Gene rearrangements in radiation‐induced thyroid carcinogenesis*

BACKGROUND: Radiation is an accepted risk factor for thyroid carcinogenesis in children. Recent observations in large cohorts of children and young adults who developed papillary thyroid carcinomas (PTC) related to accidental radiation exposure after the Chernobyl reactor accident revealed typical genetic aberrations shedding light on genetic determinants and mechanisms of radiation-induced carcinogenesis. PROCEDURE: A molecular genetic analysis was performed on 191 post-Chernobyl PTC by RT-PCR, multiplex PCR, DNA sequencing, and in some cases 5'RACE. Determination of point mutations was by means of PCR and either allele-specific oligonucleotide hybridization or SSCP and DNA sequencing. RESULTS: In various sporadic thyroid tumor types of adults structural genetic aberrations have been found involving mutations of RAS (codon 12, 13, 61), p53 (exons 5 to 8), Gsalpha (codon 201 and 227), and, at a low prevalence, the receptor tyrosine kinases RET or NTRK1. In contrast, in radiation-induced PTC of children RET rearrangements are by far the most prevalent genetic aberrations. In these RET rearrangements, the transmembrane and extracellular domains of RET are lost, and are replaced by parts of other genes at the 5' end. These genes always contain coiled-coil domains with dimerization potential and lead to constitutive, ligand-independent activation of the ret tyrosine kinase domain at the 3' end of the fusion product. The most frequent radiation-induced RET gene fusions involve the ELE1 (ARA70) gene, a transcription coactivator of the androgen receptor (PTC3), and H4, a gene of unknown function (PTC1). Both rearrangements originate from DNA double strand breaks with repair by intrachromosomal balanced paracentric inversion and recombination by illegitimate DNA endjoining at small stretches of homologous nucleotide sequences and direct or inverted repeats, without significant breakpoint clusters in the involved introns. In addition, five different RET-fused genes, RIalpha, GOLGA5, HTIF, RFG7 and RFG8, have been detected leading to the PTC2, 5, 6, 7 and 8 types of RET rearrangements, respectively. Each fusion leads, in principle, to the same effect: The ret tyrosine kinase is uncoupled from its stringent physiological regulation by replacement of its 5' end and is aberrantly activated by the 5' parts of fused genes in thyrocytes that do not normally express ret tyrosine kinase. Ectopic ret expression, clonal expansion and early invasion are peculiar to the affected cells. The RET-fused gene is obviously decisive for modulating tumor development: ELE1/RET rearrangements lead to most rapid tumor progression and are related to the solid variant of PTC, in contrast to H4/RET rearrangements connected with papillary or follicular variants of PTC. CONCLUSIONS: Typical genetic aberrations are produced by radioiodine uptake in the juvenile thyroid gland. They act as determinants of phenotype, biology, and clinical course of radiation-induced papillary thyroid carcinomas.