Paediatrics (RCH) - Research Publications

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    Toblerone: detecting exon deletion events in cancer using RNA-seq.
    Lonsdale, A ; Halman, A ; Brown, L ; Kosasih, H ; Ekert, P ; Oshlack, A (F1000 Research Ltd, 2023)
    Cancer is driven by mutations of the genome that can result in the activation of oncogenes or repression of tumour suppressor genes. In acute lymphoblastic leukemia (ALL) focal deletions in IKAROS family zinc finger 1 (IKZF1) result in the loss of zinc-finger DNA-binding domains and a dominant negative isoform that is associated with higher rates of relapse and  poorer patient outcomes. Clinically, the presence of IKZF1 deletions informs prognosis and treatment options. In this work we developed a method for detecting exon deletions in genes using RNA-seq with application to IKZF1. We developed a pipeline that first uses a custom transcriptome reference consisting of transcripts with exon deletions.  Next, RNA-seq reads are mapped using a pseudoalignment algorithm to identify reads that uniquely support deletions. These are then evaluated for evidence of the deletion with respect to gene expression and other samples. We applied the algorithm, named Toblerone, to a cohort of 99 B-ALL paediatric samples including validated IKZF1 deletions. Furthermore, we developed a graphical desktop app for non-bioinformatics users that can quickly and easily identify and report deletions in IKZF1 from RNA-seq data with informative graphical outputs.
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    TALLSorts: a T-cell acute lymphoblastic leukemia subtype classifier using RNA-seq expression data
    Gu, A ; Schmidt, B ; Lonsdale, A ; Jalaldeen, R ; Kosasih, HJ ; Brown, LM ; Sadras, T ; Ekert, PG ; Oshlack, A (ELSEVIER, 2023-12-13)
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    Enhancer retargeting of CDX2 and UBTF::ATXN7L3 define a subtype of high-risk B-progenitor acute lymphoblastic leukemia
    Kimura, S ; Montefiori, L ; Iacobucci, I ; Zhao, Y ; Gao, Q ; Paietta, EM ; Haferlach, C ; Laird, AD ; Mead, PE ; Gu, Z ; Stock, W ; Litzow, M ; Rowe, JM ; Luger, SM ; Hunger, SP ; Ryland, GL ; Schmidt, B ; Ekert, PG ; Oshlack, A ; Grimmond, SM ; Rehn, J ; Breen, J ; Yeung, D ; White, DL ; Aldoss, I ; Jabbour, EJ ; Pui, C-H ; Meggendorfer, M ; Walter, W ; Kern, W ; Haferlach, T ; Brady, S ; Zhang, J ; Roberts, KG ; Blombery, P ; Mullighan, CG (AMER SOC HEMATOLOGY, 2022-06-16)
    Transcriptome sequencing has identified multiple subtypes of B-progenitor acute lymphoblastic leukemia (B-ALL) of prognostic significance, but a minority of cases lack a known genetic driver. Here, we used integrated whole-genome (WGS) and -transcriptome sequencing (RNA-seq), enhancer mapping, and chromatin topology analysis to identify previously unrecognized genomic drivers in B-ALL. Newly diagnosed (n = 3221) and relapsed (n = 177) B-ALL cases with tumor RNA-seq were studied. WGS was performed to detect mutations, structural variants, and copy number alterations. Integrated analysis of histone 3 lysine 27 acetylation and chromatin looping was performed using HiChIP. We identified a subset of 17 newly diagnosed and 5 relapsed B-ALL cases with a distinct gene expression profile and 2 universal and unique genomic alterations resulting from aberrant recombination-activating gene activation: a focal deletion downstream of PAN3 at 13q12.2 resulting in CDX2 deregulation by the PAN3 enhancer and a focal deletion of exons 18-21 of UBTF at 17q21.31 resulting in a chimeric fusion, UBTF::ATXN7L3. A subset of cases also had rearrangement and increased expression of the PAX5 gene, which is otherwise uncommon in B-ALL. Patients were more commonly female and young adult with median age 35 (range,12-70 years). The immunophenotype was characterized by CD10 negativity and immunoglobulin M positivity. Among 16 patients with known clinical response, 9 (56.3%) had high-risk features including relapse (n = 4) or minimal residual disease >1% at the end of remission induction (n = 5). CDX2-deregulated, UBTF::ATXN7L3 rearranged (CDX2/UBTF) B-ALL is a high-risk subtype of leukemia in young adults for which novel therapeutic approaches are required.
