REVIEW Chromothripsis and beyond: rapid genome evolution from complex chromosomal rearrangements Cheng-Zhong Zhang,1,5 Mitchell L. Leibowitz,2,3,5 and David Pellman1,2,3,4,6 1BroadInstituteofHarvardandMassachusettsInstituteofTechnology,Cambridge,Massachusetts02142,USA;2Departmentof Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA; 3Department of Cell Biology, Harvard MedicalSchool,Boston,Massachusetts02115,USA;4HowardHughesMedicalInstitute,Boston,Massachusetts02115,USA Recent genome sequencing studies have identified sev- Another potential advantage of all-at-once or ‘‘punctu- eral classes of complex genomic rearrangements that ated equilibrium’’ (Gould and Eldredge 1977) mecha- appear to be derived from a single catastrophic event. nisms is that intermediate steps in tumor development These discoveries identify ways that genomes can be can actually be deleterious. Forexample, oncogene acti- altered in single large jumps rather than by many in- vationcantriggerstressresponses,suchasp53activation, cremental steps. Here we compare and contrast these that can inhibit proliferation or promote cellular senes- phenomena and examine the evidence that they arise cence(Loweetal.1994;Fearnheadetal.1997;Kastanand ‘‘all at once.’’ We consider the impact of massive chro- Bartek2004;Halazonetisetal.2008;JacksonandBartek mosomalchangeforthedevelopmentofdiseasessuchas 2009).Inprinciple,anall-at-oncemutationalmechanism cancer and for evolution more generally. Finally, we could circumvent this problem by simultaneously gen- summarize current models for underlying mechanisms erating an active oncogene together with changes that and discussstrategies for testing thesemodels. eliminatethestressresponse. Althoughall-at-oncemassivegenomicalterationsmight acceleratetheacquisitionofgrowth-promotingmutations, Theevolutionofanormalcelltoacancercellisgenerally they have an obvious downside: They could also poten- thought of as a sequential accumulation of many in- tially generate massive deleterious effects that could dependentlesionstothegenome(Nowell1976;Greaves overwhelm any growth-promoting mutations. One way and Maley 2012; Yates and Campbell 2012). In addition to minimize this collateral damage would be to have to somatic point mutations, these lesions include copy themassivegenomicchangeberestrictedtoaportionof numberalterations,suchaschromosomaldeletionsordu- thegenome.Althoughitiscommontothinkofmutation plications (Fig. 1A,B), and balanced structural rearrange- rates as numbers that apply evenly across the genome ments, such as translocations and inversions (Mitelman (Durrett 2008; Bozic et al. 2010; Tomasetti et al. 2013), etal.2007;Rabbitts2009;Stephensetal.2009;Stratton thereisagrowingappreciationoflocalizedvariabilityin et al. 2009). By chance, these somatic alterations in the theserates(HodgkinsonandEyre-Walker2011;Hodgkinson genomewillhitcancergenes—disruptingtumorsuppres- etal.2012;Robertsetal.2012;Schuster-Bo¨cklerandLehner sors or activating proto-oncogenes—affecting cells and 2012). Because of transcription-coupled DNA repair, causing their progeny to gradually accumulate the nec- transcriptionally silent portions of the genome have ap- essary ‘‘hallmarks of cancer’’ (Hanahan and Weinberg proximately threefold higher mutation rates (Fousteri and 2011).Althoughthereisampleevidencethatcancercan Mullenders 2008; Lawrence et al. 2013). Likewise, late- developthroughthistypeofgradualmutationalaccrual, replicating regions of the genome exhibit a similar fold therearereasonstothinkthattherecouldbeadvantages increaseinmutationrates(Stamatoyannopoulosetal.2009; iftheoncogenicchangescouldbeacquiredallatonce(at Chen et al. 2010; Koren et al. 2012; Donley and Thayer least from the vantage point of the aspiring cancer cell). 2013). Localized hypermutation has also been associated One obvious advantage is speed, with the possibility of withchromosomalrearrangements.Inbuddingyeast,DNA rapidly accruing a large phenotypic effect from combi- breaksrepairedbymitoticgeneconversionareaccompanied natorial acquisition of smaller-effect genetic changes. bysurprisinglyhighmutationrates(>1000-foldhigherthan [Keywords:chromothripsis;chromoplexy;chromoanasynthesis;genome (cid:2)2013Zhangetal. ThisarticleisdistributedexclusivelybyColdSpring evolution;cancer;chromosomaltranslocation;copynumberalteration] Harbor Laboratory Press for the first six months after the full-issue 5Theseauthorscontributedequallytothiswork. publicationdate(seehttp://genesdev.cshlp.org/site/misc/terms.xhtml).After 6Correspondingauthor sixmonths,itisavailableunderaCreativeCommonsLicense(Attribution- [email protected] NonCommercial3.0Unported),asdescribedathttp://creativecommons.org/ Articleisonlineathttp://www.genesdev.org/cgi/doi/10.1101/gad.229559.113. licenses/by-nc/3.0/. GENES & DEVELOPMENT 27:2513–2530 Published by Cold Spring Harbor Laboratory Press; ISSN 0890-9369/13; www.genesdev.org 2513 Zhangetal. Figure1. Characteristicsofsimpleandcomplexchromosomalrearrangements.(A)Copynumberlossesorgainscanbedetectedby array-basedorsequencing-basedtechnologiesfromabruptchangesinthereaddepthsignal(sequencing)ortheintensityoffluorescent probes(array).Lossorgaingenerallyaffectsonlyonehomolog;therefore,acopynumberlossalsoresultsinLOH.(B)Copynumber alterationsareoftengeneratedbysimplechromosomalrearrangements,suchasdeletionsortandemduplications.(C)Chromothripsis is characterized by an alternating copy number profile with loss and retention of heterozygosity. Minus signs in C and D denote chromosomalsegmentsthatareinverted.Fluorescentinsituhybridization(FISH)characterizationconfirmsthatonlyonechromatid (allele B) isaffected. (D) Chromoanasynthesisis characterizedbyacopynumber profile thatalternates betweeneuploid and higher ploidy.Incontrasttochromothripsis,chromoanasynthesisdoesnotnecessarilyexhibitLOHbutreflectsresynthesisofsegmentsfrom onechromatid.Chromoanasynthesisalsocontainsfrequentinsertionsofshortsequencesbetweentherearrangementjunctions(red arrows) that are copied from the rearranged segments (templated insertions). Both DNA resynthesis and templated insertions are suggestiveofreplication-basedmechanisms.(E)Chromoplexyischaracterizedbyaclosedchainoftranslocations,withlittleornocopy numberalteration. 