Genet. 2007, 71: 331-342. 10.1111/j.1399-0004.2007.00773.x.
Kang P, Mariapun S, Phuah SY, Lim LS, Liu J, Yoon SY, Thong MK, Mohd Taib NA, Yip CH, Teo SH: Large BRCA1 and BRCA2 genomic rearrangements in Malaysian high risk breast-ovarian cancer families. Breast Cancer Res Treat. 2010, 124: 579-584. 10.1007/s10549-010-1018-5.
Kwong A, Ng EK, Law FB, Wong HN, Wa A, Wong CL, Kurian AW, West DW, Ford JM, Ma ES: Novel BRCA1 and BRCA2 genomic rearrangements in Southern Chinese breast/ovarian cancer patients. Breast Cancer Res Treat. 2012, 136: 931-933. 10.1007/s10549-012-2292-1.
de la Hoya M, Gutiérrez-Enríquez S, Velasco E, Osorio A, Sanchez de Abajo A, Vega A, Salazar R, Esteban E, Llort G, Gonzalez-Sarmiento R, Carracedo A, Benítez J, Miner C, Díez O, Díaz-Rubio E, Caldes T: Genomic rearrangements at the BRCA1 locus in Spanish families with breast/ovarian cancer. Clin Chem. 2006, 52: 1480-1485. 10.1373/clinchem.2006.070110.
Torres D, Rashid MU, Seidel-Renkert A, Weitzel JN, Briceno I, Hamann U, Colombian Breast Cancer Study Group (COLBCS): Absence of the BRCA1 del (exons 9–12) mutation in breast/ovarian cancer families outside of Mexican Hispanics. Breast Cancer Res Treat. 2009, 117: 679-681. 10.1007/s10549-009-0383-4.
Pylkas K, Erkko H, Nikkila J, Solyom S, Winqvist R: Analysis of large deletions in BRCA1, BRCA2 and PALB2 genes in Finnish breast and ovarian cancer families. BMC Cancer. 2008, 8: 146-10.1186/1471-2407-8-146.
Deininger PL, Batzer MA: Alu repeats and human disease. Mol Genet Metab. 1999, 67: 183-193. 10.1006/mgme.1999.2864.
Smith TM, Lee MK, Szabo CI, Jerome N, McEuen M, Taylor M, Hood L, King MC: Complete genomic sequence and analysis of 117 kb of human DNA containing the gene BRCAI. Genome Res. 1996, 6: 1029-1049. 10.1101/gr.6.11.1029.
Puget N, Gad S, Perrin-Vidoz L, Sinilnikova OM, Stoppa-Lyonnet D, Lenoir GM, Mazoyer S: Distinct BRCA1 rearrangements involving the BRCA1 pseudogene suggest the existence of a recombination hot spot. Am J Hum Genet. 2002, 70: 858-865. 10.1086/339434.
Montagna M, Santacatterina M, Torri A, Menin C, Zullato D, Chieco-Bianchi L, D'Andrea E: Identification of a 3 kb Alu-mediated BRCA1 gene rearrangement in two breast/ovarian cancer families. Oncogene. 1999, 18: 4160-4165. 10.1038/sj.onc.1202754.
Stadler ZK, Saloustros E, Hansen NA, Schluger AE, Kauff ND, Offit K, Robson ME: Absence of genomic BRCA1 and BRCA2 rearrangements in Ashkenazi breast and ovarian cancer families. Breast Cancer Res Treat. 2010, 123: 581-585. 10.1007/s10549-010-0818-y.
Sluiter MD, van Rensburg EJ: Large genomic rearrangements of the BRCA1 and BRCA2 genes: review of the literature and report of a novel BRCA1 mutation. Breast Cancer Res Treat. 2011, 125: 325-349. 10.1007/s10549-010-0817-z.
Mahon SM: Large genomic rearrangements in BRCA1 and BRCA2. Implications for patient care. Oncol Nurs Forum. 2013, 40: 220-222. 10.1188/13.ONF.220-222.
Thomassen M, Gerdes AM, Cruger D, Jensen PK, Kruse TA: Low frequency of large genomic rearrangements of BRCA1 and BRCA2 in Western Denmark. Cancer Genet Cytogenet. 2006, 168: 168-171. 10.1016/j.cancergencyto.2005.12.016.
Gad S, Caux-Moncoutier V, Pages-Berhouet S, Gauthier-Villars M, Coupier I, Pujol P, Frénay M, Gilbert B, Maugard C, Bignon YJ, Chevrier A, Rossi A, Fricker JP, Nguyen TD, Demange L, Aurias A, Bensimon A, Stoppa-Lyonnet D: Significant contribution of large BRCA1 gene rearrangements in 120 French breast and ovarian cancer families. Oncogene. 2002, 21: 6841-6847. 10.1038/sj.onc.1205685.
Miller SA, Dykes DD, Poleskey HF: A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res. 1988, 16: 12-15.
We thank Dr Wasanthi De Silva for sample collection and DNA extraction. This study was supported by the Sida/Secretariat for Research Cooperation Grant for Molecular Biology and Biotechnology awarded to E.H.K. and K.H.T. and constituted part of the PhD programme of S.deS.
Authors declare that they have no competing interests.
SDS carried out molecular genetic studies, sequence alignment and drafted the manuscript. EHK and KHT conceived and designed the study, helped molecular genetic studies, data analysis and revision of the manuscript. IA and PA provided clinical expertise, recruitment of study participants and supervised clinical data and sample collection. All authors read and approved the final manuscript.
Authors’ original submitted files for images
Below are the links to the authors’ original submitted files for images.
Rights and permissions
Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( https://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
About this article
Cite this article
De Silva, S., Tennekoon, K.H., Karunanayake, E.H. et al. Analysis of BRCA1 and BRCA2 large genomic rearrangements in Sri Lankan familial breast cancer patients and at risk individuals. BMC Res Notes 7, 344 (2014). https://doi.org/10.1186/1756-0500-7-344
- Large genomic rearrangements
- Breast cancer