RAS/MAPK signaling pathway

Ras / MAPK 信号通路
  • 文章类型: English Abstract
    目的:探讨脆性X智力低下蛋白(FMRP)调控结直肠癌(CRC)细胞铁凋亡逃逸的机制。
    方法:我们使用RT-qPCR和Western印迹检测了CRC细胞系中FMRP的表达水平,并使用TCGA数据库分析了FMRP介导的CRC进展调控中涉及的生物学功能和信号通路。构建慢病毒FMRP过表达载体(Lv-FMRP)和3个敲低载体(siFMRP-1、siFMRP-2和siFMRP-3),并使用CCK8法和平板克隆形成法检测其对HCT116细胞增殖的影响;使用MDA/ROS/GSH/Fe2试剂盒测定细胞铁凋亡水平的变化,使用JC-1荧光染色检测线粒体膜电位变化,免疫印迹法检测铁凋亡相关蛋白和RAS/MAPK信号通路的表达。在裸小鼠中评估转染细胞的皮下致瘤潜力。
    结果:与正常结肠黏膜上皮NCM460细胞相比,CRC细胞系具有显著较高的FMRP表达水平。生物信息学分析提示FMRP参与活性氧的调节,氧化应激诱导的细胞死亡,线粒体呼吸,和谷胱甘肽代谢途径。在细胞实验中,FMRP敲低显著抑制HCT116细胞增殖,细胞GSH含量降低,MDA和ROS水平增加,Fe2+荧光强度,和线粒体膜电位,SLC7A11/GPX4蛋白表达和ERK磷酸化水平降低,MEK,MAPK,和RAS蛋白;FMRP过表达导致细胞发生相反的变化。在荷瘤裸鼠中,具有FMRP敲低的HCT116细胞显示出减弱的致瘤潜能,在异种移植物中降低的异种移植物生长速率和降低的SLC7A11表达。
    结论:FMRP高表达抑制CRC细胞铁凋亡,通过激活RAS/MAPK信号通路促进CRC进展。
    OBJECTIVE: To investigate the mechanism by which fragile X mental retardation protein (FMRP) regulates ferroptosis evasion in colorectal cancer (CRC) cells.
    METHODS: We examined FMRP expression levels in CRC cell lines using RT-qPCR and Western blotting and analyzed the biological functions and signaling pathways involved in FMRP-mediated regulation of CRC progression using the TCGA database. A lentiviral FMRP overexpression vector (Lv-FMRP) and 3 knockdown vectors (siFMRP-1, siFMRP-2, and siFMRP-3) were constructed, and their effects on proliferation of HCT116 cells were examined using CCK8 assay and plate clone formation assay; the changes in cell ferroptosis level was determined using MDA/ROS/GSH/Fe2+ kits, mitochondrial membrane potential changes were detected using JC-1 fluorescence staining, and the expressions of proteins associated with ferroptosis and the RAS/MAPK signaling pathway were detected using Western blotting. The subcutaneous tumorigenic potential of the transfected cells was evaluated in nude mice.
    RESULTS: Compared with normal colonic mucosal epithelial NCM460 cells, the CRC cell lines had significantly higher FMRP expression level. Bioinformatics analysis suggested the involvement of FMRP in regulation of reactive oxygen, oxidative stress-induced cell death, mitochondrial respiration, and glutathione metabolism pathways. In the cell experiments, FMRP knockdown significantly inhibited proliferation of HCT116 cells, lowered cellular GSH content, increased MDA and ROS levels, Fe2+ fluorescence intensity, and mitochondrial membrane potential, and decreased SLC7A11/GPX4 protein expressions and the phosphorylation levels of ERK, MEK, MAPK, and RAS proteins; FMRP overexpression resulted in the opposite changes in the cells. In the tumor-bearing nude mice, HCT116 cells with FMRP knockdown showed attenuated tumorigenic potential with lowered xenograft growth rate and reduced SLC7A11 expression in the xenograft.
    CONCLUSIONS: The high expression of FMRP inhibits ferroptosis in CRC cells and promotes progression of CRC by activating the RAS/MAPK signaling pathway.
