Patent Application
20220290242
This invention relates to a method for diagnosing cancer and a kit useful for implementing such a method. The invention also relates to a method implemented by computer in order to analyze the results obtained after implementing this method, in particular carried out in the context of a cancer diagnosis.
Cancers are due to an accumulation of genetic abnormalities, by tumor cells. Among these abnormalities are numerous chromosomal rearrangements (translocations, deletions, and inversions) which result in the formation of fusion genes which encode abnormal proteins. These rearrangements also lead to imbalances in the expression of exons located at 5′ and 3′ of genomic breakpoints (5′-3′ expression imbalances), the expression of the former remaining under the control of the natural transcriptional regulatory regions of the gene while that of the latter falls under the control of the transcriptional regulatory regions of the partner gene. These abnormalities also include mutations at splice sites that disrupt normal RNA maturation, resulting in particular in exon skipping. Fusion genes, exon skipping, and 5′-3′ expression imbalances, which are important diagnostic markers, are usually investigated by different techniques. Some of these genetic abnormalities are very difficult to detect/analyze, particularly those involved in the development of sarcomas, which are very heterogeneous and can involve a very large number of genes. In addition, the amounts of RNA obtained from sarcoma biopsies are often very low, of poor quality. Chromosomal rearrangements in the context of sarcomas are discussed in particular in the Nakano and Takahashi article (Int. J. Mol. Sci. 2018, 19, 3784; doi:10.3390/ijms19123784).
Fusion genes are often associated with particular forms of tumor, and their detection can significantly contribute to making the diagnosis and choosing the most suitable treatment (The impact of translocations and gene fusions on cancer causation. Mitelman F, Johansson B, Mertens F, Nat Rev Cancer. 2007 April; 7(4):233-45). They are also often used as molecular markers to monitor the efficacy of treatments and follow the course of the disease, for example in acute leukemia (Standardized RT-PCR analysis of fusion gene transcripts from chromosome aberrations in acute leukemia for detection of minimal residual disease. Report of the BIOMED-1 Concerted Action: Investigation of minimal residual disease in acute leukemia. van Dongen J J, Macintyre E A, Gabert J A, Delabesse E, Rossi V, Saglio G, Gottardi E, Rambaldi A, Dotti G, Griesinger F, Parreira A, Gameiro P, Diaz M G, Malec M, Langerak A W, San Miguel J F, Biondi A. Leukemia. 1999 December; 13(12):1901-28).
The four main techniques which are commonly used to search for fusion genes are conventional cytogenetics, molecular cytogenetics (fluorescent in situ hybridization), immunohistochemistry, and molecular genetics (RT-PCR, RNAseq, or RACE).
Conventional cytogenetics consists of establishing the karyotype of cancer cells in order to look for possible abnormalities in the number and/or structure of the chromosomes. It has the advantage of providing an overall view of the entire genome. However, it is relatively insensitive, its effectiveness being highly dependent on the percentage of tumor cells in the sample to be analyzed and on the possibility of obtaining viable cell cultures. Another of its disadvantages is its low resolution, which does not allow detecting certain rearrangements (in particular small inversions and deletions). Finally, some tumors are associated with major genomic instability which masks pathognomonic genetic abnormalities. This is the case for example in solid tumors such as lung cancer. Karyotype analysis, when possible, is therefore difficult and can only be carried out by personnel with exceptional expertise, which entails significant costs.
Molecular cytogenetics, or FISH (Fluorescent In Situ Hybridization), consists of hybridizing fluorescent probes on the chromosomes of tumor cells in order to visualize their structural abnormalities. It makes it possible to detect chromosomal rearrangements with better resolution than conventional cytogenetics, and therefore to detect rearrangements of smaller size. It also makes it possible to uncover abnormalities in tumors with high genomic instability, by precisely targeting the genes likely to be involved. Its major disadvantage is that each abnormality must be investigated individually, using specific probes. It therefore incurs significant costs, and, due to the great diversity of the abnormalities which have been described and the small amount of tumor material available for diagnosis, only a few abnormalities can be investigated. For example, in practice, in a context of diagnosing a lung carcinoma, only the rearrangement of the ALK gene is commonly investigated by this method, the search for other recurrent rearrangements in these tumors remaining highly exceptional.
Immunohistochemistry (or IHC) consists of using antibodies to investigate the overexpression of an abnormal protein. This is a simple and rapid method, but also requires searching for each abnormality individually and its specificity is often low, as certain genes can be overexpressed in a tumor without any rearrangement.
RT-PCR, RNAseq, and RACE are methods of molecular genetics carried out using RNA extracted from tumor cells. RT-PCR has excellent sensitivity, far superior to cytogenetics. This sensitivity makes it the benchmark technique for analyzing biological samples where the percentage of tumor cells is low, for example in order to monitor the effectiveness of treatments or to anticipate possible relapses very early on. Its main limitation is linked to the fact that it is extremely difficult to multiplex this type of analysis. As with molecular cytogenetics, in general each translocation must be investigated by a specific test, and only a few recurrent fusions among the very many which are currently known are therefore tested for in routine diagnostic laboratories. RT-PCR also requires having RNAs of good quality, which is rarely the case for solid tumors where, in order to facilitate pathological diagnosis, the samples are fixed in formalin and embedded in paraffin the moment the biopsy sample is obtained. This highly sensitive technique can be very useful in diagnosing a sarcoma. Nevertheless, it is necessary to perform numerous independent tests, at a minimum for the most frequent recurrent fusion genes, which incurs additional costs and lengthens the time required. RNAseq, which consists of analyzing all the RNAs expressed by the tumor by next-generation sequencing (NGS), theoretically allows detecting all abnormal fusion transcripts expressed. However, it also requires having RNAs of good quality and is therefore difficult to implement from biopsies fixed with formalin. Its application is also very complex, since many steps are required to generate the sequencing libraries. In addition, the sequencing generates a very large amount of data (since all the genes are studied) which makes the analysis particularly complex. RACE, which has recently been adapted to NGS, is a simplification of the RNAseq technique but allows targeting small panels of genes likely to be involved in fusions. It has the advantage of being able to be applied to biopsies fixed with formalin. However, although the amount of data generated is reduced compared to RNAseq, it is still significant. Unlike the method described in the present invention which only detects abnormal RNAs, RACE results in obtaining sequences which correspond to all of the targeted genes in the panel, even when they are in a germinal configuration. The vast majority of the sequences obtained therefore correspond to normal transcripts, expressed naturally by tumor cells and by the cells in their environment. The sequence files must therefore be filtered to identify the fusion transcripts. Finally, similarly to RNAseq, RACE is a long and complex technique to implement, where many steps are necessary in order to obtain the sequencing libraries, which increases the time required to deliver results.
Exon skipping generally results in the expression of an abnormally short protein which is involved in the tumor process. For example, skipping of exon 14 of the MET gene is involved in the development of lung carcinoma, and skipping of exons 2 to 7 of the EGFR gene is involved in the development of certain brain tumors, in particular glioblastoma. They are often due to point mutations which affect the exon splicing sites (3′ donor sites, 5′ acceptors, as well as intronic or exonic enhancers), or to internal deletions of genes. Today, it is particularly difficult to uncover these abnormalities in order to diagnose cancers, since neither cytogenetics nor FISH are informative. RT-PCR could be an alternative, but it is severely limited due to the formalin fixation of tumor biopsies that is necessary for pathological diagnosis. These abnormalities are therefore currently tested for primarily by next-generation sequencing of genomic DNA or of RNA, which are expensive and complex techniques.
