GJA4/Connexin 37 mutations correlate with secondary lymphedema following surgery in breast cancer patients

Mahrooyeh Hadizadeh, Seiied Mojtaba Mohaddes Ardebili, Mansoor Salehi, Chris Young, Fariborz Mokarian, James McClellan, Qin Xu, Mohammad Kazemi, Elham Moazam, Behzad Mahaki, Maziar Ashrafian Bonab

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Lymphedema is a condition resulting from mutations in various genes essential for lymphatic development and function, which leads to obstruction of the lymphatic system. Secondary lymphedema is a progressive and incurable condition, most often manifesting after surgery for breast cancer. Although its causation appears complex, various lines of evidence indicate that genetic predisposition may play a role. Previous studies show that mutations in connexin 47 are associated with secondary lymphedema. We have tested the hypothesis that connexin 37 gene mutations in humans are associated with secondary lymphedema following breast cancer surgery. A total of 2211 breast cancer patients were screened and tested for reference single nucleotide polymorphisms (SNPs) of the GJA4 gene (gap junction protein alpha 4 gene). The results presented in this paper indicate that two SNPs in the 3’ UTR (the three prime untranslated region) of the GJA4 gene are associated with an increased risk of secondary lymphedema in patients undergoing breast cancer treatment. Our results provide evidence of a novel genetic biomarker for assessing the predisposition to secondary lymphedema in human breast cancer patients. Testing for the condition-associated alleles described here could assist and inform treatment and post-operative care plans of breast cancer patients, with potentially positive outcomes for the management of disease progression.
Original languageEnglish
Article number23
Number of pages11
Issue number1
Publication statusPublished - 22 Feb 2018


  • connexin 37
  • secondary lymphedema
  • breast cancer
  • GJA4 gene
  • single nucleotide polymorphism (SNP)


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