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  • 文章类型: Journal Article
    简介:RRAS2,Ras样低分子量GTPases的R-Ras亚家族成员,被认为是通过RAS/MAPK信号通路调节细胞增殖和分化。在Noonan综合征患者中已经报道了7种RRAS2致病变异;然而,很少进行功能分析。在这里,我们报告了两名患者,他们表现为Noonan样表型,并伴有复发性和新型RRAS2致病变异(p.Gly23Val和p.Gly24Glu,分别)和它们的功能分析结果。材料和方法:野生型(WT)和突变型RRAS2基因在人胚肾293细胞中瞬时表达。通过蛋白质印迹证实RRAS2的表达和ERK1/2的磷酸化。并且使用具有血清反应元件-荧光素酶构建体的报告测定系统测量RAS信号传导途径活性。WT和p.Gly23ValRRAS2使用玻璃多重报道分子-Gal4驱动剂在果蝇眼中表达。将突变体mRNA显微注射到斑马鱼胚胎中,并观察胚胎颌骨。结果:WT蛋白的表达无明显差异,p.Gly23Val,观察到p.Gly24Glu。荧光素酶报告基因实验表明,p.Gly23Val的活性比WT高2.45±0.95倍,p.Gly24Glu是WT的3.06±1.35倍。对于转基因果蝇,p.Gly23Val表达导致没有成年苍蝇出现,表明杀伤力。对于注射突变mRNA的斑马鱼胚胎,与注射WTmRNA的胚胎相比,观察到椭圆形和颌骨发育延迟。这些表明RAS信号传导途径的过度活跃。讨论:由于功能获得RRAS2变体,我们报道的复发和新的RRAS2变体显示体外或体内RAS信号传导途径活性增加。临床特征与以前报道的相似,提示RRAS2功能获得变异在患者中引起这种疾病。
    Introduction: RRAS2, a member of the R-Ras subfamily of Ras-like low-molecular-weight GTPases, is considered to regulate cell proliferation and differentiation via the RAS/MAPK signaling pathway. Seven RRAS2 pathogenic variants have been reported in patients with Noonan syndrome; however, few functional analyses have been conducted. Herein, we report two patients who presented with a Noonan-like phenotype with recurrent and novel RRAS2 pathogenic variants (p.Gly23Val and p.Gly24Glu, respectively) and the results of their functional analysis. Materials and methods: Wild-type (WT) and mutant RRAS2 genes were transiently expressed in Human Embryonic Kidney293 cells. Expression of RRAS2 and phosphorylation of ERK1/2 were confirmed by Western blotting, and the RAS signaling pathway activity was measured using a reporter assay system with the serum response element-luciferase construct. WT and p.Gly23Val RRAS2 were expressed in Drosophila eye using the glass multiple reporter-Gal4 driver. Mutant mRNA microinjection into zebrafish embryos was performed, and the embryo jaws were observed. Results: No obvious differences in the expression of proteins WT, p.Gly23Val, and p.Gly24Glu were observed. The luciferase reporter assay showed that the activity of p.Gly23Val was 2.45 ± 0.95-fold higher than WT, and p.Gly24Glu was 3.06 ± 1.35-fold higher than WT. For transgenic flies, the p.Gly23Val expression resulted in no adults flies emerging, indicating lethality. For mutant mRNA-injected zebrafish embryos, an oval shape and delayed jaw development were observed compared with WT mRNA-injected embryos. These indicated hyperactivity of the RAS signaling pathway. Discussion: Recurrent and novel RRAS2 variants that we reported showed increased in vitro or in vivo RAS signaling pathway activity because of gain-of-function RRAS2 variants. Clinical features are similar to those previously reported, suggesting that RRAS2 gain-of-function variants cause this disease in patients.