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    Unusual PDGFRB fusion reveals novel mechanism of kinase activation in Ph-like B-ALL
    Sadras, T ; Jalud, FBB ; Kosasih, HJJ ; Horne, CRR ; Brown, LMM ; El-Kamand, S ; de Bock, CEE ; McAloney, L ; Ng, APP ; Davidson, NMM ; Ludlow, LEA ; Oshlack, A ; Cowley, MJJ ; Khaw, SLL ; Murphy, JMM ; Ekert, PGG (SPRINGERNATURE, 2023-04)
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    ALLSorts: an RNA-Seq subtype classifier for B-cell acute lymphoblastic leukemia
    Schmidt, B ; Brown, LM ; Ryland, GL ; Lonsdale, A ; Kosasih, HJ ; Ludlow, LE ; Majewski, IJ ; Blombery, P ; Ekert, PG ; Davidson, NM ; Oshlack, A (ELSEVIER, 2022-07-26)
    B-cell acute lymphoblastic leukemia (B-ALL) is the most common childhood cancer. Subtypes within B-ALL are distinguished by characteristic structural variants and mutations, which in some instances strongly correlate with responses to treatment. The World Health Organisation (WHO) recognises seven distinct classifications, or subtypes, as of 2016. However, recent studies have demonstrated that B-ALL can be segmented into 23 subtypes based on a combination of genomic features and gene expression profiles. A method to identify a patient's subtype would have clear utility. Despite this, no publically available classification methods using RNA-Seq exist for this purpose. Here we present ALLSorts: a publicly available method that uses RNA-Seq data to classify B-ALL samples to 18 known subtypes and five meta-subtypes. ALLSorts is the result of a hierarchical supervised machine learning algorithm applied to a training set of 1223 B-ALL samples aggregated from multiple cohorts. Validation revealed that ALLSorts can accurately attribute samples to subtypes and can attribute multiple subtypes to a sample. Furthermore, when applied to both paediatric and adult cohorts, ALLSorts was able to classify previously undefined samples into subtypes. ALLSorts is available and documented on GitHub (https://github.com/Oshlack/AllSorts/).
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    SFPQ-ABL1 and BCR-ABL1 use different signaling networks to drive B-cell acute lymphoblastic leukemia
    Brown, LM ; Hediyeh-Zadeh, S ; Sadras, T ; Huckstep, H ; Sandow, JJ ; Bartolo, RC ; Kosasih, HJ ; Davidson, NM ; Schmidt, B ; Bjelosevic, S ; Johnstone, R ; Webb, A ; Khaw, SL ; Oshlack, A ; Davis, MJ ; Ekert, PG (ELSEVIER, 2022-04-12)
    Philadelphia-like (Ph-like) acute lymphoblastic leukemia (ALL) is a high-risk subtype of B-cell ALL characterized by a gene expression profile resembling Philadelphia chromosome-positive ALL (Ph+ ALL) in the absence of BCR-ABL1. Tyrosine kinase-activating fusions, some involving ABL1, are recurrent drivers of Ph-like ALL and are targetable with tyrosine kinase inhibitors (TKIs). We identified a rare instance of SFPQ-ABL1 in a child with Ph-like ALL. SFPQ-ABL1 expressed in cytokine-dependent cell lines was sufficient to transform cells and these cells were sensitive to ABL1-targeting TKIs. In contrast to BCR-ABL1, SFPQ-ABL1 localized to the nuclear compartment and was a weaker driver of cellular proliferation. Phosphoproteomics analysis showed upregulation of cell cycle, DNA replication, and spliceosome pathways, and downregulation of signal transduction pathways, including ErbB, NF-κB, vascular endothelial growth factor (VEGF), and MAPK signaling in SFPQ-ABL1-expressing cells compared with BCR-ABL1-expressing cells. SFPQ-ABL1 expression did not activate phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling and was associated with phosphorylation of G2/M cell cycle proteins. SFPQ-ABL1 was sensitive to navitoclax and S-63845 and promotes cell survival by maintaining expression of Mcl-1 and Bcl-xL. SFPQ-ABL1 has functionally distinct mechanisms by which it drives ALL, including subcellular localization, proliferative capacity, and activation of cellular pathways. These findings highlight the role that fusion partners have in mediating the function of ABL1 fusions.
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    JAFFAL: detecting fusion genes with long-read transcriptome sequencing
    Davidson, NM ; Chen, Y ; Sadras, T ; Ryland, GL ; Blombery, P ; Ekert, PG ; Goke, J ; Oshlack, A (BMC, 2022-01-06)
    In cancer, fusions are important diagnostic markers and targets for therapy. Long-read transcriptome sequencing allows the discovery of fusions with their full-length isoform structure. However, due to higher sequencing error rates, fusion finding algorithms designed for short reads do not work. Here we present JAFFAL, to identify fusions from long-read transcriptome sequencing. We validate JAFFAL using simulations, cell lines, and patient data from Nanopore and PacBio. We apply JAFFAL to single-cell data and find fusions spanning three genes demonstrating transcripts detected from complex rearrangements. JAFFAL is available at https://github.com/Oshlack/JAFFA/wiki .
