Germline DLST variants promote epigenetic modifications in pheochromocytoma-paraganglioma

Alexandre Buffet, Juan Zhang, Heggert Rebel, Eleonora P M Corssmit, Jeroen C Jansen, Erik F Hensen, Judith V M G Bovée, Aurélien Morini, Anne-Paule Gimenez-Roqueplo, Frederik J Hes, Peter Devilee, Judith Favier, Jean-Pierre Bayley

Research output: Contribution to journalArticle


CONTEXT: Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors in which altered central metabolism appears to be a major driver of tumorigenesis, and many PPGL genes encode proteins involved in the tricarboxylic acid (TCA) cycle.

OBJECTIVE/DESIGN: While about 40% of PPGL cases carry a variant in a known gene, many cases remain unexplained. In patients with unexplained PPGL showing clear evidence of a familial burden or multiple tumors, we aimed to identify causative factors using genetic analysis of patient DNA and functional analyses of identified DNA variants in patient tumor material and engineered cell lines.

PATIENTS AND SETTING: Patients with a likely familial cancer burden of pheochromocytomas and/or paragangliomas and under investigation in a clinical genetic and clinical research setting in university hospitals.

RESULTS: While investigating unexplained PPGL cases, we identified a novel variant, c.1151C>T, p.(Pro384Leu), in exon 14 of the gene encoding dihydrolipoamide S-succinyltransferase (DLST), a component of the multi-enzyme complex 2-oxoglutarate dehydrogenase. Targeted sequence analysis of further unexplained cases identified a patient carrying a tumor with compound heterozygous variants in DLST, consisting of a germline variant, c.1121G>A, p.(Gly374Glu), together with a somatic missense variant identified in tumor DNA, c.1147A>G, p.(Thr383Ala), both located in exon 14. Using a range of in silico and functional assays we show that these variants are predicted to be pathogenic, profoundly impact enzyme activity, and result in DNA hypermethylation.

CONCLUSIONS: The identification and functional analysis of these DLST variants further validates DLST as an additional PPGL gene involved in the TCA cycle.

Original languageEnglish
Pages (from-to)459-471
Number of pages13
JournalJournal of Clinical Endocrinology and Metabolism
Issue number2
Early online date12 Nov 2020
Publication statusPublished - 23 Jan 2021

Bibliographical note

© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail:


  • DLST
  • 2-oxoglutarate dehydrogenase
  • Paraganglioma
  • dihydrolipoamide S-succinyltransferase
  • methylation
  • pheochromocytoma


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