The phenotype of Floating-Harbor syndrome: clinical characterization of 52 individuals with mutations in exon 34 of SRCAP

Background Floating-Harbor syndrome (FHS) is a rare condition characterized by short stature, delays in expressive language, and a distinctive facial appearance. Recently, heterozygous truncating mutations in SRCAP were determined to be disease-causing. With the availability of a DNA based confirmatory test, we set forth to define the clinical features of this syndrome. Methods and results Clinical information on fifty-two individuals with SRCAP mutations was collected using standardized questionnaires. Twenty-four males and twenty-eight females were studied with ages ranging from 2 to 52 years. The facial phenotype and expressive language impairments were defining features within the group. Height measurements were typically between minus two and minus four standard deviations, with occipitofrontal circumferences usually within the average range. Thirty-three of the subjects (63%) had at least one major anomaly requiring medical intervention. We did not observe any specific phenotype-genotype correlations. Conclusions This large cohort of individuals with molecularly confirmed FHS has allowed us to better delineate the clinical features of this rare but classic genetic syndrome, thereby facilitating the development of management protocols.

Cellular interference in craniofrontonasal syndrome: males mosaic for mutations in the X-linked EFNB1 gene are more severely affected than true hemizygotes

Craniofrontonasal syndrome (CFNS), an X-linked disorder caused by loss-of-function mutations of EFNB1, exhibits a paradoxical sex reversal in phenotypic severity: females characteristically have frontonasal dysplasia, craniosynostosis and additional minor malformations, but males are usually more mildly affected with hypertelorism as the only feature. X-inactivation is proposed to explain the more severe outcome in heterozygous females, as this leads to functional mosaicism for cells with differing expression of EPHRIN-B1, generating abnormal tissue boundaries-a process that cannot occur in hemizygous males. Apparently challenging this model, males occasionally present with a more severe female-like CFNS phenotype. We hypothesized that such individuals might be mosaic for EFNB1 mutations and investigated this possibility in multiple tissue samples from six sporadically presenting males. Using denaturing high performance liquid chromatography, massively parallel sequencing and multiplex-ligation-dependent probe amplification (MLPA) to increase sensitivity above standard dideoxy sequencing, we identified mosaic mutations of EFNB1 in all cases, comprising three missense changes, two gene deletions and a novel point mutation within the 5' untranslated region (UTR). Quantification by Pyrosequencing and MLPA demonstrated levels of mutant cells between 15 and 69%. The 5' UTR variant mutates the stop codon of a small upstream open reading frame that, using a dual-luciferase reporter construct, was demonstrated to exacerbate interference with translation of the wild-type protein. These results demonstrate a more severe outcome in mosaic than in constitutionally deficient males in an X-linked dominant disorder and provide further support for the cellular interference mechanism, normally related to X-inactivation in females.

Mutations in the quinolone resistance-determining regions of gyrA and parC in Enterobacteriaceae isolates from Brazil

Mutations in the quinolone resistance-determining regions (QRDR) in chromosomal gyrA and parC genes and fluoroquinolone susceptibility profiles were investigated in quinolone-resistant Enterobacteriaceae isolated from community and hospitalized patientsin the Brazilian Southeast region. A total of 112 nalidixic acid-resistant enterobacterial isolates collected from 2000 to 2005 were investigated for mutations in the topoisomerases genes gyrA and parC by amplifying and sequencing the QRDR regions. Susceptibility to fluoroquinolones was tested by the agar dilution method. Amongst the 112 enterobacterial isolates, 81 (72.3%) were resistant to ciprofloxacin and 5 (4.5%) showed reduced susceptibility. Twenty-six (23.2%) were susceptible to ciprofloxacin. Several alterations were detected in gyrA and parC genes. Escherichia coli isolates (47.7%) showed double mutations in the gyrA gene and a single one in the parC gene. Two unusual aminoacid substitutions are reported, an Asp87-Asn in a Citrobacter freundii isolate with reduced susceptibility to fluoroquinolones and a Glu84-Ala in one E. coli isolate.Only a parC gene mutation was found in fluoroquinolone-susceptible Enterobacter aerogenes. None of the isolates susceptible to ciprofloxacin presented mutations in topoisomerase genes. This comprehensive analysis of QRDRs in gyrA and parC genes, covering commonly isolated Enterobacteriaceae in Brazil is the largest reported up to now.

