Unique mixed phenotype and unexpected functional effect revealed by novel compound heterozygosity mutations involving SCN5A.

BACKGROUND Functional characterization of mutations involving the SCN5A-encoded cardiac sodium channel has established the pathogenic mechanisms for type 3 long QT syndrome and type 1 Brugada syndrome and has provided key insights into the physiological importance of essential structure-function domains. OBJECTIVE This study sought to present the clinical and biophysical phenotypes discerned from compound heterozygosity mutations in SCN5A on different alleles in a toddler diagnosed with QT prolongation and fever-induced ventricular arrhythmias. METHODS A 22-month-old boy presented emergently with fever and refractory ventricular tachycardia. Despite restoration of sinus rhythm, the infant sustained profound neurological injury and died. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and direct DNA sequencing, comprehensive open-reading frame/splice mutational analysis of the 12 known long QT syndrome susceptibility genes was performed. RESULTS The infant had 2 SCN5A mutations: a maternally inherited N-terminal frame shift/deletion (R34fs/60) and a paternally inherited missense mutation, R1195H. The mutations were engineered by site-directed mutagenesis and heterologously expressed transiently in HEK293 cells. As expected, the frame-shifted and prematurely truncated peptide, SCN5A-R34fs/60, showed no current. SCN5A-R1195H had normal peak and late current but abnormal voltage-dependent gating parameters. Surprisingly, co-expression of SCN5A-R34fs/60 with SCN5A-R1195H elicited a significant increase in late sodium current, whereas co-expression of SCN5A-WT with SCN5A-R34fs/60 did not. CONCLUSIONS A severe clinical phenotype characterized by fever-induced monomorphic ventricular tachycardia and QT interval prolongation emerged in a toddler with compound heterozygosity involving SCN5A: R34fs/60, and R1195H. Unexpectedly, the 94-amino-acid fusion peptide derived from the R34fs/60 mutation accentuated the late sodium current of R1195H-containing Na(V)1.5 channels in vitro.

Syntrophin mutation associated with long QT syndrome through activation of the nNOS-SCN5A macromolecular complex.

Mutations in 11 genes that encode ion channels or their associated proteins cause inherited long QT syndrome (LQTS) and account for approximately 75-80% of cases (LQT1-11). Direct sequencing of SNTA1, the gene encoding alpha1-syntrophin, was performed in a cohort of LQTS patients that were negative for mutations in the 11 known LQTS-susceptibility genes. A missense mutation (A390V-SNTA1) was found in a patient with recurrent syncope and markedly prolonged QT interval (QTc, 530 ms). SNTA1 links neuronal nitric oxide synthase (nNOS) to the nNOS inhibitor plasma membrane Ca-ATPase subtype 4b (PMCA4b); SNTA1 also is known to associate with the cardiac sodium channel SCN5A. By using a GST-fusion protein of the C terminus of SCN5A, we showed that WT-SNTA1 interacted with SCN5A, nNOS, and PMCA4b. In contrast, A390V-SNTA1 selectively disrupted association of PMCA4b with this complex and increased direct nitrosylation of SCN5A. A390V-SNTA1 expressed with SCN5A, nNOS, and PMCA4b in heterologous cells increased peak and late sodium current compared with WT-SNTA1, and the increase was partially inhibited by NOS blockers. Expression of A390V-SNTA1 in cardiac myocytes also increased late sodium current. We conclude that the A390V mutation disrupted binding with PMCA4b, released inhibition of nNOS, caused S-nitrosylation of SCN5A, and was associated with increased late sodium current, which is the characteristic biophysical dysfunction for sodium-channel-mediated LQTS (LQT3). These results establish an SNTA1-based nNOS complex attached to SCN5A as a key regulator of sodium current and suggest that SNTA1 be considered a rare LQTS-susceptibility gene.

A novel C-terminal truncation SCN5A mutation from a patient with sick sinus syndrome, conduction disorder and ventricular tachycardia.

OBJECTIVES Individual mutations in the SCN5A-encoding cardiac sodium channel alpha-subunit cause single cardiac arrhythmia disorders, but a few cause multiple distinct disorders. Here we report a family harboring an SCN5A mutation (L1821fs/10) causing a truncation of the C-terminus with a marked and complex biophysical phenotype and a corresponding variable and complex clinical phenotype with variable penetrance. METHODS AND RESULTS A 12-year-old male with congenital sick sinus syndrome (SSS), cardiac conduction disorder (CCD), and recurrent monomorphic ventricular tachycardia (VT) had mutational analysis that identified a 4 base pair deletion (TCTG) at position 5464-5467 in exon 28 of SCN5A. The mutation was also present in six asymptomatic family members only two of which showed mild ECG phenotypes. The deletion caused a frame-shift mutation (L1821fs/10) with truncation of the C-terminus after 10 missense amino acid substitutions. When expressed in HEK-293 cells for patch-clamp study, the current density of L1821fs/10 was reduced by 90% compared with WT. In addition, gating kinetic analysis showed a 5-mV positive shift in activation, a 12-mV negative shift of inactivation and enhanced intermediate inactivation, all of which would tend to reduce peak and early sodium current. Late sodium current, however, was increased in the mutated channels. CONCLUSIONS The L1821fs/10 mutation causes the most severe disruption of SCN5A structure for a naturally occurring mutation that still produces current. It has a marked loss-of-function and unique phenotype of SSS, CCD and VT with incomplete penetrance.