5′-3′ expression imbalances, which require quantitatively evaluating the expression of exons, are only very rarely tested for when diagnosing a cancer. They can be analyzed either by RNAseq or by dedicated kits such as those offered by the Nanostring company (for example the “nCounter® Lung Fusion Panel” test).
International application PCT/FR2014/052255 describes a method for diagnosing cancer by detecting fusion genes. Said method comprises a RT-MLPA step using probes fused, at at least one end, with a primer sequence.
The article by Ruminy et al. describes the detection of fusion genes by RT-MLPA in the context of acute leukemia (Multiplexed targeted sequencing of recurrent fusion genes in acute leukaemia; Leukemia, 2016 March; 30(3):757-60).
The article by Piton et al. describes the detection by RT-MLPA of rearrangement linked to the ALK, ROS and RET genes in the context of lung adenocarcinomas (Ligation-dependent-RT-PCR: a new specific and low-cost technique to detect ALK, ROS and RET rearrangements in lung adenocarcinoma; Lab Invest. 2018 March; 98(3):371-379).
Techniques are therefore currently known which allow detecting fusion genes, exon skipping, or 5′-3′ expression imbalances, but they have disadvantages.
The limitations of existing methods are essentially linked to: (i) the large number of abnormalities to be tested for (this is one of the most significant limitations of IHC, FISH, and RT-PCR techniques); (ii) the sensitivity required to detect genetic abnormalities using small tumor biopsies that are fixed and embedded in paraffin (this is one of the most significant limitations of next-generation sequencing techniques); (iii) the interpretation of the results (it is necessary to define thresholds for IHC, there are significant artifacts for FISH, RNAseq and RACE generate a very large amount of data which is difficult to analyze); (iv) the implementation complexity (the large number of steps to be carried out increases the risk of error, the technical time required increases operator costs and has a strong impact on the quality of the results generated and the times required for delivery).
The method described in international application PCT/FR2014/052255 is more specific, simple, and quick to implement compared to existing techniques for detecting fusion genes.
However, there is still a need for fusion gene diagnostic techniques capable of detecting a very wide variety of abnormalities, in specific, sensitive, and reliable ways, while remaining simple and quick to implement.
International application PCT/FR2014/052255 also describes specific probes for types of translocation observed in cancers. However, new genetic abnormalities have since been uncovered and cannot be detected by the method described in the international application referenced above.
There is therefore a need for a diagnostic method which allows detecting new genetic abnormalities.
Furthermore, the techniques which currently make it possible to detect exon skipping require performing complex additional tests. These techniques are therefore expensive, long to implement, and difficult to interpret.
There is therefore a need for a technique which allows detecting exon skipping that is sensitive, reliable, simple, economical, and quick to implement.
There is also a need for a technique which allows detecting 5′-3′ expression imbalances which is sensitive, reliable, simple, economical, and quick to implement.
As the techniques for detecting fusion genes, exon skipping, and 5′-3′ expression imbalances are different, there is also a need for a method that allows detecting these three types of genetic abnormalities simultaneously.
Finally, as the surgical tumor biopsies available for the diagnosis of solid cancers are often very small, fixed in formalin, and embedded in paraffin, there is a need for a method that allows detecting a large number of abnormalities simultaneously, in a small amount of low-quality genetic material.
The invention thus aims to meet these different needs. The invention is in fact based on the results of the Inventors who (i) have identified new genetic abnormalities linked to the RET, MET, ALK, and/or ROS genes in carcinomas (both fusion genes and exon skipping), and (ii) have developed a technique to identify them. The invention is also based on (iii) the results of the inventors which have identified new probes, in particular which allow diagnosing sarcomas, brain tumors, gynecological tumors, or tumors of the head and neck, or (iv) 5′-3′ imbalances (for example 5′-3′ imbalances of the ALK gene). The invention is also based on (v) the use of probes comprising at least one molecular barcode, which makes it possible to significantly improve the sensitivity and specificity of the detection.
The invention thus provides a method which makes it possible to simultaneously detect fusion genes, exon skipping, and 5′-3′ expression imbalances. The invention also has the advantage of being specific, sensitive, reliable, but also simple, economical, and quick to implement. Typically, by means of the technique according to the invention, the results can be obtained within two or three days after the sample is received by the analysis laboratory, compared to several weeks for conventional techniques. It also offers the advantage of being applicable to fixed tissues, such as those used in pathology laboratories. The invention thus makes it possible to identify genetic abnormalities from a small amount of poor-quality genetic material. Finally, its very high sensitivity (it allows detecting less than ten abnormal molecules in a sample), coupled with its very high specificity (the results obtained are DNA sequences, meaning qualitative data, which does not induce interpretation bias the way quantitative IHC-type methods can), make this a very efficient method. The invention thus makes it possible to have a treatment plan adapted to each patient. Indeed, the invention makes it possible to diagnose with accuracy and to guide the choice of treatment by identifying patients eligible for targeted treatments.
In a first aspect, the invention thus relates to a method for diagnosing cancer in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject, wherein the RT-MLPA step is carried out using at least one pair of probes comprising at least one probe selected from:
In this first aspect, the invention also relates to a method for diagnosing cancer in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject, wherein the RT-MLPA step is carried out using at least one pair of probes comprising at least one probe selected from:
In this first aspect, the invention also relates to a method for diagnosing cancer in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject, wherein the RT-MLPA step is carried out using at least one pair of probes comprising at least one probe selected from the probes SEQ ID NO: 1211 to 1312,
each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a first aspect, the invention thus relates to a method for diagnosing cancer in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject, wherein the RT-MLPA step is carried out using at least one pair of probes comprising at least one probe selected from:
According to the invention, the term “MLPA” means Multiplex Ligation-Dependent Probe Amplification, which allows the simultaneous amplification of several targets of interest that are adjacent to one another, using one or more specific probes. In the context of the invention, this technique is very advantageous for determining the presence of translocations, which are frequent in malignant tumors.
According to the invention, the term “RT-MLPA” means Multiplex Ligation-Dependent Probe Amplification preceded by a Reverse Transcription (RT), which, in the context of the invention, allows starting with the RNA from a subject to amplify and characterize fusion genes, exon skippings of interest, and/or 5′-3′ expression imbalances. According to the invention, the RT-MLPA step is carried out in multiplex mode. The multiplex mode saves time because it is faster than several monoplex assays, and is economically advantageous. It also makes it possible to simultaneously search for a much higher number of abnormalities than the other techniques currently available. The RT-MLPA step is derived from MLPA, described in particular in U.S. Pat. No. 6,955,901. It allows the detection and simultaneous assay of a large number of different oligonucleotide sequences. The principle is as follows (see
According to the invention, the term “subject” means an individual who is healthy or is likely to be affected by cancer or is seeking screening, diagnosis, or follow-up.
According to the invention, the term “biological sample” means a sample containing biological material. More preferably, it means any sample containing RNA. This sample may come from a biological sample taken from a living being (human patient, animal). Preferably, the biological samples of the invention are selected among blood and a biopsy, obtained from a subject, in particular a human subject. The biopsy is in particular tumoral, in particular from a section of fixed tissue (for example fixed with formalin and/or embedded in paraffin) or from a frozen sample.
