Recurrent AAV2-related insertional mutagenesis in human hepatocellular carcinomas


Hepatocellular carcinomas (HCCs) are liver tumors related to various etiologies, including alcohol intake and infection with hepatitis B (HBV) or C (HCV) virus. Additional risk factors remain to be identified, particularly in patients who develop HCC without cirrhosis. We found clonal integration of adeno-associated virus type 2 (AAV2) in 11 of 193 HCCs. These AAV2 integrations occurred in known cancer driver genes, namely CCNA2 (cyclin A2; four cases), TERT (telomerase reverse transcriptase; one case), CCNE1 (cyclin E1; three cases), TNFSF10 (tumor necrosis factor superfamily member 10; two cases) and KMT2B (lysine-specific methyltransferase 2B; one case), leading to overexpression of the target genes. Tumors with viral integration mainly developed in non-cirrhotic liver (9 of 11 cases) and without known risk factors (6 of 11 cases), suggesting a pathogenic role for AAV2 in these patients. In conclusion, AAV2 is a DNA virus associated with oncogenic insertional mutagenesis in human HCC.

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Figure 1: AAV2 integration in the TERT promoter and AAV2 mapping using viral capture.
Figure 2: AAV2 integration in CCNA2 and the consequences on gene expression.
Figure 3: AAV2 integration in TNFSF10 and the consequences on gene expression.
Figure 4: AAV2 integration in CCNE1 and KMT2B and the consequences on gene expression.
Figure 5: AAV2 inserted sequences and secondary structures of the wild-type AAV2 3′ ITR.

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We warmly thank L. Yost, E. Chevet and A. de Reynies for critical review of the manuscript and helpful discussion. We thank all the clinician surgeons and pathologists who have participated in this work: J. Saric, C. Laurent, L. Chiche, B. Le Bail and C. Castain (CHU Bordeaux) and Y. Allory, K. Leroy and D. Azoulay (CHU Henri Mondor). We also thank the Réseau National Centre de Ressources Biologiques (CRB) Foie and the tumor banks of CHU Bordeaux and CHU Henri Mondor for contributing to the tissue collection. This work was supported by Institut Nationale du Cancer (INCa) with the International Cancer Genome Consortium (ICGC) and the PAIR-CHC project NoFLIC (also funded by Association pour la Recherche sur le Cancer (ARC)). The group is supported by the Ligue Nationale contre le Cancer. J.-C.N., M.M., C.P. and A.F. were supported by fellowships from INCa, AERIO-Boehringer-Ingelheim, ARC and the Ligue Nationale contre le Cancer, respectively.

Author information




J.-C.N., S.D., S.I. and J.Z.-R. designed the study and wrote the manuscript. J.Z.-R. conceived and directed the research. J.-C.N., S.D., A.F., M.M., G.C., C.P. and B.V. performed the experiments. J.-C.N., S.D., S.I., A.F., M.M., G.C., E.L., C.P., B.V., F.C. and J.Z.-R. analyzed and interpreted the data. S.I., E.L. and M.L. performed bioinformatics and statistical analysis. J.-F.B., C.B., J.C., A.L. and P.B.-S. provided essential biological resources and collected clinical data. All authors approved the final manuscript and contributed to critical revisions to its intellectual context.

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Correspondence to Jessica Zucman-Rossi.

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Competing interests

IntegraGen performed all the next-generation sequencing, and M.L. is an employee of IntegraGen. All other authors declare no competing financial interests.

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Nault, JC., Datta, S., Imbeaud, S. et al. Recurrent AAV2-related insertional mutagenesis in human hepatocellular carcinomas. Nat Genet 47, 1187–1193 (2015).

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