SCN4B-encoded sodium channel beta4 subunit in congenital long-QT syndrome.

BACKGROUND Congenital long-QT syndrome (LQTS) is potentially lethal secondary to malignant ventricular arrhythmias and is caused predominantly by mutations in genes that encode cardiac ion channels. Nearly 25% of patients remain without a genetic diagnosis, and genes that encode cardiac channel regulatory proteins represent attractive candidates. Voltage-gated sodium channels have a pore-forming alpha-subunit associated with 1 or more auxiliary beta-subunits. Four different beta-subunits have been described. All are detectable in cardiac tissue, but none have yet been linked to any heritable arrhythmia syndrome. METHODS AND RESULTS We present a case of a 21-month-old Mexican-mestizo female with intermittent 2:1 atrioventricular block and a corrected QT interval of 712 ms. Comprehensive open reading frame/splice mutational analysis of the 9 established LQTS-susceptibility genes proved negative, and complete mutational analysis of the 4 Na(vbeta)-subunits revealed a L179F (C535T) missense mutation in SCN4B that cosegregated properly throughout a 3-generation pedigree and was absent in 800 reference alleles. After this discovery, SCN4B was analyzed in 262 genotype-negative LQTS patients (96% white), but no further mutations were found. L179F was engineered by site-directed mutagenesis and heterologously expressed in HEK293 cells that contained the stably expressed SCN5A-encoded sodium channel alpha-subunit (hNa(V)1.5). Compared with the wild-type, L179F-beta4 caused an 8-fold (compared with SCN5A alone) and 3-fold (compared with SCN5A + WT-beta4) increase in late sodium current consistent with the molecular/electrophysiological phenotype previously shown for LQTS-associated mutations. CONCLUSIONS We provide the seminal report of SCN4B-encoded Na(vbeta)4 as a novel LQT3-susceptibility gene.

Development of an ex vivo protocol to model bone fracture in laying hens resulting from collisions.

Fractures of the keel bone, a bone extending ventrally from the sternum, are a serious health and welfare problem in free range laying hens. Recent findings suggest that a major cause of keel damage within extensive systems is collisions with internal housing structures, though investigative efforts have been hindered by difficulties in examining mechanisms and likely influencing factors at the moment of fracture. The objectives of this study were to develop an ex vivo impact protocol to model bone fracture in hens caused by collision, to assess impact and bird-related factors influencing fracture occurrence and severity, and to identify correlations of mechanical and structural properties between different skeletal sites. We induced keel bone fractures in euthanized hens using a drop-weight impact tester able to generate a range of impact energies, producing fractures that replicate those commonly found in commercial settings. The results demonstrated that impact energies of a similar order to those expected in normal housing were able to produce fractures, and that greater collision energies resulted in an increased likelihood of fractures and of greater severity. Relationships were also seen with keel's lateral surface bone mineral density, and the peak reactive force (strength) at the base of the manubrial spine. Correlations were also identified between the keel and long bones with respect to both strength and bone mineral density. This is the first study able to relate impact and bone characteristics with keel bone fracture at the moment of collision. Greater understanding of these relationships will provide means to reduce levels of breakage and severity in commercial systems.

Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization

The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD.

