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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities&#46; &#40;A&#41; Flow chart of differentially prevalent mutated genes identified in our study&#46; &#40;B&#41; The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls&#46; The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene&#44; the gray bars represent the percentage of mutations within the control group&#46; The delta between percentage mutations in the COPD and control group is depicted above the white bars&#46; &#40;C&#41; The prevalence of gene mutations of <span class="elsevierStyleItalic">HLA-A</span>&#44; <span class="elsevierStyleItalic">LGALS9C</span>&#44; <span class="elsevierStyleItalic">ORT2T</span> or <span class="elsevierStyleItalic">KIF26B</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; or myocardial infarction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#46; &#40;D&#41; The gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL4</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; or hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&#46; The somatic mutation data was obtained from peripheral blood&#44; while the gene expression data was obtained from bronchial biopsies&#46; Statistical differences were tested using a Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; nominal <span class="elsevierStyleItalic">p</span> values are shown on top of the graph&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is a severe and often progressive lung disease&#46; It is currently the third leading cause of death&#44; with 3&#46;23 million deaths worldwide in 2019&#44; according to the World Health Organization&#46; COPD is caused by a combination of genetic predisposition and the chronic inhalation of smoke or other toxic particles&#46; Over the years many studies have identified several gene variants that increase an individual&#39;s susceptibility for COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Although&#44; germline mutations have been extensively studied in COPD&#44; very few studies have investigated somatic mutations&#46; Unlike germline genetic variations&#44; somatic mutations are acquired after conception and may not be passed on to the next generation&#46; The number of somatic mutations increases during aging and can be induced by exposure to carcinogens&#46; As early as 2003 it was postulated that somatic mutations can be involved in the pathophysiology of COPD&#44; by <span class="elsevierStyleItalic">e&#46;g&#46;</span> amplifying pro-inflammatory signaling and impairing host defense systems to pathogens or damage-associated molecular patterns&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3</span></a> Recently&#44; an association was found between specific somatic mutations in hematopoietic stem cells that lead to clonal hematopoiesis&#44; so-called clonal hematopoiesis of indeterminate potential &#40;CHIP&#41;&#44; and the prevalence of COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> Specifically&#44; in individuals with CHIP a strong association with COPD was identified&#44; where COPD was found to be the co-morbidity with the highest association of all age-related morbidities examined&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Previous attempts to perform a genome-wide study on the role of somatic mutations in COPD were unsuccessful as the sequencing depth was insufficient to provide the resolution required to detect somatic mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> In the current study we optimized a method to identify somatic mutations in exome data and to differentiate them from germline mutations&#46; Using this approach&#44; we identified genes that carried functionally relevant somatic mutations in white blood cells&#46; By comparing COPD patients to healthy controls&#44; we assessed the prevalence of these somatic mutations and their relation to changes in lung function&#44; emphysema severity&#44; and the prevalence of COPD co-morbidities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Whole-exome sequencing was performed on DNA extracted from full peripheral blood samples of severe COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#59; mean age 55&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3220&#41;&#44; 28&#37; male &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0078&#41;&#44; 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 packyears &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1049&#41; and healthy controls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#59; mean age 57&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#44; 52&#37; male&#44; 44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49 packyears&#41;&#44; using the DNBSEQ&#8482; Sequencing Technology&#44; with the BGI V4 kit &#40;PE100&#44; 100&#215; coverage&#41; &#40;BGI Genomics&#44; Shenzhen&#44; China&#41;&#46; Both COPD patients as well as the controls were all ex-smokers&#44; with at least 20 packyears of smoking history and having stopped smoking for at least 12 months&#46; The study was approved by the medical ethical committee of the University Medical Center Groningen&#44; and all subjects provided written informed consent&#46; Data on