Bilipid membrane phase characterization by reflectance anisotropy spectroscopy (RAS)

In this work we propose the use of experimental and theoretical reflectance anisotropy spectra (RAS) as a new tool to identify structural and dynamical aspects of the bilipid membrane and its various constituent molecules. The role of geometric details at the atomic level and macroscopic quantities, such as the membrane curvature and tilt for the different gel phases, in the theoretical RAS spectra (using Kohn-Sham density functional theory (KS-DFT)) are presented. Then the results are compared to the experimentally measured spectra taken from other techniques.

Acellular and "low" pertussis vaccines: adverse events and the role of mutations

Objective: to discuss the current PAHO recommendation that does not support the substitution of traditional cellular DTP vaccine by acellular DTP, and the role of mutations, in humans, as the main cause of rare adverse events, such as epileptic-like convulsions, triggered by pertussis vaccine. Data review: the main components related to toxic effects of cellular pertussis vaccines are the lipopolysaccharide of bacterial cell wall and pertussis toxin. The removal of part of lipopolysaccharide layer has allowed the creation of a safer cellular pertussis vaccine, with costs comparable to the traditional cellular vaccine, and which may be a substitute for the acellular vaccine. Conclusion: The new methodology introduced by Instituto Butantan allows for the development of a new safer pertussis vaccine with low LPS content (Plow), and the use of the lipopolysaccharide obtained in the process in the production of monophosphoryl lipid A. This component has shown potent adjuvant effect when administered together with influenza inactivated vaccine, making possible to reduce the antigen dose, enhancing the production capacity and lowering costs.

Precipitating factors of porphyria cutanea tarda in Brazil with emphasis on hemochromatosis gene (HFE) mutations. Study of 60 patients

BACKGROUND: Porphyria cutanea tarda is the most common form of porphyria, characterized by the decreased activity of the uroporphyrinogen decarboxylase enzyme. Several reports associated HFE gene mutations of hereditary hemochromatosis with porphyria cutanea tarda worldwide, although up to date only one study has been conducted in Brazil. OBJECTIVES: Investigation of porphyria cutanea tarda association with C282Y and H63D mutations in the HFE gene. Identification of precipitating factors (hepatitis C, HIV, alcoholism and estrogen) and their link with HFE mutations. METHODS: An ambispective study of 60 patients with PCT was conducted during the period from 2003 to 2012. Serological tests for hepatitis C and HIV were performed and histories of alcohol abuse and estrogen intake were investigated. HFE mutations were identified with real-time PCR. RESULTS: Porphyria cutanea tarda predominated in males and alcohol abuse was the main precipitating factor. Estrogen intake was the sole precipitating factor present in 25% of female patients. Hepatitis C was present in 41.7%. All HIV-positive patients (15.3%) had a history of alcohol abuse. Allele frequency for HFE mutations, i.e., C282Y (p = 0.0001) and H63D (p = 0.0004), were significantly higher in porphyria cutanea tarda patients, compared to control group. HFE mutations had no association with the other precipitating factors. CONCLUSIONS: Alcohol abuse, hepatitis C and estrogen intake are prevalent precipitating factors in our porphyria cutanea tarda population; however, hemochromatosis in itself can also contribute to the outbreak of porphyria cutanea tarda, which makes the research for HFE mutations necessary in these patients

Wilson’s disease in Southern Brazil: genotype-phenotype correlation and description of two novel mutations in ATP7B gene

OBJECTIVE: Wilson's disease (WD) is an inborn error of metabolism caused by abnormalities of the copper-transporting protein encoding gene ATP7B. In this study, we examined ATP7B for mutations in a group of patients living in southern Brazil. METHODS: 36 WD subjects were studied and classified according to their clinical and epidemiological data. In 23 subjects the ATP7B gene was analyzed. RESULTS: Fourteen distinct mutations were detected in at least one of the alleles. The c.3207C>A substitution at exon 14 was the most common mutation (allelic frequency=37.1%) followed by the c.3402delC at exon 15 (allelic frequency=11.4%). The mutations c.2018-2030del13 at exon 7 and c.4093InsT at exon 20 are being reported for the first time. CONCLUSION: The c.3207C>A substitution at exon 14, was the most common mutation, with an allelic frequency of 37.1%. This mutation is the most common mutation described in Europe.

