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Most of the emphasis in the field has been on the detection of genes that are significantly mutated in cancer, the so-called drivers that harbor deleterious somatic mutations more often than expected by chance [ 75, 76].
There are no obvious clinical differences between carriers of mutations in the three genes already known to cause FHM, although patients with FHM1 mutations more often exhibit cerebellar ataxia and FHM2 cases report (minor) head trauma as a trigger of attacks.
On the other hand recombination may be disadvantageous since the net effect may result in breaking up favorable combinations of mutations more often than combining beneficial mutations [23] [27].
So why are some mutations more often early and others more often late events?
Considering the frequency of mutations according to histology, adenocarcinomas (ACAs) show mutations more often than any other histology (22/254 (8.7%) vs 5/298 (1.7%); p<0.001).
Although compensatory adaptation can occur by reversion to the antibiotic-susceptible wild type via back mutation at the same locus (Klein and Kimmelman 1946; Miller and Bohnhoff 1950; Whitlock et al. 2003), it is estimated that such events are rare and that compensatory mutations more often alleviate the costs of resistance (Whitlock et al. 2003; Andersson 2006).
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Although maternally inherited mutations are more often found with AHO, paternally inherited mutations can also be associated with AHO and lead to PPHP.
Deleterious mutations are more likely to be recessive, while neutral or small-effect mutations are more often additive [ 26].
The research showed that many ominous mutations happen spontaneously, meaning they are not passed down from one generation to the next; and such mutations happen more often in tissues that divide often.
Lastly, despite some data indicating no association between cytogenetics and TET2 status in MPN, TET2 mutations occur more often in the presence of normal karyotype and intermediate-risk AML (Hussein et al., 2010; Weissmann et al., 2012).
TP53 mutations occurred more often in basal-like lines (P = 0.038).
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