Études génétiques moléculaires des gènes de la polarité planaire cellulaire dans les anomalies du tube neural chez l’Homme

Les anomalies du tube neural (ATN) sont des malformations congénitales parmi les plus fréquentes chez l’humain en touchant 1-2 nouveau-nés par 1000 naissances. Elles résultent d’un défaut de fermeture du tube neural pendant l’embryogenèse. Les formes les plus courantes d'ATN chez l'homme sont l'anencéphalie et le spina-bifida. Leur étiologie est complexe impliquant à la fois des facteurs environnementaux et des facteurs génétiques. Un dérèglement dans la signalisation Wnt, incluant la signalisation canonique Wnt/β-caténine et non-canonique de la polarité planaire cellulaire (PCP), peut causer respectivement le cancer ou les anomalies du tube neural (ATN). Les deux voies semblent s’antagoniser mutuellement. Dans cette étude, nous investiguons les rôles de Lrp6 et deANKRD6, entant qu’interrupteurs moléculaires entre les deux voies de signalisation Wnt, et CELSR1, en tant que membre de la PCP, chez la souris mutante Skax26m1Jus, générée par l’agent mutagène N-Ethyl-N-Nitrosuera, et dans une cohorte de patients humains ATN. Pour Lrp6, nous avons démontré que Skax26m1Jus représente un allèle hypermorphe de Lrp6 avec une augmentation de l’activité de la signalisation Wnt/canonique et une diminution de l’activité JNK induite par la voie PCP. Nous avons également montré que Lrp6Skax26m1Jus interagit génétiquement avec un mutant PCP (Vangl2Lp) où les doubles hétérozygotes ont montré une fréquence élevée d’ATN et des défauts dans la polarité des cellules ciliées de la cochlée. Particulièrement, notre étude démontre l'association des nouvelles et rares mutations faux-sens dans LRP6 avec les ATN humaines. Nous montrons que trois mutations de LRP6 causent une activité canonique réduite et non-canonique élevée. Pour ANKRD6, nous avons identifié quatre nouvelles et rares mutations faux-sens chez 0,8% des patients ATN et deux chez 1,3% des contrôles. Notamment, seulement deux, des six mutations validées (p.Pro548Leu et p.Arg632His) ont démontré un effet significatif sur l’activité de ANKRD6 selon un mode hypomorphique. Pour CELSR1, nous avons identifié une mutation non-sens dans l'exon 1 qui supprime la majeure partie de la protéine et une délétionde 12 pb. Cette perte de nucléotides ne change pas le cadre de lecture et élimine un motif putatif de phosphorylation par la PKC " SSR ". Nous avons également détecté un total de 13 nouveaux et rares variants faux-sens qui avaient été prédits comme étant pathogènes in silico. Nos données confirment le rôle inhibiteur de Lrp6 dans la signalisation PCP pendant la neurulation et indiquent aussi que les mutations faux-sens identifiées chez LRP6 et ANKRD6 pourraient affecter un équilibre réciproque et un antagonisme très sensible à un dosage précis entre les deux voies Wnt. Ces variants peuvent aussi agir comme facteurs prédisposants aux ATN. En outre, nos résultats impliquent aussi CELSR1 comme un facteur de risque pour les anomalies du tube neural ou l’agénésie caudale. Nos résultats fournissent des preuves supplémentaires que la voie de signalisation PCP a un rôle pathogène dans ces malformations congénitales et un outil important pour mieux comprendre leurs mécanismes moléculaires.

"Whole-Exome Sequencing Enables Rapid Determination of Xeroderma Pigmentosum Molecular Etiology"

Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder haracterized by extreme sensitivity to actinic pigmentation changes in the skin and increased incidence of skin cancer. In some cases, patients are affected by neurological alterations. XP is caused by mutations in 8 distinct genes (XPA through XPG and XPV). The XP-V (variant) subtype of the disease results from mutations in a gene (XPV, also named POLH) which encodes for Polg, a member of the Y-DNA polymerase family. Although the presence and severity of skin and neurological dysfunctions differ between XP subtypes, there are overlapping clinical features among subtypes such that the sub-type cannot be deduced from the clinical features. In this study, in order to overcome this drawback, we undertook whole-exome sequencing in two XP sibs and their father. We identified a novel homozygous nonsense mutation (c.897T.G, p.Y299X) in POLH which causes the disease. Our results demonstrate that next generation sequencing is a powerful approach to rapid determination of XP genetic etiology.