Bilipid Membrane Phase Characterization by Reflectance Anisotropy Spectroscopy (RAS)

In this work we propose the use of experimental and theoretical reflectance anisotropy spectra (RAS) as a new tool to identify structural and dynamical aspects of the bilipid membrane and its various constituent molecules. The role of geometric details at the atomic level and macroscopic quantities, such as the membrane curvature and tilt for the different gel phases, in the theoretical RAS spectra (using Kohn-Sham density functional theory (KS-DFT)) are presented. Then the results are compared to the experimentally measured spectra taken from other techniques.

Investigating the role of single point mutations in the human proteome: a computational study

In the post genomic era with the massive production of biological data the understanding of factors affecting protein stability is one of the most important and challenging tasks for highlighting the role of mutations in relation to human maladies. The problem is at the basis of what is referred to as molecular medicine with the underlying idea that pathologies can be detailed at a molecular level. To this purpose scientific efforts focus on characterising mutations that hamper protein functions and by these affect biological processes at the basis of cell physiology. New techniques have been developed with the aim of detailing single nucleotide polymorphisms (SNPs) at large in all the human chromosomes and by this information in specific databases are exponentially increasing. Eventually mutations that can be found at the DNA level, when occurring in transcribed regions may then lead to mutated proteins and this can be a serious medical problem, largely affecting the phenotype. Bioinformatics tools are urgently needed to cope with the flood of genomic data stored in database and in order to analyse the role of SNPs at the protein level. In principle several experimental and theoretical observations are suggesting that protein stability in the solvent-protein space is responsible of the correct protein functioning. Then mutations that are found disease related during DNA analysis are often assumed to perturb protein stability as well. However so far no extensive analysis at the proteome level has investigated whether this is the case. Also computationally methods have been developed to infer whether a mutation is disease related and independently whether it affects protein stability. Therefore whether the perturbation of protein stability is related to what it is routinely referred to as a disease is still a big question mark. In this work we have tried for the first time to explore the relation among mutations at the protein level and their relevance to diseases with a large-scale computational study of the data from different databases. To this aim in the first part of the thesis for each mutation type we have derived two probabilistic indices (for 141 out of 150 possible SNPs): the perturbing index (Pp), which indicates the probability that a given mutation effects protein stability considering all the “in vitro” thermodynamic data available and the disease index (Pd), which indicates the probability of a mutation to be disease related, given all the mutations that have been clinically associated so far. We find with a robust statistics that the two indexes correlate with the exception of all the mutations that are somatic cancer related. By this each mutation of the 150 can be coded by two values that allow a direct comparison with data base information. Furthermore we also implement computational methods that starting from the protein structure is suited to predict the effect of a mutation on protein stability and find that overpasses a set of other predictors performing the same task. The predictor is based on support vector machines and takes as input protein tertiary structures. We show that the predicted data well correlate with the data from the databases. All our efforts therefore add to the SNP annotation process and more importantly found the relationship among protein stability perturbation and the human variome leading to the diseasome.