According to the invention, the term “cancer” means a disease characterized by abnormally high cell proliferation within normal tissue of the organism, such that the survival of the organism is threatened. In a preferred embodiment of the method according to the invention, the cancer is linked to a genetic abnormality, preferably the formation of a fusion gene and/or an exon skipping and/or a 5′-3′ imbalance. In a preferred embodiment of the method according to the invention, the cancer is linked to a genetic abnormality, preferably a fusion gene or an exon skipping. In a preferred embodiment of the method according to the invention, the cancer involves at least one gene selected among RET, MET, ALK and/or ROS, and in particular is associated with the formation of a fusion gene and/or an exon skipping, more particularly a skipping of an exon of the MET gene and/or a 5′-3 imbalance, more particularly a 5′-3′ imbalance of the ALK gene. According to the invention, and in a first aspect, the cancer is preferably a carcinoma. Carcinomas are malignant tumors that develop at the expense of epithelial tissue. More particularly, the cancer is a lung carcinoma, more particularly a bronchopulmonary carcinoma, even more particularly a lung carcinoma associated with a genetic abnormality of the RET, MET, ALK and/or ROS genes. In another preferred embodiment of the method according to the invention, the 5′-3′ expression imbalance is more particularly understood to mean an expression imbalance of the ALK gene. According to another aspect of the invention, and in a second aspect, the cancer is preferably a sarcoma, a brain tumor, a gynecological tumor, or a tumor of the head and neck. Sarcomas are tumors of the soft tissue and bone. Brain tumors are tumors that grow in the brain, such as gliomas or medulloblastomas. Gynecologic tumors are tumors of the female reproductive system, such as cervical cancer, endometrial cancer, and ovarian cancer. Cancers of the head and neck are cancers of the upper respiratory tract, such as squamous cell carcinoma of the throat (larynx, pharynx) and mouth, cancer of the cavum (or nasopharynx), cancer of the salivary glands (parotid, palate), or cancer of the thyroid gland. In another preferred embodiment of the method according to the invention, exon skipping also means a skipping of an exon of the EGFR gene, and more particularly a skipping of exons 2 to 7 of the EGFR gene. Thus, according to the invention, exon skipping is understood to mean a skipping of an exon or exons of the MET and/or EGFR gene.
According to the invention, the term “probe” means a nucleic acid sequence of a length between 15 and 55 nucleotides, preferably between 15 and 45 nucleotides, and complementary to a cDNA sequence derived from RNA of the subject (endogenous). It is therefore capable of hybridizing with said cDNA sequence derived from RNA of the subject. The term “pair of probes” means a set of two probes (i.e. a “Left” probe and a “Right” probe): one located at 5′ (see in particular “L” in Table 1) of the translocation of the fusion gene, of the skipping of an exon or exons whose expression is evaluated in order to detect a 5′-3′ expression imbalance, the other located at 3′ (see in particular “R” in Table 1) of the translocation of the fusion gene, of the skipping of an exon or exons whose expression is evaluated in order to detect a 5′-3′ expression imbalance. Preferably, said pair of probes consists of two probes hybridizing side by side during the RT-MLPA step. Preferably, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 1 to 13, and/or probes of SEQ ID NO: 96 to 99 and/or probes of SEQ ID NO: 14 to 91. Even more particularly, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 1 to 13, of probes of SEQ ID NO: 96 to 99 and of probes of SEQ ID NO: 14 to 91. Preferably, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 866 to 938, and/or probes of SEQ ID NO: 940 to 1104, and/or probes of SEQ ID NO: 1105 to 1107, and/or SEQ ID NO: 939, and/or probes SEQ ID NO: 1108 to 1123. Even more particularly, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 866 to 938, probes of SEQ ID NO: 940 to 1104, probes of SEQ ID NO: 1105 to 1107, the probe of SEQ ID NO: 939 and probes SEQ ID NO: 1108 to 1123. Preferably, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 1211 to 1312. Even more particularly, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 1 to 13, probes of SEQ ID NO: 96 to 99, probes of SEQ ID NO: 14 to 91, probes of SEQ ID NO: 866 to 938, probes of SEQ ID NO: 940 to 1104, probes of SEQ ID NO: 1105 to 1107, the probe of SEQ ID NO: 939, and probes of SEQ ID NO: 1108 to 1123. Even more particularly, a pair of probes according to the invention is formed at least of probes of SEQ ID NO: 1 to 13, probes of SEQ ID NO: 96 to 99, probes of SEQ ID NO: 14 to 91, probes of SEQ ID NO: 866 to 938, probes of SEQ ID NO: 940 to 1104, probes of SEQ ID NO: 1105 to 1107, the probe of SEQ ID NO: 939, and probes of SEQ ID NO: 1108 to 1123 and probes of SEQ ID NO: 1211 to 1312.
According to the invention, the term “primer sequence” means a nucleic acid sequence of a length between 15 and 30 nucleotides, preferably between 19 and 25 nucleotides, and not complementary to the cDNA sequences obtained from RNA of the subject. It is therefore not complementary to the cDNA corresponding to endogenous RNA. It therefore cannot hybridize with said cDNA sequences. Preferably, in a preferred embodiment of the method according to the invention, the primer sequence is selected from the (pairs of) sequences SEQ ID NO: 92 and SEQ ID NO: 93 or SEQ ID NO: 94 and SEQ ID NO: 95.
According to the invention, the term “index sequence” means a nucleic acid sequence of a length between 5 and 10 nucleotides, preferably between 6 and 8 nucleotides, in particular 8 nucleotides, and not complementary to the sequences of cDNA obtained from RNA of the subject. It is therefore not complementary to the cDNA corresponding to endogenous RNA. It therefore cannot hybridize with said cDNA sequences. Preferably, the index sequence is represented by the sequence SEQ ID NO: 836. Said index sequence is composed of bases (A, T, G, or C). In a preferred embodiment of the method according to the invention, said index sequence can be fused to a primer sequence, in particular at the 3′ end of the primer sequence. The index sequence is specific to each subject/patient whose sample is tested. Each pair of probes used in the PCR step comprises a different index sequence which allows identifying the sequences linked to each of the patients analyzed.
According to the invention, the term “molecular barcode” means a nucleic acid sequence of length between 5 and 10 nucleotides, preferably between 6 and 8 nucleotides, in particular 7 nucleotides, and not complementary to the cDNA sequences from RNA of the subject. It is therefore not complementary to the cDNA corresponding to endogenous RNA. It therefore cannot hybridize with said cDNA sequences. Preferably, the molecular barcode sequence is represented by the sequence SEQ ID NO: 100. Said molecular barcode sequence is a random sequence, composed of random bases (A, T, G, or C). The use of this sequence provides information on the exact number of cDNA molecules detected by ligation, while avoiding the bias associated with PCR amplification. According to the invention, at least one of the probes of said pair comprises a molecular barcode sequence. In other words, at least one of the probes of said pair is fused at one end with a molecular barcode sequence. In an embodiment that is preferred, and particularly preferred, a molecular barcode sequence is added at 5′ of the “F” or “Forward” probe, also called “L” or “Left”. In a preferred embodiment, each of the probes can comprise a molecular barcode sequence, in particular the probes SEQ ID NO: 14 to 91 and the probes SEQ ID NO: 96 and 98, preferably the probes SEQ ID NO: 14 to 91.
According to the invention, the term “extension sequence” refers to the sequences which can be present at the ends of the primers used during the PCR step, and which allow analysis of the PCR products on an Illumina-type next-generation sequencer. An “extension” sequence corresponds to any suitable sequence enabling analysis of the PCR products on a next-generation sequencer. An extension sequence is a nucleic acid sequence of a length between 5 and 20 nucleotides, preferably between 5 and 15 nucleotides, and not complementary to the cDNA sequences derived from RNA from the subject. It is therefore not complementary to the cDNA corresponding to endogenous RNA. It therefore cannot hybridize with said cDNA sequences. It is in particular represented by SEQ ID NO: 865. The knowledge of persons skilled in the art easily allows them to adapt these extension sequences.
