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Ana-Teresa Maia

Institute for Biotechnology and Bioengineering
Centre for Molecular and Structural Biomedicine    
Department of Biomedical Sciences and Medicine        
Gambelas Campus, Building 7
University of Algarve               
8005-139 Faro, PORTUGAL
http://www.ibb.pt/                      
http://www.cbme.ualg.pt  
http://www.medicina.ualg.pt       
maia.anateresa@gmail.com

Journal articles

2012
C Curtis, S P Shah, S F Chin, G Turashvili, O M Rueda, M J Dunning, D Speed, A G Lynch, S Samarajiwa, Y Yuan, S Gräf, G Ha, G Haffari, A Bashashati, R Russell, S McKinney, METABRIC Group, Co-chairs, C Caldas, S Aparicio, committee Writing, C Curtis, S P Shah, C Caldas, S Aparicio, committee Steering, J D Brenton, I Ellis, D Huntsman, S Pinder, A Purushotham, L Murphy, C Caldas, S Aparicio, Tissue, clinical data source sites, University of Cambridge/Cancer Research UK Cambridge Research Institute, C Caldas, H Bardwell, S F Chin, C Curtis, Z Ding, S Gräf, L Jones, B Liu, A G Lynch, I Papatheodorou, S J Sammut, G Wishart, British Columbia Cancer Agency, S Aparicio, S Chia, K Gelmon, D Huntsman, S McKinney, C Speers, G Turashvili, P Watson, University of Nottingham, I Ellis, R Blamey, A Green, D Macmillan, E Rakha, King’s College London, A Purushotham, C Gillett, A Grigoriadis, S Pinder, di Rinaldis E, A Tutt, Manitoba Institute of of Biology, L Murphy, M Parisien, S Troup, genome/transcriptome characterization centres Cancer, University of Cambridge/Cancer Research UK Cambridge Research Institute, C Caldas, S F Chin, D Chan, C Fielding, A T Maia, S McGuire, M Osborne, S M Sayalero, I Spiteri, J Hadfield, British Columbia Cancer Agency, S Aparicio, G Turashvili, L Bell, K Chow, N Gale, D Huntsman, M Kovalik, Y Ng, L Prentice, analysis subgroup Data, University of Cambridge/Cancer Research UK Cambridge Research Institute, C Caldas, S Tavaré, C Curtis, M J Dunning, S Gräf, A G Lynch, O M Rueda, R Russell, S Samarajiwa, D Speed, F Markowetz, Y Yuan, J D Brenton, British Columbia Cancer Agency, S Aparicio, S P Shah, A Bashashati, G Ha, G Haffari, S McKinney, A Langerød, A Green, E Provenzano, G Wishart, S Pinder, P Watson, F Markowetz, L Murphy, I Ellis, A Purushotham, A L Børresen-Dale, J D Brenton, S Tavaré, C Caldas, S Aparicio (2012)  The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups   Nature April  
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2011
Kerstin B Meyer, Ana-Teresa Maia, Martin O'Reilly, Maya Ghoussaini, Radhika Prathalingam, Patricia Porter-Gill, Stefan Ambs, Ludmila Prokunina-Olsson, Jason Carroll, Bruce A J Ponder (2011)  A Functional Variant at a Prostate Cancer Predisposition Locus at 8q24 Is Associated with PVT1 Expression.   PLoS Genet 7: 7. Jul  
Abstract: Genetic mapping studies have identified multiple cancer susceptibility regions at chromosome 8q24, upstream of the MYC oncogene. MYC has been widely presumed as the regulated target gene, but definitive evidence functionally linking these cancer regions with MYC has been difficult to obtain. Here we examined candidate functional variants of a haplotype block at 8q24 encompassing the two independent risk alleles for prostate and breast cancer, rs620861 and rs13281615. We used the mapping of DNase I hypersensitive sites as a tool to prioritise regions for further functional analysis. This approach identified rs378854, which is in complete linkage disequilibrium (LD) with rs620861, as a novel functional prostate cancer-specific genetic variant. We demonstrate that the risk allele (G) of rs378854 reduces binding of the transcription factor YY1 in vitro. This factor is known to repress global transcription in prostate cancer and is a candidate tumour suppressor. Additional experiments showed that the YY1 binding site is occupied in vivo in prostate cancer, but not breast cancer cells, consistent with the observed cancer-specific effects of this single nucleotide polymorphism (SNP). Using chromatin conformation capture (3C) experiments, we found that the region surrounding rs378854 interacts with the MYC and PVT1 promoters. Moreover, expression of the PVT1 oncogene in normal prostate tissue increased with the presence of the risk allele of rs378854, while expression of MYC was not affected. In conclusion, we identified a new functional prostate cancer risk variant at the 8q24 locus, rs378854 allele G, that reduces binding of the YY1 protein and is associated with increased expression of PVT1 located 0.5 Mb downstream.