Konditionale Expression von HER-2, H-Ras oder BXB-Raf1 in einem Maustumormodell

Es ist bekannt, dass die Überexpression eines einzigen Onkogens im Tumorgewebe einen maligneren Phänotyp zur Folge haben kann. Ein Beispiel hierfür ist die Rezeptortyrosinkinase HER-2. Besonders in Mamma- und Ovarialkarzinomen tritt häufig eine HER-2 Überexpression auf, die mit einer schlechteren Prognose für die Patientinnen einhergeht. Die HER-2 blockierende Therapie mit Trastuzumab (Herceptin®) konnte zu einer signifikanten Verbesserung der Überlebenszeit bei Patientinnen mit metastasierendem Mammakarzinom führen. Es ist deshalb von großem Interesse herauszufinden, ob ein Tumor durch gezielte Blockade eines bestimmten Onkogens sein tumorigenes Potential verlieren kann, und dadurch das Tumorwachstum zumindest zeitweise unterbunden wird. Die Frage ist also, ob ein Tumor reversibel sein kann, wenn die Expression seiner Onkogene blockiert wird. Frühere Arbeiten meiner Arbeitsgruppe haben gezeigt, dass Tumore, die konditional humanes HER-2 exprimierten, nach Ausschalten von HER-2 tatsächlich in Remission gingen, d.h. reversibel waren. Tumorgrößenabhängig konnte sogar eine vollständige Tumorremission beobachtet werden. Die vorliegende Arbeit soll nun helfen, die beobachtete Remission nach Ausschalten von HER-2 besser verstehen zu können. Von Interesse sind dabei vor allem die molekularen Mechanismen, die in dem Tumor nach Ausschalten der HER-2 Expression ablaufen. Die konditionale Expression von HER-2 wurde mit Hilfe des TET-OFF Systems in NIH3T3 Mausfibroblasten erreicht. Mit dieser Technik wurde ein Maustumormodell etabliert, das ermöglichte, die Veränderungen in den Tumoren nach Ausschalten von HER-2 zu untersuchen. Ein besonderes Augenmerk wurde dabei auf zwei der durch HER-2 vermittelten Signalwege gerichtet, den Ras-MAP Kinase Signalweg und die Aktivierung von Akt über die Phosphoinositol-3 Kinase. Beide wurden nach Ausschalten der HER-2 Expression deaktiviert. Um herausfinden zu können, welcher der beiden Wege eine wichtigere Rolle bei der Tumorremission spielt, wurden in der vorliegenden Arbeit zwei weitere Maustumormodelle zur konditionalen Expression von humanem H-Ras bzw. einer Form des humanen c-Raf-1 (BXB-Raf1) etabliert. Die Modelle funktionierten auf dieselbe Weise wie das HER-2 Maustumormodell und es wurden auch dieselben Faktoren untersucht. Ras und Raf sind Mitglieder des Ras-MAP Kinase Signalweges. Raf ist aber im Gegensatz zu HER-2 und Ras nicht in der Lage, Akt zu aktivieren. Durch Vergleich der Ergebnisse der drei Maustumormodelle war es deshalb möglich zu differenzieren, ob Einflüsse auf die Tumorentwicklung über denn Ras-MAP Kinase oder den PI3K/Akt Signalweg vermittelt wurden. Auch Ausschalten von H-Ras oder BXB-Raf1 führte zu einer raschen Tumorremission. Damit wurde erneut die Frage nach der Reversibilität eines Tumors beantwortet. Ob die Remission auf einer Induktion von Apoptose beruhte, konnte nicht endgültig geklärt werden, da es zwar nach Ausschalten von HER-2 zu einer Erhöhung der Apoptoserate kam, nicht jedoch nach Ausschalten von H-Ras oder BXB-Raf1. Aufgrund der vorhandenen Ergebnisse wird vermutet, dass es zu einer Störung des Gleichgewichtes zwischen proliferationsfördernden und apoptotischen Faktoren nach Ausschalten der Onkogene kam. Die in den Tumoren vorhandene Spontanapoptose könnte dann ausreichen, den Prozess der Tumorremission auszulösen. Die Untersuchungen haben gezeigt, dass ERK bzw. der Ras-MAP Kinase Signalweg die bedeutendere Rolle bei der Tumorremission spielte. Zum einen wurde dies belegt durch die Beobachtung, dass die Tumorverläufe von HER-2 und BXB-Raf1 nahezu identisch waren. Zum anderen kam es in allen drei Modellen zu einer Dephosphorylierung von ERK, die der Tumorremission vorausging. Akt schien dagegen keine Rolle zu spielen, da das Ausschalten der HER-2, H-Ras oder BXB-Raf1 Expression zu keiner einheitlichen Veränderung des Posphorylierungsgrades von Akt führte. Demnach ist die Blockade des Ras-MAP Kinase Signalweges, der hauptsächlich proliferationsfördernde Eigenschaften besitzt, wichtiger für die Tumorremission als die Blockade des PI3K/Akt Signalweges, der hauptsächlich anti-apoptotische Eigenschaften vermittelt.