According to the invention, the term “sensitivity” means the proportion of positive tests in subjects suffering from cancer and actually carrying the searched-for abnormalities (calculated by the following formula: number of true positives/(number of true positives plus number of false negatives)).
According to the invention, the term “specificity” means the proportion of negative tests in subjects not suffering from cancer and not carrying the searched-for abnormalities (calculated by the following formula: number of true negatives/(number of true negatives plus number of false positives)).
The inventors of the invention have identified specific probes for new genetic abnormalities observed in certain cancers. This identification is based on analysis of the intron/exon structure of genes involved in translocations, as shown in
According to the invention, at least one of the probes of a pair used comprises a molecular barcode sequence, in particular the “L” probe. This means that the molecular barcode sequence is fused to the probe sequence at one of its ends, preferably 5′. When it is present, said molecular barcode sequence is preferably inserted between the primer sequence and the probe complementary to the exons of the genes. According to the invention, a preferred embodiment may also comprise a primer sequence at 5′ of a molecular barcode sequence, said barcode sequence itself being added at 5′ of the probe complementary to the exon of the gene forming the 5′ part of the fusion transcripts or of the transcript corresponding to an exon skipping, optionally 5′-3′ expression imbalances. According to the invention, an alternative embodiment may also comprise a primer sequence added to the 3′ end of a molecular barcode sequence, said barcode sequence itself being added at 3′ of the probe complementary to the exon of the gene forming the 3′ part of the fusion transcripts or of the transcript corresponding to an exon skipping, optionally 5′-3′ expression imbalances. According to the invention, one particular embodiment can thus comprise a primer sequence at 5′ of a molecular barcode sequence, said barcode sequence itself being added at 5′ of the probe complementary to the exon of the gene forming the 5′ part of the fusion transcripts or of the transcript corresponding to an exon skipping, optionally 5′-3′ expression imbalances, as well as a primer sequence added to the 3′ end of a molecular barcode sequence, said barcode sequence itself being added at 3′ of the probe complementary to the exon of the gene forming the 3′ part of the fusion transcripts or of the transcript corresponding to an exon skipping, optionally 5′-3′ expression imbalances.
An example of the various translocations (fusion genes) identified according to the invention is illustrated in
In a preferred embodiment of the method according to the invention, the probes SEQ ID NO: 14 to 91 are also used for the RT-MLPA step. In this aspect, each of the probes is also fused, at at least one end, with a primer sequence, and at least one of the probes preferably comprises a molecular barcode sequence. According to an even more particular embodiment, each of the “L” probes of the pair comprises a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising a probe selected from probes SEQ ID NO: 1 to 13, optionally probes SEQ ID NO: 14 to 91, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising a probe selected from probes SEQ ID NO: 96 to 99, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising a probe selected from probes SEQ ID NO: 1 to 13 and probes SEQ ID NO: 96 to 99, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 1 to 13, probes SEQ ID NO: 96 to 99, and probes SEQ ID NO: 14 to 91, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence, in particular probes SEQ ID NO: 14 to 91 and optionally probes SEQ ID NO: 96 and 98.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 866 to 938 and SEQ ID NO: 940-1104, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 1211 to 1312, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 1105 to 1107 and SEQ ID NO: 939, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 1108 to 1123, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 866 to 938, and/or SEQ ID NO: 940 to 1104, and/or probes SEQ ID NO: 1105 to 1107, and/or SEQ ID NO: 939, and/or SEQ ID NO: 1108 to 1123, each of probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes comprising the probes selected from probes SEQ ID NO: 866 to 938, SEQ ID NO: 940 to 1104, SEQ ID NO: 1105 to 1107, SEQ ID NO: 939, SEQ ID NO: 1108 to 1123, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising the probes selected from probes SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824 and SEQ ID NO: 825, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising the probes selected from probes SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824, SEQ ID NO: 825, SEQ ID NO: 866 to 938, SEQ ID NO: 940 to 1104, SEQ ID NO: 1105 to 1107, SEQ ID NO: 939, and SEQ ID NO: 1108 to 1123, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the RT-MLPA step is carried out using pairs of probes each comprising the probes selected from probes SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824, SEQ ID NO: 825, SEQ ID NO:866 to 938, SEQ ID NO: 940 to 1104, SEQ ID NO: 1105 to 1107, SEQ ID NO: 939, SEQ ID NO: 1108 to 1123, and SEQ ID NO: 1211 to 1312, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the cancer associated with the formation of a fusion gene is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1 to 13, optionally probes SEQ ID NO: 14 to 91, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the cancer associated with the formation of a fusion gene is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 866 to 938 and/or SEQ ID NO: 940 to 1104, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the cancer associated with the formation of a fusion gene is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1211 to 1312, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, the cancer associated with the formation of a fusion gene is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1 to 13, and/or SEQ ID NO: 14 to 91, and/or SEQ ID NO: 866 to 938 and/or SEQ ID NO: 940 to 1104, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence. Preferably, all the probes of SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 868 to 938, and SEQ ID NO: 940 to 1104 are used.
In a preferred embodiment of the method according to the invention, the cancer associated with the formation of a fusion gene is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1 to 13, and/or SEQ ID NO: 14 to 91, and/or SEQ ID NO: 866 to 938 and/or SEQ ID NO: 940 to 1104, and/or SEQ ID NO: 1211 to 1312, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence. Preferably, all the probes of SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 868 to 938, SEQ ID NO: 940 to 1104 and SEQ ID NO: 1211 to 1312 are used.
Alternatively and in another preferred embodiment of the method according to the invention, the cancer associated with an exon skipping is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 96 to 99, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 94 and SEQ ID NO: 95, and optionally at least one of the probes of said pair comprises a molecular barcode sequence. More particularly according to this embodiment, the cancer is associated with a skipping of an exon of the MET gene, more particularly a skipping of exon 14 of the MET gene.
Alternatively and in another preferred embodiment of the method according to the invention, the cancer associated with an exon skipping is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1105 to 1107 and/or SEQ ID NO: 939, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 94 and SEQ ID NO: 95, and optionally at least one of the probes of said pair comprises a molecular barcode sequence. More particularly according to this embodiment, the cancer is associated with a skipping of exons of the EGFR gene, more particularly a skipping of exons 2 to 7 of the EGFR gene.
Alternatively and in another preferred embodiment of the method according to the invention, the cancer associated with an exon skipping is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 96 to 99, and/or SEQ ID NO: 1105 to 1107 and/or SEQ ID NO: 939, and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 94 and SEQ ID NO: 95, and optionally at least one of the probes of said pair comprises a molecular barcode sequence. Preferably, all the probes SEQ ID NO: 96 to 99, SEQ ID NO: 1105 to 1107 and SEQ ID NO: 939 are used.
Alternatively and in another preferred embodiment of the method according to the invention, the cancer associated with a 5′-3′ imbalance is diagnosed using at least one pair of probes comprising at least one probe selected from probes SEQ ID NO: 1108 to 1123 and each of the probes is fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 94 and SEQ ID NO: 95, and optionally at least one of the probes of said pair comprises a molecular barcode sequence. Preferably, all the probes SEQ ID NO: 1108 to 1123 are used.