Polimorfismos del gen Butirilcolinesterasa responsables de reacciones adversas en pacientes consumidores de “cocaína”

La butirilcolinesterasa humana (BChE; EC 3.1.1.8) es una enzima polimórfica sintetizada en el hígado y en el tejido adiposo, ampliamente distribuida en el organismo y encargada de hidrolizar algunos ésteres de colina como la procaína, ésteres alifáticos como el ácido acetilsalicílico, fármacos como la metilprednisolona, el mivacurium y la succinilcolina y drogas de uso y/o abuso como la heroína y la cocaína. Es codificada por el gen BCHE (OMIM 177400), habiéndose identificado más de 100 variantes, algunas no estudiadas plenamente, además de la forma más frecuente, llamada usual o silvestre. Diferentes polimorfismos del gen BCHE se han relacionado con la síntesis de enzimas con niveles variados de actividad catalítica. Las bases moleculares de algunas de esas variantes genéticas han sido reportadas, entre las que se encuentra las variantes Atípica (A), fluoruro-resistente del tipo 1 y 2 (F-1 y F-2), silente (S), Kalow (K), James (J) y Hammersmith (H). En este estudio, en un grupo de pacientes se aplicó el instrumento validado Lifetime Severity Index for Cocaine Use Disorder (LSI-C) para evaluar la gravedad del consumo de “cocaína” a lo largo de la vida. Además, se determinaron Polimorfismos de Nucleótido Simple (SNPs) en el gen BCHE conocidos como responsables de reacciones adversas en pacientes consumidores de “cocaína” mediante secuenciación del gen y se predijo el efecto delos SNPs sobre la función y la estructura de la proteína, mediante el uso de herramientas bio-informáticas. El instrumento LSI-C ofreció resultados en cuatro dimensiones: consumo a lo largo de la vida, consumo reciente, dependencia psicológica e intento de abandono del consumo. Los estudios de análisis molecular permitieron observar dos SNPs codificantes (cSNPs) no sinónimos en el 27.3% de la muestra, c.293A>G (p.Asp98Gly) y c.1699G>A (p.Ala567Thr), localizados en los exones 2 y 4, que corresponden, desde el punto de vista funcional, a la variante Atípica (A) [dbSNP: rs1799807] y a la variante Kalow (K) [dbSNP: rs1803274] de la enzima BChE, respectivamente. Los estudios de predicción In silico establecieron para el SNP p.Asp98Gly un carácter patogénico, mientras que para el SNP p.Ala567Thr, mostraron un comportamiento neutro. El análisis de los resultados permite proponer la existencia de una relación entre polimorfismos o variantes genéticas responsables de una baja actividad catalítica y/o baja concentración plasmática de la enzima BChE y algunas de las reacciones adversas ocurridas en pacientes consumidores de cocaína.

Stops making sense: translational trade-offs and stop codon reassignment

Background Efficient gene expression involves a trade-off between (i) premature termination of protein synthesis; and (ii) readthrough, where the ribosome fails to dissociate at the terminal stop. Sense codons that are similar in sequence to stop codons are more susceptible to nonsense mutation, and are also likely to be more susceptible to transcriptional or translational errors causing premature termination. We therefore expect this trade-off to be influenced by the number of stop codons in the genetic code. Although genetic codes are highly constrained, stop codon number appears to be their most volatile feature. Results In the human genome, codons readily mutable to stops are underrepresented in coding sequences. We construct a simple mathematical model based on the relative likelihoods of premature termination and readthrough. When readthrough occurs, the resultant protein has a tail of amino acid residues incorrectly added to the C-terminus. Our results depend strongly on the number of stop codons in the genetic code. When the code has more stop codons, premature termination is relatively more likely, particularly for longer genes. When the code has fewer stop codons, the length of the tail added by readthrough will, on average, be longer, and thus more deleterious. Comparative analysis of taxa with a range of stop codon numbers suggests that genomes whose code includes more stop codons have shorter coding sequences. Conclusions We suggest that the differing trade-offs presented by alternative genetic codes may result in differences in genome structure. More speculatively, multiple stop codons may mitigate readthrough, counteracting the disadvantage of a higher rate of nonsense mutation. This could help explain the puzzling overrepresentation of stop codons in the canonical genetic code and most variants.