2514 GENES&DEVELOPMENT Genomeevolutionandcomplexrearrangements spontaneousmutations)inthevicinityofthebreak(Hicks Vogelsteinetal.2013).Despiteacceleratedtumorevolu- et al. 2010; Malkova and Haber 2012). Similarly, localized tion, individual mutation events are usually regarded as regionsofhypermutation(‘‘kataegis’’)thatoftenoccurredat independent of each other, acquired randomly and grad- thesiteofsomaticrearrangementswerediscoveredinbreast ually. In addition to site-specific mutation events (point cancer genomes (Nik-Zainal et al. 2012; Alexandrov et al. mutations, chromosomal translocations, and copy num- 2013). Even more dramatic local genomic change can be ber variations), doubling of the genome content due to generated from critical telomere shortening, resulting in cytokinesis failure is a one-off event that can generate breakage–fusion–bridge(BFB)cycles(McClintock1941)that aneuploidy and structural alterations of chromosomes occur over several cell division cycles (and hence are not (Fujiwaraetal.2005;HollandandCleveland2009;Carter ‘‘all-at-once’’ events). Analysis of genome copy number etal.2012;GanemandPellman2012;Zacketal.2013). alterations in cancer also identified ‘‘firestorms’’ of local Instudyingthetumorgenomeofapatientwithchronic amplificationsanddeletionswhose origin isuncertainbut lymphocytic leukemia (CLL), Stephens et al. (2011) ob- mightoriginatefromBFBcycles(Hicksetal.2006). servedastrikingpatternofchromosomalrearrangements Recently, whole-genome sequencing has led to the that was at odds with all known models of genomic discovery of three new classes of complex catastrophic alteration. The tumor from this patient contained 45 chromosomal rearrangement: chromothripsis, chromo- tumor-specifictranslocations,42ofwhichwereconcen- anasynthesis,andchromoplexy(Fig.1C–E;Liuetal.2011; trated on the long arm of chromosome 4. Furthermore, Stephensetal.2011;Rauschetal.2012;Bacaetal.2013). therearrangementeventswereclusteredwithinmultiple Althoughtheunderlyingmechanismsforthesephenom- focal regions in chromosome 4, raising the question of ena are unknown and likely to be different, all of these how the damage could be so highly localized. Did this patterns of rearrangements appear to have originated resultfromagenuinelynewmechanismforgenomedam- from a single event, simultaneously generating tens or age,or was the genome center playing the conventional evenhundredsoftranslocationsand/orDNAcopynum- gameofrandomchancebuthadbeendealtararehand? ber changes (Meyerson and Pellman 2011; Tubio and Several linesofevidencesuggestedthis was,in fact,a Estivill 2011; Forment et al. 2012; Jones and Jallepalli novel phenomenon. First, despite the large number of 2012;MaherandWilson2012).Toencompassthepoten- rearrangements,SNParraycopynumberanalysisshowed tiallyall-at-onceoriginofthesemutationalmechanisms, that the altered region of chromosome 4 existed in only a unifying term, chromoanagenesis, has been proposed twocopynumberstates,withmanytransitionsbetween (Holland and Cleveland 2012). Two of these classes of thesetwostates.(AsinthestudybyStephensetal.(2011), chromosomal rearrangement, chromothripsis and chro- weusethetermcopynumberstatesbecauseofthehighly moanasynthesis, affect limited portions of the genome aneuploid nature of cancer genomes, where each of the (oftenasinglechromosomeorchromosomearm),raising parental haplotypes can be present in multiple copies.) themechanisticquestionofhowextensivechromosomal Thispatternofhavingonlytwocopynumberstatesisin rearrangementscanbesohighlylocalized.Thefrequency sharp contrast to conventional clusters of complex rear- of these types of events in cancer remains unclear, but rangements(Hicksetal.2006;Bignelletal.2007;Zhang manyrecentstudiessuggestthattheymaybemorecom- et al. 2009a). Known causes of complex rearrangements monthaninitiallysuspected(Malhotraetal.2013;Yang such as BFB cycles characteristically result in multiple et al. 2013; Zack et al. 2013). These new classes of mu- amplifiedcopynumberstatesthatareassumedtoderive tagenesis are not restricted to human cancer and have fromeventsoccurringover manyroundsofcelldivision turnedupinsuchexoticplacesastheTasmaniandevil’s (McClintock1941;Starketal.1989;Gisselssonetal.2000; transmissiblefacialtumor(Deakinetal.2012)andhuman Bignelletal.2007;Greenmanetal.2012b). congenital diseases (Kloosterman et al. 2011a, 2012; Liu Thealternationbetween twocopy numberstateswas et al. 2011; Chiang et al. 2012; Nazaryan et al. 2013). accompanied by loss and preservation of heterozygosity Although these new classes of chromosome rearrange- (Fig. 1A,C). Whole-genome sequencing further revealed menthavemostlybeenfoundinthecontextofdisease,it a very complex pattern of segmental rearrangements at seems likely that they reflect very general mechanisms the boundaries of high copy number states, with events forgenomealterationthatcouldbeimportantfororgan- thatwereheadtotail(deletiontype),headtohead/tailto ismalevolution. tail(inversiontype),andtailtohead(tandemduplication type) (Fig. 2A). However, despite this chaotic pattern of rearrangement,locithatpreservedparentalcopynumber also preserved heterozygosity of the parental genotypes A newgame atthe genomecasino (Fig.1C).Asdiscussedbelow,thismaintenanceofislands Genome instability is not only a hallmark but also an ofheterozygosityamongmanylargeregionswithlossof enabling characteristic of cancer (Negrini et al. 2010; heterozygosity (LOH) is difficult to explain by multiple Hanahan and Weinberg 2011; Gordon et al. 2012). Dis- independentdeletions. ruption of genome maintenance and elevated rates of Athirdfeatureoftheobservationwasthatthepattern somaticmutations(e.g.,duetodisruptionofDNArepair of end-joining strongly suggested an origin from a DNA machineries or increased damage) accelerate the trans- double-strandbreak(DSB).Ashighlightedinlaterstudies formation from precancerous tissue into malignant tu- (Kloostermanetal.2011a,2012;Chiangetal.2012),the mors (Gorgoulis et al. 2005; Halazonetis et al. 2008; preponderanceofrearrangementsinvolvedligationofboth GENES&DEVELOPMENT 2515 Zhangetal. Figure 2. Signatures of chromosomal rearrange- mentsfrompaired-endsequencing.