COPD co-morbidities were obtained from self-reported co-morbidity surveys&#46; Whole-exome sequencing was performed using the Illumina platform&#44; and mapped against GRCh38 primary genome reference&#46; Genetic variants obtained from DNA-sequencing data were compared to the variants observed within the same population using the GATK Mutect2 tool &#40;using Genome of the Netherlands study&#59; GoNL as population reference&#41;&#46; To assess functionally relevant mutations&#44; only mutations predicted to induce a dysfunctional or truncated protein were included in our study&#46; Somatic mutations were selected as alternative alleles that were supported by at least two reads and constituting &#60;15&#37; of total reads overlapping the variant site&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Out of the 813 genes carrying functionally relevant somatic mutations&#44; 500 genes were more often mutated in COPD patients compared to healthy controls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; In order to make a selection for further analyses&#44; genes with the largest difference in prevalence of somatic mutations between COPD patients and controls were selected&#46; The top-10 differentially prevalent mutated genes were between 6 and 10&#37; more often mutated in COPD patients compared to healthy controls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Subsequently&#44; we focused on identifying the functional effects of these 10 differentially prevalent mutated genes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Within the COPD group it was found that the prevalence of mutations in Zinc Finger Protein 880 &#40;<span class="elsevierStyleItalic">ZNF880</span>&#41; was significantly associated with better lung function &#40;percent predicted forced expiration in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>pp&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;195&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011 and percent predicted forced vital capacity &#40;FVCpp&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;17&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41; and lower levels of emphysema &#40;percentage of voxels with less than 950 Hounsfield units &#40;&#37;-950 HU&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; while a higher prevalence of mutation of <span class="elsevierStyleItalic">IGHGP</span> was associated with a higher FVCpp &#40;Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#46; However&#44; no association was found between the prevalence of mutations of the top-10 differentially mutated genes in COPD patients&#44; and neutrophil&#44; lymphocyte and monocyte counts in blood &#40;<span class="elsevierStyleItalic">data not shown</span>&#41;&#46; Of note&#44; bronchial gene expression data for <span class="elsevierStyleItalic">OR2T2</span> were unavailable&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly&#44; we assessed whether the prevalence of gene mutations of the top-10 differentially mutated genes was related to the prevalence of three major COPD co-morbidities&#58; osteoporosis&#44; hypertension and myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> The prevalence of major histocompatibility complex&#44; class I&#44; A &#40;<span class="elsevierStyleItalic">HLA-A</span>&#41; and Galectin 9C &#40;<span class="elsevierStyleItalic">LGALS9C</span>&#41; gene mutations were increased in COPD patients with osteoporosis as co-morbidity&#44; compared to COPD patients without osteoporosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Additionally&#44; gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and mitochondrial ribosomal protein L4 &#40;<span class="elsevierStyleItalic">MRPL4</span>&#41; were increased in COPD patients with osteoporosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The prevalence of kinesin family member 26B &#40;<span class="elsevierStyleItalic">KIF26B</span>&#41; gene mutations was increased in COPD patients with myocardial infarction and the prevalence of Olfactory Receptor Family 2 Subfamily T Member 2 &#40;<span class="elsevierStyleItalic">OR2T2</span>&#41; gene mutations was increased in COPD patients with hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Additionally&#44; the gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL3</span> were lower in COPD patients with hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The genes that showed a higher prevalence of somatic mutations in individuals with COPD indicate the variety of cellular processes involved in the disease&#46; Zinc finger proteins are DNA-binding transcription factors that can regulate the expression of specific genes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Little is known about the genes affected by <span class="elsevierStyleItalic">ZNF880</span> specifically&#44; nor its role in COPD&#46; However&#44; <span class="elsevierStyleItalic">ZNF880</span> has been described as a frequently-mutated oncogene of which the expression is increased in smokers&#46; In the current study we showed that <span class="elsevierStyleItalic">ZNF880</span> is more often mutated in COPD patients but that the prevalence of <span class="elsevierStyleItalic">ZNF880</span> mutations is associated with