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2010
Miriam S Udler, Shahana Ahmed, Catherine S Healey, Kerstin Meyer, Jeffrey Struewing, Melanie Maranian, Erika M Kwon, Jinghui Zhang, Jonathan Tyrer, Eric Karlins, Radka Platte, Bolot Kalmyrzaev, Ed Dicks, Helen Field, Ana-Teresa Maia, Radhika Prathalingam, Andrew Teschendorff, Stewart McArthur, David R Doody, Robert Luben, Carlos Caldas, Leslie Bernstein, Laurence K Kolonel, Brian E Henderson, Anna H Wu, Loic Le Marchand, Giske Ursin, Michael F Press, Annika Lindblom, Sara Margolin, Chen-Yang Shen, Show-Lin Yang, Chia-Ni Hsiung, Daehee Kang, Keun-Young Yoo, Dong-Young Noh, Sei-Hyun Ahn, Kathleen E Malone, Christopher A Haiman, Paul D Pharoah, Bruce A J Ponder, Elaine A Ostrander, Douglas F Easton, Alison M Dunning (2010)  Fine scale mapping of the breast cancer 16q12 locus.   Hum Mol Genet 19: 12. 2507-2515 Jun  
Abstract: Recent genome-wide association studies have identified a breast cancer susceptibility locus on 16q12 with an unknown biological basis. We used a set of single nucleotide polymorphism (SNP) markers to generate a fine-scale map and narrowed the region of association to a 133 kb DNA segment containing the largely uncharacterized hypothetical gene LOC643714, a short intergenic region and the 5' end of TOX3. Re-sequencing this segment in European subjects identified 293 common polymorphisms, including a set of 26 highly correlated candidate causal variants. By evaluation of these SNPs in five breast cancer case-control studies involving more than 23 000 subjects from populations of European and Southeast Asian ancestry, all but 14 variants could be excluded at odds of <1:100. Most of the remaining variants lie in the intergenic region, which exhibits evolutionary conservation and open chromatin conformation, consistent with a regulatory function. African-American case-control studies exhibit a different pattern of association suggestive of an additional causative variant.
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E M Azzato, A J X Lee, A Teschendorff, B A J Ponder, P Pharoah, C Caldas, A T Maia (2010)  Common germ-line polymorphism of C1QA and breast cancer survival.   Br J Cancer 102: 8. 1294-1299 Apr  
Abstract: BACKGROUND: A synonymous single nucleotide polymorphism (SNP) rs172378 (A>G, Gly->Gly) in the complement component C1QA has been proposed to be associated with distant breast cancer metastasis. We previously reported overexpression of this gene to be significantly associated with better prognosis in oestrogen-receptor-negative tumours. The purpose of this study was to investigate the association of rs172378 with expression of C1QA and breast cancer survival. METHODS: We analysed the gene expression pattern of rs172378 in normal and tumour tissue samples, and further explored its involvement in relation to mortality in 2270 women with breast cancer participating in Studies of Epidemiology and Risk factors in Cancer Heredity, a population-based case-control study. RESULTS: We found that although rs172378 showed differential allelic expression significantly different between normal (preferentially expressing the G allele) and tumour tissue samples (preferentially expressing the A allele), there was no significant difference in survival by rs172378 genotype (per allele hazard ratio (HR) 1.02, 95% CI: 0.88-1.19, P=0.78 for all-cause mortality; HR 1.03, 95% CI: 0.87-1.22, P=0.72 for breast-cancer-specific mortality). CONCLUSION: Our study results show that rs172378 is linked to a cis-regulatory element affecting gene expression and that allelic preferential expression is altered in tumour samples, but do not support an association between genetic variation in C1QA and breast cancer survival.