(A)Fourmajor types of chromosomal rearrangement signatures deducedfrompaired-endsequencing:deletiontype, tandemduplicationtype,inversiontype,andlong- range type (including interchromosomal). Each type of read pair shows aberrations from proper pairs when aligned to the reference assembly, whichimpliesanewjunctioninthetestchromo- some. Adeletion (readpairs shownas red arrows) or tandem duplication (shown as green arrows) only introduce one fusion and hence can be un- ambiguously inferred from a single type of signa- ture (in the absence of other overlapping events). Inversion events, however, introduce at least two rearranged junctions (shown here is a simple in- version);hence,therearrangedgenomecanonlybe constructedbyconsidering allrelatedevents.The sameistrueforlong-rangeeventswithpairmates residingindifferentchromosomesorseparatedby centromeres, assembly gaps, or other rearrange- ments. In general, it is necessary to incorporate copynumber information together with rearrange- ment signatures to derive the structure of the rearrangedgenome(foracomputationalframework, seeGreenmanetal.2012a).(B)Examplesofcomplex chromosomal rearrangements exhibiting multiple overlapping rearrangement signatures that do not reflectthesameeventsasthe‘‘typing.’’Thediscor- dant read pair signatures (color arrows) are shown bothintherearrangedgenomeandaccordingtotheiralignmenttothereferencegenome.(i)Acomplexrearrangementresultinginthe deletionofsegmentAandswappingofsegmentsBandCgeneratestwo‘‘tandemduplication’’andone‘‘deletion’’readpairsignatures, noneofwhichcorrespondstoasimpleevent.(ii)Twoinversionsalteradeletionsignatureintoatandemduplicationsignature(green arrows). ends of a single DNA break to other genomic segments almostcertainlyproduceafinaloutcomewithmorethan (endsbeingoperationallydefinedassequenceswithin;1 twocopynumberstates.Finally,maintenanceofislands kbofeachother;hereafterreferredtoasapairingofends). ofheterozygosityinterspersedbetweenregionsthathave This contrasted with complex genomic rearrangements lostheterozygosityishardtoexplainbymultiplesequen- that arise by replication-based mechanisms (Lee et al. tialevents.Thisisillustratedbythefactthatadeletion 2007; Carvalho et al. 2009, 2011) where the rearrange- early in the process will remove sequences that cannot ment is often seen only on one side of the initial lesion be regained. Thus, if the observed pattern resulted from (HaberandDebatisse2006;seebelowformoredetails). sequential mutation events, deletions would need to be The final defining feature of this new mutagenesis restricted to a later time period, when they could not eventwasthenonrandom,highlylocalizedclustering interrupt the acquisition of balanced rearrangements—a of chromosomal breakpoints. These four hallmarks— complex ‘‘programmed’’ event for which it is hard to alternatingcopynumberprofiles,lossandpreservation envisionamechanism(oneexampleisshowninFig.3). of heterozygosity, pairing of the breakpoint ends, and Incontrasttothegradualmodel,Stephensetal.(2011) clusteringofrearrangements—definetheclassofchro- proposedamuchmorecompellingcatastrophicmodelof mosomal alteration termed chromothripsis (Greek for chromothripsisthatoffersaparsimoniousexplanationof shatteringofchromosomes). theobservation:Onechromosome(orregionsfromoneor morechromosomearms)isshatteredintosegmentsofdif- ferentlengthsinasinglecatastrophicevent;thesegments All atonce? are then stitched together, most likely by nonhomolo- The defining hallmarks of chromothripsis cannot be gous end-joining, resulting in a derivative chromosome explained by a gradual accumulation of independent containingasubsetoftheshatteredsegmentsinrandom events.First,trulyindependentchromosomalrearrange- orientations.Theretainedsegmentsmaintaintheparen- mentsareexpectedtoberandomlydistributedacrossthe tal copy number and heterozygosity, yielding the high genomeratherthanclusteredinfocalregions(Beroukhim copy number state. The segments that are not incorpo- et al. 2007, 2010). Second, the gradual accumulation of rated into the derivative chromosome are either lost, suchalargenumberofoverlappingrearrangements,both yieldingthelowcopynumberstate,orincorporatedinto copynumber neutralandcopynumberchanging,would adouble-minutechromosome,asdiscussedbelow. 2516 GENES&DEVELOPMENT Genomeevolutionandcomplexrearrangements Figure3. Reconstructionofalocalcomplex rearrangement and its mutational history from read pair signatures and copy number information.(A)Copynumberalterationscan bedetectedbyarraymethodsorreaddepths insequencingdata;rearrangementsignatures canbedetectedfromdiscordantreadpairsin sequencingdata.(B)Bycombiningcopynum- ber information and rearrangement signa- tures,onecanconstructtheconfigurationof therearrangedsegmentsinthechromothrip- ticchromosome.(C)Thehistoryofmutation events that could have generated the out- come inB is oftennot unique. However,all solutionshavetobreakfourjunctionsinthe reference assembly (LjA, AjB, BjC, and CjR) and generate three new junctions (LjC, CjB, and BjR). A catastrophe model can easily solve this puzzle because all of the breaks andtranslocationsoccurallatonce.Bycom- parison,asolutionfromthegradualmodelof simple events requires at least three simple eventstogeneratethefinalconfiguration(one foreachnew junction).Aseacheventcauses twobreakpoints,threeeventsneedsixbreak- points, which requires two additional breaks inadditiontothefouroriginaljunctionstobe broken. These two additional breaks arise fromeitherwithinthelostAsegment(losthistory)orhittingthesamejunctionmultipletimes(recurrentbreaks).Shownhereisone possiblesolutionthatinvolvesrecurrentbreaksatbothBjCandCjRjunctions.Bothlosthistoryandrecurrentbreaksarehighlyunlikely. Asthenumberofrearrangedfragmentsincreases,theneedtoincludethesetypesofunlikelyeventsfurtherincreases,stronglyarguing againstthegradualmodel. Historiography ofthe cancer genome et al. 2007; Campbell et al. 2008; Medvedev et al. 2009) has a completely different interpretation under a rear- Thesegeneralargumentsmakeintuitivesensebutideally ranged genome when additional rearrangement events wouldbebackedupbyadetailedmolecularassemblyof have occurred between the pair mates (Fig. 2B). This theevolutionarypathtakentogeneratethechromothrip- technical issue is less problematic for simple genomes ticchromosome.Stephensetal.