{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:09:56Z","timestamp":1778764196456,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":133,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004099","name":"Ligue Contre le Cancer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004099","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001677","name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001677","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Human Mutation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Constitutional epimutations of the\n                    <jats:italic>MLH1<\/jats:italic>\n                    gene are an alternative cause of Lynch syndrome, in which inactivation of an allele of a mismatch repair (MMR) gene results from\n                    <jats:italic>MLH1<\/jats:italic>\n                    promoter methylation, rather than a pathogenic genetic variant. These epimutations are often mosaic, and methylation levels ranging from ~50% monoallelic methylation to low\u2010level methylation (1%\u20135%) are observed in the blood of\n                    <jats:italic>MLH1<\/jats:italic>\n                    epimutation carriers. Using a specific and highly sensitive droplet digital methyl\u2010specific PCR (ddMSP) assay, six patients with very low methylation levels (&lt;\u20091%) were identified in a series of 142 patients with a\n                    <jats:italic>MLH1<\/jats:italic>\n                    \u2010methylated tumor diagnosed before age 61, who had been referred to the clinical lab between 2020 and 2024. These patients were initially missed by standard pyrosequencing assay, emphasizing the need for highly sensitive assays for constitutional epimutation screening. To confirm that methylated DNA molecules detected by ddMSP did not correspond to circulating tumor DNA rather than germline DNA, multiple validation analyses were performed, including validation of the constitutional origin of methylation on other sources of germline DNA and tumoral analysis. Taking into account the other patients identified as epimutation carriers by pyrosequencing during the same 5\u2010year period, 13.1% of patients with a\n                    <jats:italic>MLH1<\/jats:italic>\n                    \u2010methylated tumor before age 61 were diagnosed as Lynch syndrome patients, which changed their clinical follow\u2010up. These findings highlight the relevance of recommendations for systematic\n                    <jats:italic>MLH1<\/jats:italic>\n                    epimutation screening using highly sensitive assays in patients with\n                    <jats:italic>MLH1<\/jats:italic>\n                    \u2010methylated tumors diagnosed before age 61. Such screening will increase the number of patients diagnosed with Lynch syndrome caused by a\n                    <jats:italic>MLH1<\/jats:italic>\n                    constitutional epimutation, improving patient care and outcomes, as well as genetic counseling.\n                  <\/jats:p>","DOI":"10.1155\/humu\/6909313","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:30:47Z","timestamp":1778761847000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>MLH1<\/i>\n                    Constitutional Epimutation Screening Requires Highly Sensitive Assays to Identify Lynch Syndrome Patients With Very Low Mosaic Methylation 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