In a preferred embodiment, the invention thus relates to a method for diagnosing a carcinoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1 to 13, optionally probes SEQ ID NO: 14 to 91, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a carcinoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1294 to 1312, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a carcinoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1 to 13, and probes SEQ ID NO: 1294 to 1312, optionally probes SEQ ID NO: 14 to 91, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a sarcoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 866 to 938 and probes SEQ ID NO: 940 to 1054, optionally SEQ ID NO: 1148, and/or SEQ ID NO: 1149, and/or SEQ ID NO: 1178 and/or SEQ ID NO: 1179, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a sarcoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1228 to 1291, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a sarcoma in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 866 to 938 and probes SEQ ID NO: 940 to 1054, and probes SEQ ID NO: 1228 to 1291, optionally SEQ ID NO: 1148, and/or SEQ ID NO: 1149, and/or SEQ ID NO: 1178 and/or SEQ ID NO: 1179, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a tumor of the head and neck in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 866 to 938 and probes SEQ ID NO: 940 to 1054, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a tumor of the head and neck in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1211 to 1227, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a tumor of the head and neck in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 866 to 938 and probes SEQ ID NO: 940 to 1054 and probes SEQ ID NO: 1211 to 1227, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a gynecological tumor in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 866 to 938 and probes SEQ ID NO: 940 to 1054, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a brain tumor in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1040 to 1104, optionally probes of SEQ ID NO: 124-125, SEQ ID NO: 456, SEQ ID NO: 1209-1210, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a brain tumor in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1292 to 1293, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment, the invention thus relates to a method for diagnosing a brain tumor in a subject, comprising an RT-MLPA step on a biological sample obtained from said subject with at least probes SEQ ID NO: 1040 to 1104 and probes SEQ ID NO: 1292 to 1293, optionally the probes of SEQ ID NO: 124-125, SEQ ID NO: 456, SEQ ID NO: 1209-1210, each of the probes being fused, at at least one end, with a primer sequence, preferably selected from the sequences SEQ ID NO: 92 and SEQ ID NO: 93, and at least one of the probes of said pair comprises a molecular barcode sequence.
In a preferred embodiment of the method according to the invention, said RT-MLPA step comprises at least the following steps:
a) extraction of RNA from the biological sample from the subject,
b) conversion of the RNA extracted in a) into cDNA by reverse transcription,
c) incubation of the cDNA obtained in b) with a pair of probes comprising at least one probe selected from:
In a preferred embodiment of the method according to the invention, said RT-MLPA step also comprises at least the following steps:
a) extraction of RNA from the biological sample from the subject,
b) conversion of the RNA extracted in a) into cDNA by reverse transcription,
c) incubation of the cDNA obtained in b) with a pair of probes comprising at least one probe selected from:
In a preferred embodiment of the method according to the invention, said RT-MLPA step also comprises at least the following steps:
a) extraction of RNA from the biological sample from the subject,
b) conversion of the RNA extracted in a) into cDNA by reverse transcription,
c) incubation of the cDNA obtained in b) with a pair of probes comprising at least one probe selected from the probes SEQ ID NO: 1211 to 1312,
each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence,
d) addition of a DNA ligase to the mixture obtained in c), in order to establish a covalent bond between two adjacent probes,
e) PCR amplification of the covalently bound adjacent probes obtained in d), in order to obtain amplicons.
In a preferred embodiment of the method according to the invention, said RT-MLPA step comprises at least the following steps:
a) extraction of RNA from the biological sample from the subject,
b) conversion of the RNA extracted in a) into cDNA by reverse transcription,
c) incubation of the cDNA obtained in b) with a pair of probes comprising at least one probe selected from:
In a preferred embodiment of the method according to the invention, said RT-MLPA step comprises at least the following steps:
a) extraction of RNA from the biological sample from the subject,
b) conversion of the RNA extracted in a) into cDNA by reverse transcription,
c) incubation of the cDNA obtained in b) with a pair of probes comprising at least one probe selected from:
Typically, the extraction of RNA from the biological sample according to step a) is carried out according to conventional techniques, well known to those skilled in the art. For example, this extraction can be carried out by cell lysis of the cells obtained from the biological sample. This lysis may be chemical, physical or thermal. This cell lysis is generally followed by a purification step which allows separating the nucleic acids from other cellular debris and concentrating them. For the implementation of step a), commercial kits of the QIAGEN and Zymo Research type, or those marketed by Invitrogen, can be used. Of course, the relevant techniques differ depending on the nature of the biological sample tested. The knowledge of the person skilled in the art will allow said person to easily adapt these steps of lysis and purification to said biological sample tested.
Preferably, the RNA extracted in step a) is then converted by reverse transcription into cDNA; this is step b) (see
Preferably, the cDNA obtained in step b) is then incubated with at least the probes SEQ ID NO: 1 to 13 and/or SEQ ID NO: 96 to 99, preferably also the probes SEQ ID NO: 14 to 91, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence, preferably the probes of SEQ ID NO: 14 to 91 and optionally the probes of SEQ ID NO: 96 and 98. This is the probe hybridization step c) (see
Preferably, the cDNA obtained in step b) is then incubated with at least the probes SEQ ID NO: 866 to 938 and/or SEQ ID NO: 940 to 1104 and/or SEQ ID NO: 1105 to 1107 and/or SEQ ID NO: 939 and/or SEQ ID NO: 1108 to 1123, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence. This is probe hybridization step c) (see
Preferably, the cDNA obtained in step b) is then incubated with at least the probes SEQ ID NO: 1211 to 1312, each of the probes being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair comprising a molecular barcode sequence. This is probe hybridization step c) (see
Preferably, the probes SEQ ID NO: 1 to 13, 97 and 99 are “R” probes and the probes SEQ ID NO: 96 and 98 are “L” probes, as are the probes SEQ ID NO: 14 to 91.
Preferably, the probes SEQ ID NO: 870-873, 877-878, 882, 889-892, 894-895, 901-902, 912-914, 920-921, 924-926, 930, 937, 939, 943, 946, 950-968, 970-971, 973-983, 988, 991-994, 997-998, 1000, 1002-1004, 1007, 1009-1010, 1017, 1021, 1022, 1035-1040, 1042-1043, 1048-1054, 1056-1059, 1063, 1065, 1067-1068, 1070, 1079-1081, 1088-1089, 1092, 1094, 1096, 1099-1102, 1104, 1106, 1109, 1111, 1113, 1115, 1117, 1119, 1121, 1123 are “R” probes, and the probes SEQ ID NO: 866-869, 874-876, 879-881, 883-888, 893, 896-900, 903-911, 915-919, 922-923, 927-929, 931-936, 938, 940-942, 944-945, 947-949, 969, 972, 984-987, 989-990, 995-996, 999, 1001, 1005-1006, 1008, 1011-1016, 1018-1020, 1023-1034, 1041, 1044-1047, 1055, 1060-1062, 1064, 1066, 1069, 1071-1078, 1082-1087, 1090-1091, 1093, 1095, 1097-1098, 1103, 1105, 1107-1108, 1110, 1112, 1114, 1116, 1118, 1120, 1122 are “L” probes.
Preferably, the probes SEQ ID NO: 1211, 1214, 1215, 1216, 1217, 1222, 1224, 1227, 1230, 1235, 1237, 1239, 1242, 1245, 1248-1249, 1251, 1253, 1260-1265, 1269-1270, 1272, 1273, 1278, 1280, 1282, 1284-1288, 1290, 1295, 1299, 1303-1305, 1310-1312 are “R” probes, and the probes SEQ ID NO: 1212, 1213, 1218-1221, 1223, 1225-1226, 1228-1229, 1231-1234, 1236, 1238, 1240-1241, 1243-1244, 1246-1247, 1250, 1252, 1254-1259, 1266-1268, 1271, 1274-1277, 127, 1281, 1283, 128, 1291-1294, 1296-1298, 1300-1302, 1306-1309 are “L” probes.