(2011)facedtheobvious where rearrangements seldom overlap and can be de- challengeofinferringpriorhistoryfromaterminalsnap- coupledandinterpretedunambiguously(Greenmanetal. shot of the present, which is already difficult for cancer 2012a,b; Quinlan and Hall 2012). However, it becomes genomeswithsimplerearrangementpatterns(Greenman prohibitively complex in chromothripsis, where tens or etal.2012a)andquicklybecomesimpracticalforacom- hundredsofrearrangementsoverlap,resultinginanenor- plex case such as chromothripsis (Yates and Campbell mousnumberofpossiblepermutations.Thisprovidesan 2012). importantcautionarynoteforaspiringgenomeanalysts: The first complication for inferring an evolutionary Anaccurateinterpretationofahighlyrearrangedcancer trajectory is purifying selection: The mature tumor is genome from paired-end sequencing data requires an biasedtopreservegenomicchangesthatarebeneficialto integrative analysis of rearrangement signatures (such tumordevelopmentandtohavelostdeleteriouschanges asdeletiontypeortandemduplicationtype)(Fig.2A)and (Beroukhim et al. 2007; Greenman et al. 2007; Bignell copynumberdata.Inotherwords,contextmatters. etal.2010).Byviewingonlytheendpointofselection,we The following back-of-the-envelope calculations il- couldmissintermediatestepsinthedevelopmentofthe lustrate the magnitude of the problem. The number of rearrangedchromosomewhosesignatureswerelostduring differentoutcomescreatedbyrandompermutationsof10 tumor evolution. An additional technical complication overlapping rearrangements is 10! = 3,628,800 and the forsolvingthegenomicRubik’scubeforthechromothrip- number grows to ;1064 for 50 rearrangements. Typical tic chromosome is that one cannot interpret paired-end chromothripsis harbors tens or even hundreds of over- sequencesinasimplestraightforwardwaywhentheyoc- lapping rearrangements, and it is clearly impossible to cur in the context of other overlapping rearrangements. enumerate all possible outcomes. Additional complica- Forexample,adiscordantpairofsequencingreadsthatis tions are caused by intermediate events being obscured inferredtobe a ‘‘tandem duplication type’’ event when by later events; e.g., a later deletion event that removes directly mapped onto the reference genome sequence the signature of an earlier translocation. This estimate (Fig.2A;Raphaeletal.2003;Tuzunetal.2005;Korbel also does not account for rearrangements that are not GENES&DEVELOPMENT 2517 Zhangetal. detectableduetotechnicalissuessuchasuncertaintiesin approach,discussedfurtherbelow,potentiallyprovidesa thereferencegenomeassemblyorinaccuraciesinshort- complementary method to validate the idea that chro- readalignment. mothripticlesionsoccurredatthesametime. The most difficult challenge stemming from the vast Insummary,chromothripsisisbestexplainedbyacat- number of outcomes due to permutation complexity, astrophic all-at-once model and cannot be reconciled however, is finding not just one solution, but the most with the gradual model. The catastrophic model yields likely solution basedon a certain backgroundstatistical asimpleexplanationofthelownumberofobservedcopy modeloftumorevolution.Ultimately,wewanttoknow number states. It also provides an explanation for the thelikelihoodofthemultieventsolutiontochromothrip- manyoverlappingtandemduplicationtypeeventsthatdo sisbasedonthebackgroundmodeloftumorevolutionto notincreasecopynumber(seeFig.2B,i,foranexample): dismissthegradualmodelinfavorofasinglecatastrophe. These duplication type events are instead explained by (Fig. 3 illustrates this problem by a simple example.) To therandomorientationsatwhichthesegmentsarestitched answerthislastquestionwithoutenumeratingallpossi- together.Similarexplanations can apply todeletion and ble outcomes of a gradual model, Stephens et al. (2011) other‘‘type’’events(Fig.2B). focused on the number of copy number states during genomeevolution,essentiallyreducingthemultidimen- Whenis it chromothripsis? sional space of chromosome configurations to a single dimensionof‘‘copynumber.’’Theysetupsimulationsin The discovery of chromothripsis in cancer immediately which individual rearrangement events were applied to raisesthequestionofhowfrequentlyitoccurs.Afterthe the genome sequentially, starting from the reference se- initial discovery, there have been a plethora of studies quence.Insteadofbruteforceenumerationofallgenomic confirming that chromothripsis is indeed a widespread configurations, the eventual number of copy number and previously unappreciated phenomenon in both pri- states was scored, making a testable prediction about marytumors(Kloostermanetal.2011b;Magrangeasetal. thestructureofthechromothripticchromosomewithout 2011; Berger et al. 2012; Rausch et al. 2012) and cancer theneedforacompletemolecular reconstructionofthe cell lines such as HeLa (Adey et al. 2013; Landry et al. rearrangedchromosome.Thegradualmodelrapidlygen- 2013). Many cancer genomes reported in earlier studies eratedmultiplehighcopynumberstatesbecausegradual also exhibited features that resemble chromothripsis accumulationallowsforoverlappingtandemduplications (Stephens et al. 2009; Campbell et al. 2010). So how are toaffectthesameregionmultipletimes.Thediscrepancy we to recognize chromothripsis? How many rearrange- betweenthelargecopynumbercomplexityimpliedbythe ments ‘‘make’’ the definition, and how focal is focal? gradualmodelandthehallmarktwocopynumberstates Becausecopynumberdataarethemostavailable,acom- observed in chromothripsis provided a strong statistical monsenseapproachwastoadoptoperationaldefinitions argumentagainstagradualmodelforchromothripsis.Itis that would require, say, 10, 20, or 50 oscillating copy worth noting that chromothriptic chromosomes can numberchanges(Magrangeasetal.2011).Insomecases, sometimesexhibitmultiplecopynumberstates(Stephens correctionswereappliedtonormalizethenumberoffocal et al. 2011; Rausch et al. 2012). One explanation is the events to the general frequency of events on that chro- overlapbetweenchromothripsisandotherindependently mosome(Kimetal.2013). generatedcopynumbergains;anotherpossibilityisthat Although an operational criterion is reasonable for a chromothripsisthatoccurredduringorafterDNArepli- first-pass screening and many instances with multiple cation can result in a shattering and assembly of both oscillations between two copy number states likely