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Margarida Alves, Isabel Carreira, Paulo Liberato, Sância Ramos, Manuela Mafra, Alexandra S Inverno, Ana T Maia, Ana Paula Martins, Miguel Brito, Carolino Monteiro (2010)  Identification of a 0.4 Kb deletion region in 10q26 associated with endometrial carcinoma.   Oncol Rep 23: 2. 519-522 Feb  
Abstract: We have identified an allelic deletion common region in the q26 region of chromosome 10 in endometrial carcinomas, which has been reported previously as a potential target of genetic alterations related to this neoplasia. An allelotyping analysis of 19 pairs of tumoral and non-tumoral samples was accomplished using seven microsatellite polymorphic markers mapping in the 10q26 chromosomal region. Loss of heterozygosity for one or more loci was detected in 29% of the endometrial carcinoma samples. The observed pattern of loss enabled the identification of a 3.5 Mb common deleted region located between the D10S587 and D10S186 markers. An additional result from an endometrial sample with evidence of a RER phenotype may suggest a more centromeric region of loss within the above-mentioned interval. This 401.84 Kb interval flanked by the D10S587 and D10S216 markers may be a plausible location for a putative suppressor gene involved in early stage endometrial carcinogenesis.
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2009
Alison M Dunning, Catherine S Healey, Caroline Baynes, Ana-Teresa Maia, Serena Scollen, Ana Vega, Raquel Rodríguez, Nuno L Barbosa-Morais, Bruce A J Ponder, Yen-Ling Low, Sheila Bingham, Christopher A Haiman, Loic Le Marchand, Annegien Broeks, Marjanka K Schmidt, John Hopper, Melissa Southey, Matthias W Beckmann, Peter A Fasching, Julian Peto, Nichola Johnson, Stig E Bojesen, Børge Nordestgaard, Roger L Milne, Javier Benitez, Ute Hamann, Yon Ko, Rita K Schmutzler, Barbara Burwinkel, Peter Schürmann, Thilo Dörk, Tuomas Heikkinen, Heli Nevanlinna, Annika Lindblom, Sara Margolin, Arto Mannermaa, Veli-Matti Kosma, Xiaoqing Chen, Amanda Spurdle, Jenny Change-Claude, Dieter Flesch-Janys, Fergus J Couch, Janet E Olson, Gianluca Severi, Laura Baglietto, Anne-Lise Børresen-Dale, Vessela Kristensen, David J Hunter, Susan E Hankinson, Peter Devilee, Maaike Vreeswijk, Jolanta Lissowska, Louise Brinton, Jianjun Liu, Per Hall, Daehee Kang, Keun-Young Yoo, Chen-Yang Shen, Jyh-Cherng Yu, Hoda Anton-Culver, Argyrios Ziogoas, Alice Sigurdson, Jeff Struewing, Douglas F Easton, Montserrat Garcia-Closas, Manjeet K Humphreys, Jonathan Morrison, Paul D P Pharoah, Karen A Pooley, Georgia Chenevix-Trench (2009)  Association of ESR1 gene tagging SNPs with breast cancer risk.   Hum Mol Genet 18: 6. 1131-1139 Mar  
Abstract: We have conducted a three-stage, comprehensive single nucleotide polymorphism (SNP)-tagging association study of ESR1 gene variants (SNPs) in more than 55,000 breast cancer cases and controls from studies within the Breast Cancer Association Consortium (BCAC). No large risks or highly significant associations were revealed. SNP rs3020314, tagging a region of ESR1 intron 4, is associated with an increase in breast cancer susceptibility with a dominant mode of action in European populations. Carriers of the c-allele have an odds ratio (OR) of 1.05 [95% Confidence Intervals (CI) 1.02-1.09] relative to t-allele homozygotes, P = 0.004. There is significant heterogeneity between studies, P = 0.002. The increased risk appears largely confined to oestrogen receptor-positive tumour risk. The region tagged by SNP rs3020314 contains sequence that is more highly conserved across mammalian species than the rest of intron 4, and it may subtly alter the ratio of two mRNA splice forms.
