000305221 001__ 305221 000305221 005__ 20251012023142.0 000305221 0247_ $$2doi$$a10.1200/JCO-25-01114 000305221 0247_ $$2pmid$$apmid:41066719 000305221 0247_ $$2ISSN$$a0732-183X 000305221 0247_ $$2ISSN$$a1527-7755 000305221 0247_ $$2altmetric$$aaltmetric:182303742 000305221 037__ $$aDKFZ-2025-02067 000305221 041__ $$aEnglish 000305221 082__ $$a610 000305221 1001_ $$00000-0002-9806-0217$$aOak, Ninad$$b0 000305221 245__ $$aInvestigation of DNA damage response genes validates the role of DNA repair in pediatric cancer risk and identifies SMARCAL1 as novel osteosarcoma predisposition gene. 000305221 260__ $$aAlexandria, Va.$$bAmerican Society of Clinical Oncology$$c2025 000305221 3367_ $$2DRIVER$$aarticle 000305221 3367_ $$2DataCite$$aOutput Types/Journal article 000305221 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1760091598_11808 000305221 3367_ $$2BibTeX$$aARTICLE 000305221 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000305221 3367_ $$00$$2EndNote$$aJournal Article 000305221 500__ $$aepub 000305221 520__ $$aRecent studies reveal that 5-18% of children with cancer harbor pathogenic variants in known cancer predisposing genes. However, DNA damage repair (DDR) genes, which are frequently somatically altered in pediatric tumors, have not been systematically examined as a source of novel cancer predisposing signals.To address this gap, we interrogated 189 DDR genes for presence of germline predisposing variants (PV) among 5,993 childhood cancer cases and 14,477 adult non-cancer controls (discovery cohort). PV were determined using a tiered approach incorporating ClinVar annotations, InterVar classification, and in silico tools (REVEL, CADD, MetaSVM). Using logistic and firth regression, we identified genes with PV statistically enriched in tumors and replicated findings among 1,497additional childhood cancer cases across three independent cohorts.Analysis across all cancers revealed enrichment of TP53 PV. Cancer-specific analyses confirmed known associations including germline TP53 PV in adrenocortical carcinoma, high-grade glioma (HGG), and medulloblastoma (MB), PMS2 in HGG and non-Hodgkin lymphoma (NHL), MLH1 in HGG, BRCA2 in NHL, and BARD1 in neuroblastoma. In addition, four novel associations were uncovered, including BRCA1 in ependymoma, SPIDR in HGG, SMC5 in MB, and SMARCAL1 in osteosarcoma (OS). Importantly, the SMARCAL1:OS association was significant in the discovery (6/230, 2.6%, FDRlogistic=0.0189) as well as all three replication cohorts (Childhood Cancer Survivor Study: 8/275, 2.9%; PFisher<0.0001; German Childhood Cancer Registry: 4/135, 3%, PFisher=0.002; INdividualized Therapy FOr Relapsed Malignancies in Childhood: 4/217, 1.8%, PFisher=0.012). The remaining wildtype SMARCAL1 allele was deleted in three of four OS tumors with available data.Our study confirms the relevance DDR genetic variation in pediatric cancer risk and establishes SMARCAL1 as a novel OS predisposing gene, providing insights into tumor biology and creating opportunities to optimize care for patients with this challenging tumor. 000305221 536__ $$0G:(DE-HGF)POF4-312$$a312 - Funktionelle und strukturelle Genomforschung (POF4-312)$$cPOF4-312$$fPOF IV$$x0 000305221 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de 000305221 7001_ $$00000-0003-0379-2368$$aChen, Wenan$$b1 000305221 7001_ $$00000-0002-1336-7106$$aBlake, Alise$$b2 000305221 7001_ $$00000-0001-7595-080X$$aHarrison, Lynn$$b3 000305221 7001_ $$0P:(DE-He78)c53c2d99bbe5e3f46b7dfc3dc5935b92$$aO'Brien, Martha$$b4$$udkfz 000305221 7001_ $$0P:(DE-He78)1bae3784eb554a693b0e7ce03a20bdb8$$aPreviti, Christopher$$b5$$udkfz 000305221 7001_ $$0P:(DE-He78)e5bb26ffbde307745ae396c2e829dac5$$aBalasubramanian, Gnanaprakash$$b6$$udkfz 000305221 7001_ $$0P:(DE-He78)5100059e746b377e2e0a37c0e24f6bf7$$aMaass, Kendra$$b7$$udkfz 000305221 7001_ $$aHirsch, Steffen$$b8 000305221 7001_ $$00000-0002-1375-507X$$aPenkert, Judith$$b9 000305221 7001_ $$0P:(DE-He78)fae1bf941c5fd76cf5356ecfa1243cc4$$aJones, Barbara$$b10$$udkfz 000305221 7001_ $$aSchramm, Kathrin$$b11 000305221 7001_ $$00000-0002-1584-1115$$aNathrath, Michaela$$b12 000305221 7001_ $$0P:(DE-He78)a7c1bbac024fa232d9c6b78443328d9d$$aPajtler, Kristian$$b13$$udkfz 000305221 7001_ $$0P:(DE-He78)551bb92841f634070997aa168d818492$$aJones, David$$b14$$udkfz 000305221 7001_ $$0P:(DE-He78)143af26de9d57bf624771616318aaf7c$$aWitt, Olaf$$b15$$udkfz 000305221 7001_ $$00000-0002-5435-7860$$aDirksen, Uta$$b16 000305221 7001_ $$00000-0002-2017-3377$$aLi, Jiaming$$b17 000305221 7001_ $$00000-0001-5943-9454$$aSapkota, Yadav$$b18 000305221 7001_ $$00000-0002-2084-1507$$aNess, Kirsten K$$b19 000305221 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