are sisterchromatidstogeneratecopynumbergains.Ineither bonafidechromothripsis,thefieldismovingawayfrom scenario, however, the low copy number states (three or operational definitions and adopting criteria that incor- four)arestillinstarkcontrasttotherapidaccumulationof porateinformationfrompaired-endsequencing.Through multiplecopynumberstates,asthegradualmodelsuggests. more precise analysis of the structure of the derivative The focal pattern of breakpoints in chromothripsis chromosome, one can better distinguish chromothripsis providesyetanotherargumentagainstthegradualmodel. fromalargenumberofprogressivelyacquiredrearrange- Independentrearrangementsaregenerallyassumedtobe ments in tumors with high levels of genetic instability. randomlydistributedacrossthegenome.Thelargesizeof Because an excellent review by Korbel and Campbell thehumangenomeimpliesthatitisextremelyunlikely (2013) has recently covered this topic in depth, we only toseetwoeventsthatareveryclosetoeachother(;1kb brieflyreviewthemainelementsofthesecriteriahere. apart).Thelikelihoodofseeingtensorhundredsofbreak- Asdiscussedabove,onehallmarkofchromothripsisis points within one chromosome (or chromosome arm) theclusteringofrearrangements.Thedegreeofclustering withfeweventselsewhereinthegenomeisvanishingly canbeassessedbysimplestatisticalmethodsbecausethe small if these events were independent and not due to null hypothesis of random breakpoints predicts that the specific targeted mechanisms. This statistical argument distance between breakpoints should be distributed ex- suggeststhatclusteredrearrangementsinchromothripsis ponentially(Beroukhimetal.2010;Malhotraetal.2013). verylikelyoccurredsimultaneously.Ageneralizationof However,itisimportanttonotethatclusteringofbreak- this statistical argument into a systematic way of in- pointscanalsobegeneratedbyotherprocessesinvolving ferring co-occurring translocations (‘‘chained’’transloca- multiplestepsoverseveralcelldivisioncycles.Forexam- tions)wasrecentlyproposed(Bacaetal.2013).Thisnew ple,clusteringcanresultfromBFBcycles(Gisselssonetal. 2518 GENES&DEVELOPMENT Genomeevolutionandcomplexrearrangements 2000),chromosomefragilesites(Debatisseetal.2012),and structural rearrangements (e.g., simple deletions/ampli- strongpositiveselectionforlocaloncogeneamplifications fications/translocations) layered on top of chromothrip- (Bignelletal.2007).Thus,clusteringbyitselfisanecessary sis, tumor heterogeneity, and aneuploidy. All of these but not sufficient criterion for chromothripsis. An addi- technical factors may lead to an underestimate of the tionalcriterionisprovidedbythefactthatchromothripsis frequencyofchromothripsis. ischaracterizedbyregionswithinterspersedretentionand LOH, which can be verified from genotype information Howfrequently does chromothripsis happen? fromeitherSNParrayorsequencing.Finally,ifrestricted toasinglechromosome,theregionsofrearrangementand So what, then, is our best guess for the frequency of segment loss should be confined to a single parental chromothripsis?Unfortunately,thelargestvolumeofcan- haplotype because the shattering and stitching back cer genomic data (such as in The Cancer Genome Atlas togetheroccurs(mostly)onasinglechromatid.Thiscan [TCGA]project)isarray-basedanddoesnothavethepower be directly verified by cytogenetic methods, such as toprovideanaccurateestimateoftheoverallfrequencyof fluorescenceinsituhybridization(FISH),orinferredfrom chromothripsis.However,itisbecomingevidentthatthe phased haplotypes in trio family studies (Browning and frequency of chromothripsis tends to vary between dif- Browning2011). ferent tumor tissue types. In a survey of whole-genome Additional information from sequencing can evaluate sequencingdatafor64samplesofseventumortypesfrom the model that a chromosome has been shattered and TCGA, Malhotra et al. (2013) found no chromothriptic randomly stitched together in more detail. First, the rearrangementsinbasal-likebreastcancers,colonadeno- model predicts that the order of the fragments on the carcinomas,ovariancancers,orrenaladenomasbutfound derivativechromosomewouldberandomornearrandom rearrangementsconsistentwithchromothripsisintwoof withrespecttotheirpositionsonthereferencegenome. six (33%) lung adenocarcinomas, two of 13 (15%) lung Second, if reassembly of the derivative chromosome is squamouscellcarcinomas,and39%ofglioblastomas(n= random, the orientations of fragments on the derivative 18).Inarecentsurveyof4934cancersfromTCGA,Zack chromosome should also be random. This means that etal.(2013)employedmultiplecriteriatomodelchromo- thereshouldbenobiasforfragmentstobejoinedheadto thripsis by SNP array copy number alone and suggested tail (deletion type), tail to head (tandem duplication thatchromothripsisoccurredin5%ofallsamples,with type), head to head, or tail to tail (inversion type). Such frequenciesrangingfrom0%inheadandnecksquamous randomness in the orientation of fragments contrasts carcinomatoamaximumof16%inglioblastoma.Inad- with, for example, BFB cycles, which are characterized dition, chromothripsis has been observed in colorectal byinvertedsegmentsbiasedtobeheadtoheadortailto cancer (Kloosterman et al. 2011b), melanoma (Berger tail (Bignell et al. 2007). Finally, if the shattering and et al. 2012; Hammond et al. 2013; Hirsch et al. 2013), restitching indeed happen all at once, then each rear- small-cell lung cancer (Iwakawa et al. 2013), prostate rangedfragmentwillhaveauniqueheadandtailsequence cancer (Wu et al. 2012), and a variety of brain tumors (with respect to the reference sequence). Thus, when (Molenaar et al. 2012; Northcott et al. 2012; Brastianos ‘‘walking’’ down a chromothriptic chromosome, there et al. 2013) and blood malignancies (MacKinnon and will be an invariant alternation between head and tail Campbell 2013; Morin et al. 2013; Nagel et al. 2013). It (ortailandhead)sequences,reflectingalinearconnection isinterestingtopointoutthattherateofchromothripsis (Korbel and Campbell 2013). This contrasts with the seemstobeunrelatedtotheoverallrateofsomaticcopy prediction for a mechanism involving sequential acqui- numberalterations(SCNAs)(Zacketal.2013). sition of rearrangements, particularly those involving Thehighfrequencyofchromothripsisincertaintumor amplifications. In this latter case, rearranged segments types suggests that chromothripsis depends on the ge- could be ‘‘reused’’ in ways that would generate heads neticandenvironmentalbackgroundofcancers.Among followedbyheadsandtailsfollowedbytailswhenampli- the most frequently mutated genes in human cancer is ficationsarenested. TP53 (Olivier et al. 2010), which plays central roles in Clearly, within a short period of time, the field has maintaining genome stability (Zhu et al. 2002; Meek advanced far beyond ‘‘know it when you see it’’ opera- 2004; Thompson and Compton 2010). The correlation tional definitions for chromothripsis. The above-delin- between TP53 mutation and chromothripsis was first eatedcriteriaeachaddressadifferenthallmarkfeatureof demonstratedinSonicHedgehog(SHH)medulloblastoma. chromothripsisandcanbesubjectedtorigorousstatisti- Rauschetal.