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  • 文章类型: Case Reports
    Noonan综合征是一种常染色体显性疾病,其特征是由RAS/MAPK信号通路中涉及的基因变异引起的多器官疾病。已经鉴定了包括PTPN11和CBL在内的9个致病基因。肥大细胞增多症是一种以肥大细胞增生为特征的皮肤疾病,骨髓,和其他器官。迄今为止,以前没有报道过由致病性CBL变异体引起的Noonan综合征伴肥大细胞增多症的病例.一名男孩在8个月大时被诊断出患有Noonan综合征,面部特征和身体轻微异常。自2个月大以来,他的身体上出现了5-10毫米的棕色结节。该患者通过棕色结节的活检标本被诊断为肥大细胞增多症,显示肥大细胞浸润。父母三人组的全外显子组测序显示了从头致病性CBL变体。肥大细胞增多症的发生可能是Noonan综合征CBL基因分析的线索。CBL基因与肥大细胞增多症和各种癌症有关。在致病变异的情况下,有必要对与CBL变异相关的癌症风险进行长期随访.
    Noonan syndrome is an autosomal dominant disease characterized by multi-organ disorders caused by variants of genes involved in the RAS/MAPK signaling pathway. The nine causative genes including PTPN11 and CBL have been identified. Mastocytosis is a disease characterized by mast cell proliferation in skin, bone marrow, and other organs. To date, no previous cases of Noonan syndrome with mastocytosis caused by a pathogenic CBL variant have been reported. A boy was diagnosed with Noonan syndrome at 8 months of age with facial features and minor anomaly of his body. He presented with brown nodules of 5-10 mm on his body since the age of 2 months. The patient was diagnosed with mastocytosis by a biopsy specimen from brown nodules, which showed infiltration of mast cells. Whole-exome sequencing of the parent-patient trio revealed a de novo pathogenic CBL variant. The occurrence of mastocytosis may be a cue for the analysis of the CBL gene in Noonan syndrome. The CBL gene is involved in mastocytosis and various cancers. In the case of the pathogenic variant, long-term follow-up for the risk of cancers related to the CBL variant is necessary.
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  • 文章类型: Journal Article
    尽管在过去十年中批准了许多新型药物,但多发性骨髓瘤仍然是一种无法治愈的疾病。此外,疾病行为和对当前治疗的敏感性通常因患者而异。迄今为止,尚无基于基因组或免疫学发现的针对特定患者群体的骨髓瘤的批准疗法。精准医学,使用描述特定肿瘤生物学的生物标志物,并预测对适当药物的反应,通过扩大我们的治疗库,同时提高我们仅将患者暴露于可能有效的治疗方法的能力,可以继续推动该领域的发展。在这一努力中已经进行了广泛的研究努力,包括使用靶向Bcl2和RAS/MAPK和PI3K/AKT/mTOR途径的试剂。到目前为止,临床试验偶尔取得成功,但令人失望,反映了仍然存在的重大障碍,包括致癌途径和骨髓瘤的非线性遗传发育之间的复杂串扰,容易培养具有独特突变的亚克隆。在这次审查中,我们探索了多发性骨髓瘤精准治疗的前景,并强调了研究工作取得切实临床成果的程度。
    Multiple myeloma remains an incurable disease despite numerous novel agents being approved in the last decade. Furthermore, disease behavior and susceptibility to current treatments often vary drastically from patient to patient. To date there are no approved therapies in myeloma that are targeted to specific patient populations based on genomic or immunologic findings. Precision medicine, using biomarkers descriptive of a specific tumor\'s biology and predictive of response to appropriate agents, may continue to push the field forward by expanding our treatment arsenal while refining our ability to expose patients to only those treatments likely to be efficacious. Extensive research efforts have been carried out in this endeavor including the use of agents targeting Bcl2 and the RAS/MAPK and PI3K/AKT/mTOR pathways. Thus far, clinical trials have yielded occasional successes intermixed with disappointments, reflecting significant hurdles which still remain including the complex crosstalk between oncogenic pathways and the nonlinear genetic development of myeloma, prone to cultivating sub-clones with distinctive mutations. In this review, we explore the landscape of precision therapeutics in multiple myeloma and underscore the degree to which research efforts have produced tangible clinical results.