Deficiency of the human complement regulatory protein factor H associated with low levels of component C9

We identified a 4-year-old Brazilian boy from a family of Japanese descent and history of consanguinity, who suffered from severe recurrent pneumonia. He carries factor H (FH) deficiency associated with reduced levels of component C9 and low serum levels of C3 and factor B. His mother also presented low levels of these proteins and factor I, while his father and sister had only lower levels of FH. Western blot assays confirmed the complete absence of FH and FHL-1 polypeptides in this patient. Sequencing of the proband`s FH cDNA revealed a homozygous G453A substitution, encoding an Arg(127)His change. His mother, father and sister are heterozygous for this substitution. Despite the absence of FH in the plasma, this protein was detected in the patient`s fibroblasts, suggesting that Arg(127) may be important for FH secretion. Low concentrations of C9 were detected in the proband serum but no mutations in the patient`s C9 gene or promoter have been identified, suggesting that this is a consequence of uncontrolled complement activation and high C9 consumption.

Mutations in IRF6 cause Van der Woude and popliteal pterygium syndromes

Interferon regulatory factor 6 (IRF6) belongs to a family of nine transcription factors that share a highly conserved helix-turn-helix DNA-binding domain and a less conserved protein-binding domain. Most IRFs regulate the expression of interferon-alpha and -beta after viral infection(1), but the function of IRF6 is unknown. The gene encoding IRF6 is located in the critical region for the Van der Woude syndrome (VWS; OMIM 119300) locus at chromosome 1q32-q41 (refs 2,3). The disorder is an autosomal dominant form of cleft lip and palate with lip pits(4), and is the most common syndromic form of cleft lip or palate. Popliteal pterygium syndrome (PPS; OMIM 119500) is a disorder with a similar orofacial phenotype that also includes skin and genital anomalies(5). Phenotypic overlap(6) and linkage data(7) suggest that these two disorders are allelic. We found a nonsense mutation in IRF6 in the affected twin of a pair of monozygotic twins who were discordant for VWS. Subsequently, we identified mutations in IRF6 in 45 additional unrelated families affected with VWS and distinct mutations in 13 families affected with PPS. Expression analyses showed high levels of Irf6 mRNA along the medial edge of the fusing palate, tooth buds, hair follicles, genitalia and skin. Our observations demonstrate that haploinsufficiency of IRF6 disrupts orofacial development and are consistent with dominant-negative mutations disturbing development of the skin and genitalia.

Analysis of HCV quasispecies dynamic under selective pressure of combined therapy

Background: The quasispecies composition of Hepatitis C virus (HCV) could have important implications with regard to viral persistence and response to interferon-based therapy. The complete NS5A was analyzed to evaluate whether the composition of NS5A quasispecies of HCV 1a/1b is related to responsiveness to combined interferon pegylated (PEG-IFN) and ribavirin therapy.Methods: Viral RNA was isolated from serum samples collected before, during and after treatment from virological sustained responder (SVR), non-responder (NR) and the end-of-treatment responder patients (ETR). NS5A region was amplified, cloned and sequenced. Six hundred and ninety full-length NS5A sequences were analyzed.Results: This study provides evidence that lower nucleotide diversity of the NS5A region pre-therapy is associated with viral clearance. Analysis of samples of NRs and the ETRs time points showed that genetic diversity of populations tend to decrease over time. Post-therapy population of ETRs presented higher genetic distance from baseline probably due to the bottleneck phenomenon observed for those patients in the end of treatment. The viral effective population of those patients also showed a strong decrease after therapy. Otherwise, NRs demonstrated a continuous variation or stability of effective populations and genetic diversity over time that did not seem to be related to therapy. Phylogenetic relationships concerning complete NS5A sequences obtained from patients did not demonstrate clustering associated with specific response patterns. However, distinctive clustering of pre/post-therapy sequences was observed. In addition, the evolution of quasispecies over time was subjected to purifying or relaxed purifying selection. Codons 157 (P03), 182 and 440 (P42), 62 and 404 (P44) were found to be under positive selective pressure but it failed to be related to the therapy.Conclusion: These results confirm the hypothesis that a relationship exists between NS5A heterogeneity and response to therapy in patients infected with chronic hepatitis C. © 2013 Jardim et al.; licensee BioMed Central Ltd.

