TY - JOUR
T1 - Intragenic deletions and a deep intronic mutation affecting pre-mRNA splicing in the dihydropyrimidine dehydrogenase gene as novel mechanisms causing 5-fluorouracil toxicity
AU - van Kuilenburg, A.B.P.
AU - Meijer, J.
AU - Mul, A.N.P.M.
AU - Meinsma, R.
AU - Schmid, V.
AU - Dobritzsch, D.
AU - Hennekam, R.C.M.
AU - Mannens, M.M.A.M.
AU - Kiechle, M.
AU - Etienne-Grimaldi, M.C.
AU - Klümpen, H.J.
AU - Maring, J.G.
AU - Derleyn, V.A.
AU - Maartense, E.
AU - Milano, G.
AU - Vijzelaar, R.
AU - Gross, E.
PY - 2010
Y1 - 2010
N2 - Dihydropyrimidine dehydrogenase (DPD) is the initial enzyme acting in the catabolism of the widely used antineoplastic agent 5-fluorouracil (5FU). DPD deficiency is known to cause a potentially lethal toxicity following administration of 5FU. Here, we report novel genetic mechanisms underlying DPD deficiency in patients presenting with grade III/IV 5FU-associated toxicity. In one patient a genomic DPYD deletion of exons 21-23 was observed. In five patients a deep intronic mutation c.1129-5923C > G was identified creating a cryptic splice donor site. As a consequence, a 44 bp fragment corresponding to nucleotides c.1129-5967 to c.1129-5924 of intron 10 was inserted in the mature DPD mRNA. The deleterious c.1129-5923C > G mutation proved to be in cis with three intronic polymorphisms (c.483 + 18G > A, c.959-51T > G, c.680 + 139G > A) and the synonymous mutation c.1236G > A of a previously identified haplotype. Retrospective analysis of 203 cancer patients showed that the c.1129-5923C > G mutation was significantly enriched in patients with severe 5FU-associated toxicity (9.1%) compared to patients without toxicity (2.2%). In addition, a high prevalence was observed for the c.1129-5923C > G mutation in the normal Dutch (2.6%) and German (3.3%) population. Our study demonstrates that a genomic deletion affecting DPYD and a deep intronic mutation affecting pre-mRNA splicing can cause severe 5FU-associated toxicity. We conclude that screening for DPD deficiency should include a search for genomic rearrangements and aberrant splicing
AB - Dihydropyrimidine dehydrogenase (DPD) is the initial enzyme acting in the catabolism of the widely used antineoplastic agent 5-fluorouracil (5FU). DPD deficiency is known to cause a potentially lethal toxicity following administration of 5FU. Here, we report novel genetic mechanisms underlying DPD deficiency in patients presenting with grade III/IV 5FU-associated toxicity. In one patient a genomic DPYD deletion of exons 21-23 was observed. In five patients a deep intronic mutation c.1129-5923C > G was identified creating a cryptic splice donor site. As a consequence, a 44 bp fragment corresponding to nucleotides c.1129-5967 to c.1129-5924 of intron 10 was inserted in the mature DPD mRNA. The deleterious c.1129-5923C > G mutation proved to be in cis with three intronic polymorphisms (c.483 + 18G > A, c.959-51T > G, c.680 + 139G > A) and the synonymous mutation c.1236G > A of a previously identified haplotype. Retrospective analysis of 203 cancer patients showed that the c.1129-5923C > G mutation was significantly enriched in patients with severe 5FU-associated toxicity (9.1%) compared to patients without toxicity (2.2%). In addition, a high prevalence was observed for the c.1129-5923C > G mutation in the normal Dutch (2.6%) and German (3.3%) population. Our study demonstrates that a genomic deletion affecting DPYD and a deep intronic mutation affecting pre-mRNA splicing can cause severe 5FU-associated toxicity. We conclude that screening for DPD deficiency should include a search for genomic rearrangements and aberrant splicing
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=78049435885&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/20803296
U2 - https://doi.org/10.1007/s00439-010-0879-3
DO - https://doi.org/10.1007/s00439-010-0879-3
M3 - Article
C2 - 20803296
SN - 0340-6717
VL - 128
SP - 529
EP - 538
JO - Human genetics
JF - Human genetics
IS - 5
ER -