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  • 文章类型: Journal Article
    泛素介导的蛋白酶体降解紊乱的研究可能揭示人类疾病的分子基础,如癌症(前列腺癌,肺癌和肝癌,等。)和神经系统疾病(帕金森病,阿尔茨海默病和亨廷顿病,等。)并帮助设计新的治疗方法。亮氨酸拉链样转录调节因子1(LZTR1)是cullin-RINGE3连接酶的重要底物识别亚基,在细胞功能调节中起重要作用。LZTR1的突变和相关下游信号通路的失调有助于Noonan综合征(NS)的发病机理,胶质母细胞瘤和慢性粒细胞白血病。因此,了解LZTR1正常功能的分子机制对于其最终的治疗靶向至关重要。在本次审查中,描述了LZTR1的结构和功能。此外,关于LZTR1在NS中的功能的当前知识的最新进展,胶质母细胞瘤(GBM),还讨论了慢性粒细胞白血病(CML)和神经鞘瘤病以及LZTR1突变的影响,深入了解LZTR1如何靶向治疗目的。
    The study of the disorders of ubiquitin-mediated proteasomal degradation may unravel the molecular basis of human diseases, such as cancer (prostate cancer, lung cancer and liver cancer, etc.) and nervous system disease (Parkinson\'s disease, Alzheimer\'s disease and Huntington\'s disease, etc.) and help in the design of new therapeutic methods. Leucine zipper-like transcription regulator 1 (LZTR1) is an important substrate recognition subunit of cullin-RING E3 ligase that plays an important role in the regulation of cellular functions. Mutations in LZTR1 and dysregulation of associated downstream signaling pathways contribute to the pathogenesis of Noonan syndrome (NS), glioblastoma and chronic myeloid leukemia. Understanding the molecular mechanism of the normal function of LZTR1 is thus critical for its eventual therapeutic targeting. In the present review, the structure and function of LZTR1 are described. Moreover, recent advances in the current knowledge of the functions of LZTR1 in NS, glioblastoma (GBM), chronic myeloid leukemia (CML) and schwannomatosis and the influence of LZTR1 mutations are also discussed, providing insight into how LZTR1 may be targeted for therapeutic purposes.
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  • 文章类型: Journal Article
    2001年发现了与Sprouty相关的Ena/血管扩张剂刺激的磷蛋白同源性-1(EVH-1)结构域(SPRED)蛋白家族。这些与Sprouty相关的酪氨酸激酶结合蛋白负调节多种生长因子诱导的Ras/ERK信号通路。近年来,已经发现SPRED蛋白调节细胞发育等生命活动,运动,和扩散,并参与病理生理过程,如肿瘤转移,造血调节,和过敏反应。这些研究的发现对于SPRED蛋白在疾病中的参与具有重要意义。SPRED蛋白的早期研究主要集中在各种肿瘤上,心血管疾病,和器官发育。然而,近年来,在阐明SPRED蛋白在神经精神病学中的作用方面取得了很大进展,炎症,内分泌,和眼科疾病。本文综述了近年来有关SPRED蛋白及其在某些疾病发病机制中的作用的实验研究。
    The Sprouty-related Ena/vasodilator-stimulated phosphoprotein homology-1 (EVH-1) domain (SPRED) family of proteins was discovered in 2001. These Sprouty-related tyrosine kinase-binding proteins negatively regulate a variety of growth factor-induced Ras/ERK signaling pathways. In recent years, SPRED proteins have been found to regulate vital activities such as cell development, movement, and proliferation, and to participate in pathophysiological processes such as tumor metastasis, hematopoietic regulation, and allergic reactions. The findings of these studies have important implications regarding the involvement of SPRED proteins in disease. Early studies of SPRED proteins focused mainly on various tumors, cardiovascular diseases, and organ development. However, in recent years, great progress has been made in elucidating the role of SPRED proteins in neuropsychiatric, inflammatory, endocrine, and ophthalmic diseases. This article provides a review of the experimental studies performed in recent years on the SPRED proteins and their role in the pathogenesis of certain diseases.