At the end of step c), the probes hybridized to the cDNA are adjacent, if and only if the translocation (fusion gene) or the exon skipping has taken place. This step c) is typically carried out by incubating the cDNA and the mixture of probes at a temperature of between 90° C. and 100° C. in order to denature the secondary structures of the nucleic acids, for a period of 1 to 5 minutes, then leaving this to incubate for a period of at least 30 minutes, preferably 1 hour, at a temperature of about 60° C. to allow hybridization of the probes. This can be carried out using the commercial kit sold by the MRC-Holland company (SALSA MLPA Buffer) or using a buffer offered by the NEB company (Buffer U).
At the end of step c), a DNA ligase is typically added in order to covalently bind only the adjacent probes; this is step d) (see
At the end of step d), each pair of adjacent probes L and R is covalently bound, and the primer sequence of each probe is still present in 5′ and 3′, as well as the molecular barcode sequence.
Preferably, the method also comprises a step e) of PCR amplification of the adjacent covalently bound probes obtained in d) (see
PCR is typically carried out using commercial kits, such as the ready-to-use kits sold by Eurogentec (Red′y′Star Mix) or NEB (Q5 High fidelity DNA polymerase). Typically, the PCR takes place with a first phase of initial denaturation at a temperature between 90° C. and 100° C., typically around 94° C., for a time of 5 to 8 minutes; then a second phase of amplification comprising several cycles, typically 35 cycles, each cycle comprising 30 seconds at 94° C., then 30 seconds at 58° C., then 30 seconds at 72° C.; and a last phase of returning to 72° C. for approximately 4 minutes. At the end of the PCR, the amplicons are preferably stored at −20° C. According to the invention, the amplicons correspond to the fusion transcripts or to the transcripts corresponding to an exon skipping present in the sample from the patient/subject to be tested, or possibly to a 5′-3′ imbalance.
According to the invention, in one particular embodiment, and when it is present, the index sequence is in particular introduced during the PCR step at the 3′ end of a primer sequence, in particular the “R” primer sequence.
According to the invention, in one particular embodiment, a first extension sequence can be introduced at 5′ of a primer sequence, and a second extension sequence can be introduced at 3′ of the index sequence.
According to the invention, in one particular embodiment, each pair of probes used in the PCR step comprises a different index sequence which makes it possible to identify the patients. PCR is typically carried out using commercial kits, such as the ready-to-use kits sold by Eurogentec (Red′y′Star Mix) or NEB (Q5 High fidelity DNA polymerase). Typically, the PCR takes place in a first phase of initial denaturation at a temperature between 90° C. and 100° C., typically around 94° C., for a period of 5 to 8 minutes; then a second amplification phase comprising several cycles, typically 35 cycles, each cycle comprising 30 seconds at 94° C., then 30 seconds at 58° C., then 30 seconds at 72° C.; and a last phase of returning to 72° C. for approximately 4 minutes. At the end of the PCR, the amplicons are preferably stored at −20° C.
In a preferred embodiment of the method according to the invention, the RT-MLPA step also comprises a step f) of analyzing the results of the PCR of step e), preferably by sequencing. According to the invention, the sequencing step is preferably a step of capillary sequencing or next-generation sequencing. For this purpose, it is possible to use a capillary sequencer (for example such as the AB13130 Genetic Analyzer, Thermo Fisher) or a next generation sequencer (for example the MiSeq System, Illumina, or the ion S5 System, Thermo Fisher). Several sequences are analyzed simultaneously, the index sequence thus making it possible to associate any identified genetic abnormality with a tested subject.
This analysis step allows immediately reading the result, and indicates directly whether the sample from the subject carries a specific translocation, identified or not, and/or exon skipping such as the skipping of exon 14 of the MET gene or the skipping of exons of the EGFR gene, or possibly a 5′-3′ imbalance.
In a preferred embodiment of the method according to the invention, the RT-MLPA step also comprises a step g) of determining the level of expression of the amplicons that are obtained at the end of the PCR step. Determining the level of expression of the amplicons allows ensuring in particular that the ligations obtained are indeed representative of a fusion transcript or of a transcript corresponding to exon skipping, and do not correspond to a ligation artifact. According to the invention, this step g) is implemented in particular by computer. This determining of the level of expression is implemented by the following steps: (1) demultiplexing the results obtained at the end of the PCR step (i.e. step e)) in order to isolate the sequences obtained for a given subject, thanks to the index sequences, (2) determining the number of DNA or RNA fragments present in the sample from the patient to be tested (before amplification) thanks to the molecular barcodes, and optionally (3) supplying an expression matrix for each fusion transcript or transcript corresponding to an exon skipping or to a 5′-3′ imbalance identified for the tested subject. This determining of the level of expression of the amplicons obtained at the end of a PCR step makes it possible to add more precision to the results of the PCR step, and in particular to the sequencing errors that may occur (see step f) indicated above). Ultimately, determining the level of expression of the amplicons obtained at the end of a PCR step makes it possible to add more precision to the diagnosis of cancer according to the invention.
According to an even more particular embodiment, step g) is a step of analyzing the amplicons obtained at the end of the PCR step, which is implemented by computer, in particular by an arrangement of bioinformatic algorithms. More particularly, this step g) comprises the following steps: (1) a step of demultiplexing based on the identification of the indexes, (2) a step of identifying the pairs of probes, (3) a step of counting the reads (results) and molecular barcode sequences (Barcodes: UMI sequence (Unique Molecular Index)), and optionally (4) a step of evaluating the quality of the sequencing of the sample. The sequences as analyzed by the software are shown in
In a preferred embodiment of the method according to the invention, if, for a biological sample from a subject, a PCR amplification is obtained in step e) following hybridization with a pair of probes targeting fusion genes and/or exon skipping, then the subject is a carrier of the cancer linked to the genetic abnormality corresponding to the pair of probes identified. Preferably, this abnormality is typically analyzed in step f) and/or g) as mentioned above.
In a preferred embodiment of the method according to the invention, the PCR amplification of step e) is carried out using the pair of primers SEQ ID NO: 101 and 92 or SEQ ID NO: 102 and 94.
In a preferred embodiment of the method according to the invention, a cancer is thus identified and allows the patient (meaning the subject to whom the tested biological sample belongs) to benefit from a targeted therapy. According to the invention, “targeted therapy” means any anticancer therapy, such as chemotherapy, radiotherapy, or immunotherapy, but preferably means pharmacological inhibitors of the ALK, ROS, RET, EGFR, and MET proteins.
The invention also relates to a kit comprising at least the probes SEQ ID NO: 1 to 13, and/or the probes SEQ ID NO: 96 to 99, preferably further comprising the probes SEQ ID NO: 14 to 91, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence, in particular the probes SEQ ID NO: 14 to 91 and optionally SEQ ID NO: 96 and 98.