A genomic assisted breeding program for cassava to improve nutritional quality and industrial traits of storage root

A mandioca é cultivada como "mandioca mansa" para consumo in natura e "mandioca para indústria" como fonte de amidos e farinhas. Raças locais foram utilizadas para descoberta de "mutações espontâneas" e desenvolvimento de abordagem evolutiva e de melhoramento para estudos de função gênica. Recursos de Genômica e Proteômica foram obtidos. Análises de expressão gênica por blot de RNA e microarranjos foram desenvolvidos para identificação de expressão diferencial. "Mandioca açucarada" foi identificada, sendo relacionada com falta de expressão do gene da BEI e de uma mutação "nonsence" na sequência do gene GBSSI causando a formação do amido serose. "Mandioca avermelhada" apresentou falta de expressão do gene CasLYB, e a "amarela" uma regulação de repressão do gene CasHYb. Análise Proteômica do complexo carotenóide-proteína, juntamente com a análise de expressão de gene da CAP4, revelaram uma dupla fita de cDNA associada ao elevado acúmulo de carotenóide. Sequenciamento do gene da GBSSI identificou 22 haplótipos e grande diversidade de nucleotídios. Populações segregantes de cruzamentos de fenótipos bioquímicos diferenciados com cultivares elites dos Cerrados foram obtidas.

Sequence and Copy Number Analyses of HEXB Gene in Patients Affected by Sandhoff Disease: Functional Characterization of 9 Novel Sequence Variants

Sandhoff disease (SD) is a lysosomal disorder caused by mutations in the HEXB gene. To date, 43 mutations of HEXB have been described, including 3 large deletions. Here, we have characterized 14 unrelated SD patients and developed a Multiplex Ligation-dependent Probe Amplification (MLPA) assay to investigate the presence of large HEXB deletions. Overall, we identified 16 alleles, 9 of which were novel, including 4 sequence variation leading to aminoacid changes [c.626C>T (p.T209I), c.634C>A (p.H212N), c.926G>T (p.C309F), c.1451G>A (p.G484E)] 3 intronic mutations (c.1082+5G>A, c.1242+1G>A, c.1169+5G>A), 1 nonsense mutation c.146C>A (p.S49X) and 1 small in-frame deletion c.1260_1265delAGTTGA (p.V421_E422del). Using the new MLPA assay, 2 previously described deletions were identified. In vitro expression studies showed that proteins bearing aminoacid changes p.T209I and p.G484E presented a very low or absent activity, while proteins bearing the p.H212N and p.C309F changes retained a significant residual activity. The detrimental effect of the 3 novel intronic mutations on the HEXB mRNA processing was demonstrated using a minigene assay. Unprecedentedly, minigene studies revealed the presence of a novel alternative spliced HEXB mRNA variant also present in normal cells. In conclusion, we provided new insights into the molecular basis of SD and validated an MLPA assay for detecting large HEXB deletions.

optomotor-blind and the horizontal and vertical system cells of the drosophila optic lobes

