FPGS relapse-specific mutations in relapsed childhood acute lymphoblastic leukemia

Sung Liang Yu, Hui Zhang, Bing Ching Ho, Chih Hsiang Yu, Chia Ching Chang, Yin Chen Hsu, Yu Ling Ni, Kai Hsin Lin, Shiann Tarng Jou, Meng Yao Lu, Shu Huey Chen, Kang Hsi Wu, Shih Chung Wang, Hsiu Hao Chang, Ching Hon Pui, Jun J. Yang, Jinghui Zhang, Dong Tsamn Lin, Shu Wha Lin, Xiaotu MaYung Li Yang

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9 Citations (Scopus)


Although the cure rate for childhood acute lymphoblastic leukemia (ALL) has exceeded 80% with contemporary therapy, relapsed ALL remains a leading cause of cancer-related death in children. Relapse-specific mutations can be identified by comprehensive genome sequencing and might have clinical significance. Applying whole-exome sequencing to eight triplicate samples, we identified in one patient relapse-specific mutations in the folylpolyglutamate synthetase (FPGS) gene, whose product catalyzes the addition of multiple glutamate residues (polyglutamation) to methotrexate upon their entry into the cells. To determine the prevalence of mutations of the FPGS mutations, and those of two important genes in the thiopurine pathway, NT5C2 and PRPS1, we studied 299 diagnostic and 73 relapsed samples in 372 patients. Three more FPGS mutants were identified in two patients, NT5C2 mutations in six patients, and PRPS1 mutants in two patients. One patient had both NT5C2 and PRPS1 mutants. None of these alterations were detected at diagnosis with a sequencing depth of 1000X, suggesting that treatment pressure led to increased prevalence of mutations during therapy. Functional characterization of the FPGS mutants showed that they directly resulted in decreased enzymatic activity, leading to significant reduction in methotrexate polyglutamation, and therefore likely contributed to drug resistance and relapse in these cases. Thus, besides genomic alterations in thiopurine metabolizing enzymes, the relapse-specific mutations of FPGS represent another critical mechanism of acquired antimetabolite drug resistance in relapsed childhood ALL.

Original languageEnglish
Article number12074
JournalScientific Reports
Issue number1
Publication statusPublished - Dec 1 2020

ASJC Scopus subject areas

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