The invention also relates to a kit comprising at least the probes SEQ ID NO: 868 to 938 and/or the probes SEQ ID NO: 940 to 1104 and/or the probes SEQ ID NO: 1105 to 1107 and/or the probe SEQ ID NO: 939 and/or the probes SEQ ID NO: 1108 to 1123, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the probes SEQ ID NO: 1211 to 1312, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the probes SEQ ID NO: 1 to 13, and/or the probes SEQ ID NO: 96 to 99 and/or the probes SEQ ID NO: 866 to 938 and/or the probes SEQ ID NO: 940 to 1104 and/or the probes SEQ ID NO: 1105 to 1107 and/or the probe SEQ ID NO: 939 and/or the probes SEQ ID NO: 1108 to 1123, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the probes SEQ ID NO: 1 to 13, and/or the probes SEQ ID NO: 96 to 99 and/or the probes SEQ ID NO: 866 to 938 and/or the probes SEQ ID NO: 940 to 1104 and/or the probes SEQ ID NO: 1105 to 1107 and/or the probe SEQ ID NO: 939 and/or the probes SEQ ID NO: 1108 to 1123, and/or the probes SEQ ID NO: 1211 to 1312, optionally the probes SEQ ID NO: 1148, 1149, 1178, 1179, 1209 and/or 1210, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the following probes: SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824 and SEQ ID NO: 825, each of the probes being preferably fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the following probes: SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824, SEQ ID NO: 825, SEQ ID NO: 866 to 938, SEQ ID NO: 940 to 1104, SEQ ID NO: 1105 to 1107, SEQ ID NO: 939 and SEQ ID NO: 1108 to 1123, each of the probes being preferably fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
The invention also relates to a kit comprising at least the following probes: SEQ ID NO: 1 to 13, SEQ ID NO: 14 to 91, SEQ ID NO: 96 to 99, SEQ ID NO: 103 to 127, SEQ ID NO: 128, SEQ ID NO: 129, SEQ ID NO: 130 to 137, SEQ ID NO: 138 to 168, SEQ ID NO: 169 to 194, SEQ ID NO: 826 to 835, SEQ ID NO: 195 to 198, SEQ ID NO: 199 to 245, SEQ ID NO: 246 to 344, SEQ ID NO: 345 to 403, SEQ ID NO: 404 to 428, SEQ ID NO: 429 to 436, SEQ ID NO: 437 to 479, SEQ ID NO: 480 to 504, SEQ ID NO: 505, SEQ ID NO: 506, SEQ ID NO: 507 to 514, SEQ ID NO: 515 to 546, SEQ ID NO: 547 to 582, SEQ ID NO: 583 to 586, SEQ ID NO: 587 to 633, SEQ ID NO: 634 to 732, SEQ ID NO: 733 to 791, SEQ ID NO: 792 to 816, SEQ ID NO: 817 to 824, SEQ ID NO: 825, SEQ ID NO: 866 to 938, SEQ ID NO: 940 to 1104, SEQ ID NO: 1105 to 1107, SEQ ID NO: 939, SEQ ID NO: 1108 to 1123, and SEQ ID NO: 1211 to 1312, optionally the probes SEQ ID NO: 1148, 1149, 1178, 1179, 1209 and/or 1210, each of the probes preferably being fused, at at least one end, with a primer sequence, and at least one of the probes of said pair preferably comprising a molecular barcode sequence.
Determining the level of expression of the amplicons that are obtained at the end of a PCR step (for example carried out according to step e) above) is very advantageous because it allows ensuring that the obtained results are reliable. It allows in particular determining the number of RNA molecules (in particular the fusion transcripts or the transcripts corresponding to exon skipping or the transcripts of the genes whose 5′-3′ imbalance is to be analyzed) present in the sample to be tested. This adds more precision to the diagnosis performed.
In this aspect, the invention thus relates to a method for determining the level of expression of the amplicons that are obtained at the end of a PCR step, said method being implemented by computer and comprising the following steps:
(a) providing a sample to be tested, said sample comprising amplicons obtained at the end of a PCR step, and
(b) determining the level of expression of the amplicons.
In one particular embodiment of the method implemented by computer according to the invention, the determination of the level of expression of the amplicons aims in particular to:
(1) demultiplex the results of amplicons obtained at the end of a PCR step,
(2) determine the number of DNA or RNA fragments present in the sample of the patient to be tested (before amplification), and optionally
(3) provide an expression matrix for each fusion transcript or transcript corresponding to exon skipping identified for the patient being tested.
This determination of the level of expression of the amplicons that are obtained at the end of a PCR step allows adding more precision to the results. Analysis of the amplicons and their quantification can also be carried out very quickly.
In one particular embodiment, the method implemented by computer comprises the following steps:
(1) a step of demultiplexing the results of amplicons obtained at the end of a PCR step,
(2) a step of searching for pairs of probes used during the PCR step,
(3) a step of counting the reads (results, i.e. fusion transcripts or exon skippings) and molecular barcode sequences (UMI sequence (Unique Molecular Index)), optionally the index sequence, and optionally
(4) a step of evaluating the quality of sequencing of the sample.
The software according to the invention requires three files for its execution: a FASTQ, an index file and a marker file.
FASTQ: During a sequencing experiment, the raw data are generated in the form of a standard file called FASTQ. This FASTQ format will group, for each read sequenced by the device: (1) a unique sequence identifier, (2) the sequence of the read, (3) the read direction, (4) an ASCII sequence grouping the quality scores per base for each base that is read. An example of a read in FASTQ format is shown in
Marker file: This file groups all the sequences of each probe as well as their name. It brings together all the pairs of probes used during a diagnosis. It is specific to each kit (expression measurement, searching for fusion transcripts, for exon skipping, for imbalance, etc.).
Index file: This file groups the list of sequences used to identify the subjects tested. It gathers together all the index sequences used during a diagnosis. Each sequence will correspond to a tested subject and will allow reassigning the sequenced reads. This file is specific to each experiment.
According to the invention, the term “step of demultiplexing” means the step which aims to identify the various index sequences used during construction of the library to identify the reads for each of the subjects tested. This search is carried out by an exact and inexact matching algorithm for comparing sequences to allow taking into account the sequencing errors linked to the method of acquisition by high-throughput sequencing. According to the invention, a “library” is understood to mean the construction comprising at least an index sequence, a left probe and a right probe that are characteristic of a genetic abnormality, and optionally a molecular barcode sequence.
According to the invention, the term “step of searching for pairs of probes” means the step which aims to identify, for each sequence of the FASTQ file, whether there is a pair of probes in the marker file that allow attributing it to an entity that was to be measured (fusion transcripts, exon skipping . . . ). A data structure in the algorithm allows associating with each sequence a tag bearing the name of the two probes, left (“L”) and right (“R”). This search is carried out as an exact search by comparing sequences (e.g. the Hamming and Levenshtein distance calculation) and by an approximate method tolerating ‘k’ errors. This ‘k’ parameter can be changed when launching the tool. For the expression measurement, each pair of probes (right and left) is specific to an entity whose expression is to be measured. To measure the expression of a gene, two probes are used which hybridize strictly one behind the other to this gene. These probes will then be assembled during the ligation step, then amplified and read. Sequences having no logical tag during the search for probes are stored, in order to perform a search for chimeras. Indeed, it is possible that certain probes cross-hybridize during the hybridization, ligation, and amplification steps during construction of the library, leading to the appearance of hybrid sequences (for example a right probe of gene A with a left probe of gene B). Here again, these sequences are detected by exact and inexact matching of sequences. For the search for fusion transcripts, it is not known which probes will hybridize together and be amplified. The search for the probes is therefore carried out without preconceptions, by comparison of all pairs of possible right/left sequences.
