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    1. Clonal dynamics towards the development of venetoclax resistance in chronic lymphocytic leukemia

      [Paper-level Aggregated] PMCID: PMC5820258

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The BRAFV600E mutation was shown to induce venetoclax resistance in a cell line, demonstrating its oncogenic potential in the context of treatment resistance. Functional: The study demonstrates that the overexpression of mutated BRAF (p.V600E) in a cell line resulted in increased venetoclax resistance, highlighting its functional impact on drug sensitivity.

      Gene→Variant (gene-first): BRAF(673):BRAFV600E BRAF(673):p.V600E TP53(7157):p.W110* SF3B1(23451):c.1996A > C SF3B1(23451):c.1997A > C SF3B1(23451):p.K666Q SF3B1(23451):p.K666T TP53(7157):p.E46K BTG1(694):p.Q36H BRAF(673):p.K601E BIRC3(330):p.Q547fs KMT2C(58508):p.S321fs

      Genes: BRAF(673) TP53(7157) SF3B1(23451) BTG1(694) BIRC3(330) KMT2C(58508)

      Variants: BRAFV600E p.V600E p.W110* c.1996A > C c.1997A > C p.K666Q p.K666T p.E46K p.Q36H p.K601E p.Q547fs p.S321fs

    2. In order to assess if oncogenic BRAF signaling may induce venetoclax resistance, we overexpressed mutated BRAF (p.V600E) in a venetoclax-sensitive cell line OCI-LY19 (Fig. 3a). Exome sequencing of this cell line revealed

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses how the BRAFV600E variant correlates with venetoclax resistance, indicating a relationship between the variant and treatment response. Oncogenic: The passage describes the overexpression of the mutated BRAF (p.V600E) in a cell line, which is associated with increased resistance to venetoclax, suggesting that this somatic variant contributes to tumor progression.

      Gene→Variant (gene-first): 673:BRAFV600E 673:p.V600E 7157:p.W110*

      Genes: 673 7157

      Variants: BRAFV600E p.V600E p.W110*

    3. Finally, case C586 showed a remarkable pattern of convergent evolution (Fig. 2d). We found two SF3B1 mutations (c.1996A > C; p.K666Q and c.1997A > C; p.K666T) affecting the same codon, but evolved in two independent clon

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the SF3B1 mutations in the context of venetoclax exposure and resistance, indicating a correlation between these variants and treatment response. Oncogenic: The SF3B1 mutations are described as evolving during treatment and being selected for during venetoclax therapy, suggesting their role in tumor development or progression.

      Gene→Variant (gene-first): 23451:c.1996A > C 23451:c.1997A > C 23451:p.K666Q 23451:p.K666T

      Genes: 23451

      Variants: c.1996A > C c.1997A > C p.K666Q p.K666T

    4. Patient C548 showed a divergent evolutionary path of two branches (Fig. 2c). One branch (subclone C3 and C4) was selected during venetoclax therapy. This branch harbored a homozygous loss of CDKN2A/B, and mutations in BR

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the selection of specific mutations (including p.K601E and p.Q547fs) during venetoclax therapy, indicating a correlation with treatment response. Oncogenic: The mutations p.K601E and p.S321fs are described as contributing to tumor development, as they are retained in the clonal evolution of the cancer during relapse.

      Gene→Variant (gene-first): 673:p.K601E 330:p.Q547fs 58508:p.S321fs

      Genes: 673 330 58508

      Variants: p.K601E p.Q547fs p.S321fs

    5. To gain insight into the clonal evolution towards therapy resistance, we inferred subclonal populations and reconstructed phylogenetic trees (see Methods). Intriguingly, we observed a wide spectrum of evolutionary dynami

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the involvement of BTG1 mutations (p.E46K and p.Q36H) in the resistance to venetoclax treatment, indicating a correlation between these variants and treatment response. Oncogenic: The passage describes the BTG1 mutations as being involved in the clonal evolution towards therapy resistance, suggesting that these somatic variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 7157:p.E46K 694:p.Q36H

      Genes: 7157 694

      Variants: p.E46K p.Q36H

    6. Recurrent genomic changes that evolved during venetoclax treatment were homozygous deletions affecting CDKN2A/B in three patients (C548, C577, C586) and BTG1 missense mutations in two cases (C577: p.Q36H; C789: p.E46K).

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how damaging mutations in BTG1, including the p.Q36H and p.E46K variants, may provide a survival advantage to CLL cells under targeted BCL2-inhibition, indicating their contribution to tumor development or progression. Functional: The passage mentions that BTG1 has been shown to counteract cell proliferation, suggesting that the mutations may alter its molecular or biochemical function.

