Genomic modifiers of PHTS

Introduction

Different individuals with the same PTEN variant, even within the same family, can develop very different combinations of symptoms, with some being affected from early childhood and others only later in life. This suggests that it is not just the alteration in the PTEN gene that determines how PHTS develops in an individual and makes it difficult for doctors and people with PHTS to know what symptoms they are likely to develop.

The term ‘genome’ is used to describe the entire genetic material of an individual. Made of DNA, the genome consists of over 30,000 different genes. In between these genes is a large amount of less characterised, silent DNA, a bit like the so-called “dark matter” in the genomic universe.

An earlier PTEN Research funded project by Professor Eng’s group suggested that alterations in the silent DNA of the genome may play a role, alongside the PTEN gene variants, in determining which, how and when different PHTS symptoms may develop in an individual. 

Key facts

Project title: Whole Genome Sequencing for Non-Coding Modifiers of Clinical Outcomes in Individuals with Germline PTEN Mutations

Type of study: Natural history/translational medicine

Lead researcher: Professor Charis Eng, MD PhD

Institution: Genomic Medicine Institute, Cleveland Clinic, USA

Project start: September 2020      Expected completion: December 2026

The whole of PTEN Research Foundation were greatly saddened to hear of the death of Prof Charis Eng. This work has been completed and the key results have been published with an additional publication in progress. 

Project goals

This  project aimed to identify specific DNA alterations that may be associated with the development of more common symptoms, such as cancer, developmental delay, and autism in PHTS.

Project overview

Professor Eng’s group has already established a large group of people with PHTS through a network of expert centres in the USA who help researchers studying PHTS and the PTEN gene. From these, approximately 600 individuals have volunteered to have their whole genome sequenced – including both their genes and the silent DNA in between. By using sophisticated analytical techniques, the researchers then hunted through the genetic sequences of these people, to see if there were certain alterations in the genome that appeared to be associated with the development of particular PHTS symptoms (such as cancer, developmental delay, autism) or combinations of symptoms. 

Outcomes

The headline results of the study have been published, identifying many potential genes that are linked to either PHTS associated cancer or neurodevelopmental symptoms. However, further studies are needed to understand if these statistical associations can be translated into clinical care in the future.

 

The following publications have resulted from work associated with this grant:

Eng CS2 2021 Image
  • I have always wanted to crack Cowden syndrome and find the gene responsible since I was a medical student so that we may empower our patients. The triumph of genetic research has led to our ability to predict what clinical features PHTS is at risk for, which form the basis for our national practice guidelines for enhanced clinical screening and catching things early (when curable). However, this first step makes predictions based on a group (x% likelihood by age y, etc). Our proposed research hopes to be able to find genomic markers which can stratify risk of cancer versus autism at a more individual level, thus empowering each individual and his/her caregiver to tailor treatment and management person by person. This sounds like a tall order, and it is, but we are taking the first baby step here, thanks to the PTEN Research Foundation. “千里之行,始於足下" (A journey of a thousand miles begins with a single step) – Lao Tze, Dao De Tzing, Ch. 64

    Professor Charis Eng