(2012)appliedhigh-throughputwhole-genome cal evaluation. Nevertheless, challenges remain. How sequencing and long-fragment mate-pair sequencing to exactly to combine multiple criteria and weigh them characterize genomic rearrangements in four patients of properly to make the most probable case for or against SHHmedulloblastomawhoalsohadgermline-inactivat- chromothripsisneedsfurtherdevelopment.Therearealso ingTP53mutations(Li-Fraumenisyndrome).Sequencing numeroustechnicalchallenges.Shortsequencereadscan ofeachofthesetumorsnotonlyconfirmedclusteringof onlybealignedtothemappableregionsofthegenome,and chromosomal breaks indicative of chromothripsis but the interesting question of what happens within highly alsorevealedhigh-levelamplificationsduetodouble-minute repetitive sequences remains to be resolved. Complica- chromosomes that originated from the shattered frag- tions alsocomefromother factors, suchasinaccuracies ments. Thus, TP53 mutations are permissive or condu- in short-read alignments, the obscuring effect of other cive for either the initiating chromothriptic event, the GENES&DEVELOPMENT 2519 Zhangetal. selective advantage of cells bearing the rearranged chro- ing mechanism in the formation of high-level focal mosome, or both. Rausch et al. (2012) further identified amplifications that incorporate multiple disconnected strongcorrelationsbetweenTP53mutationandchromo- segments(Iwakawaetal.2013;Sanbornetal.2013).The thripsis in acute myeloid leukemia, demonstrating that multiple focal amplificationscanbeeither extrachromo- the effect of TP53 mutation can manifest in multiple somal (double minutes) or intrachromosomal (homoge- tissuetypes. neously staining regions [HSRs]) due to chromosomal How accurate are the estimates of the frequency of integration of double minutes (Storlazzi et al. 2010; chromothripsis?Althoughtherecouldbesomeoveresti- Gibaud et al. 2013). Indeed, data linking the formation mationduetoambiguitiesintheinterpretationofgeno- of double minutes to the formation of derivative chro- micdata,wemustalsoconsiderunderestimationdueto mosomes containing complex rearrangements were thefactthattheoverwhelmingmajorityofchromothrip- known prior to the first description of chromothripsis. ticeventsarealmostcertainlylostbecauseofdeleterious Gibaud et al. (2010) characterized five different extra- fitness effects. Negatively selected events in normal or chromosomal amplifications of double-minute chromo- premalignant tissues could be detected only at a single- somes in a glioma sample: One double-minute chromo- cell level immediately after the chromothriptic rear- someconsistedofmultiplesegmentsfromchromosome5 rangement occurs,whichiscurrentlynotfeasibleonthe and chromosome 9, which, in retrospect, was likely to appropriate scale. Ultimately, understanding the mecha- haveresultedfromchromothripsis.FISHanalysisverified nisms that generate chromothripsis will be integral to thattheextrachromosomalampliconsequenceswerenot estimatingitsfrequency.Iftheunderlyingcellulardefects present in the derivative chromosomes derived from could lead to, but not cause, chromothripsis every time chromosome5andchromosome9.Wefurthernotethat they occur, then the observed cases of chromothripsis copy number profiles of both chromosomes showed the onlyrepresentthetipoftheicebergforlessdramaticbut hallmark copy number patterns suggestive of chromo- possiblymorecommonmutationalevents. thripsis. In addition, the rearrangements also created oncogenic lesions. The double minute contained the TERT (telomere reverse transcriptase) gene from a frag- Doeschromothripsis cause cancer? ment in chromosome 5. TERT is amplified or overex- Ingeneral,weexpectthatthedisruptionofchromosomal pressedinmanycancertypes(Beroukhimetal.2010).The integrityinacatastrophesuchaschromothripsiswillbe functional significance of TERT overexpression is re- negatively selected or even trigger apoptosis. However, markably underscored by the recent discovery that this does not exclude the possibility that rare catas- ;80% of glioblastomas harbored mutations in the 59 trophes could promote cellular transformation, which flanking region of TERT that activate its expression couldhappeninatleasttwowaysthroughcopynumber (Horn et al. 2013; Huang et al. 2013; Killela et al. 2013). alterations.First,themassiveDNAlosscanincludeone Interestingly,thegliomasamplestudiedbyGibaudet al. or more tumor suppressor genes (Stephens et al. 2011; (2010) also had deletions encompassing the CDKN2A Yangetal.2013).IntheirsurveyoftheTCGASNParray locus on the chromosome 9 derivatives. Thus, one data,Zacketal.(2013)foundthat72%ofchromothripsis episode of chromothripsis appears to have generated events resulted in SCNAs in regions that are frequently two critical oncogenic lesions (TERT amplification and disrupted in cancer, with the most dramatic case in CDKN2Adeletion). glioblastoma showing that 20 out of 22 samples with Besides copy number alterations, translocations in chromothripsis had one event disrupting the CDKN2A chromothripsiscanalsoleadtogenefusionsordysregu- locus. Second, and perhaps most importantly, shattered latedgeneexpression.Mehineetal.