      Gene→Variant (gene-first): 7157:p.E46K 694:p.Q36H

      Genes: 7157 694

      Variants: p.E46K p.Q36H

    7. In line with previous findings patients responded to venetoclax therapy, even if TP53 was initially mutated in a bi-allelic fashion (5/8 patients). Two patients showed genome alterations that might qualify for further th

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Oncogenic, Predictive

      Justification: Oncogenic: The passage states that the BRAF (p.K601E) mutation was shown to be oncogenic and can be targeted by MEK inhibitors, indicating its role in tumor development or progression. Predictive: The mention of patients responding to venetoclax therapy, even with the presence of the BRAF mutation, suggests a correlation with treatment response, which aligns with predictive evidence.

      Gene→Variant (gene-first): 673:p.K601E

      Genes: 673

      Variants: p.K601E

    8. In order to assess if oncogenic BRAF signaling may induce venetoclax resistance, we overexpressed mutated BRAF (p.V600E) in a venetoclax-sensitive cell line OCI-LY19 (Fig. 3a). Exome sequencing of this cell line revealed

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses how the BRAFV600E variant correlates with venetoclax resistance, indicating a relationship between the variant and treatment response. Oncogenic: The passage describes the overexpression of the mutated BRAF (p.V600E) in a cell line, which is associated with increased resistance to venetoclax, suggesting that this somatic variant contributes to tumor progression.

      Gene→Variant (gene-first): 673:BRAFV600E 673:p.V600E 7157:p.W110*

      Genes: 673 7157

      Variants: BRAFV600E p.V600E p.W110*

    9. Finally, case C586 showed a remarkable pattern of convergent evolution (Fig. 2d). We found two SF3B1 mutations (c.1996A > C; p.K666Q and c.1997A > C; p.K666T) affecting the same codon, but evolved in two independent clon

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the SF3B1 mutations in the context of venetoclax exposure and resistance, indicating a correlation between these variants and treatment response. Oncogenic: The SF3B1 mutations are described as evolving during treatment and being selected for during venetoclax therapy, suggesting their role in tumor development or progression.

      Gene→Variant (gene-first): 23451:c.1996A > C 23451:c.1997A > C 23451:p.K666Q 23451:p.K666T

      Genes: 23451

      Variants: c.1996A > C c.1997A > C p.K666Q p.K666T

    10. Patient C548 showed a divergent evolutionary path of two branches (Fig. 2c). One branch (subclone C3 and C4) was selected during venetoclax therapy. This branch harbored a homozygous loss of CDKN2A/B, and mutations in BR

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the selection of specific mutations (including p.K601E and p.Q547fs) during venetoclax therapy, indicating a correlation with treatment response. Oncogenic: The mutations p.K601E and p.S321fs are described as contributing to tumor development, as they are retained in the clonal evolution of the cancer during relapse.

      Gene→Variant (gene-first): 673:p.K601E 330:p.Q547fs 58508:p.S321fs

      Genes: 673 330 58508

      Variants: p.K601E p.Q547fs p.S321fs

    11. To gain insight into the clonal evolution towards therapy resistance, we inferred subclonal populations and reconstructed phylogenetic trees (see Methods). Intriguingly, we observed a wide spectrum of evolutionary dynami

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the involvement of BTG1 mutations (p.E46K and p.Q36H) in the resistance to venetoclax treatment, indicating a correlation between these variants and treatment response. Oncogenic: The passage describes the BTG1 mutations as being involved in the clonal evolution towards therapy resistance, suggesting that these somatic variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 7157:p.E46K 694:p.Q36H

      Genes: 7157 694

      Variants: p.E46K p.Q36H

    12. Recurrent genomic changes that evolved during venetoclax treatment were homozygous deletions affecting CDKN2A/B in three patients (C548, C577, C586) and BTG1 missense mutations in two cases (C577: p.Q36H; C789: p.E46K).

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how damaging mutations in BTG1, including the p.Q36H and p.E46K variants, may provide a survival advantage to CLL cells under targeted BCL2-inhibition, indicating their contribution to tumor development or progression. Functional: The passage mentions that BTG1 has been shown to counteract cell proliferation, suggesting that the mutations may alter its molecular or biochemical function.

      Gene→Variant (gene-first): 7157:p.E46K 694:p.Q36H

      Genes: 7157 694

      Variants: p.E46K p.Q36H

    13. In line with previous findings patients responded to venetoclax therapy, even if TP53 was initially mutated in a bi-allelic fashion (5/8 patients). Two patients showed genome alterations that might qualify for further th

      [Paragraph-level] PMCID: PMC5820258 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Oncogenic, Predictive

      Justification: Oncogenic: The passage states that the BRAF (p.K601E) mutation was shown to be oncogenic and can be targeted by MEK inhibitors, indicating its role in tumor development or progression. Predictive: The mention of patients responding to venetoclax therapy, even with the presence of the BRAF mutation, suggests a correlation with treatment response, which aligns with predictive evidence.

      Gene→Variant (gene-first): 673:p.K601E

      Genes: 673

      Variants: p.K601E