The horizontal and vertical system neurons (HS and VS cells) are part of a conserved set of lobula plate giant neurons (LPGNs) in the optic lobes of the adult brain. Structure and physiology of these cells are well known, predominantly from studies in larger Dipteran flies. Our knowledge about the ontogeny of these cells is limited and stems predominantly from laser ablation studies in larvae of the house fly Musca domestica. These studies suggested that the HS and VS cells stem from a single precursor, which, at least in Musca, has not yet divided in the second larval instar. A regulatory mutation (In(1)omb[H31]) in the Drosophila gene optomotor-blind (omb) leads to the selective loss of the adult HS and VS cells. This mutation causes a transient reduction in omb expression in what appears to be the entire optic lobe anlage (OLA) late in embryogenesis. Here, I have reinitiated the laser approach with the goal of identifying the presumptive embryonic HS/VS precursor cell in Drosophila. The usefulness of the laser ablation approach which has not been applied, so far, to cells lying deep within the Drosophila embryo, was first tested on two well defined embryonic sensory structures, the olfactory antenno-maxillary complex (AMC) and the light-sensitive Bolwing´s organ (BO). In the case of the AMC, the efficiency of the ablation procedure was demonstrated with a behavioral assay. When both AMCs were ablated, the response to an attractive odour (n-butanol) was clearly reduced. Interestingly, the larvae were not completely unresponsive but had a delayed response kinetics, indicating the existence of a second odour system. BO will be a useful test system for the selectivity of laser ablation when used at higher spatial resolution. An omb-Gal4 enhancer trap line was used to visualize the embryonic OLA by GFP fluorescence. This fluorescence allowed to guide the laser beam to the relevant structure within the embryo. The success of the ablations was monitored in the adult brain via the enhancer trap insertion A122 which selectively visualizes the HS and VS cell bodies. Due to their tight clustering, individual cells could not be identified in the embryonic OLA by conventional fluorescence microscopy. Nonetheless, systematic ablation of subdomains of the OLA allowed to localize the presumptive HS/VS precursor to a small area within the OLA, encompassing around 10 cells. Future studies at higher resolution should be able to identify the precursor as (an) individual cell(s). Most known lethal omb alleles do not complement the HS/VS phenotype of the In(1)omb[H31] allele. This is the expected behaviour of null alleles. Two lethal omb alleles that had been isolated previously by non-complementation of the omb hypomorphic allele bifid, have been reported, however, to complement In(1)omb[H31]. This report was based on low resolution paraffin histology of adult heads. Four mutations from this mutagenesis were characterized here in more detail (l(1)omb[11], l(1)omb[12], l(1)omb[13], and l(1)omb[15]). Using A122 as marker for the adult HS and VS cells, I could show, that only l(1)omb[11] can partly complement the HS/VS cell phenotype of In(1)omb[H31]. In order to identify the molecular lesions in these mutants, the exons and exon/intron junctions were sequenced in PCR-amplified material from heterozygous flies. Only in two mutants could the molecular cause for loss of omb function be identified: in l(1)omb[13]), a missense mutation causes the exchange of a highly conserved residue within the DNA-binding T-domain; in l(1)omb[15]), a nonsense mutation causes a C-terminal truncation. In the other two mutants apparently regulatory regions or not yet identified alternative exons are affected. To see whether mutant OMB protein in the missense mutant l(1)omb[13] is affected in DNA binding, electrophoretic shift assays on wildtype and mutant T-domains were performed. They revealed that the mutant no longer is able to bind the consensus palindromic T-box element.

Suche nach Zielgenen des T-Box-Transkriptionsfaktors Optomotor-blind aus Drosophila melanogaster

Zusammenfassung:rnrnDas Ziel der Arbeit bestand darin mehr über die Funktion des T-Box Transkriptionsfaktors Omb zu erfahren. Dm omb ist der nächste Verwandte zu Hs Tbx2/3, die wegen ihrer Rolle bei verschiedenen Krebsarten für die Entwicklung neuer Therapien bedeutsam sind. rnIn drei, von Herrn Pflugfelder hergestellten, omb Allelen l(1)omb282, l(1)omb12, l(1)omb15 wurden neue Mutationen kartiert. Dabei handelt es sich um zwei missense-Mutationen und eine Stopmutation. Sie betreffen Aminosäurereste, die in allen T-Box Proteinen konserviert sind und daher vermutlich lebenswichtige Proteinabschnitte betreffen. In EMSA Versuchen konnte gezeigt werden, dass die missense-Mutationen die DNA-Bindung des Omb-T Proteins verhindern.rnFür die Suche nach Omb Zielgenen wurden Gene und phylogenetisch konservierte TBE-Genabschnitte auf ihre Regulation durch Omb getestet. Dabei wurde das Expressionsmuster von Genen mitels in situ und das Muster von enhancer getriebener β-Gal Expression histochemisch oder durch Immunfärbung von wildtypischen und l(1)omb15 Larven des dritten Stadiums verglichen. rnUpstream der mirr Transkriptionseinheit wurde ein cis-regulatorisches TBE-Fragment identifiziert, das ein Aktivitätsmuster in Flügelimaginalscheiben zeigte, welches dem von Mirr nahe kommt. Sowohl ein Omb Verlust als auch die Mutation der TBE Sequenz führten zu einer ähnlichen ektopischen Aktivierung des Fragments, was auf eine Abhängigkeit von Omb hinweist. rnIn der intronischen Sequenz von inv wurde ebenfalls ein TBE-Fragment entdeckt, das eine β-Gal-Aktivität in Flügelscheiben des späten L3 Stadiums anterior der A/P Grenze zeigte. Diese Expression könnte sich mit der späten für en/inv beschriebenen Expression (Blair, 1992) decken. Immunfärbungen bestätigten, dass der Verlust dieser Aktivität in omb0 tatsächlich durch den Verlust von Omb hervorgerufen wird und nicht durch eine Entwicklungsverzögerung der Larven verursacht wird.rnSchließlich wurde durch die Reparatur von TBX Expressionsvektoren eine Konstruktreihe (Legler, 2010) fertiggestellt, mit deren Hilfe die Auswirkungen einer Überexpression auf die Zellmotilität in Drosophila untersucht werden kann. Das soll helfen den Einfluss von TBX Proteinen auf die Invasivität von Krebszellen zu verstehen.rn