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Ana-Teresa Maia, Inmaculada Spiteri, Alvin J X Lee, Martin O'Reilly, Linda Jones, Carlos Caldas, Bruce A J Ponder (2009)  Extent of differential allelic expression of candidate breast cancer genes is similar in blood and breast.   Breast Cancer Res 11: 6. 12  
Abstract: INTRODUCTION: Normal gene expression variation is thought to play a central role in inter-individual variation and susceptibility to disease. Regulatory polymorphisms in cis-acting elements result in the unequal expression of alleles. Differential allelic expression (DAE) in heterozygote individuals could be used to develop a new approach to discover regulatory breast cancer susceptibility loci. As access to large numbers of fresh breast tissue to perform such studies is difficult, a suitable surrogate test tissue must be identified for future studies. METHODS: We measured differential allelic expression of 12 candidate genes possibly related to breast cancer susceptibility (BRCA1, BRCA2, C1qA, CCND3, EMSY, GPX1, GPX4, MLH3, MTHFR, NBS1, TP53 and TRXR2) in breast tissue (n = 40) and fresh blood (n = 170) of healthy individuals and EBV-transformed lymphoblastoid cells (n = 19). Differential allelic expression ratios were determined by Taqman assay. Ratio distributions were compared using t-test and Wilcoxon rank sum test, for mean ratios and variances respectively. RESULTS: We show that differential allelic expression is common among these 12 candidate genes and is comparable between breast and blood (fresh and transformed lymphoblasts) in a significant proportion of them. We found that eight out of nine genes with DAE in breast and fresh blood were comparable, as were 10 out of 11 genes between breast and transformed lymphoblasts. CONCLUSIONS: Our findings support the use of differential allelic expression in blood as a surrogate for breast tissue in future studies on predisposition to breast cancer.
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2008
Yoko Ito, Thibaud Koessler, Ashraf E K Ibrahim, Sushma Rai, Sarah L Vowler, Sayeda Abu-Amero, Ana-Luisa Silva, Ana-Teresa Maia, Joanna E Huddleston, Santiago Uribe-Lewis, Kathryn Woodfine, Maja Jagodic, Raffaella Nativio, Alison Dunning, Gudrun Moore, Elena Klenova, Sheila Bingham, Paul D P Pharoah, James D Brenton, Stephan Beck, Manjinder S Sandhu, Adele Murrell (2008)  Somatically acquired hypomethylation of IGF2 in breast and colorectal cancer.   Hum Mol Genet 17: 17. 2633-2643 Sep  
Abstract: The imprinted insulin-like growth factor 2 (IGF2) gene is expressed predominantly from the paternal allele. Loss of imprinting (LOI) associated with hypomethylation at the promoter proximal sequence (DMR0) of the IGF2 gene was proposed as a predisposing constitutive risk biomarker for colorectal cancer. We used pyrosequencing to assess whether IGF2 DMR0 methylation is either present constitutively prior to cancer or whether it is acquired tissue-specifically after the onset of cancer. DNA samples from tumour tissues and matched non-tumour tissues from 22 breast and 42 colorectal cancer patients as well as peripheral blood samples obtained from colorectal cancer patients [SEARCH (n=case 192, controls 96)], breast cancer patients [ABC (n=case 364, controls 96)] and the European Prospective Investigation of Cancer [EPIC-Norfolk (n=breast 228, colorectal 225, controls 895)] were analysed. The EPIC samples were collected 2-5 years prior to diagnosis of breast or colorectal cancer. IGF2 DMR0 methylation levels in tumours were lower than matched non-tumour tissue. Hypomethylation of DMR0 was detected in breast (33%) and colorectal (80%) tumour tissues with a higher frequency than LOI indicating that methylation levels are a better indicator of cancer than LOI. In the EPIC population, the prevalence of IGF2 DMR0 hypomethylation was 9.5% and this correlated with increased age not cancer risk. Thus, IGF2 DMR0 hypomethylation occurs as an acquired tissue-specific somatic event rather than a constitutive innate epimutation. These results indicate that IGF2 DMR0 hypomethylation has diagnostic potential for colon cancer rather than value as a surrogate biomarker for constitutive LOI.