(2013)suggestedthat chromosomalsegmentsnotincorporatedintothederiva- chromothripsis is a frequent driver event in uterine tivechromosomecanbelinkedtoformadouble-minute leiomyomas,resultinginincreasedexpressionofthetrans- (circular)chromosome.Thesedoubleminutesarereadily located HMGA1 and HMGA2 genes. However, the proba- amplified, which commonly occurs if they harbor an bilityofgeneratingin-framegenefusions—themajorclassof oncogene.Anillustrationofthiscomesfromtheoriginal oncogenic translocations—through random chromosomal reports on chromothripsis (Stephens et al. 2011; Rausch translocationsisgenerallysmall(Stephensetal.2009),and et al. 2012). Stephens et al. (2011) described a small-cell theobservedfrequencyofin-framefusionsduetochromo- lung cancer cell line where a chromothriptic event gen- thripsis is comparable with those resulting from simple erated a derivative chromosome 8 and a double minute rearrangementevents(Stephensetal.2011).Nonetheless, containing MYC and other segments of chromosome 8. although each rearranged segment in chromothripsis has Most notably, the sequences on the derivative chromo- asmallprobabilityofgeneratingafunctionallyimportant some and the double minute were exclusive, providing fusion gene (Teles Alves et al. 2013), it is reasonable to compellingevidencethatearlyinthedevelopmentofthis speculatethatchromothripsis,becauseitgeneratesmany tumor, chromosome 8 was shattered, with some bits rearrangements,willincreasethefrequencyofsuchfusions. being contemporaneously incorporated into the deriva- Thisisnotbecausechromothripsishasanyuniqueability tiveandothersgoingintothedoubleminute. togenerategenefusionsbutsimplyreflectsthefactthat Having recognized the association between chromo- inchromothripsis,moreshotsaretakenongoal. thripsis, double minutes, and cancer-causing mutations, Although there is good reason to think that chromo- onecaninferchromothripsisasthemostlikelyunderly- thripsiscangenerateoncogenicalterationsandpotentially 2520 GENES&DEVELOPMENT Genomeevolutionandcomplexrearrangements multiplemutationsatonefellswoop,wearejuststartingto Chromoanasynthesis understandtheimpactofchromothripsisoncancerpatho- genesis or prognosis. Recent studies have shown that A different pattern of constitutional complex genome chromothripsis can independently arise in either the pri- rearrangementswasreportedbyLiuetal.(2011)intheir marytumororitsmetastasis(Kloostermanetal.2011b)and investigation of patients with congenital developmental does not necessarily predict resistance to drug treatment defects. The investigators combined aCGH and FISH to (Bassaganyas et al. 2013). Even though chromothripsis characterize copy number alterations and chromosomal hasbeensuggestedasapoorprognosticfactor(Molenaar rearrangementsinthesepatientsandsequencedthePCR et al. 2012; Hirsch et al. 2013), direct experimental products at rearrangement junctions to resolve break- characterization of chromothripsis-derived mutations pointsequences.Incontrasttochromothripsis,Liuetal. islacking. (2011) observed frequent copy number gains with inter- Oneimportantquestioniswhenchromothripsisoccurs spersed regions containing duplication or triplication of during tumor development: Can it be an early driving oneparentalallelebutnoLOH(Fig.1D).Breakpointjunc- event,orisitjustanotherconsequenceofgenomicchaos tion sequences exhibited microhomology but also in- in late stage cancers? The latter possibility is intuitive, cluded templated sequence insertions (100–1000 base butthereisalsointerestingevidenceforchromothripsis pairs [bp]) on the rearranged chromosome. The short occurring in the absence of massive genetic instability. template insertions suggested a replication-based mech- First, allele frequencies of chromothriptic rearrange- anismforincorporatingthesesegmentsduringtherepair ments suggest that chromothripsis generally occurs ear- ofDNADSBs(Leeetal.2007;Hastingsetal.2009).The lier than simple rearrangements (Malhotra et al. 2013). observationofmicrohomologyfurtherledLiuetal.(2011) Moreover, the high frequency of chromothripsis identi- to propose microhomology-mediated breakage-induced fied in tumors with low to moderate mutation rates repair (MMBIR) as the major mechanism for generating (neuroblastoma, medulloblastoma, glioblastoma, and theobservedtranslocations(Carvalhoetal.2009;Zhang bloodandbonemarrowmalignancies)suggeststhatchro- etal.2009b;Liuetal.2012).Inthismodel,theextraallele mothripsisdoesnot,inanyobligatoryway,requireaback- copiesareincorporatedduetotemplate-switchingevents groundofelevatedgenomicinstability.Ontheotherhand, in DNA replication instead of ligation (via end-joining) tumortypeswithfrequentcopynumberalterations,such of shattered fragments. To emphasize the difference in as ovarian or lung cancers, exhibit a larger number of mechanisms, Liu et al. (2011) termed this phenomenon chromosomal alterations, but they are often indepen- chromoanasynthesis (synthesis of new chromosomes). dentlyacquiredratherthancorrelatedasinchromothrip- Theyalsosuggestedthatthesamereplicativemechanism sis(Malhotraetal.2013;Zacketal.2013).Additionally, mayplayaroleinchromothripsisduetosimilarfeatures as described in more detail below, de novo complex in both phenomena, such as localized clusters of rear- rearrangements that resemble chromothripsis have also rangementsandcopynumberalternations. been observed in patients with congenital disorders. So One of the hallmark features of chromothripsis is far, there has been no evidence that these patients have interspersedlossandpreservationofheterozygosity,which a cancerpredisposition ordefectsinthemaintenance of suggestsa‘‘shatter-and-stitch’’processofonechromatid. genome stability like patients with germline mutations This is in sharp contrast to chromoanasynthesis, which intheTP53orBRCAgenes.Together,thesefindingsimply reflectsextrasynthesisofDNAsegments.Althoughextra thatchromothripsiscanoriginateincellswithnormalor synthesiscanleadtoalternatingDNAcopynumbers,it near-normalgeneticstability. doesnotnecessarilyresultinLOH:LOHoccursbyDNA deletionorgeneconversion.Anotherdifferencebetween chromoanasynthesisandchromothripsisisthatadjacent Chromothripsis incongenitaldisorders chromosomal ends in chromothripsis (especially in the Strong selection during embryonic development en- germline)oftenresultfromoneDNADSB,whereasseg- suresthatonlymildgenomicalterationscanbetolerated mental breaks in chromoanasynthesis are separated by through development. It was therefore very surprising longer distances (0.01;1 Mb) and appear to result from