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  • 文章类型: Journal Article
    常染色体显性遗传性多囊肾病(ADPKD)是最常见的威胁生命的单基因疾病之一,其特征是充满液体的肾囊肿进行性扩大。我们先前的研究表明,灵芝三萜(GT)可延迟PKD肾囊肿的发展。在本研究中,我们确定了GT抑制肾囊肿发展的有效成分。使用体外MDCK膀胱发生模型,我们确定了灵芝酸A(GA-A)是12种灵芝酸(GA)单体中最有希望的候选物。我们进一步显示GA-A(6.25-100μM)在体外MDCK囊肿模型和胚胎肾囊肿模型中显著抑制囊肿生长,抑制作用是可逆的。在肾脏特异性Pkd1基因敲除(kPKD)小鼠中表现出严重的囊性肾病,服用GA-A(50mg·kg-1·d-1,sc)可显着减轻肾囊肿的发展。在KPKD小鼠的MDCK细胞和肾脏中,我们发现GA-A剂量依赖性地下调Ras/MAPK信号通路.增殖细胞核抗原(PCNA)的表达也被抑制,表明GA-A对细胞增殖的可能影响。这些实验数据表明,GA-A可能是GT的主要成分,可作为治疗ADPKD的潜在治疗剂。
    Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common life-threatening monogenetic diseases characterized by progressive enlargement of fluid-filled renal cysts. Our previous study has shown that Ganoderma triterpenes (GT) retards PKD renal cyst development. In the present study we identified the effective ingredient of GT in suppression of kidney cyst development. Using an in vitro MDCK cystogenesis model, we identified ganoderic acid A (GA-A) as the most promising candidate among the 12 ganoderic acid (GA) monomers. We further showed that GA-A (6.25-100 μM) significantly inhibited cyst growth in MDCK cyst model and embryonic kidney cyst model in vitro, and the inhibitory effect was reversible. In kidney-specific Pkd1 knockout (kPKD) mice displaying severe cystic kidney disease, administration of GA-A (50 mg· kg-1 ·d-1, sc) significantly attenuated renal cyst development. In both MDCK cells and kidney of kPKD mice, we revealed that GA-A dose-dependently downregulated the Ras/MAPK signaling pathway. The expression of proliferating cell nuclear antigen (PCNA) was also suppressed, suggesting a possible effect of GA-A on cell proliferation. These experimental data suggest that GA-A may be the main ingredient of GT as a potential therapeutic reagent for treating ADPKD.
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  • 文章类型: Journal Article
    努南综合征(NS)是一种常见的常染色体显性遗传多系统疾病,由Ras/MAPK信号通路中10多个基因的突变引起。在群体中观察到差异突变频率。NS的临床表达高度可变,包括身材矮小,独特的颅面畸形,心血管异常,和发育迟缓。关于非洲NS的表型特异性和分子特征知之甚少。本研究调查了开普敦(南非)的NS患者。总共26例患者的临床特征被仔细记录。对16个不相关的先证者进行了靶向下一代测序(NGS),使用包含14个基因的多基因组:PTPN11,SOS1,RIT1,A2ML1,BRAF,CBL,HRAS,KRAS,MAP2K1,MAP2K2,NRAS,RAF1、SHOC2和SPRED1。诊断时的中位年龄为4.5岁(范围:1个月-51岁)。混血血统的人最多(53.8%),其次是非洲黑人(30.8%)。我们的队列显示肺动脉瓣狭窄的频率较低(34.6%)和较不严重的发育里程碑表型。分子分析发现,在5/16例(31.2%)中,变异体被预测为致病性。在这些突变中,先前报道了两个:MAP2K1-c.389A>G(p。Tyr130Cys)和PTPN11-c.151A>G(p。Met504Val);三个是新颖的:CBL-c.2520T>G(p。Cys840Trp),PTPN11-c.1496C>T(p。Ser499Phe),和MAP2K1-c.200A>C(p。Asp67Ala)。分子动力学模拟表明鉴定的新变体影响其相应蛋白质的稳定性和灵活性。基因型-表型相关性表明,NS的临床特征在MAP2K1变异的患者中更为典型。靶向NGS在南非NS分子诊断中的首次应用表明,虽然与其他人群相比没有主要的表型差异,南非人NS中遗传变异的分布可能不同。
    Noonan Syndrome (NS) is a common autosomal dominant multisystem disorder, caused by mutations in more than 10 genes in the Ras/MAPK signaling pathway. Differential mutation frequencies are observed across populations. Clinical expressions of NS are highly variable and include short stature, distinctive craniofacial dysmorphism, cardiovascular abnormalities, and developmental delay. Little is known about phenotypic specificities and molecular characteristics of NS in Africa. The present study has investigated patients with NS in Cape Town (South Africa). Clinical features