higher lung function and reduced emphysema&#44; suggesting a positive effect of <span class="elsevierStyleItalic">ZNF880</span> mutations&#46; <span class="elsevierStyleItalic">MRPL4</span> is a nuclear gene that aids the protein synthesis within mitochondria&#44; has been described as a prognostic gene for the outcome of squamous cell carcinoma in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The increased susceptibility of COPD patients to develop somatic mutations in this gene demonstrated in this study&#44; could be a common consequence of smoke exposure but it may be worthwhile to explore whether this may represent a causal association with squamous cell carcinoma&#46; Likewise&#44; KIF26B has a functional role in the development of non-small cell lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> We showed that the prevalence of <span class="elsevierStyleItalic">HLA-A</span> gene mutations was higher in COPD patients that also have osteoporosis compared to COPD patients without osteoporosis&#46; This is in agreement with a previous study showing that <span class="elsevierStyleItalic">HLA-A</span> gene polymorphisms associate with increased susceptibility to develop osteoporosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Moreover&#44; the number of males was higher in the control group compared to the COPD group&#44; potentially influencing our results&#46; In summary&#44; COPD patients harbor more putative somatic mutations in their peripheral blood cells&#46; The prevalence of gene mutations of several genes displayed a weak but significant association with improved lung function&#46; Additionally&#44; we identified that specific genes were more often mutated in COPD patients with a co-morbidity which may be an indication that the increased number of somatic mutations contributes to the development of co-morbidities in COPD patients&#46; However&#44; future studies should be aimed at identifying the role of somatic mutations in the development of COPD co-morbidities&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Approval</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the medical ethical committee of the University Medical Center Groningen&#44; and all subjects provided written informed consent&#46; Severe COPD patients are derived from ClinicalTrials&#46;gov Identifier&#58; <a href="ctgov:NCT04263961">NCT04263961</a> and healthy controls are derived from ClinicalTrials&#46;gov Identifier&#58; <a href="ctgov:NCT00848406">NCT00848406</a>&#46; Data from these study cohorts can be accessed through collaboration by contacting Maarten van den Berge &#40;<a href="mailto:m.van.den.berge@umcg.nl">m&#46;van&#46;den&#46;berge&#64;umcg&#46;nl</a>&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; Contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Concept and design</span>&#58; AF&#44; VRW&#44; JBS&#44; SDP&#46; <span class="elsevierStyleItalic">Data analysis</span>&#58; AF&#44; VG&#44; SDP&#46; <span class="elsevierStyleItalic">Patient inclusion&#47;data collection</span>&#58; CAB&#44; WT&#44; MvdB&#44; DJS&#46; <span class="elsevierStyleItalic">Project supervision</span>&#58; JKB&#44; DJS&#44; SDP&#46; <span class="elsevierStyleItalic">Manuscript preparation</span>&#58; VRW&#44; SDP&#46; <span class="elsevierStyleItalic">Manuscript revision</span>&#58; AF&#44; VRW&#44; JBS&#44; CAB&#44; WT&#44; JKB&#44; MvdB&#44; DJS&#44; VG&#44; SDP&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities&#46; &#40;A&#41; Flow chart of differentially prevalent mutated genes identified in our study&#46; &#40;B&#41; The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls&#46; The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene&#44; the gray bars represent the percentage of mutations within the control group&#46; The delta between percentage mutations in the COPD and control group is depicted above the white bars&#46; &#40;C&#41; The prevalence of gene mutations of <span class="elsevierStyleItalic">HLA-A</span>&#44; <span class="elsevierStyleItalic">LGALS9C</span>&#44; <span class="elsevierStyleItalic">ORT2T</span> or <span class="elsevierStyleItalic">KIF26B</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; or myocardial infarction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#46; &#40;D&#41; The gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL4</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; or hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&#46; The somatic mutation data was obtained from peripheral blood&#44; while the gene expression data was obtained from bronchial biopsies&#46; Statistical differences were tested using a Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; nominal <span class="elsevierStyleItalic">p</span> values are shown on top of the graph&#46;</p>"
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Scientific Letter
COPD Patients Display Increased Peripheral Blood Somatic Mutations Which Associate With the Prevalence of Co-morbidities
Alen Faiza,b,c, Valerie R. Wiersmad, Jonas B. Salzbrunnd, Corry-Anke Brandsmab,e, Wim Timensb,e, Janette K. Burgessb,e, Maarten van den Bergeb,c, Dirk-Jan Slebosb,c, Victor Guryevf, Simon D. Pouwelsb,c,e,
Corresponding author
s.d.pouwels@umcg.nl

Corresponding author.
