Reassessing the role of the p.(Arg304Gln) missense AIP variant in pituitary tumorigenesis.
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Loughrey Paul Benjamin, Mothojakan Nadira B, Iacovazzo Donato, Arni Ankit, Aflorei Elena D, Arnaldi Giorgio, Barlier Anne, Beckers Albert, Bizzi Mariana F, Chanson Philippe, Dal Jakob, Daly Adrian F, Dang Mary N, David Alessia, Andrade Matheus de Oliveira, Else Tobias, Elston Marianne S, Evans Amy, Ferrau Francesco, Fica Simona, Flanagan Daniel, Gadelha Monica R, Grossman Ashley B, Kapur Sonal, Khoo Bernard, Kumar Ajith V, Kumar-Sinha Chandan, Lechan Ronald M, Ludman Mark, Metherell Louise A, Miljic Dragana, Mourougavelou Vishnou, Musat Madalina, Occhi Gianluca, Owens Martina, Pascanu Ionela, Pinheiro Sergio V B, Radian Serban, Ribeiro-Oliveira Antonio, Schöfl Christof, Patel Kashyap A, Hernández-Ramírez Laura C, Korbonits Márta
Аннотация
DESIGN: Data were collected on published R304Q pituitary neuroendocrine tumour cases and from International Familial Isolated Pituitary Adenoma Consortium R304Q cases (n = 38, R304Q cohort). Clinical features, population cohort frequency, computational analyses, prediction models, presence of loss-of-heterozygosity, and in vitro/in vivo functional studies were assessed and compared with data from pathogenic/likely pathogenic AIP variant patients (AIPmut cohort, n = 184).
RESULTS: Of 38 R304Q patients, 61% (23/38) had growth hormone excess, in contrast to 80% of AIPmut cohort (147/184, P < .001). R304Q cohort was older at disease onset and diagnosis than the AIPmut cohort (median [quartiles] onset: 25 y [16-35] vs 16 y [14-23], P < .001; median [quartiles] diagnosis: 36 y [24-44] vs 21 y [15-29], P < .001). R304Q is present in gnomADv2.1 (0.31%) and UK Biobank (0.16%), including three persons with homozygous R304Q. No loss-of-heterozygosity was detected in four R304Q pituitary neuroendocrine tumour samples. In silico predictions and experimental data were conflicting.
CONCLUSIONS: Evidence suggests that R304Q is not pathogenic for pituitary neuroendocrine tumour. We recommend changing this variant classification to likely benign and do not recommend pre-symptomatic genetic testing of family members or follow-up of already identified unaffected individuals with the R304Q variant.