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M Barber, A Murrell, Y Ito, A - T Maia, S Hyland, C Oliveira, V Save, F Carneiro, A L Paterson, N Grehan, S Dwerryhouse, P Lao-Sirieix, C Caldas, R C Fitzgerald (2008)  Mechanisms and sequelae of E-cadherin silencing in hereditary diffuse gastric cancer.   J Pathol 216: 3. 295-306 Nov  
Abstract: Around 25-40% of cases of hereditary diffuse gastric cancer (HDGC) are caused by heterozygous E-cadherin (CDH1) germline mutations. The mechanisms for loss of the second allele still remain unclear. The aims of this study were to elucidate mechanisms for somatic inactivation of the wild-type CDH1 allele and to seek evidence for cadherin switching. Archival tumour material was analysed from 16 patients with CDH1 germline mutations and seven patients fulfilling HDGC criteria without CDH1 germline mutations. The 16 CDH1 exons were sequenced. E-cadherin promoter methylation was analysed by bisulphite sequencing and pyrosequencing and allele specificity was determined using polymorphic loci. Loss of heterozygosity was analysed using microsatellite markers. Cadherin expression levels were determined by real-time RT-PCR and immunohistochemistry. Six of 16 individuals with germline mutations had at least one second hit mechanism. Two exonic mutations (exon 9 truncating, exon 3 missense) and four intronic mutations which may affect splicing were identified. Tumours from 4/16 individuals had promoter hypermethylation that was restricted to the A allele haplotype in three cases. E-cadherin loss (mRNA and protein) generally correlated with identification of a second hit. In cases without germline E-cadherin mutations there was no evidence for somatic mutation or significant promoter methylation. P-cadherin (>25% cells) was expressed in 7/13 (54%) and 4/5 (80%) with and without germline CDH1 mutations, respectively, independent of complete E-cadherin loss. Overall, inactivation of the second CDH1 allele occurs by mutation and methylation events. Methylation is commonly allele-specific and is uncommon without germline mutations. P-cadherin over-expression commonly occurs in individuals with diffuse type gastric cancer.
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Kerstin B Meyer, Ana-Teresa Maia, Martin O'Reilly, Andrew E Teschendorff, Suet-Feung Chin, Carlos Caldas, Bruce A J Ponder (2008)  Allele-specific up-regulation of FGFR2 increases susceptibility to breast cancer.   PLoS Biol 6: 5. May  
Abstract: The recent whole-genome scan for breast cancer has revealed the FGFR2 (fibroblast growth factor receptor 2) gene as a locus associated with a small, but highly significant, increase in the risk of developing breast cancer. Using fine-scale genetic mapping of the region, it has been possible to narrow the causative locus to a haplotype of eight strongly linked single nucleotide polymorphisms (SNPs) spanning a region of 7.5 kilobases (kb) in the second intron of the FGFR2 gene. Here we describe a functional analysis to define the causative SNP, and we propose a model for a disease mechanism. Using gene expression microarray data, we observed a trend of increased FGFR2 expression in the rare homozygotes. This trend was confirmed using real-time (RT) PCR, with the difference between the rare and the common homozygotes yielding a Wilcox p-value of 0.028. To elucidate which SNPs might be responsible for this difference, we examined protein-DNA interactions for the eight most strongly disease-associated SNPs in different breast cell lines. We identify two cis-regulatory SNPs that alter binding affinity for transcription factors Oct-1/Runx2 and C/EBPbeta, and we demonstrate that both sites are occupied in vivo. In transient transfection experiments, the two SNPs can synergize giving rise to increased FGFR2 expression. We propose a model in which the Oct-1/Runx2 and C/EBPbeta binding sites in the disease-associated allele are able to lead to an increase in FGFR2 gene expression, thereby increasing the propensity for tumour formation.