According to the invention, the term “a step of counting the reads (results) and molecular barcode sequences” means the step occurring when the FASTQ file is scanned and the pairs of probes identified (markers and chimeras). The algorithm will proceed to count them. These counts are of two types: (1) quantifying the number of sequences read by the sequencer, and (2) the number of unique molecular barcode (UMI) sequences assigned to the marker. Sequence counting is done based on the data structure previously described during identification of the markers. The number of tags assigned for each marker will be determined by traversing the data structure. Counting the IMUs is more complex. It involves a step of extracting the UMI of each sequence and a step of correcting sequencing errors in the UMIs. The significant combinatorial analysis of these random sequences, their counts, and the amplification factor of the sample will make it possible to identify the IMUs carrying sequencing errors in order to correct the count data. This correction of the UMIs involves creating a graph structure associating a counter with each unique UMI. The UMIs are then grouped by increasing count with k tolerated errors. The UMIs allow identifying the number of unique sequences read by the sequencer before the amplification step during preparation of the library. They therefore provide information about the number of transcripts actually read and not the number of transcripts read after amplification.
According to the invention, the term “a step of evaluating the quality of sequencing of the sample” means the step which aims to determine the analyzed sequences which are not significant. A quality score indicative of the diversity of the libraries, meaning the number of unique transcripts read, has been implemented in the algorithm so as to provide an indication of the richness of the sample analyzed and to eliminate samples that would be considered as failures (i.e. having a score <5000).
Preferably, the method implemented by computer according to the invention makes it possible to calculate the level of expression of a large number of fusion transcripts or transcripts corresponding to exon skipping (in particular greater than 1000) for a large number of samples (in particular greater than 40), and to do so in a very short time (in particular 5 to 10 minutes).
According to one particular embodiment, the method implemented by computer can make it possible to correct sequencing errors which arise during sequencing of the amplicons, for example the correction of sequencing errors in molecular barcode sequences (UMI) (see for example ‘Method called Directional & Reference: Smith, T., Heger, A., & Sudbery, I. (2017). UMI-tools: modeling sequencing errors in Unique Molecular Identifiers to improve quantification accuracy. Genome Research, 27(3), 491-499. http://doi.org/10.1101/gr.209601.116))
Tables 1 and 2 below provide details concerning the sequences of the invention.
Description of sequences 1 to 102 and 866 to 1123 and 1209 to 1312 according to the invention
Correspondence between sequences 103 to 835 and the sequences described in international application PCT/FR2014/052255. The L/R information for sequences 103 to 835 is indicated in
Other features, details, and advantages of the invention will become apparent on reading the appended Figures.
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above (more particularly at least probes SEQ ID NO: 1 to 13 and 14 to 91).
At the end of the PCR step, 98,993 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes allows accurately determining the number of fusion RNA molecules present in the starting sample (in the case tested here: 729, see
Table 3 shows the results obtained.
Example of probes used and results obtained during a diagnosis of carcinoma
Analysis of the sequence corresponding to PCR products makes it possible to identify the two partner genes involved in the chromosomal rearrangement, here the EML4 and ALK genes. The diagnosis of carcinoma was thus confirmed for the patient to be tested.
This rearrangement is recurrent in lung carcinomas, and makes the patient eligible for certain targeted therapies.
The sample from a subject was analyzed to confirm or rule out the presence of a skipping of exon 14 of the MET gene. Said sample was subjected to an RT-MLPA step according to the invention, using the probes described above (more particularly at least probes SEQ ID NO: 96 to 99).
In a normal situation, the splicing of the transcripts of this gene induces junctions between exons 13 and 14, and 14 and 15. In a pathological situation, for example if a mutation destroys the splicing donor site of exon 14, tumor cells express an abnormal transcript, resulting from the junction of exons 13 and 15 (
The various amplification products obtained by virtue of the invention are visible in
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above (more particularly at least probes SEQ ID NO: 1 to 13 and 14 to 91).
At the end of the PCR step, 152,227 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to accurately determine the number of fusion RNA molecules present in the starting sample (in the case tested here: 587, see
Table 4 shows the results obtained.
Example of probes used and results obtained during a diagnosis of carcinoma
Analysis of the sequence corresponding to PCR products makes it possible to identify the two partner genes involved in the chromosomal rearrangement, here the KIF5B and RET genes. The diagnosis of carcinoma was thus confirmed for the patient to be tested.
This rearrangement is recurrent in lung carcinomas, and makes the patient eligible for certain targeted therapies.
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above (more particularly at least probes SEQ: 868 to 938 and probes SEQ ID NO: 940 to 1054).
At the end of the PCR step, 62,151 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to accurately determine the number of fusion RNA molecules present in the starting sample (in the case tested here: 505, see
Table 5 shows the results obtained.
Example of probes used and results obtained during a diagnosis of sarcoma
Analysis of the sequence corresponding to PCR products makes it possible to identify the two partner genes involved in the chromosomal rearrangement, here the EWSR1 and FLI1 genes. The diagnosis of sarcoma was thus confirmed for the patient to be tested.
This rearrangement is recurrent in Ewing sarcomas, which makes it possible to make the diagnosis.
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above (more particularly at least probes SEQ: 868 to 938 and probes SEQ ID NO: 940 to 1054).
At the end of the PCR step, 119,161 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to accurately determine the number of fusion RNA molecules present in the starting sample (in the case tested here: 960, see
Table 6 shows the results obtained.
Example of probes used and results obtained during a diagnosis of sarcoma
Analysis of the sequence corresponding to PCR products makes it possible to identify the two partner genes involved in the chromosomal rearrangement, here the SS18 and SSX genes. The diagnosis of sarcoma was thus confirmed for the patient to be tested.
This rearrangement is recurrent in synovial sarcomas, which makes it possible to make the diagnosis.
Table 7 shows some examples.
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above.
At the end of the PCR step, 70,571 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to precisely determine the number of fusion RNA molecules present in the starting sample (in the case tested here: (71 junctions between exons 13 and 14, 119 between exons 13 and 15, and 92 between exons 14 and 15 of the METgene)). These results, and in particular the detection of transcripts 13-15, indicate the presence of a splicing abnormality of the MET gene, making this patient eligible for targeted therapy (see
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above.
At the end of the PCR step, 116,165 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to precisely determine the number of fusion RNA molecules present in the starting sample (in the case tested here: (455 junctions between exons 1 and 2, 332 between exons 1 and 8, and 349 between exons 7 and 8 of the EGFR gene)). These results, and in particular the detection of transcripts 1-8, indicate the presence of an internal deletion of the EGFR gene, making this patient eligible for targeted therapy (see
The sample from a subject was subjected to an RT-MLPA step according to the invention, using the probes described above.
At the end of the PCR step, 59,214 sequences corresponding to unique PCR products (fusion transcripts) were read by next-generation sequencing. These sequences all carry a 7 base-pair molecular barcode sequence at 5′. Due to PCR amplification, these molecular barcode sequences are read several times (number of reads). Counting these barcodes makes it possible to precisely determine the number of fusion RNA molecules present in the starting sample (in the case tested here: 157 junctions between exons 21 and 22, 75 between exons 22 and 23, 52 between exons 25 and 26, and 50 between exons 27 and 28 of the ALK gene). These results, and in particular the demonstration of an expression imbalance between the 5′ and 3′ portions of the ALK gene, indicate that this gene is rearranged, making this patient eligible for targeted therapy (see
| Number | Date | Country | Kind |
|---|---|---|---|
| 18 60174 | Nov 2018 | FR | national |
| 19 08905 | Aug 2019 | FR | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/FR2019/052617 | 11/5/2019 | WO |