Analysen zur molekularen Charakterisierung von Proteinen des humanen Usher-Syndroms und Evaluation genbasierter Therapiestrategien

Analysen zur molekularen Charakterisierung von Proteinen des humanen Usher-Syndroms und Evaluation genbasierter Therapiestrategien rnDas humane Usher Syndrom (USH) ist die häufigste Form vererbter Taub-Blindheit. In der vorliegenden Dissertation wurde diese komplexe Erkrankung auf verschiedenen Ebenen analysiert: in Arbeiten zur Expression und Lokalisation von USH-Proteinen, der Analyse der USH-Proteinnetzwerke und deren Funktionen sowie darauf aufbauend die Entwicklung von Therapiestrategien für USH.rnIm Rahmen der Arbeit wurde die Expression und (sub)-zelluläre Lokalisation des USH1D-Genproduktes CDH23 in der Retina und Cochlea analysiert. CDH23-Isoformen werden in der Maus zeitlich und räumlich differentiell exprimiert. In den Retinae von Mäusen, nicht humanen Primaten und Menschen zeigten Analysen eine unterschiedliche Expression und Lokalisation des Zell-Zelladhäsionsmoleküls CDH23, was auf Funktions-unterschiede der einzelnen Isoformen in den analysierten Spezies hindeutet.rnAnalysen zur Aufklärung der USH-Proteinnetzwerke ergaben eine potentielle Interaktion des USH1G-Gerüstproteins SANS mit dem Golgi- und Centrosom-assoziierten Protein Myomegalin. Die direkte Interaktion der Proteine konnte durch unabhängige Experimente verifiziert werden. Beide Interaktionspartner sind in den Retinae verschiedener Spezies partiell ko-lokalisiert und partizipieren im periciliären USH-Proteinnetzwerk. Die Assoziation von SANS und Myomegalin mit dem Mikrotubuli-Cytoskelett weist auf eine Funktion des Proteinkomplexes in gerichteten Transportprozessen innerhalb der Photorezeptoren hin und bekräftigt die Hypothese einer Rolle von SANS und assoziierten Netzwerken mit Transportprozessen.rnDas hier gewonnene erweiterte Verständnis der molekularen Grundlagen sowie die Aufklärung der zellulären Funktion der Proteinnetzwerke ermöglichen die Entwicklung therapeutischer Strategien für USH. Ein Fokus der vorliegenden Arbeit lag auf der Entwicklung genbasierter Therapiestrategien und deren Evaluation, wobei der Schwerpunkt auf der Therapiestrategie der Genreparatur lag. Die mit Hilfe von Zinkfinger-Nukleasen (ZFN) induzierte Homologe Rekombination für die Genkorrektur wurde exemplarisch an der 91C>T/p.R31X-Mutation im USH1C-Gen gezeigt. Effiziente ZFN wurden identifiziert, generiert und erfolgreich im Zellkulturmodellsystem eingesetzt. Die Analysen demonstrierten eine Reparatur der Mutation durch Homologe Rekombination auf genomischer Ebene und die Expression des wiederhergestellten Proteins. Durch die Genkorrektur im endogenen Lokus sind Größe des Gens, Isoformen oder die Art der Mutation keine limitierenden Faktoren für die Therapie. Die in der vorliegenden Arbeit durchgeführten Experimente unterstreichen das enorme Potential ZFN-basierter Therapiestrategien hin zu personalisierten Therapieformen nicht nur für USH sondern auch für andere erbliche Erkrankungen, deren genetische Grundlagen bekannt sind.rn