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2007
Miriam Udler, Ana-Teresa Maia, Arancha Cebrian, Clement Brown, David Greenberg, Mitul Shah, Carlos Caldas, Alison Dunning, Douglas Easton, Bruce Ponder, Paul Pharoah (2007)  Common germline genetic variation in antioxidant defense genes and survival after diagnosis of breast cancer.   J Clin Oncol 25: 21. 3015-3023 Jul  
Abstract: PURPOSE: The prognosis of breast cancer varies considerably among individuals, and inherited genetic factors may help explain this variability. Of particular interest are genes involved in defense against reactive oxygen species (ROS) because ROS are thought to cause DNA damage and contribute to the pathogenesis of cancer. PATIENTS AND METHODS: We examined associations between 54 polymorphisms that tag the known common variants (minor allele frequency > 0.05) in 10 genes involved in oxidative damage repair (CAT, SOD1, SOD2, GPX1, GPX4, GSR, TXN, TXN2, TXNRD1, and TXNRD2) and survival in 4,470 women with breast cancer. RESULTS: Two single nucleotide polymorphisms (SNPs) in GPX4 (rs713041 and rs757229) were associated with all-cause mortality even after adjusting for multiple hypothesis testing (adjusted P = .0041 and P = .0035). These SNPs are correlated with each other (r2 = 0.61). GPX4 rs713041 is located near the selenocysteine insertion sequence element in the GPX4 3' untranslated region, and the rare allele of this SNP is associated with an increased risk of death, with a hazard ratio of 1.27 per rare allele carried (95% CI, 1.13 to 11.43). This effect was not attenuated after adjusting for tumor stage, grade, or estrogen receptor status. We found that the common allele is preferentially expressed in normal lymphocytes, normal breast, and breast tumors compared with the rare allele, but there were no differences in total levels of GPX4 mRNA across genotypes. CONCLUSION: These data provide strong support for the hypothesis that common variation in GPX4 is associated with prognosis after a diagnosis of breast cancer.
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2006
Jacob G Bundy, N Gopalakrishna Iyer, Michelle S Gentile, De-En Hu, Mikko Kettunen, Ana-Teresa Maia, Natalie P Thorne, James D Brenton, Carlos Caldas, Kevin M Brindle (2006)  Metabolic consequences of p300 gene deletion in human colon cancer cells.   Cancer Res 66: 15. 7606-7614 Aug  
Abstract: Metabolite profiling using (1)H nuclear magnetic resonance (NMR) spectroscopy was used to investigate the metabolic changes associated with deletion of the gene for the transcriptional coactivator p300 in the human colon carcinoma cell line HCT116. Multivariate statistical methods were used to distinguish between metabolite patterns that were dependent on cell growth conditions and those that were specifically associated with loss of p300 function. In the absence of serum, wild-type cells showed slower growth, which was accompanied by a marked decrease in phosphocholine concentration, which was not observed in otherwise isogenic cell lines lacking p300. In the presence of serum, several metabolites were identified as being significantly different between the two cell types, including glutamate and glutamine, a nicotinamide-related compound and glycerophosphocholine (GPC). However, in the absence of serum, these metabolites, with the exception of GPC, were not significantly different, leading us to conclude that most of these changes were context dependent. Transcript profiling, using DNA microarrays, showed changes in the levels of transcripts for several enzymes involved in choline metabolism, which might explain the change in GPC concentration. Localized in vivo (1)H NMR measurements on the tumors formed following s.c. implantation of these cells into mice showed an increase in the intensity of the peak from choline-containing compounds in the p300(-) tumors. These data show that NMR-based metabolite profiling has sufficient sensitivity to identify the metabolic consequences of p300 gene deletion in tumor cells in vitro and in vivo.
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2004
Ana Teresa Maia, Roxane Tussiwand, Giovanni Cazzaniga, Paolo Rebulla, Susan Colman, Andrea Biondi, Mel Greaves (2004)  Identification of preleukemic precursors of hyperdiploid acute lymphoblastic leukemia in cord blood.   Genes Chromosomes Cancer 40: 1. 38-43 May  
Abstract: Previous studies involving identical twins with concordant leukemia and retrospective scrutiny of archived neonatal blood spots have shown that common chromosome translocations of pediatric leukemia frequently arise before birth. The IGH/TCR clonotypic sequences used as surrogate molecular markers suggest this is also likely to be true for hyperdiploid acute lymphoblastic leukemia (ALL). Yet evidence that hyperdiploidy itself is an early or initiating event occurring prenatally has been limited. Now, however, we can provide direct evidence of this from our identification of CD34+/CD19+ B-lineage progenitor cells with triploid chromosomes in the stored cord blood of an individual who subsequently developed hyperdiploid ALL.
