Identification of a Novel FAM135B Cancer Susceptibility Mutation in a Family with Multiple Cases of MLL-Rearranged AML

Background: Familial aggregation of malignancies, including leukemia, is rarely reported due to the scattered cases, weakened bonding among generations, and low birth rates in modern society. The emerging demands for predicting and preventing cancer development are outgrowing the progress in the studies of the mechanism underlying the propensity of malignancies.

Results: Here we reported a family with 4 cases of acute leukemia (AL) and four solid tumors (2 for lung cancer, 1 for renal clear cell carcinoma, and one for rectal adenocarcinoma). Besides, one member in the family was diagnosed with intraspinal cavernous hemangioma, and another one was diagnosed with congenital heart disease (transposition of the great arteries). 2 out of 4 AL patients were cousins and diagnosed with acute monocytic leukemia (AML-M5 with MLL-rearrangement) in our center. Whole genome sequencing was performed on two patients with AML, two patients with solid tumors, one obligated carrier, and three healthy members. Using an in-house bioinformatic data analysis pipeline, we identified 18 single nucleotide variants (SNVs) and four insertions/deletions (Indel) in all the affected members and one obligated carrier while absent in healthy members. Genotyping of these variants in 57 family members confirmed that 18/22 variants co-segregated with the malignant phenotype of this family. By screening for these 18 variants in 13 AL pedigrees, we narrow our cancer-predisposing candidate list to one variant, hitting FAM135B (family with sequence similarity 135 member B; NM_015912: exon13:c.A2621G:p.E874G), which is recurrent in another AML pedigree with two cases in two consecutive generations. This mutation resides in a highly conserved locus among species and is predicted to be deleterious. FAM135B is predicted to encode serine esterase, and the role of FAM135B in AML was not documented. Intriguingly, all the affected familial AML cases from two pedigrees were diagnosed with AML-M5 with MLL-rearrangement. Moreover, this mutation is recurrent in sporadic adult AML cohort (6/467), among which half (3/6) were AML-M5, two M3, and one M2. Functionally, we found that overexpression of FAM135B promotes the proliferation and colony formation of AML cells. Consistently, downregulation of FAM135B nearly abolished the colony-forming capacity of AML cells and impaired cell proliferation. Further studies on the role of FAM135B in AML development are under investigation.

Conclusion: We identify a novel cancer-predisposing gene, FAM135B, and its mutation E874G occurred in both familial and sporadic AML cases, especially AML-M5 with MLL-rearrangement.

No relevant conflicts of interest to declare.