Detailed analyses of mutations affecting structural formation of neuromuscular synapses in Drosophila melanogaster

The establishment of appropriate synapses between neurons and their target cells is an essential requirement for the formation of functional neuronal circuits. However, there is very little insight into the mechanisms underlying de novo formation of synapses and synaptic terminals. To identify novel genes involved in signalling or structural aspects of these processes I capitalised on possibilities provided by the model organism Drosophila. Thus, I contributed to a screen of a collection of third chromosomal mutations (Salzberg et al., 1997, Genetics 147, 1723ff.) selecting those mutant strains displaying structural defects of Drosophila neuromuscular junctions (NMJ). Carrying out genetic mapping experiments, I could assign 7 genes to interesting candidate mutations. All 7 mutations selected in this process cause size alterations of the embryonic NMJ, and one shows additional disturbances in the distribution of synaptic markers. 4 of these turned out to be transcription factors, not falling into the remit of this project. Only for one of these, the neuronal transcription factor Castor, I could show that its overgrown mutant NMJ phenotype is due to an increase in the number of motorneurons. The remaining genes encode a potential nitrophenylphosphatase, the translation initiation factor eIF4AIII, and a novel protein Waharan. Unfortunately, the nitophenylphosphatase gene was identified too late to carry out functional studies in the context of this project, but potential roles are discussed. eIF4AIII promotes NMJ size tempting to speculate that local translation at the NMJ is affected. I found that the synaptic scaffolding molecule Discs large (Dlg; orthologue of PSD95) is upregulated at eIF4AIII mutant NMJs. Targeted upregulation of Dlg can not mimic the eIF4AIII mutant phenotype, but dlg mutations suppress it. Therefore, Dlg function is required but not sufficient in this context. My findings are discussed in detail, pointing out future directions. The main focus of this work is the completely novel gene waharan (wah), an orthologue of the human gene KIAA1267 encoding a big brain protein of likewise unknown structure and function. My studies show that mutations or RNAi knock-down of wah cause NMJ overgrowth and reveal additional crucial roles in the patterning of wing imginal discs. RNAi studies suggest Wah to be required pre- and postsynaptically at NMJs and, consistently, wah is transcribed in the nervous system and muscles. Anti-Wah antisera were produced but could no longer be tested here, but preliminary studies with newly generated HA-targeted constructs suggest that Wah localises at NMJs and in neuronal nuclei. In silico analyses predict Wah to be structurally related to the Rad23-family of proteins, likely to target ubiquitinated proteins to the proteasome for degradation (Chen et al., 2002, Mol Cell Biol 22, 4902ff.) . In agreement with this prediction, poly-ubiquitinated proteins were found to accumulate in the absence of wah function, and wah-like mutant phenotypes were induced in NMJs and wing discs by knocking down proteasome function. My analysis further revealed that poly-ubiquitinated proteins are reduced in nuclei of wah mutant neurons and muscles, suggesting that Wah may play additional roles in ubiquitin-mediated nuclear import. Taken together, this study has uncovered a number of interesting candidate genes required for the de novo formation of Drosophila NMJs. 3 of these genes fell into the focus of this project. As discussed in detail, discovery of these genes and insights gained into their function have high potential to be translatable into vertebrate systems.

Genetic analysis of tumour initiation and progression in a Drosophila model of epithelial cancer

Neoplastic overgrowth depends on the cooperation of several mutations ultimately leading to major rearrangements in cellular behaviour. The molecular crosstalk occurring between precancerous and normal cells strongly influences the early steps of the tumourigenic process as well as later stages of the disease. Precancerous cells are often removed by cell death from normal tissues but the mechanisms responsible for such fundamental safeguard processes remain in part elusive. To gain insight into these phenomena I took advantage of the clonal analysis methods available in Drosophila for studying the phenotypes due to loss of function of the neoplastic tumour suppressor lethal giant larvae (lgl). I found that lgl mutant cells growing in wild-type imaginal wing discs are subject to the phenomenon of cell competition and are eliminated by JNK-dependent cell death because they express very low levels of dMyc oncoprotein compared to those in the surrounding tissue. Indeed, in non-competitive backgrounds lgl mutant clones are able to overgrow and upregulate dMyc, overwhelming the neighbouring tissue and forming tumourous masses that display several cancer hallmarks. These phenotypes are completely abolished by reducing dMyc abundance within mutant cells while increasing it in lgl clones growing in a competitive context re-establishes their tumourigenic potential. Similarly, the neoplastic growth observed upon the oncogenic cooperation between lgl mutation and activated Ras/Raf/MAPK signalling was found to be characterised by and dependent on the ability of cancerous cells to upregulate dMyc with respect to the adjacent normal tissue, through both transcriptional and post-transcriptional mechanisms, thereby confirming its key role in lgl-induced tumourigenesis. These results provide first evidence that the dMyc oncoprotein is required in lgl mutant tissue to promote invasive overgrowth in developing and adult epithelial tissues and that dMyc abundance inside versus outside lgl mutant clones plays a key role in driving neoplastic overgrowth.

