Approaches to diagnose DNA mismatch repair gene defects in XXXX .

@entity1 @entity4309 @entity5 @entity5527 @entity14 @entity4334 @entity694
UNASSIGNED: The DNA repair pathway mismatch repair (MMR) is responsible for the recognition and correction of DNA biosynthetic errors caused by inaccurate @entity4334 incorporation during replication. Faulty MMR leads to failure to address the mispairs or insertion deletion loops (IDLs) left behind by the replicative polymerases and results in increased mutation load at the genome. The realization that defective MMR leads to a hypermutation phenotype and increased risk of tumorigenesis highlights the relevance of this pathway for @entity1 disease. The association of MMR defects with increased risk of @entity5 development was first observed in @entity14 @entity1 that carried inactivating germline mutations in MMR genes and the disease was named as @entity14 ( @entity14 ). Currently, a growing list of @entity5 is found to be MMR defective and @entity14 has been renamed @entity4309 ( @entity4309 ) partly to include the associated risk of developing @entity694 . In addition, a number of non-hereditary, mostly epigenetic, alterations of MMR genes have been described in @entity5 . Besides conferring a strong @entity5 predisposition, genetic or epigenetic inactivation of MMR genes also renders cells resistant to some chemotherapeutic agents. Therefore, diagnosis of @entity5527 has important implications for the management of the @entity1 , the surveillance of their relatives in the case of @entity4309 and for the choice of treatment. Some of the alterations found in MMR genes have already been well defined and their pathogenicity assessed. Despite this substantial wealth of knowledge, the effects of a large number of alterations remain uncharacterized (variants of uncertain significance, VUSs). The advent of personalized genomics is likely to increase the list of VUSs found in MMR genes and anticipates the need of diagnostic tools for rapid assessment of their pathogenicity. This review describes current tools and future strategies for addressing the relevance of MMR gene alterations in @entity1 disease.
