Colegrove, H. L. | Search bioRxiv

bioRxiv2026

Ultra-deep duplex sequencing reveals unique features of somatic evolution in the normal tissues of a family with Li-Fraumeni syndrome

Li-Fraumeni Syndrome (LFS) is caused by germline pathogenic variants in TP53 which predispose carriers to early onset cancer across multiple tissues. While genomically profiling those cancers has revealed factors contributing to their formation, little is understood about how LFS impacts clonal evolution in healthy tissues preceding cancer. Here, we use ultra-deep duplex sequencing (mean [~]15,000x depth) to investigate somatic mutation and selection in a family carrying the germline TP53 p.R181H pathogenic variant and a cohort of non-carrier controls. In blood samples, the germline variant is associated with more mutations in a panel designed to capture genomewide mutagenesis, and with reduced positive selection on somatic TP53 mutations, despite confounding by chemotherapy treatment in one individual. DNMT3A and TET2 mutations appear positively selected and GATA2 mutations negatively selected across the cohort, independent of the p.R181H status. Extensive multi-tissue sampling of 22 non-cancerous and 6 cancerous samples was also performed at autopsy in one individual with LFS who succumbed to esophageal cancer. Cross-tissue analysis reveals excess mutations in sun-exposed skin, esophagus and chronically-inflamed stomach tissue, and concordant mutations in the p.R248 hotspot of TP53 across most (18/28) tissue samples. Most somatic TP53 mutations in LFS that can be assessed for phase arose on the chromosomal copy lacking the p.R181H variant. Our study reveals how the germline p.R181H variant reshapes baseline somatic mutation and selection in normal tissues and highlights the importance of understanding early somatic evolution in LFS prior to cancer development and treatment.

cancer biology↗

bioRxiv2025

Epithelial competition determines gene therapy potential to suppress Fanconi Anemia oral cancer risk

Fanconi Anemia (FA) is a heritable syndrome characterized by DNA damage repair deficits, frequent malformations and a significantly elevated risk of bone marrow failure, leukemia, and mucosal head and neck squamous cell carcinomas (HNSCC). Hematopoietic stem cell gene therapy can prevent marrow failure and lower leukemia risk, but mucosal gene therapy to lower HNSCC risk remains untested. Major knowledge gaps include an incomplete understanding of how rapidly gene-corrected cellular lineages could spread through the oral epithelium, and which delivery parameters are critical for ensuring efficient gene correction. To answer these questions, we extended an agent-based model of the oral epithelium to include the delivery of gene correction in situ to FA cells and the competitive dynamics between cellular lineages with and without gene correction. We found that only gene-corrected lineages with substantial proliferative advantages (probability of resisting displacement out of the basal layer [≥] 0. 1) could spread on clinically relevant timelines, and that these lineages were initially at high risk of loss in the generations following correction. Delivering gene correction to many cells minimizes the risk of loss, while delivery to many distinct locations within a tissue maximizes the rate of spread. To determine the impact of mucosal gene therapy in preventing the clonal expansion of pre-cancerous mutations, we compared the expected burden of TP53 mutations in simulated tissue sections with and without gene correction. We found that when FA cells have elevated genome instability or a TP53-dependent proliferative advantage, gene correction can substantially reduce the accumulation of pro-tumorigenic mutations. This model illustrates the power of computational frameworks to identify critical determinants of therapeutic success to enable experimental optimization and support novel and effective gene therapy applications. Author summaryWe investigated factors influencing the success of oral mucosal gene therapy for Fanconi Anemia (FA), a genetic syndrome marked by DNA repair defects in conjunction with a heightened risk of cancer. We used a computational model of the oral epithelium to determine how gene therapy corrected cells compete with FA background cells and the best gene delivery approaches to promote effective tissue replacement by gene-corrected cells. We find that gene-corrected cells require strong proliferative advantages to spread effectively, and that initially delivering gene correction to more cells reduces the chance that these cells are stochastically eliminated before they can spread. We also demonstrate that gene correction reduces the accumulation of pro-tumorigenic TP53 mutations in an FA context, where genomic instability can elevate the mutation rate and FA-specific selective pressures could favor accelerated TP53 clonal expansion. This research provides a useful framework for guiding mucosal gene therapy experiments and the development of effective oral gene therapy protocols for cancer prevention in FA.

cell biology↗