Cancer Cell
Volume 35, Issue 2, 11 February 2019, Pages 256-266.e5
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Article
Mutational Signature Analysis Reveals NTHL1 Deficiency to Cause a Multi-tumor Phenotype

https://doi.org/10.1016/j.ccell.2018.12.011Get rights and content
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Highlights

  • Biallelic germline NTHL1 mutations predispose to a multi-tumor syndrome

  • Biallelic germline NTHL1 mutation carriers are at risk for breast cancer

  • Tumors from NTHL1-deficient patients reveal a cross-cancer NTHL1-associated signature

  • Mutational signature analyses can assist to identify germline DNA repair defects

Summary

Biallelic germline mutations affecting NTHL1 predispose carriers to adenomatous polyposis and colorectal cancer, but the complete phenotype is unknown. We describe 29 individuals carrying biallelic germline NTHL1 mutations from 17 families, of which 26 developed one (n = 10) or multiple (n = 16) malignancies in 14 different tissues. An unexpected high breast cancer incidence was observed in female carriers (60%). Mutational signature analysis of 14 tumors from 7 organs revealed that NTHL1 deficiency underlies the main mutational process in all but one of the tumors (93%). These results reveal NTHL1 as a multi-tumor predisposition gene with a high lifetime risk for extracolonic cancers and a typical mutational signature observed across tumor types, which can assist in the recognition of this syndrome.

Keywords

mutational signature
base excision repair
adenomatous polyposis
genetic predisposition
DNA repair defect
somatic mutation spectrum
multiple malignancies
breast cancer
colorectal cancer
NTHL1

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