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Evidence for genetic anticipation in vonHippel-Lindau syndrome
  1. Laura Aronoff1,2,
  2. David Malkin1,3,4,5,
  3. Kalene van Engelen3,
  4. Bailey Gallinger1,3,6,7,
  5. Jonathan Wasserman3,4,8,
  6. Raymond H Kim9,10,11,
  7. Anita Villani1,4,
  8. M Stephen Meyn3,4,6,9,
  9. Harriet Druker1,6,7
  1. 1 Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
  2. 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
  3. 3 Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Canada
  4. 4 Department of Paediatrics, University of Toronto, Toronto, Canada
  5. 5 Department of Medical Biophysics, University of Toronto, Toronto, Canada
  6. 6 Department of Molecular Genetics, University of Toronto, Toronto, Canada
  7. 7 Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Canada
  8. 8 Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada
  9. 9 Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Canada
  10. 10 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
  11. 11 Department of Medicine, University of Toronto, Toronto, Canada
  1. Correspondence to Professor M Stephen Meyn, Center for Human Genomics and Precision Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; stephen.meyn{at}


Background von Hippel-Lindau (vHL) syndrome is a rare autosomal-dominant disorder that confers a lifelong risk for developing both benign and malignant tumours in multiple organs. Recent evidence suggests that vHL may exhibit genetic anticipation (GA). The aim of this study was to determine if GA occurs in vHL, and if telomere shortening may be a factor in GA.

Methods A retrospective chart review of vHL families seen at The Hospital for Sick Children between 1984 and 2016 was performed. Age of onset (AOO, defined as the age of first physician-diagnosed vHL-related manifestation) was confirmed for 96 patients from 20 unrelated families (80 clinically affected and 16 unaffected carriers). Flow-FISH(flow cytometry sorting of cells whose telomeres are labeled by Fluorescence In Situ Hybridization) was used to measure mean telomere length of six white blood cell subtypes from 14 known VHL pathogenic variant carriers.

Results The median AOO for generations I, II and III were 32.5, 22.5 and 12.0 years, respectively. The differences in the AOO between generations were highly significant using a Cox proportional hazards model (P=6.00×10-12). Telomere lengths were significantly different for granulocytes and natural killer lymphocytes of patients with vHL compared with age-matched controls. For six vHL parent–child pairs, median white blood cell telomere lengths between parent and child were not significantly different.

Conclusions Our results suggest that vHL telomere abnormalities may be primarily somatic in origin rather than a cause of GA. As tumour development exhibits GA in our cohort, vHL surveillance guidelines may need to account for a patient’s generational position within a vHL pedigree.

  • anticipation
  • von Hippel-Lindau
  • surveillance
  • telomeres
  • cancer predisposition

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  • MSM and HD contributed equally.

  • Contributors DM, BG, MSM and HD: conceptualised and designed the study. LA and KvE: performed data collection and analysis. LA: prepared the initial draft. LA, KvE, HD and MSM: revised subsequent drafts. LA, DM, KvE, BG, JW, RHK, AV, MSM and HD: provided clinical input and reviewed, edited and approved the final manuscript.

  • Funding Starbucks Coffee Company Endowment Fund for the Starbucks Student Award 2015 (to LA) and the SickKids Foundation (to DM).

  • Competing interests None declared.

  • Ethics approval Research Ethics Board (REB# 1000050340) at The Hospital for Sick Children.

  • Provenance and peer review Not commissioned; externally peer reviewed.