a Respiratory Bioinformatics and Molecular Biology Group, University of Technology Sydney, Australia
b GRIAC Research Institute, University of Groningen, Groningen, The Netherlands
c Department of Pulmonary Diseases, University Medical Center Groningen, The Netherlands
d Department of Hematology, Cancer Research Center Groningen, University Medical Center Groningen, Groningen, The Netherlands
e Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
f European Research Institute for the Biology of Ageing, Groningen, The Netherlands
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is a severe and often progressive lung disease&#46; It is currently the third leading cause of death&#44; with 3&#46;23 million deaths worldwide in 2019&#44; according to the World Health Organization&#46; COPD is caused by a combination of genetic predisposition and the chronic inhalation of smoke or other toxic particles&#46; Over the years many studies have identified several gene variants that increase an individual&#39;s susceptibility for COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Although&#44; germline mutations have been extensively studied in COPD&#44; very few studies have investigated somatic mutations&#46; Unlike germline genetic variations&#44; somatic mutations are acquired after conception and may not be passed on to the next generation&#46; The number of somatic mutations increases during aging and can be induced by exposure to carcinogens&#46; As early as 2003 it was postulated that somatic mutations can be involved in the pathophysiology of COPD&#44; by <span class="elsevierStyleItalic">e&#46;g&#46;</span> amplifying pro-inflammatory signaling and impairing host defense systems to pathogens or damage-associated molecular patterns&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3</span></a> Recently&#44; an association was found between specific somatic mutations in hematopoietic stem cells that lead to clonal hematopoiesis&#44; so-called clonal hematopoiesis of indeterminate potential &#40;CHIP&#41;&#44; and the prevalence of COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> Specifically&#44; in individuals with CHIP a strong association with COPD was identified&#44; where COPD was found to be the co-morbidity with the highest association of all age-related morbidities examined&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Previous attempts to perform a genome-wide study on the role of somatic mutations in COPD were unsuccessful as the sequencing depth was insufficient to provide the resolution required to detect somatic mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> In the current study we optimized a method to identify somatic mutations in exome data and to differentiate them from germline mutations&#46; Using this approach&#44; we identified genes that carried functionally relevant somatic mutations in white blood cells&#46; By comparing COPD patients to healthy controls&#44; we assessed the prevalence of these somatic mutations and their relation to changes in lung function&#44; emphysema severity&#44; and the prevalence of COPD co-morbidities&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Whole-exome sequencing was performed on DNA extracted from full peripheral blood samples of severe COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#59; mean age 55&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3220&#41;&#44; 28&#37; male &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0078&#41;&#44; 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 packyears &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1049&#41; and healthy controls &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#59; mean age 57&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&#44; 52&#37; male&#44; 44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49 packyears&#41;&#44; using the DNBSEQ&#8482; Sequencing Technology&#44; with the BGI V4 kit &#40;PE100&#44; 100&#215; coverage&#41; &#40;BGI Genomics&#44; Shenzhen&#44; China&#41;&#46; Both COPD patients as well as the controls were all ex-smokers&#44; with at least 20 packyears of smoking history and having stopped smoking for at least 12 months&#46; The study was approved by the medical ethical committee of the University Medical Center Groningen&#44; and all subjects provided written informed consent&#46; Data on COPD co-morbidities were obtained from self-reported co-morbidity surveys&#46; Whole-exome sequencing was performed using the Illumina platform&#44; and mapped against GRCh38 primary genome reference&#46; Genetic variants obtained from DNA-sequencing data were compared to the variants observed within the same population using the GATK Mutect2 tool &#40;using Genome of the Netherlands study&#59; GoNL as population reference&#41;&#46; To assess functionally relevant mutations&#44; only mutations predicted to induce a dysfunctional or truncated protein were included in our study&#46; Somatic mutations were selected as alternative alleles that were supported by at least two reads and constituting &#60;15&#37; of