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Ana Teresa Maia, Joachim Koechling, Robin Corbett, Markus Metzler, Joseph L Wiemels, Mel Greaves (2004)  Protracted postnatal natural histories in childhood leukemia.   Genes Chromosomes Cancer 39: 4. 335-340 Apr  
Abstract: Studies of monozygotic twins with concordant leukemia and scrutiny of archived neonatal blood by polymerase chain reaction (PCR) indicated that many pediatric leukemias are initiated prenatally by chromosomal translocation followed by a variable postnatal period before diagnosis of disease. The latter is thought to reflect a persistent preleukemic stage and a requirement for secondary genetic events. We sought to examine this further by examination of blood spots in rare cases of MLL fusion-positive or ETV6/RUNX1 (TEL-AML1) fusion gene-positive acute leukemia that were diagnosed at ages beyond the normal age range. We present evidence that the duration of the postnatal preleukemic state can occasionally be very protracted in these biological subtypes of pediatric leukemia, and we discuss its biological significance.
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2003
Jan Zuna, Katerina Muzikova, Anthony M Ford, Ana Teresa Maia, Ondrej Krejci, Katerina Tousovska, Irina Oravkinova, Mel Greaves, Jan Trka (2003)  Pre-natal, clonal origin of acute lymphoblastic leukaemia in triplets.   Leuk Lymphoma 44: 12. 2099-2102 Dec  
Abstract: A unique case of ALL in three monozygotic triplets diagnosed at the age of 24, 27 and 37 months is described. Archived bone marrow smears were available for molecular analysis of immunoglobulin heavy chain (IGH) and IGK genes and T-cell receptor (TCR)-delta and gamma gene rearrangements. A shared IGH rearrangement was found in triplets "A" and "B", and an identical rearrangement of TCR-delta in triplets "B" and "C". These data suggest a common, monoclonal initiation of ALL in one of these three triplets, followed by dissemination of clonal progeny to the other twins via vascular anastomoses within the single, monochorionic placenta that they shared in utero. Differences in IGH rearrangements in diagnostic samples also indicates divergent subclonal evolution of the original "pre-leukaemic" clone.
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A T Maia, V H J van der Velden, C J Harrison, T Szczepanski, M D Williams, M J Griffiths, J J M van Dongen, M F Greaves (2003)  Prenatal origin of hyperdiploid acute lymphoblastic leukemia in identical twins.   Leukemia 17: 11. 2202-2206 Nov  
Abstract: Studies in identical twins and with neonatal blood spots (Guthrie cards) have backtracked the origin of childhood acute leukemia and their associated chromosomal translocations to before birth. High hyperdiploidy is the most common genetic abnormality in childhood acute lymphoblastic leukemia (ALL). Evidence for an in utero initiation of this important genetic event in ALL is available from blood spots but remains limited. Twin children with hyperdiploid ALL have not hitherto been reported. We describe a pair of 2-year-old monozygotic twins with concordant B-cell precursor ALL and hyperdiploid karyotypes. One twin's leukemic cells had two rearranged TCRD alleles and one of these was a clonotypic Vdelta2-Ddelta3 sequence shared with leukemic cells of the other twin. The twins' leukemic cells had several different IGH V(H)-J(H) rearrangements but shared two common D(H)-J(H) 'stem' sequences. We conclude that ALL in these twins is likely to have originated prenatally in one fetus before spreading to the other via intraplacental anastomoses. It is likely that one or more additional postnatal genetic events was required for overt leukemogenesis.