Brugada syndrome ECG provoked by the selective serotonin reuptake inhibitor fluvoxamine

A patient with an SCN5A p.W822X nonsense mutation, localized in the transmembrane region DII-S4 of the Na(v)1.5 sodium channel and leading to a non-expression of the mutant allele, was prescribed the selective serotonin reuptake inhibitor (SSRI) fluvoxamine (Floxyfral), 100 mg per day. His normal baseline ECG changed to a characteristic Brugada-Type-1-ECG pattern. To investigate whether fluvoxamine may reduce the cardiac sodium current, the effect of this drug was studied on the wild-type voltage-gated cardiac sodium channel Na(v)1.5 stably expressed in HEK293 cells. Patch-clamp recording showed a 50% inhibition of the current at a concentration of 57.3 microM. In our patient, no arrhythmia occurred but the proarrhythmic potential of SSRI in patients with SCN5A mutations cannot be excluded. Therefore, we advise 12-lead ECG control after administering SSRI in these patients.

Allelic Heterogeneity at the Equine KIT Locus in Dominant White (W) Horses

White coat color has been a highly valued trait in horses for at least 2,000 years. Dominant white (W) is one of several known depigmentation phenotypes in horses. It shows considerable phenotypic variation, ranging from approximately 50% depigmented areas up to a completely white coat. In the horse, the four depigmentation phenotypes roan, sabino, tobiano, and dominant white were independently mapped to a chromosomal region on ECA 3 harboring the KIT gene. KIT plays an important role in melanoblast survival during embryonic development. We determined the sequence and genomic organization of the approximately 82 kb equine KIT gene. A mutation analysis of all 21 KIT exons in white Franches-Montagnes Horses revealed a nonsense mutation in exon 15 (c.2151C>G, p.Y717X). We analyzed the KIT exons in horses characterized as dominant white from other populations and found three additional candidate causative mutations. Three almost completely white Arabians carried a different nonsense mutation in exon 4 (c.706A>T, p.K236X). Six Camarillo White Horses had a missense mutation in exon 12 (c.1805C>T, p.A602V), and five white Thoroughbreds had yet another missense mutation in exon 13 (c.1960G>A, p.G654R). Our results indicate that the dominant white color in Franches-Montagnes Horses is caused by a nonsense mutation in the KIT gene and that multiple independent mutations within this gene appear to be responsible for dominant white in several other modern horse populations.

Dysphagia due to triple A syndrome: successful treatment of achalasia by balloon dilatation

Triple A syndrome is a rare autosomal recessive inherited disorder which is characterized by alacrima, adrenal insufficiency, and achalasia. We report on a 14-year old girl with dysphagia, regurgitation, and vomiting since 5 years. At the age of five years an Addison crisis was diagnosed and cortisone substitution was initiated. In addition, the patient had episodes of conjunctivitis. Severe esophagitis and candida infection were diagnosed by esophago-gastro-duodenoscopy and treated with omeprazole and fluconazole. The esophageal barium swallow was typical for achalasia. Medical treatment of achalasia with oral nifedipine resulted only in a partial and temporal improvement. But after seven balloon dilatations dysphagia and nocturnal coughing improved clearly and a remarkable gain of weight could be seen. Direct sequencing showed a homozygous nonsense mutation in exon 11 of the AAAS gene leading to truncation at position 342 of the 546 amino acid protein. CONCLUSION: Triple A syndrome has to be considered in patients with dysphagia. In our patient, the absence of tears since birth followed by adrenal insufficiency were early signs of the triple A syndrome. Balloon dilatation of the esophago-gastric junction is an effective treatment, which can avoid surgical interventions.