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    Targeted therapy and disease monitoring in CNTRL-FGFR1-driven leukaemia
    Brown, LM ; Bartolo, RC ; Davidson, NM ; Schmidt, B ; Brooks, I ; Challis, J ; Petrovic, V ; Khuong-Quang, D-A ; Mechinaud, F ; Khaw, SL ; Majewski, IJ ; Oshlack, A ; Ekert, PG (WILEY, 2019-10)
    We report two patients with leukaemia driven by the rare CNTRL-FGFR1 fusion oncogene. This fusion arises from a t(8;9)(p12;q33) translocation, and is a rare driver of biphenotypic leukaemia in children. We used RNA sequencing to report novel features of expressed CNTRL-FGFR1, including CNTRL-FGFR1 fusion alternative splicing. From this knowledge, we designed and tested a Droplet Digital PCR assay that detects CNTRL-FGFR1 expression to approximately one cell in 100 000 using fusion breakpoint-specific primers and probes. We also utilised cell-line models to show that effective tyrosine kinase inhibitors, which may be included in treatment regimens for this disease, are only those that block FGFR1 phosphorylation.
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    Clinker: visualizing fusion genes detected in RNA-seq data
    Schmidt, BM ; Davidson, NM ; Hawkins, ADK ; Bartolo, R ; Majewski, IJ ; Ekert, PG ; Oshlack, A (OXFORD UNIV PRESS, 2018-07-04)
    BACKGROUND: Genomic profiling efforts have revealed a rich diversity of oncogenic fusion genes. While there are many methods for identifying fusion genes from RNA-sequencing (RNA-seq) data, visualizing these transcripts and their supporting reads remains challenging. FINDINGS: Clinker is a bioinformatics tool written in Python, R, and Bpipe that leverages the superTranscript method to visualize fusion genes. We demonstrate the use of Clinker to obtain interpretable visualizations of the RNA-seq data that lead to fusion calls. In addition, we use Clinker to explore multiple fusion transcripts with novel breakpoints within the P2RY8-CRLF2 fusion gene in B-cell acute lymphoblastic leukemia. CONCLUSIONS: Clinker is freely available software that allows visualization of fusion genes and the RNA-seq data used in their discovery.
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    The application of RNA sequencing for the diagnosis and genomic classification of pediatric acute lymphoblastic leukemia
    Brown, LM ; Lonsdale, A ; Zhu, A ; Davidson, NM ; Schmidt, B ; Hawkins, A ; Wallach, E ; Martin, M ; Mechinaud, FM ; Khaw, SL ; Bartolo, RC ; Ludlow, LEA ; Challis, J ; Brooks, I ; Petrovic, V ; Venn, NC ; Sutton, R ; Majewski, IJ ; Oshlack, A ; Ekert, PG (AMER SOC HEMATOLOGY, 2020-03-10)
    Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, and implementation of risk-adapted therapy has been instrumental in the dramatic improvements in clinical outcomes. A key to risk-adapted therapies includes the identification of genomic features of individual tumors, including chromosome number (for hyper- and hypodiploidy) and gene fusions, notably ETV6-RUNX1, TCF3-PBX1, and BCR-ABL1 in B-cell ALL (B-ALL). RNA-sequencing (RNA-seq) of large ALL cohorts has expanded the number of recurrent gene fusions recognized as drivers in ALL, and identification of these new entities will contribute to refining ALL risk stratification. We used RNA-seq on 126 ALL patients from our clinical service to test the utility of including RNA-seq in standard-of-care diagnostic pipelines to detect gene rearrangements and IKZF1 deletions. RNA-seq identified 86% of rearrangements detected by standard-of-care diagnostics. KMT2A (MLL) rearrangements, although usually identified, were the most commonly missed by RNA-seq as a result of low expression. RNA-seq identified rearrangements that were not detected by standard-of-care testing in 9 patients. These were found in patients who were not classifiable using standard molecular assessment. We developed an approach to detect the most common IKZF1 deletion from RNA-seq data and validated this using an RQ-PCR assay. We applied an expression classifier to identify Philadelphia chromosome-like B-ALL patients. T-ALL proved a rich source of novel gene fusions, which have clinical implications or provide insights into disease biology. Our experience shows that RNA-seq can be implemented within an individual clinical service to enhance the current molecular diagnostic risk classification of ALL.