total reads overlapping the variant site&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Out of the 813 genes carrying functionally relevant somatic mutations&#44; 500 genes were more often mutated in COPD patients compared to healthy controls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; In order to make a selection for further analyses&#44; genes with the largest difference in prevalence of somatic mutations between COPD patients and controls were selected&#46; The top-10 differentially prevalent mutated genes were between 6 and 10&#37; more often mutated in COPD patients compared to healthy controls &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Subsequently&#44; we focused on identifying the functional effects of these 10 differentially prevalent mutated genes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Within the COPD group it was found that the prevalence of mutations in Zinc Finger Protein 880 &#40;<span class="elsevierStyleItalic">ZNF880</span>&#41; was significantly associated with better lung function &#40;percent predicted forced expiration in 1 second &#40;FEV<span class="elsevierStyleInf">1</span>pp&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;195&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011 and percent predicted forced vital capacity &#40;FVCpp&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;17&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41; and lower levels of emphysema &#40;percentage of voxels with less than 950 Hounsfield units &#40;&#37;-950 HU&#41;&#44; Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; while a higher prevalence of mutation of <span class="elsevierStyleItalic">IGHGP</span> was associated with a higher FVCpp &#40;Spearman Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#46; However&#44; no association was found between the prevalence of mutations of the top-10 differentially mutated genes in COPD patients&#44; and neutrophil&#44; lymphocyte and monocyte counts in blood &#40;<span class="elsevierStyleItalic">data not shown</span>&#41;&#46; Of note&#44; bronchial gene expression data for <span class="elsevierStyleItalic">OR2T2</span> were unavailable&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lastly&#44; we assessed whether the prevalence of gene mutations of the top-10 differentially mutated genes was related to the prevalence of three major COPD co-morbidities&#58; osteoporosis&#44; hypertension and myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> The prevalence of major histocompatibility complex&#44; class I&#44; A &#40;<span class="elsevierStyleItalic">HLA-A</span>&#41; and Galectin 9C &#40;<span class="elsevierStyleItalic">LGALS9C</span>&#41; gene mutations were increased in COPD patients with osteoporosis as co-morbidity&#44; compared to COPD patients without osteoporosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Additionally&#44; gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and mitochondrial ribosomal protein L4 &#40;<span class="elsevierStyleItalic">MRPL4</span>&#41; were increased in COPD patients with osteoporosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The prevalence of kinesin family member 26B &#40;<span class="elsevierStyleItalic">KIF26B</span>&#41; gene mutations was increased in COPD patients with myocardial infarction and the prevalence of Olfactory Receptor Family 2 Subfamily T Member 2 &#40;<span class="elsevierStyleItalic">OR2T2</span>&#41; gene mutations was increased in COPD patients with hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Additionally&#44; the gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL3</span> were lower in COPD patients with hypertension &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The genes that showed a higher prevalence of somatic mutations in individuals with COPD indicate the variety of cellular processes involved in the disease&#46; Zinc finger proteins are DNA-binding transcription factors that can regulate the expression of specific genes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Little is known about the genes affected by <span class="elsevierStyleItalic">ZNF880</span> specifically&#44; nor its role in COPD&#46; However&#44; <span class="elsevierStyleItalic">ZNF880</span> has been described as a frequently-mutated oncogene of which the expression is increased in smokers&#46; In the current study we showed that <span class="elsevierStyleItalic">ZNF880</span> is more often mutated in COPD patients but that the prevalence of <span class="elsevierStyleItalic">ZNF880</span> mutations is associated with higher lung function and reduced emphysema&#44; suggesting a positive effect of <span class="elsevierStyleItalic">ZNF880</span> mutations&#46; <span class="elsevierStyleItalic">MRPL4</span> is a nuclear gene that aids the protein synthesis within mitochondria&#44; has been described as a prognostic gene for the outcome of squamous cell carcinoma in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> The increased susceptibility of COPD patients to develop somatic mutations in this gene