High sensitivity analysis of BRAF mutations in neoplastic and non-neoplastic thyroid lesions

The clonal distribution of BRAFV600E in papillary thyroid carcinoma (PTC) has been recently debated. No information is currently available about precursor lesions of PTCs. My first aim was to establish whether the BRAFV600E mutation occurs as a subclonal event in PTCs. My second aim was to screen BRAF mutations in histologically benign tissue of cases with BRAFV600E or BRAFwt PTCs in order to identify putative precursor lesions of PTCs. Highly sensitive semi-quantitative methods were used: Allele Specific LNA quantitative PCR (ASLNAqPCR) and 454 Next-Generation Sequencing (NGS). For the first aim 155 consecutive formalin-fixed and paraffin-embedded (FFPE) specimens of PTCs were analyzed. The percentage of mutated cells obtained was normalized to the estimated number of neoplastic cells. Three groups of tumors were identified: a first had a percentage of BRAF mutated neoplastic cells > 80%; a second group showed a number of BRAF mutated neoplastic cells < 30%; a third group had a distribution of BRAFV600E between 30-80%. The large presence of BRAFV600E mutated neoplastic cell sub-populations suggests that BRAFV600E may be acquired early during tumorigenesis: therefore, BRAFV600E can be heterogeneously distributed in PTC. For the second aim, two groups were studied: one consisted of 20 cases with BRAFV600E mutated PTC, the other of 9 BRAFwt PTCs. Seventy-five and 23 histologically benign FFPE thyroid specimens were analyzed from the BRAFV600E mutated and BRAFwt PTC groups, respectively. The screening of BRAF mutations identified BRAFV600E in “atypical” cell foci from both groups of patients. “Unusual” BRAF substitutions were observed in histologically benign thyroid associated with BRAFV600E PTCs. These mutations were very uncommon in the group with BRAFwt PTCs and in BRAFV600E PTCs. Therefore, lesions carrying BRAF mutations may represent “abortive” attempts at cancer development: only BRAFV600E boosts neoplastic transformation to PTC. BRAFV600E mutated “atypical foci” may represent precursor lesions of BRAFV600E mutated PTCs.

Cell death mechanisms triggered by monoclonal antibodies against CD99 in Ewing sarcoma: Cross-talk between MDM2, IGF-1R and Ras/MAPK

CD99 is a 32 kDa transmembrane protein whose high expression characterizes Ewing sarcoma (ES), a very aggressive pediatric bone tumor. In addition to its diagnostic value, CD99 has therapeutic potential since it leads to rapid and massive ES cell death when engaged with specific antibodies. Here a novel mechanism of cell death triggered via CD99 is shown, leading, ultimately, to the appearance of macropinocytotic vescicles. Anti-CD99 mAb 0662 induces MDM2 ubiquitination and degradation, which causes not only a p53 reactivation but also the IGF-1R induction and its subsequent internalization; CD99 results internalized together with IGF-1R inside endosomes, but then the two molecules display a different sorting: CD99 is degraded, while IGF-1R is recycled on the surface, causing, as a final step, the up-regulation of RAS-MAPK. High-expressing CD99 mesenchymal stem cells show mild Ras induction but no p53 activation and escape cell death, but in presence of EWS/FLI1 mesenchymal stem cells expressing CD99 show a stronger Ras induction and a p53 reactivation, leading to a significant cell death rate. We propose that CD99 triggering in a EWS/FLI1-driven oncogenetic context creates a synergy between RAS upregulation and p53 activation in ES cells, leading to cell death. Moreover, our data rule out possible concerns on toxicity related to the broad CD99 expression in normal tissues and provide the rationale for the therapeutic use of anti-CD99 MAbs in the clinic.