were carefully documented in a total of 26 patients. Targeted Next-Generation Sequencing (NGS) was performed on 16 unrelated probands, using a multigene panel comprising 14 genes: PTPN11, SOS1, RIT1, A2ML1, BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, RAF1, SHOC2, and SPRED1. The median age at diagnosis was 4.5 years (range: 1 month-51 years). Individuals of mixed-race ancestry were most represented (53.8%), followed by black Africans (30.8%). Our cohort revealed a lower frequency of pulmonary valve stenosis (34.6%) and a less severe developmental milestones phenotype. Molecular analysis found variants predicted to be pathogenic in 5 / 16 cases (31.2%). Among these mutations, two were previously reported: MAP2K1-c.389A>G (p.Tyr130Cys) and PTPN11 - c.1510A>G (p.Met504Val); three are novel: CBL-c.2520T>G (p.Cys840Trp), PTPN11- c.1496C>T (p.Ser499Phe), and MAP2K1- c.200A>C (p.Asp67Ala). Molecular dynamic simulations indicated that novel variants identified impact the stability and flexibility of their corresponding proteins. Genotype-phenotype correlations showed that clinical features of NS were more typical in patients with variants in MAP2K1. This first application of targeted NGS for the molecular diagnosis of NS in South Africans suggests that, while there is no major phenotypic difference compared to other populations, the distribution of genetic variants in NS in South Africans may be different.
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  • 文章类型: Journal Article
    花粉等各种外部因子之间的关系,食物,和传染性病原体和人类敏感性存在,并且根据个人的健康状况而变化。例如,我们认为默克尔细胞多瘤病毒(MCPyV)的致病潜力,皮肤中的常驻病毒,是可变的,取决于个体反应性的程度。MCPyV以及爱泼斯坦-巴尔病毒,通常以亚临床感染的形式与人类联系在一起,被认为在不同程度上参与了几种肿瘤和炎性疾病。在这次审查中,我们涵盖了两种类型的朗格汉斯细胞肿瘤,朗格汉斯细胞肉瘤(LCS)和朗格汉斯细胞组织细胞增生症(LCH),表现为由MCPyV引起的肿瘤性或炎性疾病。
    我们对之前的两个分析进行了荟萃分析,由MCPyV-DNA的定量PCR组成,蛋白质组学,免疫组织化学构建IL-17内分泌模型和白细胞介素-1(IL-1)激活环模型,和其他组\'数据。
    我们已经表明,在这两种不同的肿瘤中,存在与MCPyV相关的亚组作为致病因子。相对而言,LCS,与LCH不同,是在老年人中经常观察到的不存在炎性肉芽肿的肿瘤性病变(或肉瘤)。LCH是朗格汉斯样异常细胞的增殖性疾病,其携带参与RAS/MAPK信号通路的基因突变。我们发现MCPyV可能参与了LCH的发展。
    我们假设根据与默克尔细胞癌发病机制有关的相同机制发展了LCS亚组。我们提出了由由于基因突变而持续的炎症过程开发的LCH。我们假设MCPyV感染触发了位于LCH发病机理之下的IL-1激活环,并提出了一种新的三因子模型。
    The relationship between various external agents such as pollen, food, and infectious agents and human sensitivity exists and is variable depending upon individual\'s health conditions. For example, we believe that the pathogenetic potential of the Merkel cell polyomavirus (MCPyV), the resident virus in skin, is variable and depends from the degree of individual\'s reactivity. MCPyV as well as Epstein-Barr virus, which are normally connected with humans under the form of subclinical infection, are thought to be involved at various degrees in several neoplastic and inflammatory diseases. In this review, we cover two types of Langerhans cell neoplasms, the Langerhans cell sarcoma (LCS) and Langerhans cell histiocytosis (LCH), represented as either neoplastic or inflammatory diseases caused by MCPyV.
    We meta-analyzed both our previous analyses, composed of quantitative PCR for MCPyV-DNA, proteomics, immunohistochemistry which construct IL-17 endocrine model and interleukin-1 (IL-1) activation loop model, and other groups\' data.