EXPOSURE OF PHARMACY PERSONNEL TO ANTINEOPLASTIC DRUGS

This dissertation consists of two parts: (1) Exposure of pharmacy personnel to antineoplastic drugs. The Salmonella reversion test was used to measure the mutagenic activities of urine concentrates from individuals preparing antineoplastic drugs for intravenous administration. Longitudinal studies were performed in which the total urine produced in 24-hour periods was collected, starting on a Sunday at 7 P.M. after a duty-free weekend and extending over an eight-day period. There was no detectable increase in mutagenic activity in the urine concentrates of three pharmacy administrators who had no contact with these drugs. All six individuals admixing drugs in open-faced, horizontal laminar flow hoods displayed a two-fold increase in mutagenesis by the fourth day with peak values of 2.7 to 24-fold occurring on days five and six, reduced values by day seven with a return to the spontaneous level by day eight. When four of the six positive individuals in the preceding experiment admixed comparable amounts of antineoplastic drugs in a closed-faced, vertical laminar flow hood, no increase in mutagenic activity was detected in their urine concentrates over the eight-day period. (2) Estimate of potential carcinogenic risks of antineoplastic drugs. Excision repair is the major repair system that is involved with the elimination of chemically induced DNA (deoxyribonucleic acid) lesions. This DNA excision repair capability increases in mammalian species with longer life span such as humans. In this study, the effect of functional DNA excision repair on the mutagenesis invoked by 17 antineoplastic drugs was determined by using a Salmonella/Microsome assay which was expanded to include some uvr('+) counterparts of the excisionless (uvrB) tester strains routinely employed. Although extrapolation cannot be made from bacteria to humans, one should be able to make a qualitative comparison as to which antineoplastic drugs are more potentially carcinogenic to humans based on the effects of excision repair on their mutagenesis in bacteria. The tested antineoplastic drugs were divided into three classes: those requiring excision repair for mutagenesis; those producing nonrepairable genetic damage; and those producing mostly repairable premutational DNA lesions. ^

Determinación de la microdureza de la dentina coronaria previamente acondicionada

La dureza es una de las propiedades utilizadas para comparar tanto los materiales restauradores como los tejidos biológicos. El objetivo de este trabajo es determinar la microdureza de la dentina coronaria en dientes sin acondicionar y luego acondicionados con EDTA al 17%. Para este estudio se seleccionaron 30 muestras de dentina de dientes recientemente extraídos. Los elementos fueron seccionados longitudinalmente con discos de diamante de doble corte (Horico), con abundante refrigeración acuosa, a nivel coronario, y serán conservados en saliva artificial (laboratorio NAF) a 37°C. La medición de la microdureza dentinaria se realizó con un microdurómetro Vickers, con una carga de 50g durante 30 s. Los datos fueron recolectados en una planilla ad hoc y procesados estadísticamente mediante el Test de Student.

Impact bruises in pomaceae fruits: Evaluation methods and structural features.

Using a laboratory impact tester, impacts were applied to fruits of different varieties of apples and pears. The response to impact was analized, and many parameters were recorded, to be correlated to bruise susceptibility and to ripeness changes. Different methods for the detection and evaluation of the bruised Area and its features were studied, using direct observation and various reactives. Different types of bruises were established.

Sensing physical stage of fruits by their response to non destructive impacts.

Fruits of two varieties of both apples and pears were tested in the laboratory to measure their response to a small energy impact applied by an impact tester. Samples of fruits of increasing maturity were tested during several weeks. Non-destructive impacts and other destructive and non-destructive measurements of post-harvest ripeness were applied. A new software was created to control the impact test, calculate the eleven parameters, and sort out the fruit. This software needs a data base and may create new ones. The implementation of an on-line impact device for automatic detection of texture is being designed (patent pending).

Generación de Casos de Prueba en Programación Orientada a Objetos = Test Case Generation in Object-Oriented Programming