when recent studies reported massive constitutional template-switching events. Although replication-based chromosomal rearrangements similar to those of chro- DNA repair can contribute to chromothripsis, as evi- mothripsis in cancer in some patients with congenital denced from examplesof templated insertion sequences developmentaldisorders(Kloostermanetal.2011a,2012; (Chiangetal.2012),itisdifficulttoexplaintheproximity Chiangetal.2012;Nazaryanetal.2013).Incomparison ofadjacentchromosomalbreaksbasedpurelyontemplate withchromothripsis incancer,theseinstancesofappar- switching without DNA DSBs. Finally, chromoanasyn- entgermlinechromothripsisshowedminimalDNAloss, thesisresultsinoneaberrantchromosomewithduplicated presumably reflecting the selection against haploinsuffi- segments due to extra DNA synthesis; in contrast, chro- ciency or complete loss of gene function due to mono- mothripsisgenerally givesrisetoone or multiple deriva- allelicgeneexpression.Array-basedcopynumberanalysis, tive chromosomes with either massive DNA loss (in suchasarraycomparativegenomehybridization(aCGH) cancer)or noapparentDNAcopy number alterations(in or SNP arrays, cannot, as expected, detect these copy- the germline). Based on these differential characteristics, neutral chromosomal alterations, necessitating whole- weagreewiththeconclusionthatchromoanasynthesisis genomesequencing. adistinctphenomenonfromchromothripsis(Hollandand GENES&DEVELOPMENT 2521 Zhangetal. Cleveland 2012; Liu et al. 2012; Kloosterman and signaturesofchromoplexysuggestthatallofthepartner Cuppen2013). segments involved in the translocations originate from The distinction between chromothripsis and chromo- DNADSBs,withbothendsofeachbreakcontributingto anasynthesis is also evident in a more recent report of the daisy chain cycle of translocations (Fig. 4A). This germline genomic rearrangements. Kloosterman et al. organizationofbreakpointendsbearssomesimilarityto (2012) identified eight cases that resemble chromothrip- thepairingoftheendsdescribedaboveinchromothripsis. sis,exhibitingrandomstitchingofsegmentsfrommulti- As with chromothripsis, the pairing pattern strongly ple chromosomes with little DNA loss, and two cases implies that chromoplexy is another example of an all- withapparentgainordeletionofDNAsegmentsthatare at-once mechanism for chromosomal rearrangement: If suggestiveofreplicationerrors.Oneinterestingobserva- the breakpoint ends originate from DSBs and are joined tionisthattherearrangedallelesinbothchromothripsis intoanintegratedpatternoftranslocations,thenthebreaks and chromoanasynthesis are preferentially of paternal musthaveoccurredsimultaneously. origin; this was attributed to errors that result from the To put the intuitive argument into a more rigorous higher number of mitotic divisions in gametogenesis in framework, Baca et al. (2013) developed an algorithm malesrelativetofemales(KloostermanandCuppen2013). calledChainFindertoidentifythechainedtranslocations In contrast, most human germline aneuploidies are ma- of chromoplexy. The assumption is that the probability ternally derived (Handyside et al. 2012; Nagaoka et al. that the observed translocations of two adjacent break- 2012), and de novo chromosomal instability in early em- point ends occurred simultaneously is related to the bryonic development does not show a preferred origin probability that two breakpoint ends originate from a (Vannesteetal.2009;Voetetal.2011). singleDSB.TheinferenceofaDSBisnotstraightforward because the breakpoint ends originating from a single DSB due to resection and other processing are not pre- Chromoplexy ciselyconnectedinthereferencesequence(seeFig.4Bfor Chromothripsis and chromoanasynthesis are two exam- anillustration);anullmodelforindependentlygenerated ples of complex genomic rearrangement triggered or breaksisthereforenecessaryforastatisticalinference.To generated by a single event. A single catastrophic event create the null model of independently generated chro- wasalsoinvokedtoexplainarecentlydescribedpattern mosomalbreaks,ChainFinderfirstestimatesthedensity of rearrangement found in prostate cancers (Fig. 1E; of chromosomal breaks at any locus by averaging over Bergeretal.2011;Bacaetal.2013).Termedchromoplexy multipletumorsamplesandthenmultiplyingthisbythe (Greek for braid of chromosomes), this event is charac- total number of chromosomal breaks detected in a par- terized by ‘‘chains’’ of translocations involving multiple ticular sample. This generates a sample-specific, locus- chromosomes—uptoeightsofardescribed.Thesequence dependentfrequency ofbreaks. Basedonthenull model Figure4. ChromoplexyandChainFinder.(A)Chromo- plexy is an extension of balanced rearrangements to multiplepartners.Thedifferentcolorsoflinkeddiscor- dantpairmatesreflectdifferentchromosomesorlocito whicheachmateisaligned.DNAresectionduringthe repairofDSBsoftenresultsinlossofasmallsegment between the two ends. (B) Adjacent translocations of two breakpoint ends can arise in two different ways. (Left) In a single-event model, a single DNA DSB generates two broken ends with a small deletion due toDNAresection;joiningofthetwobrokenendswith ends from other DNA breaks produces the observed translocations. (Right) In a multiple-event model, two independent balanced translocations occur indepen- dentlyatdifferenttimes;theinnerDNAsegmentcould havebeenlostinasubsequentdeletionevent(shownin thedashedbox)orduetoDNAresection.Thedistance between the two adjacent translocation ends, D, pro- vides a statistical measure of the likelihood of either scenario.Thetwo-eventmodelimpliesthattwoindepen- dentbreaksmusthaveoccurredwithindistanceD.This likelihood is approximately given by 1 (cid:2) exp((cid:2)mD), wheremistheaveragedensityofchromosomalbreaks that can be estimated for each sample at any given locus (&10(cid:2)6 per base pair). When the ends are very close (100–1000 bp), this probability is vanishingly small, favoring the single-event model and rejecting the multievent model. The central idea of ChainFinder is to find ‘‘chained’’ translocationsthatformaclosedcycleandwherethemultiple-eventmodelcanberejectedforanytwopairsofadjacenttranslocations (i.e.,noreciprocaltranslocationcanbepostulatedasanintermediatestate,connectingtwosmallerchains). 2522 GENES&DEVELOPMENT