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Mel F Greaves, Ana Teresa Maia, Joseph L Wiemels, Anthony M Ford (2003)  Leukemia in twins: lessons in natural history.   Blood 102: 7. 2321-2333 Oct  
Abstract: Identical infant twins with concordant leukemia were first described in 1882, and since that time many such pairs of infants and older children have been described. It has long been recognized that this situation offers a unique opportunity to identify aspects of the developmental timing, natural history, and molecular genetics of pediatric leukemia in general. We reviewed both the older literature and more recent molecular biologic studies that have uncovered the basis of concordance of leukemia. Molecular markers of clonality, including unique, genomic fusion gene sequences, have provided unequivocal evidence that twin pairs of leukemia have a common clonal origin. The only plausible basis for this, first suggested more than 40 years ago, is that following initiation of leukemia in one twin fetus, clonal progeny spread to the co-twin via vascular anastomoses within a single, monochorionic placenta. This explanation has been endorsed by the identification of clonotypic gene fusion sequences in archived neonatal blood spots of individuals who subsequently developed leukemia. These analyses of twin leukemias have thrown considerable light on the natural history of disease. They reveal a frequent prenatal origin and an early or initiating role for chromosome translocations. Further, they provide evidence for a variable and often protracted latency and the need, in childhood acute lymphoblastic leukemia (ALL)/acute myeloblastic leukemia (AML), for further postnatal exposures and/or genetic events to produce clinical disease. We argue that these insights provide a very useful framework for attempts to understand etiologic mechanisms.
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2002
Joseph L Wiemels, Zhijian Xiao, Patricia A Buffler, Ana T Maia, Xiaomei Ma, Brian M Dicks, Martyn T Smith, Luoping Zhang, James Feusner, John Wiencke, Kathy Pritchard-Jones, Helena Kempski, Mel Greaves (2002)  In utero origin of t(8;21) AML1-ETO translocations in childhood acute myeloid leukemia.   Blood 99: 10. 3801-3805 May  
Abstract: Recent reports have established the prenatal origin of leukemia translocations and resultant fusion genes in some patients, including MLL-AF4 translocations in infants and TEL-AML1 translocations in children. We now report evidence for the prenatal origin of a translocation in childhood acute myeloid leukemia (AML). The t(8;21) AML1-ETO translocations were sequenced at the genomic level in 10 diagnostic leukemia samples from children with available neonatal Guthrie blood spots. Clonotypic genomic AML1-ETO sequences were detected in the Guthrie spots for 5 individuals, providing unambiguous evidence of prenatal origin in these cases. Two of these patients were older than 10 years of age at diagnosis, indicative of a protracted postnatal latency. Three of the patients were assessed for the persistence of genomic fusion sequences in complete clinical remission samples and were found to be positive. These data indicate that t(8;21) in childhood AML can arise in utero, possibly as an initiating event in childhood AML, and may establish a long-lived or stable parental clone that requires additional secondary genetic alterations to cause leukemia.
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2001
A T Maia, A M Ford, G R Jalali, C J Harrison, G M Taylor, O B Eden, M F Greaves (2001)  Molecular tracking of leukemogenesis in a triplet pregnancy.   Blood 98: 2. 478-482 Jul  
Abstract: The occurrence of childhood acute lymphoblastic leukemia (ALL) in 2 of 3 triplets provided a unique opportunity for the investigation of leukemogenesis and the natural history of ALL. The 2 leukemic triplets were monozygotic twins and shared an identical, acquired TEL-AML1 genomic fusion sequence indicative of a single-cell origin in utero in one fetus followed by dissemination of clonal progeny to the comonozygotic twin by intraplacental transfer. In accord with this interpretation, clonotypic TEL-AML1 fusion sequences could be amplified from the archived neonatal blood spots of the leukemic twins. The blood spot of the third, healthy, dizygotic triplet was also fusion gene positive in a single segment, though at age 3 years, his blood was found negative by sensitive polymerase chain reaction (PCR) screening for the genomic sequence and by reverse transcription-PCR. Leukemic cells in both twins had, in addition to TEL-AML1 fusion, a deletion of the normal, nonrearranged TEL allele. However, this genetic change was found by fluorescence in situ hybridization to be subclonal in both twins. Furthermore, mapping of the genomic boundaries of TEL deletions using microsatellite markers indicated that they were individually distinct in the twins and therefore must have arisen as independent and secondary events, probably after birth. These data support a multihit temporal model for the pathogenesis of the common form of childhood leukemia.
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