Las pruebas de software (Testing) son en la actualidad la técnica más utilizada para la validación y la evaluación de la calidad de un programa. El testing está integrado en todas las metodologías prácticas de desarrollo de software y juega un papel crucial en el éxito de cualquier proyecto de software. Desde las unidades de código más pequeñas a los componentes más complejos, su integración en un sistema de software y su despliegue a producción, todas las piezas de un producto de software deben ser probadas a fondo antes de que el producto de software pueda ser liberado a un entorno de producción. La mayor limitación del testing de software es que continúa siendo un conjunto de tareas manuales, representando una buena parte del coste total de desarrollo. En este escenario, la automatización resulta fundamental para aliviar estos altos costes. La generación automática de casos de pruebas (TCG, del inglés test case generation) es el proceso de generar automáticamente casos de prueba que logren un alto recubrimiento del programa. Entre la gran variedad de enfoques hacia la TCG, esta tesis se centra en un enfoque estructural de caja blanca, y más concretamente en una de las técnicas más utilizadas actualmente, la ejecución simbólica. En ejecución simbólica, el programa bajo pruebas es ejecutado con expresiones simbólicas como argumentos de entrada en lugar de valores concretos. Esta tesis se basa en un marco general para la generación automática de casos de prueba dirigido a programas imperativos orientados a objetos (Java, por ejemplo) y basado en programación lógica con restricciones (CLP, del inglés constraint logic programming). En este marco general, el programa imperativo bajo pruebas es primeramente traducido a un programa CLP equivalente, y luego dicho programa CLP es ejecutado simbólicamente utilizando los mecanismos de evaluación estándar de CLP, extendidos con operaciones especiales para el tratamiento de estructuras de datos dinámicas. Mejorar la escalabilidad y la eficiencia de la ejecución simbólica constituye un reto muy importante. Es bien sabido que la ejecución simbólica resulta impracticable debido al gran número de caminos de ejecución que deben ser explorados y a tamaño de las restricciones que se deben manipular. Además, la generación de casos de prueba mediante ejecución simbólica tiende a producir un número innecesariamente grande de casos de prueba cuando es aplicada a programas de tamaño medio o grande. Las contribuciones de esta tesis pueden ser resumidas como sigue. (1) Se desarrolla un enfoque composicional basado en CLP para la generación de casos de prueba, el cual busca aliviar el problema de la explosión de caminos interprocedimiento analizando de forma separada cada componente (p.ej. método) del programa bajo pruebas, almacenando los resultados y reutilizándolos incrementalmente hasta obtener resultados para el programa completo. También se ha desarrollado un enfoque composicional basado en especialización de programas (evaluación parcial) para la herramienta de ejecución simbólica Symbolic PathFinder (SPF). (2) Se propone una metodología para usar información del consumo de recursos del programa bajo pruebas para guiar la ejecución simbólica hacia aquellas partes del programa que satisfacen una determinada política de recursos, evitando la exploración de aquellas partes del programa que violan dicha política. (3) Se propone una metodología genérica para guiar la ejecución simbólica hacia las partes más interesantes del programa, la cual utiliza abstracciones como generadores de trazas para guiar la ejecución de acuerdo a criterios de selección estructurales. (4) Se propone un nuevo resolutor de restricciones, el cual maneja eficientemente restricciones sobre el uso de la memoria dinámica global (heap) durante ejecución simbólica, el cual mejora considerablemente el rendimiento de la técnica estándar utilizada para este propósito, la \lazy initialization". (5) Todas las técnicas propuestas han sido implementadas en el sistema PET (el enfoque composicional ha sido también implementado en la herramienta SPF). Mediante evaluación experimental se ha confirmado que todas ellas mejoran considerablemente la escalabilidad y eficiencia de la ejecución simbólica y la generación de casos de prueba. ABSTRACT Testing is nowadays the most used technique to validate software and assess its quality. It is integrated into all practical software development methodologies and plays a crucial role towards the success of any software project. From the smallest units of code to the most complex components and their integration into a software system and later deployment; all pieces of a software product must be tested thoroughly before a software product can be released. The main limitation of software testing is that it remains a mostly manual task, representing a large fraction of the total development cost. In this scenario, test automation is paramount to alleviate such high costs. Test case generation (TCG) is the process of automatically generating test inputs that achieve high coverage of the system under test. Among a wide variety of approaches to TCG, this thesis focuses on structural (white-box) TCG, where one of the most successful enabling techniques is symbolic execution. In symbolic execution, the program under test is executed with its input arguments being symbolic expressions rather than concrete values. This thesis relies on a previously developed constraint-based TCG framework for imperative object-oriented programs (e.g., Java), in which the imperative program under test is first translated into an equivalent constraint logic program, and then such translated program is symbolically executed by relying on standard evaluation mechanisms of Constraint Logic Programming (CLP), extended with special treatment for dynamically allocated data structures. Improving the scalability and efficiency of symbolic execution constitutes a major challenge. It is well known that symbolic execution quickly becomes impractical due to the large number of paths that must be explored and the size of the constraints that must be handled. Moreover, symbolic execution-based TCG tends to produce an unnecessarily large number of test cases when applied to medium or large programs. The contributions of this dissertation can be summarized as follows. (1) A compositional approach to CLP-based TCG is developed which overcomes the inter-procedural path explosion by separately analyzing each component (method) in a program under test, stowing the results as method summaries and incrementally reusing them to obtain whole-program results. A similar compositional strategy that relies on program specialization is also developed for the state-of-the-art symbolic execution tool Symbolic PathFinder (SPF). (2) Resource-driven TCG is proposed as a methodology to use resource consumption information to drive symbolic execution towards those parts of the program under test that comply with a user-provided resource policy, avoiding the exploration of those parts of the program that violate such policy. (3) A generic methodology to guide symbolic execution towards the most interesting parts of a program is proposed, which uses abstractions as oracles to steer symbolic execution through those parts of the program under test that interest the programmer/tester most. (4) A new heap-constraint solver is proposed, which efficiently handles heap-related constraints and aliasing of references during symbolic execution and greatly outperforms the state-of-the-art standard technique known as lazy initialization. (5) All techniques above have been implemented in the PET system (and some of them in the SPF tool). Experimental evaluation has confirmed that they considerably help towards a more scalable and efficient symbolic execution and TCG.