Inherited predisposition to pneumothorax: estimating the frequency of Birt-Hogg-Dubé syndrome from genomics and population cohorts

Abstract

Birt-Hogg-Dubé syndrome (BHDS) is the most common monogenic cause of pneumothorax. Most affected families have pathogenic variants in the FLCN gene. Using large genomic registries (UK Biobank (UKB), 100,000 Genomes Project and East London Genes & Health) including >550 000 individuals, we demonstrate that the frequency of clinically validated loss-of-function FLCN variants is 1 in 2710 to 4190. While the lifetime risk of pneumothorax in FLCN mutation carriers in the UKB and a BHDS clinical cohort was substantial (28.4% and 37.3%, respectively, to age 65 years), the lifetime risk of renal cancer was significantly lower in UKB than in BHDS patients (1% vs 32.1%). These findings highlight the importance of clinical context in managing individuals with FLCN mutations.

Keywords: Pleural Disease.

Figure 1. Age-related manifestations of Birt-Hogg-Dubé syndrome (BHDS). Kaplan-Meier survival curves (with 95% CI) for age-related risk of developing (A) pneumothorax and (B) renal cell carcinoma (RCC) in patients with BHDS with pathogenic loss-of-function FLCN mutations (blue line) versus UK Biobank participants with pathogenic loss-of-function FLCN mutations (red line).