Pancreatitis

Gene: CEL

Amber List (moderate evidence)

CEL (carboxyl ester lipase)
EnsemblGeneIds (GRCh38): ENSG00000170835
EnsemblGeneIds (GRCh37): ENSG00000170835
OMIM: 114840, Gene2Phenotype
CEL is in 5 panels

3 reviews

Ivone Leong (Genomics England Curator)

Comment on list classification: Promoted from Red to Amber based on expert review by Miranda Durkie. This gene is associated with a phenotype in OMIM but not in Gene2Phenotype.
Created: 25 Mar 2022, 8:37 a.m. | Last Modified: 25 Mar 2022, 8:37 a.m.
Panel Version: 2.16

Miranda Durkie (Genetics)

I don't know

Email from Anders Molven (Norway):
"The only variants of CEL with a pathogenic effect demonstrated are so far:
(1) Extremely rare single-bp deletions that introduce a frameshift in the exon 11 VNTR region (Ræder et al., NG 2006 + the new JCEM paper)
(2) The rare CEL-HYB allele = a CNV involving the CEL pseudogene (Fjeld et al., NG 2015).
All other variants, rare or common, substitutions or frameshifts, gene duplications or deletions, must at present be considered benign or VUS.

(1) are highly penetrant and cause MODY8. We have now shown that these mutations also can cause hereditary CP.
(2) is a risk factor for CP, being 2.5-5 times overrepresented in cases compared to controls.

(1) should be screened for in the context of suspected MODY, as we have described. It may also be worthwhile to check in unsolved hereditary CP cases, esp. if there also is diabetes and more common CP genes have been excluded.
(2) should be screened for in idiopathic CP cases (no alcohol abuse or other obvious CP explanation), especially if there is young onset or a family history. Some labs do this already, along with checking for other CP genetic risk factors. Here is a recent example from our lab: Protein misfolding in combination with other risk factors in CEL-HYB1-mediated chronic pancreatitis - PubMed (nih.gov)
(1) and (2) need to be screened by different, targeted approaches. They will easily be missed in the analysis of NGS data (or not be detectable at all).

CP is much trickier to diagnose than diabetes! There is no single measurement such as BG to help, just a set of criteria and several proposed scoring systems. For idiopathic CP cases, genetic tests are considered worth doing as it may help verifying the diagnosis. If the patient has one or more risk variants (like CEL-HYB), this elucidates why that patient did the develop the disease, often in combination with some other risk factor present (see paper above).
And to make the story even more complicated, there are two versions of CEL-HYB:
Lipase Genetic Variants in Chronic Pancreatitis: When the End Is Wrong, All's Not Well - PubMed (nih.gov)
CEL-HYB1 (the CP genetic risk factor in Europeans found by us; not present in Asian populations)
vs.
CEL-HYB2 (China, Japan, India; has a premature stop codon in exon 10 à nonsense-mediated mRNA decay, has NO association with CP)."

PMID: 16369531 - 2 families with CEL VNTR single base deletion with diabetes and exocrine pancreatic dysfunction although no one in large family 1 had clinical diagnosis of pancreatitis

PMID: 34850019 - 2 / 352 cases found to have single base deletions in VNTR region of exon 11. Phenotype = dominantly inherited insulin-dependent diabetes, pancreatic exocrine dysfunction and atrophic pancreas with lipomatosis and cysts. Hereditary pancreatitis was the predominant phenotype in one pedigree.
GOF mechanism likely "The mutations are predicted to lead to aberrant protein tails that make the CEL protein susceptible to aggregation."

Conclusion: CEL VNTR deletion is a very rare cause of Pancreatitis - more likely to be ascertained via MODY and needs long-range PCR approach, not NGS
CEL-HYB is a risk alleles and part of polygenic model of HP and cannot be detected by NGS
= Amber rating
Created: 21 Mar 2022, 12:43 p.m. | Last Modified: 21 Mar 2022, 12:43 p.m.
Panel Version: 2.12

Mode of inheritance
MONOALLELIC, autosomal or pseudoautosomal, NOT imprinted

Phenotypes
Hereditary Pancreatitis; Diabetes

Publications

Mode of pathogenicity
Other

Ellen McDonagh (Genomics England Curator)

Red List (low evidence)

Comment on publications: PMID: 29233499 - suggests CEL is an interesting candidate gene links to pancreatic disease; a recombined allele between CEL and its pseudogene CELP has been discovered which encodes a chimeric protein with impaired secretion increasing the risk for chronic pancreatitis five-fold. However, there are several publications that find no association (see publications). There does not seem to be enough evidence at this time for loss-of-function variants in this gene to be causative of pancreatitis.
Created: 6 Dec 2018, 1:27 p.m.
This gene encodes for carboxyl ester lipase, which is produced by the pancreas and is a major component of pancreatitc juice. It is associated with MODY in OMIM. Not clearly associated with pancreatitis cases in OMIM.
Created: 6 Dec 2018, 12:19 p.m.

Details

Mode of Inheritance
MONOALLELIC, autosomal or pseudoautosomal, imprinted status unknown
Sources
  • Expert Review Amber
  • EUROPAC
Phenotypes
  • Hereditary Pancreatitis
OMIM
114840
Clinvar variants
Variants in CEL
Penetrance
None
Publications
Panels with this gene

History Filter Activity

25 Mar 2022, Gel status: 2

Entity classified by Genomics England curator

Ivone Leong (Genomics England Curator)

Gene: cel has been classified as Amber List (Moderate Evidence).

25 Mar 2022, Gel status: 1

Set Phenotypes

Ivone Leong (Genomics England Curator)

Phenotypes for gene: CEL were changed from to Hereditary Pancreatitis

25 Mar 2022, Gel status: 1

Set publications

Ivone Leong (Genomics England Curator)

Publications for gene: CEL were set to 29233499; 28881607; 28500240; 27802312; 27650499; 27773618; 26946345; 25774637; 23770712

25 Mar 2022, Gel status: 1

Set mode of inheritance

Ivone Leong (Genomics England Curator)

Mode of inheritance for gene: CEL was changed from to MONOALLELIC, autosomal or pseudoautosomal, imprinted status unknown

10 Dec 2018, Gel status: 1

Panel promoted to version 1.0

Ellen McDonagh (Genomics England Curator)

Ellen McDonagh: This gene encodes for carboxyl

6 Dec 2018, Gel status: 1

Set publications

Ellen McDonagh (Genomics England Curator)

Publications for gene: CEL were set to 29233499

6 Dec 2018, Gel status: 1

Set publications

Ellen McDonagh (Genomics England Curator)

Publications for gene: CEL were set to

2 May 2018, Gel status: 1

Added New Source

Ellen McDonagh (Genomics England Curator)

CEL was added to Pancreatitis panel. Sources: EUROPAC

2 May 2018, Gel status: 1

Created

Ellen McDonagh (Genomics England Curator)

CEL was created by Ellen McDonagh