Pathological assessment of mismatch repair gene variants in Lynch syndrome: Past, present, and future

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Lene Juel Rasmussen, Christopher D Heinen, Brigitte Royer-Pokora, Mark Drost, Sean Tavtigian, Robert M W Hofstra, Niels de Wind

Lynch syndrome (LS) is caused by germline mutations in DNA mismatch repair (MMR) genes and is the most prevalent hereditary colorectal cancer syndrome. A significant proportion of variants identified in MMR and other common cancer susceptibility genes are missense or noncoding changes whose consequences for pathogenicity cannot be easily interpreted. Such variants are designated as "variants of uncertain significance" (VUS). Management of LS can be significantly improved by identifying individuals who carry a pathogenic variant and thus benefit from screening, preventive, and therapeutic measures. Also, identifying family members that do not carry the variant is important so they can be released from the intensive surveillance. Determining which genetic variants are pathogenic and which are neutral is a major challenge in clinical genetics. The profound mechanistic knowledge on the genetics and biochemistry of MMR enables the development and use of targeted assays to evaluate the pathogenicity of variants found in suspected patients with LS. We describe different approaches for the functional analysis of MMR gene VUS and propose development of a validated diagnostic framework. Furthermore, we call attention to common misconceptions about functional assays and endorse development of an integrated approach comprising validated assays for diagnosis of VUS in patients suspected of LS.
Original languageEnglish
JournalHuman Mutation
Volume33
Issue number12
Pages (from-to)1617-25
Number of pages9
ISSN1059-7794
DOIs
Publication statusPublished - Dec 2012

ID: 40840242