demonstrated in this study&#44; could be a common consequence of smoke exposure but it may be worthwhile to explore whether this may represent a causal association with squamous cell carcinoma&#46; Likewise&#44; KIF26B has a functional role in the development of non-small cell lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> We showed that the prevalence of <span class="elsevierStyleItalic">HLA-A</span> gene mutations was higher in COPD patients that also have osteoporosis compared to COPD patients without osteoporosis&#46; This is in agreement with a previous study showing that <span class="elsevierStyleItalic">HLA-A</span> gene polymorphisms associate with increased susceptibility to develop osteoporosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Moreover&#44; the number of males was higher in the control group compared to the COPD group&#44; potentially influencing our results&#46; In summary&#44; COPD patients harbor more putative somatic mutations in their peripheral blood cells&#46; The prevalence of gene mutations of several genes displayed a weak but significant association with improved lung function&#46; Additionally&#44; we identified that specific genes were more often mutated in COPD patients with a co-morbidity which may be an indication that the increased number of somatic mutations contributes to the development of co-morbidities in COPD patients&#46; However&#44; future studies should be aimed at identifying the role of somatic mutations in the development of COPD co-morbidities&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Approval</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the medical ethical committee of the University Medical Center Groningen&#44; and all subjects provided written informed consent&#46; Severe COPD patients are derived from ClinicalTrials&#46;gov Identifier&#58; <a href="ctgov:NCT04263961">NCT04263961</a> and healthy controls are derived from ClinicalTrials&#46;gov Identifier&#58; <a href="ctgov:NCT00848406">NCT00848406</a>&#46; Data from these study cohorts can be accessed through collaboration by contacting Maarten van den Berge &#40;<a href="mailto:m.van.den.berge@umcg.nl">m&#46;van&#46;den&#46;berge&#64;umcg&#46;nl</a>&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; Contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Concept and design</span>&#58; AF&#44; VRW&#44; JBS&#44; SDP&#46; <span class="elsevierStyleItalic">Data analysis</span>&#58; AF&#44; VG&#44; SDP&#46; <span class="elsevierStyleItalic">Patient inclusion&#47;data collection</span>&#58; CAB&#44; WT&#44; MvdB&#44; DJS&#46; <span class="elsevierStyleItalic">Project supervision</span>&#58; JKB&#44; DJS&#44; SDP&#46; <span class="elsevierStyleItalic">Manuscript preparation</span>&#58; VRW&#44; SDP&#46; <span class="elsevierStyleItalic">Manuscript revision</span>&#58; AF&#44; VRW&#44; JBS&#44; CAB&#44; WT&#44; JKB&#44; MvdB&#44; DJS&#44; VG&#44; SDP&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Higher prevalence of somatic mutations in COPD patients compared to healthy controls and associations with COPD co-morbidities&#46; &#40;A&#41; Flow chart of differentially prevalent mutated genes identified in our study&#46; &#40;B&#41; The top-10 genes that displayed the highest differential prevalence of somatic mutations in COPD patients compared to healthy controls&#46; The white bars represent the percentage of the COPD group that had a putative somatic mutation within the gene&#44; the gray bars represent the percentage of mutations within the control group&#46; The delta between percentage mutations in the COPD and control group is depicted above the white bars&#46; &#40;C&#41; The prevalence of gene mutations of <span class="elsevierStyleItalic">HLA-A</span>&#44; <span class="elsevierStyleItalic">LGALS9C</span>&#44; <span class="elsevierStyleItalic">ORT2T</span> or <span class="elsevierStyleItalic">KIF26B</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41; or myocardial infarction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#46; &#40;D&#41; The gene expression levels of <span class="elsevierStyleItalic">HLA-A</span> and <span class="elsevierStyleItalic">MRPL4</span> in COPD patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41; with or without osteoporosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; or hypertension &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;&#46; The somatic mutation data was obtained from peripheral blood&#44; while the gene expression data was obtained from bronchial biopsies&#46; Statistical differences were tested using a Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; nominal <span class="elsevierStyleItalic">p</span> values are shown on top of the graph&#46;</p>"
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                      "titulo" => "Genetics of chronic obstructive pulmonary disease&#58; understanding the pathobiology and heterogeneity of a complex disorder"
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Original language: English
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