    We have shown that there were subgroups associated with the MCPyV as a causal agent in these two different neoplasms. Comparatively, LCS, distinct from the LCH, is a neoplastic lesion (or sarcoma) without presence of inflammatory granuloma frequently observed in the elderly. LCH is a proliferative disease of Langerhans-like abnormal cells which carry mutations of genes involved in the RAS/MAPK signaling pathway. We found that MCPyV may be involved in the development of LCH.
    We hypothesized that a subgroup of LCS developed according the same mechanism involved in Merkel cell carcinoma pathogenesis. We proposed LCH developed from an inflammatory process that was sustained due to gene mutations. We hypothesized that MCPyV infection triggered an IL-1 activation loop that lies beneath the pathogenesis of LCH and propose a new triple-factor model.
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  • 文章类型: Journal Article
    多灶性房性心动过速(MAT)与Costello综合征有众所周知的关联,但很少描述相关的RAS/MAPK通路障碍(RASopathies)。我们报告了11例放射病患者(Costello,Noonan,和Noonan综合征伴多个腹水[以前的LEOPARD综合征])和非折返性房性心动过速(MAT和异位房性心动过速),表明心律失常表型重叠。类似的重叠在骨骼的RASopathies中可见,肌肉骨骼和皮肤异常,畸形面部特征,和神经发育缺陷。如果窦性心律不能迅速恢复,非折返性房性心动过速可能会导致心脏受损。典型的一线室上性心动过速抗心律失常药物(普萘洛尔和地高辛)在该队列中通常不能有效恢复或维持窦性心律。而氟卡尼或胺碘酮单独或与普萘洛尔联合使用是急性和慢性使用的有效抗心律失常药。所有患者房性心动过速均消失。然而,队列中一名4个月大的男孩被发现有房性心律失常(并发蜂窝织炎),另一名患者因心力衰竭并发顽固性房性心律失常接受了心脏移植.虽然普萘洛尔单药常常不能转换或维持窦性心律,氟卡尼或胺碘酮,偶尔与普萘洛尔合用,对RASopathy患者治疗非折返性房性心律失常有效。我们的分析表明,RASopathy患者可能患有非折返性房性心动过速,并伴有或不伴有心脏肥大。虽然非折返性心律失常传统上与Costello综合征相关,这项工作提供了RASopathy心律失常表型的扩展视图,因为我们证明了贯穿该信号通路的突变蛋白也可以引起异位和/或MAT.
    Multifocal atrial tachycardia (MAT) has a well-known association with Costello syndrome, but is rarely described with related RAS/MAPK pathway disorders (RASopathies). We report 11 patients with RASopathies (Costello, Noonan, and Noonan syndrome with multiple lentigines [formerly LEOPARD syndrome]) and nonreentrant atrial tachycardias (MAT and ectopic atrial tachycardia) demonstrating overlap in cardiac arrhythmia phenotype. Similar overlap is seen in RASopathies with respect to skeletal, musculoskeletal and cutaneous abnormalities, dysmorphic facial features, and neurodevelopmental deficits. Nonreentrant atrial tachycardias may cause cardiac compromise if sinus rhythm is not restored expeditiously. Typical first-line supraventricular tachycardia anti-arrhythmics (propranolol and digoxin) were generally not effective in restoring or maintaining sinus rhythm in this cohort, while flecainide or amiodarone alone or in concert with propranolol were effective anti-arrhythmic agents for acute and chronic use. Atrial tachycardia resolved in all patients. However, a 4-month-old boy from the cohort was found asystolic (with concurrent cellulitis) and a second patient underwent cardiac transplant for heart failure complicated by recalcitrant atrial arrhythmia. While propranolol alone frequently failed to convert or maintain sinus rhythm, fleccainide or amiodarone, occasionally in combination with propranolol, was effective for RASopathy patient treatment for nonreentrant atrial arrhythmia. Our analysis shows that RASopathy patients may have nonreentrant atrial tachycardia with and without associated cardiac hypertrophy. While nonreentrant arrhythmia has been traditionally associated with Costello syndrome, this work provides an expanded view of RASopathy cardiac arrhythmia phenotype as we demonstrate mutant proteins throughout this signaling pathway can also give rise to ectopic and/or MAT.
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